Development of an ICD Coding Definition for Inflammatory Bowel ...

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UNIVERSITY OF CALGARY FACULTY OF GRADUATE STUDIES The undersigned certify that they have read, and recommend to the Faculty of Graduate Studies for acceptance, a thesis entitled "DEVELOPMENT OF AN ICD CODING DEFINITION FOR INFLAMMATORY BOWEL DISEASE" submitted by Ali Rezaie in partial fulfilment of the requirements of the degree of Master Of Science. Supervisor, Dr. Robert Hilsden Departments of Medicine and Community Health Sciences Dr. Remo Panaccione Department of Medicine Dr. Hude Quan Department of Community Health Sciences Dr. John Marshall Department of Medicine, McMaster University ii Date
Abstract INTRODUCTION: To facilitate the conduction of population-based epidemiologic studies, this study was performed to develop a criterion for capturing IBD patients through comprehensive administrative databases in the province of Alberta, Canada. METHODS: Reports of endoscopy procedures performed within the Calgary Health Region are housed in a computerized database (EndoPro). Computerized and manual search strategies were conducted on EndoPro to categorize the patients undergone a colonoscopy into definite IBD, possible IBD, and definite non-IBD patients. Between 1995-2004, the medical service history (lCD diagnostic codes) was tracked by a unique personal health identification number in physician claims, hospital abstracts and Ambulatory Care Classification System (ACCS) databases. ICD-9 and lCD-10 codes for Crohn‘s disease and ulcerative colitis were extracted. Over 150 administrative definitions were developed for IBD patients depending on the number and periodicity of IBD codes in each database. Complementary chart reviews were done in case of disagreement between administrative criteria and EndoPro. RESULTS: 1,399 IBD patients and 15,439 definite non-IBD individuals were identified through EndoPro database search and chart reviews. The favorable definition classifies individuals as having IBD only if they have four physician claims OR two ACCS claims OR a hospitalization with an ICD diagnostic code of IBD. The definition must be met within a maximum time period of three years (Specificity, 99.75%, 95%CI, 99.66%-99.82%; Sensitivity, 85.70%, 95%CI, 83.76%- 87.50%). CONCLUSION: Through a novel methodology we have developed a reliable lCD coding definition for IBD, which could be used in future population-based studies. iii
Page 1: UNIVERSITY OF CALGARY DEVELOPMENT O
Page 5 and 6: Dedication To my parents and my sis
Page 7 and 8: 4.3.1 Computerized search..........
Page 9 and 10: List of Tables Table1. Incidence an
Page 11 and 12: List of Abbreviations Symbol Defini
Page 13 and 14: Chapter One: INTRODUCTION Crohn‘s
Page 15 and 16: 2.1 Inflammatory Bowel disease Chap
Page 17 and 18: are usually apparent. Potentially l
Page 19 and 20: Incidence and prevalence rates of I
Page 21 and 22: contact in 1989 or later, to allow
Page 23 and 24: significant condition of the patien
Page 25 and 26: Young et al.[36] found that agreeme
Page 27 and 28: 3.1 Significance Chapter Three: Sig
Page 29 and 30: 4.1 Summarized design Chapter Four:
Page 31 and 32: 4.2.4 Ambulatory Care Classificatio
Page 33 and 34: 4.4 Retrieving the personal health
Page 35 and 36: 4.7 Preliminary development of the
Page 37 and 38: Each time frame 1 (i.e. ”t‘ in
Page 39 and 40: 4.7.1 Sensitivity Sensitivity (true
Page 41 and 42: hospitals were reviewed for each pa
Page 43 and 44: final two definitions was founded o
Page 45 and 46: Figure 1. Distribution of the proce
Page 47 and 48: 5.4.1 IP database (FY 1994 œ FY 20
Page 49 and 50: 5.4.2 PC database (FY 1995 œ FY 20
Page 51 and 52: Diagram 4. Frequency of ACCS contac
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Table 3. 2×2 contingency table and
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within 5 years“. Of 137 false pos
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—IP≥1 or PC≥5 or ACCS≥2 wit
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5.6.2 False negative patients Defin
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definitions were selected as our fi
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• Incomplete documentation of lin
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94.5% of our subjects were regarded
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prevalence of IBD in the Calgary He
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with no flare in the last 10 years
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• At least two independent and se
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FP rate (i.e. 1-specificity or ). T
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CD, IC patients who become CD or UC
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6.5 Limitations When extrapolating
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egions that do not have access to t
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17. Trallori, G., et al., A populat
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APPENDIX 1. INTERNATIONAL CLASSIFIC
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556.8 Other ulcerative colitis 556.
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• ICD-10-CA Enteritis, NOS, diete
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APPENDIX 2. SEARCH TERMS IN ENDOPRO
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INVOLVEMENT Shade the corresponding
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APPENDIX 4. ETHICAL APPROVAL 81
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IP = 1 PC =3 ACCS =2 IP = 1 PC = 3
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IP = 1 PC = 5 ACCS = 2 IP = 1 PC =
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IP = 2 PC = 2 ACCS = 2 IP = 2 PC =
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IP = 2 PC = 4 ACCS = 2 IP = 2 PC =
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IP = 2 PC = 6 ACCS = 2 IP = 2 PC =
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IP = 1 PC =4 IP = 1 PC = 5 Criteria
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IP = 2 PC = 3 IP = 2 PC = 4 Criteri
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APPENDIX 7. 2×2 TABLES AND TEST CH
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• Definition —IP≥1 or PC≥4
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IBD patients had a median number of
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Diagram 8. Frequency of ACCS contac
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IP = 1 PC =3 ACCS =2 IP = 1 PC = 3
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IP = 1 PC = 5 ACCS = 2 IP = 1 PC =
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IP = 2 PC = 2 ACCS = 2 IP = 2 PC =
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IP = 2 PC = 4 ACCS = 2 IP = 2 PC =
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IP = 2 PC = 6 ACCS = 2 IP = 2 PC =
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IP = 1 PC =4 IP = 1 PC = 5 Criteria
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IP = 2 PC = 3 IP = 2 PC = 4 Criteri
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APPENDIX 11. 2×2 TABLES AND TEST C
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