Abstract

CONTEXT
Public health surveillance systems for acute hepatitis are limited: clinician reporting is insensitive and electronic laboratory reporting is nonspecific. Insurance claims and electronic health records are potential alternative sources.
OBJECTIVE
To compare the utility of laboratory data, diagnosis codes, and electronic health record combination data (current and prior viral hepatitis studies, liver function tests, and diagnosis codes) for acute hepatitis A and B surveillance.
DESIGN
Retrospective chart review.
SETTING
Massachusetts ambulatory practice serving 350 000 patients per year.
PARTICIPANTS
All patients seen between 1990 and 2008.
MAIN OUTCOME MEASURES
Sensitivity and positive predictive value of immunoglobulin M (IgM), International Classification of Disease-Ninth Revision (ICD-9) diagnosis codes, and combination electronic health record data for acute hepatitis A and B.
RESULTS
During the study period, there were 111 patients with positive hepatitis A IgMs, 154 with acute hepatitis A ICD-9 codes, and 77 with positive IgM and elevated liver function tests. On review, 79 cases were confirmed. Sensitivity and positive predictive value were 100% and 71% (95% confidence interval, 62%-79%) for IgM, 94% (92%-100%) and 48% (40%-56%) for ICD-9 codes and 97% (92%-100%) and 100% (96%-100%) for combination electronic health record data. There were 14 patients with positive hepatitis B core IgMs, 2564 with acute hepatitis B ICD-9 codes, and 125 with suggestive combinations of electronic health record data. Acute hepatitis B was confirmed in 122 patients. Sensitivity and positive predictive value were 9.4% (5.2%-16%) and 86% (60%-98%) for hepatitis B core IgM, 73% (65%-80%) and 3.6% (2.9%-4.4%) for ICD-9 codes, and 96% (91%-99%) and 98% (94%-99%) for electronic health record data.
CONCLUSIONS
Laboratory surveillance using IgM tests overestimates the burden of acute hepatitis A and underestimates the burden of acute hepatitis B. Claims data are subject to many false positives. Electronic health record data are both sensitive and predictive. Electronic health record-based surveillance systems merit development.

Links

Publisher Full Text

Authors

Allen-Dicker J, Klompas M

Institution

Department of Medicine, Beth-Israel Deaconess Medical Center, Boston, MA, USA.

Source

Journal of public health management and practice : JPHMP 18:3 pg 209-14

MeSH

Acute Disease
Adult
Algorithms
Ambulatory Care
Diagnosis-Related Groups
Electronic Health Records
Female
Hepatitis A
Hepatitis B
Humans
Immunoglobulin M
Insurance Claim Review
Laboratories
Liver Function Tests
Male
Massachusetts
Middle Aged
Population Surveillance
Predictive Value of Tests
Sensitivity and Specificity

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

22473112