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J Gastroenterol Hepatol. 2019 Sep 9. doi: 10.1111/jgh.14855. [Epub ahead of print]

Nationwide Validation Study of Diagnostic Algorithms for Inflammatory Bowel Disease in Korean National Health Insurance Service Database.

Author information

1
Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University College of Medicine, Seoul, Korea.
2
Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
3
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
4
Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
5
Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
6
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
7
Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
8
Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
9
Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea.
10
Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
11
Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea.
12
Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
13
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
14
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
15
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
16
Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University College of Medicine, Seoul, Korea.
17
Department of Gastroenterology, Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
18
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS:

We conducted a nationwide validation study of diagnostic algorithms to identify cases of inflammatory bowel disease (IBD) within the Korea National Health Insurance System (NHIS) database.

METHOD:

Using the NHIS dataset, we developed 44 algorithms combining the Internal Classification of Diseases (ICD)-10 codes, codes for Rare and Intractable Diseases (RID) registration and claims data for healthcare encounters, and pharmaceutical prescriptions for IBD-specific drugs. For each algorithm, we compared the case identification results from electronic medical records data with the gold standard (chart-based diagnosis). A multiple sampling test verified the validation results from the entire study population.

RESULTS:

A random nationwide sample of 1,697 patients (848 potential cases, 849 negative control cases) from 17 hospitals were included for validation. A combination of the ICD-10 code, ≥1 claims for healthcare encounters, and ≥1 prescription claims (reference algorithm) achieved excellent performance (sensitivity, 93.1% [95% confidence interval 91-94.7]; specificity, 98.1% [96.9-98.8]; positive predictive value, 97.5% [96.1-98.5]; negative predictive value, 94.5% [92.8-95.8]) with the lowest error rate (4.2% [3.3-5.3]). The multiple sampling test confirmed that the reference algorithm achieves the best performance regarding IBD diagnosis. Algorithms including the RID registration codes exhibited poorer performance compared with that of the reference algorithm, particularly for the diagnosis of patients affiliated with secondary hospitals. The performance of the reference algorithm showed no statistical difference depending on the hospital volume or IBD type, with p-value < 0.05.

CONCLUSIONS:

We strongly recommend the reference algorithm as a uniform standard operational definition for future studies using the NHIS database.

KEYWORDS:

administrative claims, healthcare; diagnostic algorithm; inflammatory bowel disease; operational definition

PMID:
31498502
DOI:
10.1111/jgh.14855

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