Validation of Intensive Care and Mechanical Ventilation Codes in Medicare Data

Hannah Wunsch, Andrew Kramer, Hayley B. Gershengorn

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: To assess the reliability of codes relevant to critically ill patients in administrative data. Design: Retrospective cohort study linking data from Acute Physiology and Chronic Health Evaluation Outcomes, a clinical database of ICU patients with data from Medicare Provider Analysis and Review. We linked data based on matching for sex, date of birth, hospital, and date of admission to hospital. Setting: Forty-six hospitals in the United States participating in Acute Physiology and Chronic Health Evaluation Outcomes. Patients: All patients in Acute Physiology and Chronic Health Evaluation Outcomes greater than or equal to 65 years old who could be linked with hospitalization records in Medicare Provider Analysis and Review from January 1, 2009, through September 30, 2012. Measurements and Main Results: Of 62,451 patients in the Acute Physiology and Chronic Health Evaluation Outcomes dataset, 80.1% were matched with data in Medicare Provider Analysis and Review. All but 2.7% of Acute Physiology and Chronic Health Evaluation Outcomes ICU patients had either an ICU or coronary care unit charge in Medicare Provider Analysis and Review. In Acute Physiology and Chronic Health Evaluation Outcomes, 37.0% received mechanical ventilation during the ICU stay versus 24.1% in Medicare Provider Analysis and Review. The Medicare Provider Analysis and Review procedure codes for mechanical ventilation had high specificity (96.0%; 95% CI, 95.8-96.2), but only moderate sensitivity (58.4%; 95% CI, 57.7-59.1), with a positive predictive value of 89.6% (95% CI, 89.1-90.1) and negative predictive value of 79.7% (95% CI, 79.4-80.1). For patients with mechanical ventilation codes, Medicare Provider Analysis and Review overestimated the percentage with a duration greater than 96 hours (36.6% vs 27.3% in Acute Physiology and Chronic Health Evaluation Outcomes). There was discordance in the hospital discharge status (alive or dead) for only 0.47% of all linked records (κ = 1.00). Conclusions: Medicare Provider Analysis and Review data contain robust information on hospital mortality for patients admitted to the ICU but have limited ability to identify all patients who received mechanical ventilation during a critical illness. Estimates of use of mechanical ventilation in the United States should likely be revised upward.

Original languageEnglish (US)
Pages (from-to)e711-e714
JournalCritical Care Medicine
Volume45
Issue number7
DOIs
StatePublished - Jul 1 2017

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Critical Care
Medicare
Artificial Respiration
APACHE
Critical Illness
Coronary Care Units
Hospital Mortality
Hospitalization
Cohort Studies
Retrospective Studies
Parturition
Databases

Keywords

  • critical care
  • hospital mortality
  • intensive care unit
  • mechanical ventilation
  • Medicare
  • validation studies

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Validation of Intensive Care and Mechanical Ventilation Codes in Medicare Data. / Wunsch, Hannah; Kramer, Andrew; Gershengorn, Hayley B.

In: Critical Care Medicine, Vol. 45, No. 7, 01.07.2017, p. e711-e714.

Research output: Contribution to journalArticle

Wunsch, Hannah ; Kramer, Andrew ; Gershengorn, Hayley B. / Validation of Intensive Care and Mechanical Ventilation Codes in Medicare Data. In: Critical Care Medicine. 2017 ; Vol. 45, No. 7. pp. e711-e714.
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AB - Objectives: To assess the reliability of codes relevant to critically ill patients in administrative data. Design: Retrospective cohort study linking data from Acute Physiology and Chronic Health Evaluation Outcomes, a clinical database of ICU patients with data from Medicare Provider Analysis and Review. We linked data based on matching for sex, date of birth, hospital, and date of admission to hospital. Setting: Forty-six hospitals in the United States participating in Acute Physiology and Chronic Health Evaluation Outcomes. Patients: All patients in Acute Physiology and Chronic Health Evaluation Outcomes greater than or equal to 65 years old who could be linked with hospitalization records in Medicare Provider Analysis and Review from January 1, 2009, through September 30, 2012. Measurements and Main Results: Of 62,451 patients in the Acute Physiology and Chronic Health Evaluation Outcomes dataset, 80.1% were matched with data in Medicare Provider Analysis and Review. All but 2.7% of Acute Physiology and Chronic Health Evaluation Outcomes ICU patients had either an ICU or coronary care unit charge in Medicare Provider Analysis and Review. In Acute Physiology and Chronic Health Evaluation Outcomes, 37.0% received mechanical ventilation during the ICU stay versus 24.1% in Medicare Provider Analysis and Review. The Medicare Provider Analysis and Review procedure codes for mechanical ventilation had high specificity (96.0%; 95% CI, 95.8-96.2), but only moderate sensitivity (58.4%; 95% CI, 57.7-59.1), with a positive predictive value of 89.6% (95% CI, 89.1-90.1) and negative predictive value of 79.7% (95% CI, 79.4-80.1). For patients with mechanical ventilation codes, Medicare Provider Analysis and Review overestimated the percentage with a duration greater than 96 hours (36.6% vs 27.3% in Acute Physiology and Chronic Health Evaluation Outcomes). There was discordance in the hospital discharge status (alive or dead) for only 0.47% of all linked records (κ = 1.00). Conclusions: Medicare Provider Analysis and Review data contain robust information on hospital mortality for patients admitted to the ICU but have limited ability to identify all patients who received mechanical ventilation during a critical illness. Estimates of use of mechanical ventilation in the United States should likely be revised upward.

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