Computerized definitions showed high positive predictive values for identifying hospitalizations for congestive heart failure and selected infections in Medicaid enrollees with rheumatoid arthritis.
OBJECTIVE
Computerized definitions are used to identify serious infections and congestive heart failure leading to hospitalizations in studies of medication safety. However, information on their accuracy is limited. We evaluated the ability of computerized definitions to identify these conditions as the reason for admission among patients diagnosed with rheumatoid arthritis (RA).


METHODS
Medical charts were randomly selected from a systematic sample of hospitalizations for selected conditions in a cohort of Medicaid patients with RA. We calculated positive predictive values (PPVs) for computerized definitions for community-acquired pneumonia, invasive pneumococcal disease, sepsis, opportunistic mycoses, and congestive heart failure using charts reviews as gold standard and computed inter-reviewer agreement statistics.


RESULTS
From 2667 hospitalizations, 336 (13%) records were selected for review. A total of 277 charts (82%) were available. Based on any discharge diagnosis, PPVs for hospitalizations due to community-acquired pneumonia, invasive pneumococcal disease, sepsis, and opportunistic mycoses were 84, 100, 80, and 62%, respectively. Restricting definitions to principal diagnoses yielded higher PPVs, 95% for pneumonia and 100% for other diagnoses. The PPV of a principal diagnosis for congestive heart failure was 100%. Inter-reviewer agreement was at least 77% for all outcomes.


CONCLUSIONS
These findings suggest that computerized definitions can identify congestive heart failure and selected infections leading to hospitalization in Medicaid patients with RA.
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37212, USA. carlos.grijalva@vanderbilt.edu
Carlos G
CG
Grijalva
Cecilia P
CP
Chung
C Michael
CM
Stein
Patricia S
PS
Gideon
Shannon M
SM
Dyer
Edward F
EF
Mitchel
Marie R
MR
Griffin
D001172:Arthritis, Rheumatoid / Q000453:epidemiology*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data / Q000639:trends*; D016347:Medical Records Systems, Computerized / Q000639:trends*; D008875:Middle Aged; D011237:Predictive Value of Tests; D014481:United States