Disease identification based on ambulatory drugs dispensation and in-hospital ICD-10 diagnoses: a comparison

Halfon, Patricia; Eggli, Yves; Decollogny, Anne; Seker, Erol

doi:10.1186/1472-6963-13-453

BMC Health Services Research

Table 2 Accuracy of disease detection through drugs prescription among hospitalized patients (N = 108,915)

From: Disease identification based on ambulatory drugs dispensation and in-hospital ICD-10 diagnoses: a comparison

Morbidity group	Diagnosed condition	Screened by drug	Sensitivity	Specificity	K_c ^a	K₀ ^a	K₁ ^a	Use^b
With K _C > 0.4
Transplant	467	601	0.82	1.00	0.71	(0.63)	(0.82)	M, C, R
Diabetes mellitus	8,171	8,114	0.71	0.98	0.70	(0.70)	(0.69)	M, C, R
HIV disease	413	372	0.60	1.00	0.63	(0.67)	(0.60)	M, C, R
Hypertensive disease	22,307	34,680	0.77	0.80	0.49	(0.37)	(0.67)
Alternative refinement:
Hypertension and heart failure	23,886	35,954	0.78	0.80	0.51	(0.39)	(0.68)	M, C, R
Thyroid disorders	3,179	2,993	0.40	0.98	0.40	(0.41)	(0.38)	M, C, R
With K ₀ >0.4 and alternatives to pharmacological treatment
Multiple sclerosis	444	115	0.20	1.00	(0.32)	0.78	(0.20)	C, R
Abuse of alcohol	4,584	619	0.09	1.00	(0.16)	0.68	(0.09)	C, R
Ischemic heart disease	10,691	4,537	0.26	0.98	(0.33)	0.56	(0.23)	C, R
Conduction disorders and cardiac arrhythmias	8,297	2,512	0.18	0.99	(0.26)	0.56	(0.16)	C, R
Malignant neoplasms	7,528	3,757	0.29	0.98	(0.36)	0.54	(0.26)	C, R
Abuse of opioid	1,131	45	0.02	1.00	(0.04)	0.51	(0.02)	C, R
Hepatitis B or C	885	90	0.05	1.00	(0.09)	0.50	(0.05)	C, R
Non-nutritional anaemia	6,114	642	0.05	1.00	(0.08)	0.41	(0.04)
Including those of end stage renal disease and due to chemotherapy	8,868	642	0.05	1.00	(0.08)	0.63	(0.04)	C, R
With K ₁ > 0.4
Obvious under-coded diagnoses
Glaucoma	431	4167	0.70	0.96	(0.13)	(0.07)	0.69	M, C, R
Hyperlipidemia	8,052	18,050	0.71	0.88	(0.38)	(0.26)	0.65	M, C, R
Functional digestive disorders	1,275	27,846	0.63	0.75	(0.04)	(0.02)	0.50	^c
Hyperplasia of prostate	2,793	7,816	0.52	0.94	(0.26)	(0.17)	0.49	M, C, R
Osteoporosis	2,443	4,765	0.49	0.97	(0.31)	(0.23)	0.46	M, C, R
Signs of under-coded diagnoses
Mood disorders	6,649	19,624	0.68	0.85	(0.29)	(0.18)	0.61	M, C, R
Reactive airway disease	6,045	11,960	0.58	0.92	(0.36)	(0.25)	0.53	M, C, R
Alzheimer’s disease	844	1,307	0.48	0.99	(0.37)	(0.31)	0.48	M, C, R
Crohn’s disease and ulcerative colitis	433	824	0.48	0.99	(0.33)	(0.25)	0.48	M, C, R
Multiple diagnoses indication of tracer drugs
Parkinson’s disease	914	2,219	0.67	0.99	(0.38)	(0.27)	0.66
Alternative refinement
w/o anti-psychotic	914	1,739	0.65	0.99	0.44	(0.37)	0.64	M, C, R
Schizophrenia and other disorders	1,911	6,439	0.67	0.95	(0.29)	(0.18)	0.64
Alternative refinement
w/o anti-cholinesterasic	1,911	5,985	0.66	0.96	(0.30)	(0.20)	0.64	C, R
Epilepsy	1,656	5,727	0.54	0.96	(0.23)	(0.14)	0.52
Alternative refinement
w/o chronic pain drugs	1,656	4,260	0.52	0.97	(0.28)	(0.19)	0.50	C, R
Prophylactic treatment
Thrombo-embolic risk or disease	6,122	29,427	0.72	0.76	(0.18)	(0.10)	0.61
if including thrombogenic cardiac diseases	17,804	29,427	0.73	0.82	0.45	(0.33)	0.63	M, C, R
Diseases of esophagus, peptic ulcer	3,805	31,331	0.72	0.73	(0.11)	(0.05)	0.60	^c
With all K values < 0.4
Acute diseases with time limited treatment, minor or rare conditions as inpatients
Migraine	601	1,771	0.29	0.99	(0.14)	(0.09)	0.28	C
Vertigo	623	2,084	0.29	0.98	(0.13)	(0.08)	0.28	^c
Bacterial infection or septicemia	10,433	41,704	0.58	0.64	(0.13)	(0.05)	0.32	^c
Eye inflammation	467	6,827	0.33	0.94	(0.04)	(0.02)	0.29	C
Dermatitis	1,091	14,461	0.33	0.87	(0.03)	(0.02)	0.23	C , R
Mycosis	988	16,971	0.36	0.85	(0.03)	(0.01)	0.25	C
Other diseases of upper respiratory tract – allergy	466	9,917	0.31	0.91	(0.02)	(0.01)	0.24	C
Disorders of external ear	71	2,070	0.27	0.98	(0.02)	(0.01)	0.25	C
Parasitosis	61	1,984	0.26	0.98	(0.01)	(0.01)	0.25	C
Other acute upper respiratory infections	856	32,259	0.50	0.71	(0.01)	(0.01)	0.28	^c
Acne	72	2,774	0.25	0.97	(0.01)	(0.01)	0.23	C , R
Psoriasis	466	1,188	0.35	0.99	(0.19)	(0.13)	0.34	C , R
Gout	659	2,126	0.39	0.98	(0.18)	(0.12)	0.38	C , R
Female inflammatory diseases	864	6,331	0.25	0.94	(0.05)	(0.03)	0.20
Conjonctivitis	114	6,458	0.24	0.94	(0.01)	(0.00)	0.19
Hemorrhoids	1,188	3,048	0.19	0.97	(0.10)	(0.06)	0.16
Skin or subcutaneous infections	695	9,565	0.21	0.91	(0.02)	(0.01)	0.14
Paludism 28 444 0.14 1.00 0.02 0.01 0.14	28	444	0.14	1.00	(0.02)	(0.01)	0.14
Intestinal infectious diseases	1,608	7,131	0.19	0.94	(0.06)	(0.03)	0.13
Viral diseases	1,261	1,801	0.15	0.98	(0.11)	(0.09)	0.13
Influenza	177	74	0.00	0.00	(0.00)
Multiple diagnoses indication of tracer drugs
Inflammatory polyarthritis and connective tissue disorders	1,321	6,526	0.39	0.94	(0.12)	(0.07)	0.35	^c
Anaemias – nutritional	3,122	11,845	0.31	0.90	(0.10)	(0.06)	0.23	^c
Other mental and behavioral disorders	7,852	28,126	0.54	0.76	(0.16)	(0.08)	0.37	^c
Pain	12,341	66,022	0.73	0.41	(0.07)	(0.02)	0.31	^c
Severe pain ^d	12,341	7,429	0.16	0.92	(0.13)	(0.13)	0.07
Prophylaxis treatment
Tuberculosis	216	226	0.31	1.00	(0.30)	(0.29)	0.30
Active tuberculosis	216	82	0.25	1.00	(0.36)	(0.66)	0.25	C, R
Alternatives to pharmacological treatment
Neutropenia	468	369	0.18	1.00	(0.21)	0.26	(0.17)
Extended to prophylaxis of myelosuppressive chemotherapy	1,452	369	0.16	1.00	(0.25)	0.63	(0.16)	C, R
Obesity	6,106	639	0.03	1.00	(0.05)	0.23	(0.02)	^c
Other endocrine nutritional and metabolic diseases	8,393	160	0.00	1.00	(0.01)	0.19	(0.00)
Hemorrhagic risk or disease	1,434	756	0.05	0.99	(0.07)	0.09	(0.05)
Poisonings	1,061	309	0.00	1.00	(0.00)	0.00	(0.00)
Heart failure	3,166	94	0.00	1.00	(0.00)	0.02	(0.00)
Alternative refinement: see hypertension/heart failure above
Abuse of tobacco	7,062	14	0.00	1.00	(0.00)	0.08	(0.00)

^aKappa values, not used as judgment criteria are in parenthesis.
^bContext of use: morbidity indicator (M), ambulatory costs control (C), insurers’ risk adjustment (R) only for chronic conditions.
^cAppropriateness of pharmacologic treatment uncertain, prone to practice variations.
^dStrong opioids.

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