Abara Winston E, Moorman Anne C, Zhong Yuna, Collier Melissa G, Rupp Lora B, Gordon Stuart C, Boscarino Joseph A, Schmidt Mark A, Trinacty Connie Mah, Holmberg Scott D
Division of Viral Hepatitis, CDC, Atlanta, Georgia.
Henry Ford Hospital, Detroit, Michigan.
Popul Health Manag. 2018 Apr;21(2):110-115. doi: 10.1089/pop.2017.0004. Epub 2017 Jul 5.
Surveillance of chronic hepatitis C virus (HCV) cases faces limitations that result in delays and under-reporting. With increasing use of electronic health records (EHRs), the authors evaluated the predictive value of using (ICD-9) codes to identify chronic HCV cases from EHR data. Longitudinal EHR data from 4 health care systems during 2006-2012 were evaluated. Using chart abstraction and review to confirm chronic HCV cases ("gold standard" definition), the authors calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 2 case definitions: (1) ≥2 ICD-9 codes separated by ≥6 months and (2) ≥1 positive HCV RNA (ribonucleic acid) test. Among 2,718,995 patients, 20,779 (0.8%) with ICD-9 codes indicating a likely diagnosis of chronic HCV infection were identified; 13,595 (65.4%) of these were randomly selected for review. Case definition 1 (≥2 ICD-9 codes separated by ≥6 months) had 70.3% sensitivity, 91.9% PPV, 99.9% specificity, and 99.9% NPV while case definition 2 (≥1 positive HCV RNA test) had 74.1% sensitivity, 97.4% PPV, 99.9% specificity, and 99.9% NPV. The predictive values of these alternate EHR-derived ICD-9 code-based case definitions suggest that these measures may be useful in capturing the burden of diagnosed chronic HCV infections. Their use can augment current chronic HCV case surveillance efforts; however, their accuracy may vary by length of observation and completeness of EHR data.
慢性丙型肝炎病毒（HCV）病例监测存在局限性，导致诊断延迟和报告不足。随着电子健康记录（EHR）的使用日益增加，作者评估了使用国际疾病分类第九版（ICD - 9）编码从EHR数据中识别慢性HCV病例的预测价值。对2006年至2012年期间4个医疗系统的纵向EHR数据进行了评估。作者通过图表提取和审查来确认慢性HCV病例（“金标准”定义），计算了两种病例定义的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）：（1）≥2个间隔≥6个月的ICD - 9编码；（2）≥1次HCV核糖核酸（RNA）检测呈阳性。在2,718,995名患者中，识别出20,779名（0.8%）ICD - 9编码显示可能诊断为慢性HCV感染的患者；其中13,595名（65.4%）被随机选择进行审查。病例定义1（≥2个间隔≥6个月的ICD - 9编码）的敏感性为70.3%，PPV为91.9%，特异性为99.9%，NPV为99.9%；而病例定义（≥1次HCV RNA检测呈阳性）的敏感性为74.1%，PPV为97.4%，特异性为99.9%，NPV为99.9%。这些基于EHR衍生的ICD - 9编码的替代病例定义的预测价值表明，这些措施可能有助于掌握已诊断慢性HCV感染的负担情况。它们的使用可以加强当前慢性HCV病例监测工作；然而，其准确性可能因观察时间长度和EHR数据的完整性而异。
