How valid is the ICD-9-CM based AHRQ patient safety indicator for postoperative venous thromboembolism?

Richard H White, Banafsheh Sadeghi, Daniel J Tancredi, Patricia Zrelak, Joanne Cuny, Pradeep Sama, Garth H Utter, Jeffrey J. Geppert, Patrick S Romano

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

BACKGROUND: Hospital administrative data are being used to identify patients with postoperative venous thromboembolism (VTE), either pulmonary embolism (PE) or deep-vein thrombosis (DVT). However, few studies have evaluated the accuracy of these ICD-9-CM codes across multiple hospitals. METHODS AND MATERIALS: The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI)-12 was used to identify cases with postoperative VTE in 80 hospitals that volunteered for either an AHRQ or University HealthSystem Consortium (UHC) validation project. Trained abstractors using a standardized tool and guidelines retrospectively verified all coded VTE events. RESULTS: In the combined samples, the positive predictive value of the set of prespecified VTE codes for any acute VTE at any time during the hospitalization was 451 of 573 = 79% (95% CI: 75%-82%). However, the positive predictive value for acute lower extremity DVT or PE diagnosed after an operation was 209 of 452 = 44% (95% CI: 37%-51%) in the UHC sample and 58 of 121 = 48% (95% CI: 42-67%) in the AHRQ sample. Fourteen percent of all cases had an acute upper extremity DVT, 6% had superficial vein thrombosis and 21% had no acute VTE, however, 61% of the latter had a documented prior/chronic VTE. In the UHC cohort, the sensitivity for any acute VTE was 95.5% (95% CI: 86.4%-100%); the specificity was 99.5% (95% CI: 99.4%-99.7%). CONCLUSION: Current PSI 12 criteria do not accurately identify patients with acute postoperative lower extremity DVT or PE. Modification of the ICD-9-CM codes and implementation of "present on admission" flags should improve the predictive value for clinically important VTE events.

Original languageEnglish (US)
Pages (from-to)1237-1243
Number of pages7
JournalMedical Care
Volume47
Issue number12
DOIs
StatePublished - Dec 2009

Fingerprint

Health Services Research
Venous Thromboembolism
International Classification of Diseases
Patient Safety
Pulmonary Embolism
Venous Thrombosis
Lower Extremity
Upper Extremity Deep Vein Thrombosis
Veins
Hospitalization
Thrombosis
Guidelines

Keywords

  • Deep vein thrombosis
  • ICD-9-CM coding
  • Patient safety
  • Pulmonary embolism
  • Validation
  • Venous thromboembolism

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

How valid is the ICD-9-CM based AHRQ patient safety indicator for postoperative venous thromboembolism? / White, Richard H; Sadeghi, Banafsheh; Tancredi, Daniel J; Zrelak, Patricia; Cuny, Joanne; Sama, Pradeep; Utter, Garth H; Geppert, Jeffrey J.; Romano, Patrick S.

In: Medical Care, Vol. 47, No. 12, 12.2009, p. 1237-1243.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Hospital administrative data are being used to identify patients with postoperative venous thromboembolism (VTE), either pulmonary embolism (PE) or deep-vein thrombosis (DVT). However, few studies have evaluated the accuracy of these ICD-9-CM codes across multiple hospitals. METHODS AND MATERIALS: The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI)-12 was used to identify cases with postoperative VTE in 80 hospitals that volunteered for either an AHRQ or University HealthSystem Consortium (UHC) validation project. Trained abstractors using a standardized tool and guidelines retrospectively verified all coded VTE events. RESULTS: In the combined samples, the positive predictive value of the set of prespecified VTE codes for any acute VTE at any time during the hospitalization was 451 of 573 = 79{\%} (95{\%} CI: 75{\%}-82{\%}). However, the positive predictive value for acute lower extremity DVT or PE diagnosed after an operation was 209 of 452 = 44{\%} (95{\%} CI: 37{\%}-51{\%}) in the UHC sample and 58 of 121 = 48{\%} (95{\%} CI: 42-67{\%}) in the AHRQ sample. Fourteen percent of all cases had an acute upper extremity DVT, 6{\%} had superficial vein thrombosis and 21{\%} had no acute VTE, however, 61{\%} of the latter had a documented prior/chronic VTE. In the UHC cohort, the sensitivity for any acute VTE was 95.5{\%} (95{\%} CI: 86.4{\%}-100{\%}); the specificity was 99.5{\%} (95{\%} CI: 99.4{\%}-99.7{\%}). CONCLUSION: Current PSI 12 criteria do not accurately identify patients with acute postoperative lower extremity DVT or PE. Modification of the ICD-9-CM codes and implementation of {"}present on admission{"} flags should improve the predictive value for clinically important VTE events.",
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AU - White, Richard H

AU - Sadeghi, Banafsheh

AU - Tancredi, Daniel J

AU - Zrelak, Patricia

AU - Cuny, Joanne

AU - Sama, Pradeep

AU - Utter, Garth H

AU - Geppert, Jeffrey J.

AU - Romano, Patrick S

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N2 - BACKGROUND: Hospital administrative data are being used to identify patients with postoperative venous thromboembolism (VTE), either pulmonary embolism (PE) or deep-vein thrombosis (DVT). However, few studies have evaluated the accuracy of these ICD-9-CM codes across multiple hospitals. METHODS AND MATERIALS: The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI)-12 was used to identify cases with postoperative VTE in 80 hospitals that volunteered for either an AHRQ or University HealthSystem Consortium (UHC) validation project. Trained abstractors using a standardized tool and guidelines retrospectively verified all coded VTE events. RESULTS: In the combined samples, the positive predictive value of the set of prespecified VTE codes for any acute VTE at any time during the hospitalization was 451 of 573 = 79% (95% CI: 75%-82%). However, the positive predictive value for acute lower extremity DVT or PE diagnosed after an operation was 209 of 452 = 44% (95% CI: 37%-51%) in the UHC sample and 58 of 121 = 48% (95% CI: 42-67%) in the AHRQ sample. Fourteen percent of all cases had an acute upper extremity DVT, 6% had superficial vein thrombosis and 21% had no acute VTE, however, 61% of the latter had a documented prior/chronic VTE. In the UHC cohort, the sensitivity for any acute VTE was 95.5% (95% CI: 86.4%-100%); the specificity was 99.5% (95% CI: 99.4%-99.7%). CONCLUSION: Current PSI 12 criteria do not accurately identify patients with acute postoperative lower extremity DVT or PE. Modification of the ICD-9-CM codes and implementation of "present on admission" flags should improve the predictive value for clinically important VTE events.

AB - BACKGROUND: Hospital administrative data are being used to identify patients with postoperative venous thromboembolism (VTE), either pulmonary embolism (PE) or deep-vein thrombosis (DVT). However, few studies have evaluated the accuracy of these ICD-9-CM codes across multiple hospitals. METHODS AND MATERIALS: The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI)-12 was used to identify cases with postoperative VTE in 80 hospitals that volunteered for either an AHRQ or University HealthSystem Consortium (UHC) validation project. Trained abstractors using a standardized tool and guidelines retrospectively verified all coded VTE events. RESULTS: In the combined samples, the positive predictive value of the set of prespecified VTE codes for any acute VTE at any time during the hospitalization was 451 of 573 = 79% (95% CI: 75%-82%). However, the positive predictive value for acute lower extremity DVT or PE diagnosed after an operation was 209 of 452 = 44% (95% CI: 37%-51%) in the UHC sample and 58 of 121 = 48% (95% CI: 42-67%) in the AHRQ sample. Fourteen percent of all cases had an acute upper extremity DVT, 6% had superficial vein thrombosis and 21% had no acute VTE, however, 61% of the latter had a documented prior/chronic VTE. In the UHC cohort, the sensitivity for any acute VTE was 95.5% (95% CI: 86.4%-100%); the specificity was 99.5% (95% CI: 99.4%-99.7%). CONCLUSION: Current PSI 12 criteria do not accurately identify patients with acute postoperative lower extremity DVT or PE. Modification of the ICD-9-CM codes and implementation of "present on admission" flags should improve the predictive value for clinically important VTE events.

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KW - Pulmonary embolism

KW - Validation

KW - Venous thromboembolism

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