Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims database
The National Health Insurance Research Database, which uses claims data from hospitals contracted with the National Health Insurance (NHI) program in Taiwan, has been widely used for stroke research. The diagnostic accuracy of the NHI claims data with regard to acute ischemic stroke (AIS) has rarely...
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| Format: | Article |
| Language: | English |
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Elsevier
2015-03-01
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| Series: | Journal of the Formosan Medical Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664613003082 |
| _version_ | 1817999305548496896 |
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| author | Cheng-Yang Hsieh Chih-Hung Chen Chung-Yi Li Ming-Liang Lai |
| author_facet | Cheng-Yang Hsieh Chih-Hung Chen Chung-Yi Li Ming-Liang Lai |
| author_sort | Cheng-Yang Hsieh |
| collection | DOAJ |
| description | The National Health Insurance Research Database, which uses claims data from hospitals contracted with the National Health Insurance (NHI) program in Taiwan, has been widely used for stroke research. The diagnostic accuracy of the NHI claims data with regard to acute ischemic stroke (AIS) has rarely been validated. The aim of this study was to validate the diagnosis of AIS in NHI claims data using the Taiwan Stroke Registry (TSR) as a reference.
Methods: We retrieved patients' data with a discharge diagnosis of AIS [five-digit International Classification of Diseases Code, 9th version (ICD-9 code): 433xx or 434xx] in a single medical center from August 2006 to December 2008. We then linked these patients to the TSR to validate their AIS diagnosis in the claims data. The positive predictive value (PPV) and sensitivity were determined.
Results: We reviewed the claims data of 1736 consecutive AIS patients, of whom 1299 (74.8%) were linked successfully to the stroke registry database. After reviewing the medical records and imaging results of other patients not linked to the registry database (n = 437), 235 patients were found to have had an AIS. The PPV was 88.4% [95% confidence interval (CI): 86.8–89.8%] and sensitivity was 97.3% (95% CI: 96.4–98.1%). Forty-four (21.8%) of the false-positive cases (n = 202) were coded as 433x0 or 434x0.
Conclusion: The PPV of a diagnosis of AIS in the NHI claims data was high. Using five-digit ICD-9 codes to identify AIS cases will markedly decrease the false-positive rate compared with using the commonly used three-digit method. |
| first_indexed | 2024-04-14T03:06:05Z |
| format | Article |
| id | doaj.art-52b88a1da800412e8a65dc709f5c46e5 |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-04-14T03:06:05Z |
| publishDate | 2015-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-52b88a1da800412e8a65dc709f5c46e52022-12-22T02:15:43ZengElsevierJournal of the Formosan Medical Association0929-66462015-03-01114325425910.1016/j.jfma.2013.09.009Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims databaseCheng-Yang Hsieh0Chih-Hung Chen1Chung-Yi Li2Ming-Liang Lai3Stroke Center and Department of Neurology, Tainan Sin Lau Hospital, Tainan, TaiwanStroke Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanInstitute of Public Health, College of Medicine, National Cheng Kung University, Tainan, TaiwanInstitute of Clinical Pharmacy and Pharmaceutical Science, National Cheng Kung University, Tainan, TaiwanThe National Health Insurance Research Database, which uses claims data from hospitals contracted with the National Health Insurance (NHI) program in Taiwan, has been widely used for stroke research. The diagnostic accuracy of the NHI claims data with regard to acute ischemic stroke (AIS) has rarely been validated. The aim of this study was to validate the diagnosis of AIS in NHI claims data using the Taiwan Stroke Registry (TSR) as a reference. Methods: We retrieved patients' data with a discharge diagnosis of AIS [five-digit International Classification of Diseases Code, 9th version (ICD-9 code): 433xx or 434xx] in a single medical center from August 2006 to December 2008. We then linked these patients to the TSR to validate their AIS diagnosis in the claims data. The positive predictive value (PPV) and sensitivity were determined. Results: We reviewed the claims data of 1736 consecutive AIS patients, of whom 1299 (74.8%) were linked successfully to the stroke registry database. After reviewing the medical records and imaging results of other patients not linked to the registry database (n = 437), 235 patients were found to have had an AIS. The PPV was 88.4% [95% confidence interval (CI): 86.8–89.8%] and sensitivity was 97.3% (95% CI: 96.4–98.1%). Forty-four (21.8%) of the false-positive cases (n = 202) were coded as 433x0 or 434x0. Conclusion: The PPV of a diagnosis of AIS in the NHI claims data was high. Using five-digit ICD-9 codes to identify AIS cases will markedly decrease the false-positive rate compared with using the commonly used three-digit method.http://www.sciencedirect.com/science/article/pii/S0929664613003082acute ischemic strokeclaims datadiagnosisNational Health InsuranceTaiwan Stroke Registryvalidation |
| spellingShingle | Cheng-Yang Hsieh Chih-Hung Chen Chung-Yi Li Ming-Liang Lai Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims database Journal of the Formosan Medical Association acute ischemic stroke claims data diagnosis National Health Insurance Taiwan Stroke Registry validation |
| title | Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims database |
| title_full | Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims database |
| title_fullStr | Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims database |
| title_full_unstemmed | Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims database |
| title_short | Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims database |
| title_sort | validating the diagnosis of acute ischemic stroke in a national health insurance claims database |
| topic | acute ischemic stroke claims data diagnosis National Health Insurance Taiwan Stroke Registry validation |
| url | http://www.sciencedirect.com/science/article/pii/S0929664613003082 |
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