Using administrative data to measure ambulatory mental health service provision in primary care.
OBJECTIVE
We sought to determine the accuracy of administrative data for identifying mental health service provision in primary care.


METHODS
This was a chart abstraction study measuring agreement between billing data and clinical data on the binary variable "mental health visit." Data were collected from the charts and billing records of 5 academic family practice clinics in Toronto, Ontario (1999 to 2000). Billing claims (n = 952) were selected from the billings for all visits by a stratified random sampling technique. A blinded data abstractor reviewed the clinical charts and assigned diagnostic codes for each patient visit associated with the selected claims. Any visit with at least 1 abstracted mental health diagnostic code was defined as a mental health visit. The test characteristics of 4 administrative measures of mental health service provision, based on different combinations of billing codes, were calculated.


RESULTS
The accuracy of the administrative data was 86.8% when compared with clinical data. The sensitivity of the 4 administrative measures ranged from 22.3% to 80.7%. The specificity ranged from 97.0% to 99.5%.


CONCLUSIONS
This is the first study to establish the performance of administrative data in measuring mental health service provision in a primary care setting. In our setting, broadly defined administrative measures of mental health have excellent specificity and adequate sensitivity for exploring and understanding mental health service utilization.
Steele
Leah S
LS
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. leah.steele@utoronto.ca
Glazier
Richard H
RH
Lin
Elizabeth
E
Evans
Michael
M
D000328:Adult; D000553:Ambulatory Care; D016001:Confidence Intervals; D019992:Databases as Topic; D006302:Health Services Research; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009819:Office Visits; D009864:Ontario; D011320:Primary Health Care; D012494:Sampling Studies; D012680:Sensitivity and Specificity