Biggerstaff K S, Frankfort B J, Orengo-Nania S, Garcia J, Chiao E, Kramer J R, White D
a Houston Center for Innovations in Quality, Effectiveness and Safety , Michael E. DeBakeyVeterans Affairs Medical Center , Houston , TX , USA.
b Eye Care Line , Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.
Ophthalmic Epidemiol. 2018 Apr;25(2):162-168. doi: 10.1080/09286586.2017.1378688. Epub 2017 Sep 25.
The validity of the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9) code for primary open angle glaucoma (POAG) in the Department of Veterans Affairs (VA) electronic medical record has not been examined. We determined the accuracy of the ICD-9 code for POAG and developed diagnostic algorithms for the detection of POAG.
We conducted a retrospective study of abstracted data from the Michael E. DeBakey VA Medical Center's medical records of 334 unique patients with at least one visit to the Eye Clinic between 1999 and 2013. Algorithms were developed to validly identify POAG using ICD-9 codes and pharmacy data. The positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and percent agreement of the various algorithms were calculated.
For the ICD-9 code 365.1x, the PPV was 65.9%, NPV was 95.2%, sensitivity was 100%, specificity was 82.6%, and percent agreement was 87.8%. The algorithm with the highest PPV was 76.3%, using pharmacy data in conjunction with two or more ICD-9 codes for POAG, but this algorithm also had the lowest NPV at 88.2%.
Various algorithms for identifying POAG in the VA administrative databases have variable validity. Depending on the type of research being done, the ICD-9 code 365.1x can be used for epidemiologic or health services database research.
退伍军人事务部（VA）电子病历中第九版国际疾病分类临床修订本（ICD - 9）用于原发性开角型青光眼（POAG）的编码有效性尚未得到检验。我们确定了POAG的ICD - 9编码准确性，并开发了用于检测POAG的诊断算法。
我们对迈克尔·E·德贝基VA医疗中心1999年至2013年间至少到眼科门诊就诊一次的334例独特患者的病历摘要数据进行了回顾性研究。开发了利用ICD - 9编码和药房数据有效识别POAG的算法。计算了各种算法的阳性预测值（PPV）、阴性预测值（NPV）、敏感性、特异性和一致性百分比。
对于ICD - 9编码365.1x，PPV为65.9%，NPV为95.2%，敏感性为100%，特异性为82.6%，一致性百分比为87.8%。PPV最高的算法为76.3%，该算法结合药房数据以及两个或更多POAG的ICD - 9编码，但此算法的NPV最低，为88.2%。
VA管理数据库中用于识别POAG的各种算法有效性各异。根据所开展研究的类型，ICD - 9编码365.1x可用于流行病学或卫生服务数据库研究。
