Suitability of administrative claims databases for bariatric surgery research – is the glass half-full or half-empty?
Abstract Background Claims databases are generally considered inadequate for obesity research due to suboptimal capture of body mass index (BMI) measurements. This might not be true for bariatric surgery because of reimbursement requirements and changes in coding systems. We assessed the availabilit...
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| Format: | Article |
| Language: | English |
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BMC
2020-09-01
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| Series: | BMC Medical Research Methodology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12874-020-01106-8 |
| _version_ | 1831842028092129280 |
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| author | Xiaojuan Li Kristina H. Lewis Katherine Callaway J. Frank Wharam Sengwee Toh |
| author_facet | Xiaojuan Li Kristina H. Lewis Katherine Callaway J. Frank Wharam Sengwee Toh |
| author_sort | Xiaojuan Li |
| collection | DOAJ |
| description | Abstract Background Claims databases are generally considered inadequate for obesity research due to suboptimal capture of body mass index (BMI) measurements. This might not be true for bariatric surgery because of reimbursement requirements and changes in coding systems. We assessed the availability and validity of claims-based weight-related diagnosis codes among bariatric surgery patients. Methods We identified three nested retrospective cohorts of adult bariatric surgery patients who underwent adjusted gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy between January 1, 2011 and June 30, 2018 using different components of OptumLabs® Data Warehouse, which contains linked de-identified claims and electronic health records (EHRs). We measured the availability of claims-based weight-related diagnosis codes in the 6-month preoperative and 1-year postoperative periods in the main cohort identified in the claims data. We created two claims-based algorithms to classify the presence of severe obesity (a commonly used cohort selection criterion) and categorize BMI (a commonly used baseline confounder or postoperative outcome). We evaluated their performance by estimating sensitivity, specificity, positive predictive value, negative predictive value, and weighted kappa in two sub-cohorts using EHR-based BMI measurements as the reference. Results Among the 29,357 eligible patients identified using claims only, 28,828 (98.2%) had preoperative weight-related diagnosis codes, either granular indicating BMI ranges or nonspecific denoting obesity status. Among the 27,407 patients with granular preoperative codes, 12,346 (45.0%) had granular codes and 9355 (34.1%) had nonspecific codes in the 1-year postoperative period. Among the 3045 patients with both preoperative claims-based diagnosis codes and EHR-based BMI measurements, the severe obesity classification algorithm had a sensitivity 100%, specificity 71%, positive predictive value 100%, and negative predictive value 78%. The BMI categorization algorithm had good validity categorizing the last available preoperative or postoperative BMI measurements (weighted kappa [95% confidence interval]: preoperative 0.78, [0.76, 0.79]; postoperative 0.84, [0.80, 0.87]). Conclusions Claims-based weight-related diagnosis codes had excellent validity before and after bariatric surgical operation but suboptimal availability after operation. Claims databases can be used for bariatric surgery studies of non-weight-related effectiveness and safety outcomes that are well-captured. |
| first_indexed | 2024-12-23T06:41:33Z |
| format | Article |
| id | doaj.art-f310b5c0c3a645849ccf84a506102afe |
| institution | Directory Open Access Journal |
| issn | 1471-2288 |
| language | English |
| last_indexed | 2024-12-23T06:41:33Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Research Methodology |
| spelling | doaj.art-f310b5c0c3a645849ccf84a506102afe2022-12-21T17:56:41ZengBMCBMC Medical Research Methodology1471-22882020-09-0120111310.1186/s12874-020-01106-8Suitability of administrative claims databases for bariatric surgery research – is the glass half-full or half-empty?Xiaojuan Li0Kristina H. Lewis1Katherine Callaway2J. Frank Wharam3Sengwee Toh4Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care InstituteDivision of Public Health Sciences, Wake Forest University School of MedicineDepartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care InstituteDepartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care InstituteDepartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care InstituteAbstract Background Claims databases are generally considered inadequate for obesity research due to suboptimal capture of body mass index (BMI) measurements. This might not be true for bariatric surgery because of reimbursement requirements and changes in coding systems. We assessed the availability and validity of claims-based weight-related diagnosis codes among bariatric surgery patients. Methods We identified three nested retrospective cohorts of adult bariatric surgery patients who underwent adjusted gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy between January 1, 2011 and June 30, 2018 using different components of OptumLabs® Data Warehouse, which contains linked de-identified claims and electronic health records (EHRs). We measured the availability of claims-based weight-related diagnosis codes in the 6-month preoperative and 1-year postoperative periods in the main cohort identified in the claims data. We created two claims-based algorithms to classify the presence of severe obesity (a commonly used cohort selection criterion) and categorize BMI (a commonly used baseline confounder or postoperative outcome). We evaluated their performance by estimating sensitivity, specificity, positive predictive value, negative predictive value, and weighted kappa in two sub-cohorts using EHR-based BMI measurements as the reference. Results Among the 29,357 eligible patients identified using claims only, 28,828 (98.2%) had preoperative weight-related diagnosis codes, either granular indicating BMI ranges or nonspecific denoting obesity status. Among the 27,407 patients with granular preoperative codes, 12,346 (45.0%) had granular codes and 9355 (34.1%) had nonspecific codes in the 1-year postoperative period. Among the 3045 patients with both preoperative claims-based diagnosis codes and EHR-based BMI measurements, the severe obesity classification algorithm had a sensitivity 100%, specificity 71%, positive predictive value 100%, and negative predictive value 78%. The BMI categorization algorithm had good validity categorizing the last available preoperative or postoperative BMI measurements (weighted kappa [95% confidence interval]: preoperative 0.78, [0.76, 0.79]; postoperative 0.84, [0.80, 0.87]). Conclusions Claims-based weight-related diagnosis codes had excellent validity before and after bariatric surgical operation but suboptimal availability after operation. Claims databases can be used for bariatric surgery studies of non-weight-related effectiveness and safety outcomes that are well-captured.http://link.springer.com/article/10.1186/s12874-020-01106-8Bariatric surgeryBody mass indexHealthcare administrative claimsPredictive value of testsSensitivity and specificityValidation study |
| spellingShingle | Xiaojuan Li Kristina H. Lewis Katherine Callaway J. Frank Wharam Sengwee Toh Suitability of administrative claims databases for bariatric surgery research – is the glass half-full or half-empty? BMC Medical Research Methodology Bariatric surgery Body mass index Healthcare administrative claims Predictive value of tests Sensitivity and specificity Validation study |
| title | Suitability of administrative claims databases for bariatric surgery research – is the glass half-full or half-empty? |
| title_full | Suitability of administrative claims databases for bariatric surgery research – is the glass half-full or half-empty? |
| title_fullStr | Suitability of administrative claims databases for bariatric surgery research – is the glass half-full or half-empty? |
| title_full_unstemmed | Suitability of administrative claims databases for bariatric surgery research – is the glass half-full or half-empty? |
| title_short | Suitability of administrative claims databases for bariatric surgery research – is the glass half-full or half-empty? |
| title_sort | suitability of administrative claims databases for bariatric surgery research is the glass half full or half empty |
| topic | Bariatric surgery Body mass index Healthcare administrative claims Predictive value of tests Sensitivity and specificity Validation study |
| url | http://link.springer.com/article/10.1186/s12874-020-01106-8 |
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