title: Validity of maternal and infant outcomes within nationwide Medicaid data.
abstract: OBJECTIVE
  The aim of this study is to assess the validity of preeclampsia, congenital cardiac malformations, and persistent pulmonary hypertension of the newborn (PPHN) diagnoses in the US Medicaid Analytic eXtract (MAX), a nationwide health care utilization database that may be useful for perinatal research.
  
  
  METHODS
  Using the 2000-2007 MAX, we identified more than 1 million pregnancies ending in live birth. We identified potential cases based on claims, reviewed their hospital medical records, and calculated the positive predictive values (PPVs) and 95% confidence intervals (CIs) using records as the reference.
  
  
  RESULTS
  Among 183 women with any preeclampsia diagnoses, the PPV was 66.5% (53.6, 77.4%), but it increased to 94.5% (84.0, 98.3%) for inpatient preeclampsia diagnoses. The PPV for inpatient PPHN diagnoses (N = 82) was 68.3% (57.6, 77.4%), but it increased to 89.6% (CI: 77.8, 95.5%) when restricting to infants not transferred to another facility shortly after birth (N = 48). The PPV for cardiac malformations was 77.6% (65.7, 86.2%) when requiring inpatient codes on more than one date (N = 63).
  
  
  CONCLUSIONS
  These PPVs are conservative, particularly when patients were transferred or received outpatient diagnoses, because we reviewed records from a single hospitalization only. PPVs improve with stringent identification criteria, at the cost of sensitivity, and can be used to correct for measurement error.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Palmsten
authors.forename: Krista F
authors.initials: KF
authors.lastname: Huybrechts
authors.forename: Mary K
authors.initials: MK
authors.lastname: Kowal
authors.forename: Helen
authors.initials: H
authors.lastname: Mogun
authors.forename: Sonia
authors.initials: S
authors.lastname: Hernández-Díaz
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D038801:International Classification of Diseases / Q000592:standards / Q000706:statistics & numerical data; D050498:Live Birth / Q000453:epidemiology*; D008484:Medicaid / Q000592:standards* / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: Medicaid; congenital cardiac malformations; persistent pulmonary hypertension of the newborn; pharmacoepidemiology; preeclampsia; pregnancy; validation study
references.citation: Obstet Gynecol. 2005 Oct;106(4):717-25
references.pmid: 16199627
references.citation: Pharmacoepidemiol Drug Saf. 2008 May;17(5):455-60
references.pmid: 18081215
references.citation: J Perinatol. 2005 Nov;25(11):737-42
references.pmid: 16163368
references.citation: Pharmacoepidemiol Drug Saf. 2013 Jan;22(1):16-24
references.pmid: 22550030
references.citation: Hypertension. 2012 Oct;60(4):913-20
references.pmid: 22966012
references.citation: Int J Epidemiol. 2005 Dec;34(6):1370-6
references.pmid: 16172102
references.citation: J Clin Epidemiol. 2005 Apr;58(4):323-37
references.pmid: 15862718
references.citation: Am J Epidemiol. 2007 Jul 15;166(2):117-24
references.pmid: 17556761
references.citation: Epidemiology. 2007 Jul;18(4):518
references.pmid: 17568226
references.citation: Am J Obstet Gynecol. 2006 Apr;194(4):992-1001
references.pmid: 16580288
references.citation: BMJ. 2013 Aug 21;347:f4877
references.pmid: 23965506
references.citation: Public Health Rep. 1990 May-Jun;105(3):296-307
references.pmid: 2113690
references.citation: Pharmacoepidemiol Drug Saf. 2012 Jun;21(6):640-50
references.pmid: 22504840
references.citation: Pharmacoepidemiol Drug Saf. 2013 Jan;22(1):7-15
references.pmid: 22753079
references.citation: Pharmacoepidemiol Drug Saf. 2010 Jun;19(6):555-62
references.pmid: 19844945
references.citation: Epidemiology. 2013 Sep;24(5):682-91
references.pmid: 23873072
references.citation: Gen Hosp Psychiatry. 2013 May-Jun;35(3):265-71
references.pmid: 23374897
references.citation: Paediatr Perinat Epidemiol. 2005 Nov;19(6):460-71
references.pmid: 16269074
references.citation: Am J Epidemiol. 1998 Jun 1;147(11):1062-70
references.pmid: 9620050
references.citation: PLoS One. 2013 Jun 26;8(6):e67405
references.pmid: 23840692
references.citation: Am J Obstet Gynecol. 2004 Jun;190(6):1629-33; discussion 1633-4
references.pmid: 15284758
references.citation: Paediatr Perinat Epidemiol. 2004 Mar;18(2):112-9
references.pmid: 14996250