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Validity of physician billing claims to identify deceased organ donors in large healthcare databases.

ABSTRACT: We evaluated the validity of physician billing claims to identify deceased organ donors in large provincial healthcare databases.We conducted a population-based retrospective validation study of all deceased donors in Ontario, Canada from 2006 to 2011 (n?=?988). We included all registered deaths during the same period (n?=?458,074). Our main outcome measures included sensitivity, specificity, positive predictive value, and negative predictive value of various algorithms consisting of physician billing claims to identify deceased organ donors and organ-specific donors compared to a reference standard of medical chart abstraction.The best performing algorithm consisted of any one of 10 different physician billing claims. This algorithm had a sensitivity of 75.4% (95% CI: 72.6% to 78.0%) and a positive predictive value of 77.4% (95% CI: 74.7% to 80.0%) for the identification of deceased organ donors. As expected, specificity and negative predictive value were near 100%. The number of organ donors identified by the algorithm each year was similar to the expected value, and this included the pre-validation period (1991 to 2005). Algorithms to identify organ-specific donors performed poorly (e.g. sensitivity ranged from 0% for small intestine to 67% for heart; positive predictive values ranged from 0% for small intestine to 37% for heart).Primary data abstraction to identify deceased organ donors should be used whenever possible, particularly for the detection of organ-specific donations. The limitations of physician billing claims should be considered whenever they are used.

SUBMITTER: Li AH

PROVIDER: S-EPMC3743842 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Validity of physician billing claims to identify deceased organ donors in large healthcare databases.

Li Alvin Ho-ting AH Kim S Joseph SJ Rangrej Jagadish J Scales Damon C DC Shariff Salimah S Redelmeier Donald A DA Knoll Greg G Young Ann A Garg Amit X AX

PloS one 20130814 8

<h4>Objective</h4>We evaluated the validity of physician billing claims to identify deceased organ donors in large provincial healthcare databases.<h4>Methods</h4>We conducted a population-based retrospective validation study of all deceased donors in Ontario, Canada from 2006 to 2011 (n = 988). We included all registered deaths during the same period (n = 458,074). Our main outcome measures included sensitivity, specificity, positive predictive value, and negative predictive value of various al ...[more]

PMID: 23967114

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Project description:While medical records have detailed information, they are limited in reach to the availability and accessibility of those records. On the other hand, administrative data while limited in scope, have a much further reach in coverage of an entire population. However, few studies have validated the use of administrative data for identifying infections in pediatric populations. Pediatric patients from Ontario, Canada aged <18 years were randomly sampled from the Electronic Medical Record Administrative data Linked Database (EMRALD). Using physician diagnoses from the electronic medical record (EMR) as the reference standard, we determined the criterion validity of physician billing claims in administrative data for identifying infectious disease syndromes from 2012 to 2014. Diagnosis codes were assessed by infection category (respiratory, skin and soft tissue, gastrointestinal, urinary tract and otitis externa) and for all infections combined. Sensitivity analyses assessed the performance if patients had more than one reason to visit the physician. We analysed 2,139 patients and found 33.3% of all visits were for an infection, and respiratory infections accounted for 67.6% of the infections. When we combined all infection categories, sensitivity was 0.74 (95% CI 0.70-0.77), specificity was 0.95 (95% CI 0.93-0.96), positive predictive value (PPV) was 0.87 (95% CI 0.84-0.90), and negative predictive value (NPV) was 0.88 (95% CI 0.86-0.89). For respiratory infections, sensitivity was 0.77 (95% CI 0.73-0.81), specificity was 0.96 (95% CI 0.95-0.97), PPV was 0.85 (95% CI 0.81-0.88), and NPV was 0.94 (95% CI 0.92-0.95). Similar performance was observed for skin and soft tissue, gastrointestinal, urinary tract, and otitis externa infections, but with lower sensitivity. Performance measures were highest when the patient visited the physician with only one health complaint. We found when using linked EMR data as the reference standard, administrative billing codes are reasonably accurate in identifying infections in a pediatric population.

Dataset Information

Validity of physician billing claims to identify deceased organ donors in large healthcare databases.

Publications

Validity of physician billing claims to identify deceased organ donors in large healthcare databases.

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