title: Does a claims diagnosis of autism mean a true case?
abstract: The purpose of this study was to validate autism spectrum disorder cases identified through claims-based case identification algorithms against a clinical review of medical charts. Charts were reviewed for 432 children who fell into one of the three following groups: (a) more than or equal to two claims with an autism spectrum disorder diagnosis code (n = 182), (b) one claim with an autism spectrum disorder diagnosis code (n = 190), and (c) those who had no claims for autism spectrum disorder but had claims for other developmental or neurological conditions (n = 60). The algorithm-based diagnoses were compared with documented autism spectrum disorders in the medical charts. The algorithm requiring more than or equal to two claims for autism spectrum disorder generated a positive predictive value of 87.4%, which suggests that such an algorithm is a valid means to identify true autism spectrum disorder cases in claims data.
authors.affiliation: 1OptumInsight, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Burke
authors.forename: Anjali
authors.initials: A
authors.lastname: Jain
authors.forename: Wenya
authors.initials: W
authors.lastname: Yang
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Kelly
authors.forename: Marygrace
authors.initials: M
authors.lastname: Kaiser
authors.forename: Laura
authors.initials: L
authors.lastname: Becker
authors.forename: Lindsay
authors.initials: L
authors.lastname: Lawer
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Newschaffer
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis*; D002675:Child, Preschool; D003625:Data Collection; D005260:Female; D006801:Humans; D007348:Insurance, Health; D038801:International Classification of Diseases; D008297:Male; D008499:Medical Records; D055815:Young Adult
keywords: Administrative data; autism; chart review; validation study