Validation of
Administrative Data
Diagnoses of Chronic
Childhood Arthritis in
Saskatchewan
Investigators:
Natalie Shiff
Alan Rosenberg
Lisa Lix
Objectives
 To
briefly discuss administrative data
 To briefly discuss childhood arthritis
 To illustrate how administrative data can
be used to answer clinical health services
related questions using the example of
childhood arthrits
Complications

Seen in all types


Contractures, growth abnormalities, reduced
vision
Treatment goals:






Relieve pain
Maintain function
Prevent damage and deformities
Normalize growth
Rehabilitate
Educate
Juvenile Idiopathic Arthritis
 Most
common chronic rheumatic disease of childhood
 Group of diseases
 Multiple classification systems



Juvenile idiopathic arthritis (current)
Juvenile Rheumatoid Arthritis (North American)
Juvenile Chronic Arthritis (European)
Etiology
 Multifactorial
 Immune


dysfunction
Innate immunity
Adaptive immunity
 Environmental


factors
Smoking
Infections
 Hormonal
factors
Examples of administrative
health databases
Database
Medical Services
Contains billing data for outpatient based medical
services covered by Saskatchewan Health
Hospital Services
Database contains information about in-hospital services
received by individuals covered through Saskatchewan
Health
Prescription Drug
Contains information about outpatient prescriptions for
drugs covered in the Saskatchewan Drug Formulary
Research questions



Are existing rheumatoid arthritis algorithms valid
for identifying cases of JIA/JRA in provincial
administrative databases?
Are there additional diagnostic codes,
prescription drug data, or exclusion criteria that
can be used to improve the sensitivity and/or
specificity of an algorithm for JIA/JRA?
What is the estimated prevalence and
incidence of JIA/JRA in Saskatchewan?
Databases and variables
Database
Variable
Medical
Services
Physician billing data
Justification
Diagnosis (ICD-9; three-digit)
To identify cases of JIA/JRA
Date of visit, service code
Location of patient residence
To assess healthcare
utilization
To assess follow-up; to
validate algorithms
Indication of urban/rural
Method of remuneration
Determine if true billing
Registered Indian status
Possible population for future
interventions
Physician specialty
Databases and variables
Hospital
Services
Information for each hospital admission
Most responsible
diagnosis
All additional diagnoses
To identify cases of JIA/JRA and
identify co-morbid conditions
Principal procedure
All other procedures
Accident code
(External cause requiring
hospital admission)
To identify procedures to treat
complications of arthritis
To identify injuries preceding
JIA/JRA diagnosis
Admission and discharge
dates
Resource intensity weight
To identify time of diagnosis and
potential relationship to therapies
To assess cost of hospitalization
Databases and variables
Prescription
Drug
For all non-steroidal anti-inflammatory drugs (NSAIDs), disease
modifying anti-rheumatic drugs (DMARDs), steroids, and
biologics used to treat inflammatory arthritis
Drug pharmacologic-therapeutic To group similar drugs
classification
Drug identification (DIN),
To identify product name,
active ingredient (AIN)
strength, route of administration
number
Strength, dosage, date and
To determine doses, treatment
quantity dispensed
timing, and treatment duration
respectively
Prescriber specialty
To identify care providers
Total cost
To describe costs
Other medications grouped by
drug class
To identify possible
complications of JIA/JRA or
treatment of comorbidities
ICD
Version
ICD 9
Code Description
710
diffuse diseases of connective tissue
ICD 9
714
rheumatoid arthritis
ICD 9
716
other and unspecified arthropathies
ICD 9
720
spondyloarthropathies
ICD 10 CA
M05
seropositive rheumatoid arthritis
ICD 10 CA
M06
other rheumatoid arthritis
ICD 10 CA
M07
psoriatic and enteropathic arthropathies
ICD 10 CA
M08
juvenile arthritis
ICD 10 CA
M09
juvenile arthritis in diseases classified elsewhere
ICD 10 CA
M13
other arthritis
ICD 10 CA
M30
polyarteritis nodosa and related conditions
ICD 10 CA
M31
other necrotizing vasculopathies
ICD 10 CA
M32
systemic lupus erythematosus
ICD 10 CA
M33
dermatopolymyositis
ICD 10 CA
M34
systemic sclerosis
ICD 10 CA
ICD 10 CA
M35
M36
other systemic involvement of connective tissue
systemic disorders of connective tissue in diseases classified elsewhere
Validation
 establish
the accuracy of administrative
databases diagnoses
 examples include



inflammatory bowel disease
rheumatoid arthritis
psoriatic arthritis
Defining the Gold Standard for
Validation
 single
diagnosis of JRA or JIA assigned by
a pediatric rheumatologist
 no subsequent diagnosis of any other
type of connective tissue disease or any
other type of arthritis
 spondyloarthropathies will be examined
separately and then combined with JIA
and JRA
Algorithms

Single diagnostic code of rheumatoid arthritis




sensitivity ranging from 89% to 100 %
specificity of 55% to 74%
low positive predictive values of 57% to 66%
JRA in literature:


a single diagnostic code of JRA;
2 diagnostic codes for JRA at least 2 months
apart but within 2 years billed by a non-arthritis
specialist
Algorithms
2
claims at least 2 months apart for a
physician visit billed as JIA or JRA
 Modify:



time between visits
additional prescription drug dispensations,
stricter exclusion criteria
Verifying diagnoses
 can
not access chart diagnoses
 JIA more inclusive than JRA
 pediatric Rheumatology clinical
database maintained continuously since
1982
 calculate proportions of different
diagnoses seen over time
Population size estimates
 Clinical




referrals:
3269 referrals between 1981 and 2004
326 JRA
360 spondyloarthropathy
Quebec ≈25% not referred
Incidence and Prevalence
Periods
 annual
incidence

from 2000 to 2010

washout period
 prevalence

once diagnosed, always have disease
 cumulative
prevalence
Analysis
 two

by two tables
Sensitivity, specificity, positive predictive
value, and negative predictive value
 incidence
and prevalence
 comparison
of patient populations
Limitations
 Selection

bias
Confounding by disease severity
 Can
not examine by subtype
 Certain subtypes may not be captured

Psoriatic
 Inability

to use clinical diagnosis
Coding errors from 3rd party billings
 Generalizability
Administrative Data
 Help
address gaps in care
 Long-term tracking
 Morbidities
 Outcomes
 Utilization
 Economic analysis
References
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Questions?