Use of administrative data to identify health plan members with unrecognized bipolar disorder: a retrospective cohort study.
OBJECTIVE
This retrospective cohort study used an algorithmic case-finding system on claims data from nationwide commercial health plans to validate previously identified predictors of unrecognized bipolar disorder among adults.


METHODS
Retrospective cohort design.


METHODS
Using logistic regression, 2 claims data sets were evaluated to explore potential predictors; the first included claims for all healthcare encounters (all-encounters data set); the second excluded mental health provider claims (carve-out data set). A total of 280,244 members aged 18 to 64 years were included from 2 commercial health plans.


RESULTS
Claims related to attention deficit-hyperactivity disorder, depression, depression treated with antipsychotics, use of 3 (of 5) classes of psychotherapeutic drugs, younger age, and sex were all significant predictors of a subsequent diagnosis of bipolar disorder. In the all-encounters data set, a predicted value of 5% or greater yielded a sensitivity of 9.8% and a specificity of 99.9%; a predicted threshold of 3% increased sensitivity to 20.7%; area under the receiver operating characteristic curve (AUC) was 0.82. Performance of the model was acceptable in the carve-out data set, with AUC 0.69.


CONCLUSIONS
The case-finding system described here, which compares favorably with other screening tests used in primary care, may have significant value in helping physicians to identify patients with unrecognized bipolar disorder.
Juster
Iver A
IA
Outcomes Management Department, Active Health Management, Inc, New York, NY, USA. iverjuster@aol.com
Stensland
Michael
M
Brauer
Lisa
L
Thuras
Paul
P
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014481:United States