title: Use of administrative data to identify health plan members with unrecognized bipolar disorder: a retrospective cohort study.
abstract: 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.
authors.affiliation: Outcomes Management Department, Active Health Management, Inc, New York, NY, USA. iverjuster@aol.com
authors.forename: Iver A
authors.initials: IA
authors.lastname: Juster
authors.forename: Michael
authors.initials: M
authors.lastname: Stensland
authors.forename: Lisa
authors.initials: L
authors.lastname: Brauer
authors.forename: Paul
authors.initials: P
authors.lastname: Thuras
mesh_terms: 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