Study characteristics and test measures of studies for physician claims data
| Country | Study years | Author(reference) | Reference | Type of administrative data | Diabetes case definition | ICD codes used | Study, N | Sensitivity % (95% CI) | Specificity % (95% CI) | PPV % (95% CI) | NPV % (95% CI) | κ |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Canada | 1995–1996 | Wilchesky et al23 | Medical chart | Physician claims | Using only diagnoses recorded in the claims of study physicians | ICD-9 250.0-.9 | 2752 | 51.78 (49.9 to 53.6) | 98.41 (98.2 to 98.6) | |||
| Using diagnostic codes recorded on claims made by all physicians who provided medical services to patients in the year prior to the start of the study | ICD-9 250.0-.9 | 64.43 (62.6 to 66.2) | 96.82 (96.5 to 97.1) | |||||||||
| USA | 1997–2001 | Crane et al14 | Clinician documentation in EMR progress notes | Physician claims | At least one clinician-coded diagnoses | ICD 9 250.0, .1, .2, .3 | 1441 | 93 (86 to 100) | 99 (99 to 100) | 91 (83 to 99) | ||
| USA | 1998–1999 | Borzecki et al13 | Medical charts | Physician claims | At least one diagnosis in National Department of Veterans Affairs (VA) database, Outpatient Clinic file over 1 year | ICD 9 250.x | 1176 | 97 | 96 | 0.92 | ||
| At least two diagnoses in National Department of Veterans Affairs (VA) database, Outpatient Clinic file over 1 year | ICD 9 250.x | 0.91 | ||||||||||
| At least one diagnosis in National Department of Veterans Affairs (VA) database, Outpatient Clinic file over 2 years | ICD 9 250.x | 0.89 | ||||||||||
| At least two diagnoses in National Department of Veterans Affairs (VA) database, Outpatient Clinic file over 2 years | ICD 9 250.x | 0.93 | ||||||||||
| USA | 1992–1995 | Hebert et al15 | Self-reported survey | Physician claims | One or more diagnoses of diabetes in any claim file over 1-year period | ICD 9-CM 250.00-.93, 357.2, 362.0-362.02, 366.41 | 71.6 | 96.6 | 79 | |||
| One or more diagnoses of diabetes in any claim file over 2-year period | ICD 9-CM 250.00-.93, 357.2, 362.0–0.02, 366.41 | 79.1 | 94.3 | 71.4 | ||||||||
| USA | 1993–1994 | O’Connor et al20 | Telephone survey | Physician claims | Two or more ICD-9 diagnostic codes | ICD 9 250.x | 1976 | 92.22* | 98.62* | 76.15* | 99.63* | |
| USA | 1996–1998 | Singh19 | Self-reported survey | Physician claims | Veterans Affairs databases | ICD 9 250 | 76 (75 to 76) | 98 (98 to 98) | 91 (91 to 91) | 95 (94 to 95) | 0.79 (0.79 to 0.80) | |
| USA | 1997 | Ngo et al16 | Self-reported survey | Physician claims | Oregon Medicaid Claims Data, any claim ≤24 months before interview with a diabetes diagnosis code | ICD 9 250, 357.2, 362, 366.41 | 21 564 | 83.9 | 97.9 | 81.9 | 98.2 | 0.81 (0.77 to 0.85) |
| Oregon Medicaid Claims Data, any claim ≤12 months before interview with a diabetes diagnosis code | ICD 9 250, 357.2, 362, 366.41 | 88.7 | 97.4 | 76.4 | 98.9 | 0.8 (0.76 to 0.85) | ||||||
| USA | 1997–2000 | Miller et al18 | Self-reported survey | Physician claims (Medicare) | Any diagnostic code | ICD 9 250, 357.2, 362.0, 366.41 | 2 924 148 | 78.3 | 95.7 | 85.3 | ||
| Any outpatient diagnostic code | ICD 9 250, 357.2, 362.0, 366.41 | 77.5 | 95.9 | 85.8 | ||||||||
| ≥2 any diagnostic code | ICD 9 250, 357.2, 362.0, 366.41 | 73.1 | 98.3 | 93.4 | ||||||||
| ≥2 outpatient codes | ICD 9 250, 357.2, 362.0, 366.41 | 72.2 | 98.4 | 93.7 | ||||||||
| ≥3 any diagnostic code | ICD 9 250, 357.2, 362.0, 366.41 | 69 | 98.4 | 95.2 | ||||||||
| ≥3 outpatient codes | ICD 9 250, 357.2, 362.0, 366.41 | 68 | 98.9 | 95.4 | ||||||||
| ≥4 any diagnostic code | ICD 9 250, 357.2, 362.0, 366.41 | 65 | 99.1 | 96 | ||||||||
| ≥4 outpatient codes | ICD 9 250, 357.2, 362.0, 366.41 | 63.8 | 99.2 | 96.2 |
Superior performance characteristics within studies have been highlighted in bold.
*Sensitivity, specificity, PPV and NPV are all hand-calculated:
sensitivity identifies the proportion of patients who truly do have the disease/condition;
specificity identifies the proportion of patients who truly do not have the disease/condition;
PPV is the probability that participants with a positive screening test truly have the disease/condition;
NPV is the probability that participants with a negative screening test truly do not have the disease/condition;
κ is an inter-rater agreement statistic to evaluate the agreement between two classifications on ordinal or nominal scales.
EMR, electronic medical record; ICD 10-AM, International Classification of Diseases, Tenth Revision, Australian Modification; ICD, International Classification of Diseases; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; NPV, negative predictive value; PPV, positive predictive value.