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

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• Genetic predispositions and environmental factors both play potential etiologic roles in IBD; furthermore, the epidemiology of IBD changes over time. Hence, establishing a database for IBD patients in the Calgary Health Region is essential to obtain valuable information about the direction and determinants of the dynamic process of IBD epidemiology in this region. • This study will provide valuable information regarding the accuracy of Alberta physician claims, and endoscopy and hospital discharge abstract databases. 3.2 Objectives 3.2.1 Primary objective • To develop an ICD coding definition to identify IBD patients using IP, PC and ACCS administrative databases in the Calgary Health Region. • To determine the sensitivity and specificity of the administrative definition 3.2.2 Secondary objectives • To develop an alternative ICD coding definition using administrative databases of IP and PC for health regions that do not have access to ACCS database • To describe the distribution of IBD diagnostic codes in the Calgary Health Region‘s administrative databases 16
4.1 Summarized design Chapter Four: METHODOLOGY AND DATA ANALYSIS Computerized and manual search strategies were conducted on EndoPro database to categorize the patients who had undergone a colonoscopy within the period of May 16 th , 2000 through April 1 st , 2004 into definite IBD, possible IBD, and definite non-IBD patients. Records were linked to Alberta Health Care Insurance Plan population registry to retrieve unique personal health identification numbers (PHNs). PHN was then used to identify any records for these patients in physician claims, hospital discharge abstracts and Ambulatory Care Classification System (ACCS) databases form April 1995 through April 2004 that included a diagnostic code for CD or UC. Over 150 administrative definitions were developed to classify patients as having or not having IBD depending on the number and periodicity of IBD codes in each database. Chart reviews were completed on false positive, false negative and true positive cases to increase the accuracy of our definitions. The EndoPro and chart diagnosis was then used as the ”gold standard‘ test to determine if the classification by ”administrative definitions‘ was correct. The most practical definition was chosen to have a high specificity and an acceptable sensitivity. 17
Page 1 and 2: UNIVERSITY OF CALGARY DEVELOPMENT O
Page 3 and 4: Abstract INTRODUCTION: To facilitat
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: 3.1 Significance Chapter Three: Sig
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
Page 53 and 54: Table 3. 2×2 contingency table and
Page 55 and 56: within 5 years“. Of 137 false pos
Page 57 and 58: —IP≥1 or PC≥5 or ACCS≥2 wit
Page 59 and 60: 5.6.2 False negative patients Defin
Page 61 and 62: definitions were selected as our fi
Page 63 and 64: • Incomplete documentation of lin
Page 65 and 66: 94.5% of our subjects were regarded
Page 67 and 68: prevalence of IBD in the Calgary He
Page 69 and 70: with no flare in the last 10 years
Page 71 and 72: • At least two independent and se
Page 73 and 74: FP rate (i.e. 1-specificity or ). T
Page 75 and 76: CD, IC patients who become CD or UC
Page 77 and 78: 6.5 Limitations When extrapolating
Page 79 and 80:
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
Page 96 and 97:
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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