An algorithm for the identification of undiagnosed COPD cases using administrative claims data.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a major cause of death in the United States, but most persons who have airflow obstruction have never been diagnosed with lung disease. This undiagnosed COPD negatively affects health status, and COPD patients may have increased health care utilization several years before the initial diagnosis of COPD is made.


OBJECTIVE
To investigate whether utilization patterns derived from analysis of administrative claims data using a discriminant function algorithm could be used to identify undiagnosed COPD patients.


METHODS
Each patient who had a new diagnosis of COPD during the study period (N = 2,129) was matched to as many as 3 control subjects by age and gender. Controls were assigned an index date that was identical to that of the corresponding case, and then all health care utilization for cases and controls for the 24 months prior to the initial COPD diagnosis was compared using logistic regression models. Factors that were significantly associated with COPD were then entered into a discriminant function algorithm. This algorithm was then validated using a separate patient population.


RESULTS
In the main model, 19 utilization characteristics were significantly associated with preclinical COPD, although most of the power of the discriminant function algorithm was concentrated in a few of these factors. The main model was able to identify COPD patients in the validation population of adult subjects aged 40 years and older (N = 41,428), with a sensitivity of 60.5% and specificity of 82.1%, even without having information on the history of tobacco use for the majority of the group. Models developed and tested on only 12 months of utilization data performed similarly.


CONCLUSIONS
Discriminant function algorithms based on health care utilization data can be developed that have sufficient positive predictive value to be used as screening tools to identify individuals at risk for having undiagnosed COPD.
Mapel
Douglas W
DW
Lovelace Clinic Foundation, Albuquerque, New Mexico 87106-4264, USA. Doug@LCFresearch.org
Frost
Floyd J
FJ
Hurley
Judith S
JS
Petersen
Hans
H
Roberts
Melissa
M
Marton
Jeno P
JP
Shah
Hemal
H
D000328:Adult; D000368:Aged; D000465:Algorithms; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D016002:Discriminant Analysis; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D016015:Logistic Models; D008329:Managed Care Programs; D016347:Medical Records Systems, Computerized; D009516:New Mexico; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis*; D015203:Reproducibility of Results; D019141:Respiratory System Agents / Q000627:therapeutic use; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000009:adverse effects
D018927:Anti-Asthmatic Agents; D019141:Respiratory System Agents