Validity of ICD9-CM codes to diagnose chronic obstructive pulmonary disease from National Health Insurance claim data in Taiwan
Journal
International Journal of COPD
Journal Volume
13
Pages
3055-3063
Date Issued
2018
Author(s)
Abstract
Purpose: Claim data from Taiwan’s National Health Insurance (NHI) database have previously been utilized in the study of COPD. However, there are limited data on the positive predictive value of claim data for COPD diagnosis. Therefore, this study aimed to characterize and validate the COPD cohort identified from the NHI research database. Methods: This cross-sectional study compared records from claim data with those from a medical center. From 2007 to 2014, a COPD cohort was constructed from claim data using ICD9-CM codes for COPD. The diagnostic positive predictive value of these data was assessed with reference to physician-verified COPD. In addition, a multivariate logistic regression model was built to identify independent factors associated with the positive predictive value of COPD diagnosis by claim data. Results: During the 8-year study period, a total of 12,127 subjects met the criterion of having two or more outpatient codes in 1 year or one or more inpatient COPD codes in their claim data. Of this total, the diagnosis of COPD was verified by physicians in 7,701 (63.5%) subjects. Applying a more stringent criterion - three or more outpatient codes or two or more inpatient codes - improved the diagnostic positive predictive value to 72.2%. Age ≥65 years and a claim for spirometry were the two most important factors associated with the positive predictive value of claim-data-defined COPD. Adding spirometry testing to diagnostic ICD9-CM codes for COPD increased the positive predictive value to 84.6%. Conclusion: This study emphasizes the importance of validation of disease-specific diagnosis prior to applying an administrative database in clinical studies. It also indicates the limitation of ICD9-CM codes alone in recognizing COPD patients within the NHI research database. © 2018 Ho et al.
Subjects
Chronic obstructive pulmonary disease; Database; International classification of diseases code; Taiwan; Validity
SDGs
Other Subjects
age; aged; Article; chronic obstructive lung disease; cohort analysis; comorbidity; controlled study; cross-sectional study; diagnostic accuracy; female; health insurance; human; ICD-9-CM; major clinical study; male; physician; predictive value; retrospective study; sex; spirometry; Taiwan; chronic obstructive lung disease; classification; comparative study; factual database; insurance; International Classification of Diseases; middle aged; multivariate analysis; procedures; public health; risk assessment; sex factor; statistical model; statistics and numerical data; university hospital; validation study; very elderly; Age Factors; Aged; Aged, 80 and over; Cross-Sectional Studies; Databases, Factual; Female; Hospitals, University; Humans; Insurance Claim Review; International Classification of Diseases; Logistic Models; Male; Middle Aged; Multivariate Analysis; National Health Programs; Predictive Value of Tests; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Risk Assessment; Sex Factors; Spirometry; Taiwan
Publisher
Dove Medical Press Ltd.
Type
journal article