St Sauver Jennifer L, Chamberlain Alanna M, Bobo William V, Boyd Cynthia M, Finney Rutten Lila J, Jacobson Debra J, McGree Michaela E, Grossardt Brandon R, Rocca Walter A
Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
BMJ Open. 2021 Apr 24;11(4):e042870. doi: 10.1136/bmjopen-2020-042870.
To assess the validity of the US Department of Health and Human Services (DHHS) definition of multimorbidity using International Classification of Diseases, ninth edition (ICD-9) codes from administrative data.
Cross-sectional comparison of two ICD-9 billing code algorithms to data abstracted from medical records.
Olmsted County, Minnesota, USA.
An age-stratified and sex-stratified random sample of 1509 persons ages 40-84 years old residing in Olmsted County on 31 December 2010.
Seventeen chronic conditions identified by the US DHHS as important in studies of multimorbidity were identified through medical record review of each participant between 2006 and 2010. ICD-9 administrative billing codes corresponding to the 17 conditions were extracted using the Rochester Epidemiology Project records-linkage system. Persons were classified as having each condition using two algorithms: at least one code or at least two codes separated by more than 30 days. We compared the ICD-9 code algorithms with the diagnoses obtained through medical record review to identify persons with multimorbidity (defined as ≥2, ≥3 or ≥4 chronic conditions).
Use of a single code to define each of the 17 chronic conditions resulted in sensitivity and positive predictive values (PPV) ≥70%, and in specificity and negative predictive values (NPV) ≥70% for identifying multimorbidity in the overall study population. PPV and sensitivity were highest in persons 65-84 years of age, whereas NPV and specificity were highest in persons 40-64 years. The results varied by condition, and by age and sex. The use of at least two codes reduced sensitivity, but increased specificity.
The use of a single code to identify each of the 17 chronic conditions may be a simple and valid method to identify persons who meet the DHHS definition of multimorbidity in populations with similar demographic, socioeconomic, and health care characteristics.
利用行政数据中的国际疾病分类第九版（ICD - 9）编码，评估美国卫生与公众服务部（DHHS）的多重疾病定义的有效性。
将两种ICD - 9计费代码算法与从病历中提取的数据进行横断面比较。
美国明尼苏达州奥尔姆斯特德县。
2010年12月31日居住在奥尔姆斯特德县的1509名年龄在40 - 84岁之间、按年龄和性别分层的随机样本。
通过对2006年至2010年间每位参与者的病历审查，确定了美国卫生与公众服务部在多重疾病研究中认定为重要的17种慢性病。使用罗切斯特流行病学项目记录链接系统提取与这17种疾病对应的ICD - 9行政计费代码。采用两种算法将个体分类为患有每种疾病：至少一个代码或至少两个间隔超过30天的代码。我们将ICD - 9代码算法与通过病历审查获得的诊断结果进行比较，以识别患有多重疾病（定义为≥2种、≥3种或≥4种慢性病）的个体。
使用单个代码定义17种慢性病中的每一种，在总体研究人群中识别多重疾病时，敏感性和阳性预测值（PPV）≥70%，特异性和阴性预测值（NPV）≥70%。PPV和敏感性在65 - 84岁人群中最高，而NPV和特异性在40 - 64岁人群中最高。结果因疾病、年龄和性别而异。使用至少两个代码会降低敏感性，但会提高特异性。
使用单个代码识别17种慢性病中的每一种，可能是一种简单有效的方法，用于在具有相似人口统计学、社会经济和医疗保健特征的人群中识别符合美国卫生与公众服务部多重疾病定义的个体。
