title: Validation of an administrative claims-based diagnostic code for pneumonia in a US-based commercially insured COPD population.
abstract: OBJECTIVE
  To estimate the accuracy of claims-based pneumonia diagnoses in COPD patients using clinical information in medical records as the reference standard.
  
  
  METHODS
  Selecting from a repository containing members' data from 14 regional United States health plans, this validation study identified pneumonia diagnoses within a group of patients initiating treatment for COPD between March 1, 2009 and March 31, 2012. Patients with ≥1 claim for pneumonia (International Classification of Diseases Version 9-CM code 480.xx-486.xx) were identified during the 12 months following treatment initiation. A subset of 800 patients was randomly selected to abstract medical record data (paper based and electronic) for a target sample of 400 patients, to estimate validity within 5% margin of error. Positive predictive value (PPV) was calculated for the claims diagnosis of pneumonia relative to the reference standard, defined as a documented diagnosis in the medical record.
  
  
  RESULTS
  A total of 388 records were reviewed; 311 included a documented pneumonia diagnosis, indicating 80.2% (95% confidence interval [CI]: 75.8% to 84.0%) of claims-identified pneumonia diagnoses were validated by the medical charts. Claims-based diagnoses in inpatient or emergency departments (n=185) had greater PPV versus outpatient settings (n=203), 87.6% (95% CI: 81.9%-92.0%) versus 73.4% (95% CI: 66.8%-79.3%), respectively. Claims-diagnoses verified with paper-based charts had similar PPV as the overall study sample, 80.2% (95% CI: 71.1%-87.5%), and higher PPV than those linked to electronic medical records, 73.3% (95% CI: 65.5%-80.2%). Combined paper-based and electronic records had a higher PPV, 87.6% (95% CI: 80.9%-92.6%).
  
  
  CONCLUSIONS
  Administrative claims data indicating a diagnosis of pneumonia in COPD patients are supported by medical records. The accuracy of a medical record diagnosis of pneumonia remains unknown. With increased use of claims data in medical research, COPD researchers can study pneumonia with confidence that claims data are a valid tool when studying the safety of COPD therapies that could potentially lead to increased pneumonia susceptibility or severity.
authors.affiliation: HealthCore, Inc., Wilmington, DE, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Kern
authors.affiliation: AstraZeneca Pharmaceuticals, Wilmington, DE, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Davis
authors.affiliation: AstraZeneca Pharmaceuticals, Gaithersburg, MD, USA.
authors.forename: Setareh A
authors.initials: SA
authors.lastname: Williams
authors.affiliation: HealthCore, Inc., Wilmington, DE, USA.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Tunceli
authors.affiliation: HealthCore, Inc., Wilmington, DE, USA.
authors.forename: Bingcao
authors.initials: B
authors.lastname: Wu
authors.affiliation: AstraZeneca Pharmaceuticals, Cheshire, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Hollis
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Charlie
authors.initials: C
authors.lastname: Strange
authors.affiliation: AstraZeneca Pharmaceuticals, Wilmington, DE, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Trudo
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003132:Commerce; D057225:Data Mining; D057286:Electronic Health Records; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007297:Inpatients; D007345:Insurance Claim Review; D007348:Insurance, Health; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: claims data; medical record review; pneumonia; positive predictive value; validation