title: Identification of rheumatoid arthritis patients using an administrative database: a Veterans Affairs study.
abstract: OBJECTIVE
  The accuracy of the diagnosis is vital when administrative databases are used for pharmacoepidemiologic and outcome studies. Data pertaining to the utility of databases for rheumatoid arthritis (RA) are sparse and variable. We assessed the utility of various diagnostic algorithms to identify RA patients within the Veterans Health Administration (VHA) databases.
  
  
  METHODS
  Using the International Classification of Diseases, Ninth Revision code for RA at 2 visits at least 6 months apart, we identified 1,779 patients between October 1, 1998 and September 30, 2009 in our local Veterans Affairs Medical Center (VAMC) administrative database. Disease-modifying antirheumatic drug (DMARD) use was ascertained from the pharmacy database. Cases were analyzed based on DMARD therapy and RA codes at clinic visits. A total of 543 patients' medical records, selected by stratification and random selection on the basis of their visits, were reviewed to ascertain the clinicians' diagnoses and clinical criteria documentation. Positive predictive values (PPVs) were calculated for various database case identification algorithms using diagnosis of RA by medical record review as the gold standard.
  
  
  RESULTS
  The PPV for identification of RA with 2 RA codes 6 months apart was 30.9%. Addition of DMARD therapy increased the PPV to 60.4%. The PPV further increased to 91.4% when having an RA code at the last VAMC rheumatology clinic visit criterion was added. An algorithm using only 2 administrative RA codes 6 months apart had a low PPV for correctly identifying patients with RA in the VHA database.
  
  
  CONCLUSIONS
  Including DMARD therapy and requiring an RA code at the last visit with a rheumatologist increased the performance of the data extraction algorithm.
authors.affiliation: Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, and Baylor College of Medicine, Houston, TX 77030, USA. bernardng1@gmail.com
authors.forename: Bernard
authors.initials: B
authors.lastname: Ng
authors.forename: Fawad
authors.initials: F
authors.lastname: Aslam
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Petersen
authors.forename: Hong-Jen
authors.initials: HJ
authors.lastname: Yu
authors.forename: Maria E
authors.initials: ME
authors.lastname: Suarez-Almazor
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D059019:Clinical Coding; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D018501:Antirheumatic Agents