Identifying in-hospital venous thromboembolism (VTE): A comparison of claims-based approaches with the rochester epidemiology project VTE cohort

Cynthia L. Leibson, Jack Needleman, Peter Buerhaus, John A. Heit, L. Joseph Melton, James M. Naessens, Kent R. Bailey, Tanya M. Petterson, Jeanine E. Ransom, Marcelline R. Harris

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

BACKGROUND:: Efforts to identify hospital-acquired complications from claims data by applying exclusion rules to discharge diagnosis codes exhibit low positive predictive value (PPV). The PPV improves when a variable is added to each secondary diagnosis to indicate whether the condition was "present-on-admission" (POA) or "hospital-acquired". Such indicator variables will soon be required for Medicare reimbursement. No estimates are available, however, of the proportion of hospital-acquired complications that are missed (sensitivity) using either exclusion rules or indicator variables. We estimated sensitivity, specificity, PPV, and negative predictive value (NPV) of claims-based approaches using the Rochester Epidemiology Project (REP) venous thromboembolism (VTE) cohort as a "gold standard." METHODS:: All inpatient encounters by Olmsted County, Minnesota, residents at Mayo Clinic-affiliated hospitals 1995-1998 constituted the at-risk-population. REP-identified hospital-acquired VTE consisted of all objectively-diagnosed VTE among County residents 1995-1998, whose onset of symptoms occurred during inpatient stays at these hospitals, as confirmed by detailed review of County residents' provider-linked medical records. Claims-based approaches used billing data from these hospitals. RESULTS:: Of 37,845 inpatient encounters, 98 had REP-identified hospital-acquired VTE; 47 (48%) were medical encounters. NPV and specificity were >99% for both claims-based approaches. Although indicator variables provided higher PPV (74%) compared with exclusion rules (35%), the sensitivity for exclusion rules was 74% compared with only 38% for indicator variables. Misclassification was greater for medical than surgical encounters. CONCLUSIONS:: Utility and accuracy of claims data for identifying hospital-acquired conditions, including POA indicator variables, requires close attention be paid by clinicians and coders to what is being recorded.

Original languageEnglish (US)
Pages (from-to)127-132
Number of pages6
JournalMedical care
Volume46
Issue number2
DOIs
StatePublished - Feb 2008

Keywords

  • Administrative data
  • Complications of care
  • Presenton-admission indicator
  • Venous thromboembolism

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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