Chest
Original ResearchCOPDThe Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Diagnosis Codes for Identifying Patients Hospitalized for COPD Exacerbations
Section snippets
Materials and Methods
In the COPD-ARTIFACT (Administrative Data to Identify COPD or Heart Failure) study, hospital discharge databases at two academic health centers affiliated with different universities in Chicago were used to select a stratified probability sample of 200 adults admitted between November 2005 and October 2006. Inclusion criteria were age ≥ 25 years and hospital admission to a medical service (Fig 1); this lower boundary for age was used based on previous studies.17, 18 To avoid gaps in chart
Patient Characteristics
Of the 49,239 patients (hospital 1, 28,643; hospital 2, 20,596) admitted during the study period, 8,790 met eligibility criteria (hospital 1, 5,602; hospital 2, 3,188). Based on the reference standard, the prevalence (using sampling weights) of hospitalizations for AE-COPD was 7.9% (Table 2). As expected, the prevalence of AE-COPD in stratum 1 (81.2%) was higher than in stratum 2 (26.0%) or stratum 3 (4.0%). Only 20.8% of patients hospitalized for AE-COPD had a documented spirometry in the
Discussion
About one in 13 hospitalized patients in this study (7.9%) had AE-COPD. We demonstrated that algorithms based on ICD-9-CM codes vary in their ability to distinguish patients admitted for AE-COPD from those who are not. The sensitivity of all four ICD-9-CM algorithms was poor, but they were generally better if a combination of primary and secondary diagnosis codes were used. The PPVs varied across algorithms and favored the approach that relies on a primary diagnosis of COPD exacerbation
Acknowledgments
Author contributions: Dr Stein had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Stein: contributed to study design, data analysis and interpretation, and preparation of the manuscript.
Dr Bautista: contributed to the study design, data analysis and interpretation, and preparation of the manuscript.
Dr Schumock: contributed to the study design, data analysis and interpretation, and preparation of the
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Funding/Support: This work was supported by the National Institutes of Health [HL07605, HL101618] and the Agency for Healthcare Research and Quality [HS016967, HS017894].
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