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Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records.
Am Heart J. 2004 Jul; 148(1):99-104.AH

Abstract

BACKGROUND

Many cardiovascular epidemiologic studies rely on diagnosis codes in health care claims databases. Despite important changes in the care and diagnosis of acute myocardial infarction (AMI), the validity of hospital discharge diagnosis codes for AMI in the US Medicare system has not been recently examined. Our objective was to examine the accuracy of International Classification of Diseases--ninth revision--Clinical Modifications (ICD-9-CM) discharge diagnosis codes and diagnosis-related groups (DRG) codes for AMI in a Medicare claims database.

METHODS

We sampled hospitalization episodes from Medicare beneficiaries in Pennsylvania during 1999, 2000, or both. We used Medicare data to identify patients with hospitalizations containing indicators of AMI (ICD-9-CM diagnosis codes 410.X0 and 410.X1 or DRG codes 121, 122, and 123). Hospital records for these episodes were reviewed by trained abstractors using World Health Organization criteria for diagnosing AMI. We then calculated the positive predictive value of Medicare claims-based definitions of AMI.

RESULTS

Of 2200 hospitalization episodes with Medicare diagnosis codes suggestive of AMI, 2022 hospital records (91.9%) were obtained. The positive predictive value for a primary Medicare claims-based definition was 94.1% (95% CI, 93.0%-95.2%). Positive predictive values for alternative claims-based definitions ranged slightly, with the definition including DRG codes and length-of-stay restrictions yielding the highest positive predictive value, 95.4% (95% CI, 94.3%-96.4%). Subjects with a history of myocardial infarction had a significantly lower positive predictive value than subjects without a history of myocardial infarction (88.1% vs 94.6%, P <.001).

CONCLUSIONS

In this study, we observed high positive predictive values for a Medicare claims-based diagnosis of AMI and a diagnosis based on structured hospital record review.

Authors+Show Affiliations

Division of Pharmacoepidemiology and Pharmacoeconomics, Boston, Mass USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15215798

Citation

Kiyota, Yuka, et al. "Accuracy of Medicare Claims-based Diagnosis of Acute Myocardial Infarction: Estimating Positive Predictive Value On the Basis of Review of Hospital Records." American Heart Journal, vol. 148, no. 1, 2004, pp. 99-104.
Kiyota Y, Schneeweiss S, Glynn RJ, et al. Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records. Am Heart J. 2004;148(1):99-104.
Kiyota, Y., Schneeweiss, S., Glynn, R. J., Cannuscio, C. C., Avorn, J., & Solomon, D. H. (2004). Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records. American Heart Journal, 148(1), 99-104.
Kiyota Y, et al. Accuracy of Medicare Claims-based Diagnosis of Acute Myocardial Infarction: Estimating Positive Predictive Value On the Basis of Review of Hospital Records. Am Heart J. 2004;148(1):99-104. PubMed PMID: 15215798.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records. AU - Kiyota,Yuka, AU - Schneeweiss,Sebastian, AU - Glynn,Robert J, AU - Cannuscio,Carolyn C, AU - Avorn,Jerry, AU - Solomon,Daniel H, PY - 2004/6/25/pubmed PY - 2004/10/6/medline PY - 2004/6/25/entrez SP - 99 EP - 104 JF - American heart journal JO - Am Heart J VL - 148 IS - 1 N2 - BACKGROUND: Many cardiovascular epidemiologic studies rely on diagnosis codes in health care claims databases. Despite important changes in the care and diagnosis of acute myocardial infarction (AMI), the validity of hospital discharge diagnosis codes for AMI in the US Medicare system has not been recently examined. Our objective was to examine the accuracy of International Classification of Diseases--ninth revision--Clinical Modifications (ICD-9-CM) discharge diagnosis codes and diagnosis-related groups (DRG) codes for AMI in a Medicare claims database. METHODS: We sampled hospitalization episodes from Medicare beneficiaries in Pennsylvania during 1999, 2000, or both. We used Medicare data to identify patients with hospitalizations containing indicators of AMI (ICD-9-CM diagnosis codes 410.X0 and 410.X1 or DRG codes 121, 122, and 123). Hospital records for these episodes were reviewed by trained abstractors using World Health Organization criteria for diagnosing AMI. We then calculated the positive predictive value of Medicare claims-based definitions of AMI. RESULTS: Of 2200 hospitalization episodes with Medicare diagnosis codes suggestive of AMI, 2022 hospital records (91.9%) were obtained. The positive predictive value for a primary Medicare claims-based definition was 94.1% (95% CI, 93.0%-95.2%). Positive predictive values for alternative claims-based definitions ranged slightly, with the definition including DRG codes and length-of-stay restrictions yielding the highest positive predictive value, 95.4% (95% CI, 94.3%-96.4%). Subjects with a history of myocardial infarction had a significantly lower positive predictive value than subjects without a history of myocardial infarction (88.1% vs 94.6%, P <.001). CONCLUSIONS: In this study, we observed high positive predictive values for a Medicare claims-based diagnosis of AMI and a diagnosis based on structured hospital record review. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/15215798/Accuracy_of_Medicare_claims_based_diagnosis_of_acute_myocardial_infarction:_estimating_positive_predictive_value_on_the_basis_of_review_of_hospital_records_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S000287030400184X DB - PRIME DP - Unbound Medicine ER -