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J Palliat Med. 2017 Apr;20(4):372-377. doi: 10.1089/jpm.2016.0363. Epub 2016 Dec 7.

Validation of the V66.7 Code for Palliative Care Consultation in a Single Academic Medical Center.

Author information

1
1 Department of Anesthesiology, Columbia University , New York, New York.
2
2 Department of Epidemiology, Columbia University Mailman School of Public Health , New York, New York.
3
3 Department of Anesthesiology, Center for Health Policy and Outcomes in Anesthesia and Critical Care, Columbia University College of Physicians and Surgeons .
4
4 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.
5
5 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre , Toronto, Ontario, Canada .
6
6 Department of Anesthesia, University of Toronto , Toronto, Ontario, Canada .

Abstract

BACKGROUND:

Use of administrative data to study the effectiveness of specialized palliative care is limited by the lack of a reliable method to identify patients receiving palliative care consultation. The International Classification of Diseases, Ninth Revision (ICD-9) code V66.7 has been used, but its validity for this purpose is unknown.

OBJECTIVE:

To examine the validity of the ICD-9 code V66.7 for identifying whether hospitalized patients received palliative care consultation.

DESIGN:

Retrospective cohort study.

SETTING/SUBJECTS:

All patients of age ≥18 years admitted to a single academic medical center between August 2013 and August 2015.

MEASUREMENTS:

Sensitivity and specificity of the V66.7 code for palliative care consultation for all patients and several a priori identified subgroups. The reference standard was the presence of a palliative care consultation note in the electronic medical record.

RESULTS:

Of 100,910 admissions, 1999 received a palliative care consultation (2.0%) and 1846 (1.8%) had usage of the V66.7 code. Sensitivity and specificity for the V66.7 code were 49.9% and 99.1%, respectively. Sensitivity was considerably higher for certain subgroups, such as patients with dementia (76.3%) and metastatic cancer (66.3%); addition of age restrictions further improved sensitivity while maintaining high specificity. Specificity was substantially lower for patients who died during hospitalization (sensitivity 53.9%, specificity 75.1%).

CONCLUSIONS:

In a single center, the ICD-9 code V66.7 had poor sensitivity and high specificity for identifying hospitalized patients who received a palliative care consultation. Appropriate use of this code for this purpose should take these characteristics into consideration.

KEYWORDS:

International Classification of Disease Codes; end-of-life care; palliative medicine; validation studies

PMID:
27925839
PMCID:
PMC5385421
DOI:
10.1089/jpm.2016.0363
[Indexed for MEDLINE]
Free PMC Article

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