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Validation of ICD-9-CM Diagnostic Codes for Inflammatory Bowel Disease Among Veterans

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Abstract

Background

Inflammatory bowel disease (IBD) is well described among young whites and less so among the elderly and non-whites. Population-level data is required to assess outcomes among minority groups.

Aim

To validate diagnostic codes for IBD from the Department of Veterans Affairs.

Methods

National databases were used to identify local patients with Crohn’s disease (CD) and ulcerative colitis (UC), the extra-intestinal manifestations and surgical procedures associated with IBD. Diagnosis was confirmed by manual chart abstraction. Multivariable logistic regression was used to derive diagnostic algorithms for CD and UC, which were then validated in an independent cohort.

Results

The test cohort of 3,827 patients (1,316 potential cases, 2,511 random controls) was predominantly male (94%), white (56%), and of age of 58 (standard deviation 15). The positive predictive value (PPV) of CD codes was superior (88–100%) to UC (50–93%). The accuracy of extra-intestinal manifestations and surgeries was poor (PPV 0–29%). ICD-9-CM code 555.x without 560.9 had a PPV of 91% for CD in the validation cohort. Code 556.x with age, gender, and race factors was highly predictive of UC (c-statistic 0.9, PPV of 81%).

Conclusion

VA administrative data can diagnose elderly and non-white patients with IBD.

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Abbreviations

VA:

Department of Veterans Affairs

PTF:

Patient treatment file

OPC:

Outpatient care file

VA-PBM:

Veterans Affairs Pharmacy Benefits Management

BIRLS:

Beneficiary identification and records locator subsystem death file

MEDVAMC:

Michael E. DeBakey VA Medical Center

IBD:

Inflammatory bowel disease

UC:

Ulcerative colitis

CD:

Crohn’s disease

CPT:

Current procedural terminology

ICD-9-CM:

International classification of diseases, ninth revision, clinical modification

SD:

Standard deviation

PPV:

Positive predictive value

CI:

Confidence interval

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Acknowledgments

This material is based upon work supported (wholly or in part) by the Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. It was also supported in part by the Houston VA HSR&D Center of Excellence (HFP90-020). Dr. Abraham is supported by an American Gastroenterological Association Foundation-Sucampo-Association of Specialty Professors Designated Research Award in Geriatric Gastroenterology, and a Merit Review Award from the Department of Veterans Affairs (VA IIR08-028). This work was presented in part at the American College of Gastroenterology Annual Meeting, Philadelphia, Pennsylvania, October 2007. Dr. Thirumurthi has received research funding from UCB Pharmaceuticals.

Role of the Sponsors

None of the funding agencies played a role in the design and conduct of the study, analysis, and interpretation of the data, or preparation and approval of the manuscript. The views expressed herein are those of the authors and do not necessarily reflect those of the Department of Veterans Affairs (Baylor College of Medicine).

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Correspondence to Selvi Thirumurthi.

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Thirumurthi, S., Chowdhury, R., Richardson, P. et al. Validation of ICD-9-CM Diagnostic Codes for Inflammatory Bowel Disease Among Veterans. Dig Dis Sci 55, 2592–2598 (2010). https://doi.org/10.1007/s10620-009-1074-z

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