Provider Adherence to Syphilis Testing Guidelines Among Stillbirth Cases

Background The Centers for Disease Control and Prevention (CDC) recommends that all women with a stillbirth have a syphilis test after delivery. Our study seeks to evaluate adherence to CDC guidelines for syphilis screening among women with a stillbirth delivery. Methods We utilized data recorded in electronic health records for women who gave birth between January 1, 2014 and December 31, 2016. Patients were included if they were 18-44 years old and possessed an ICD-9-CM or ICD-10-CM diagnosis of stillbirth. Stillbirth diagnoses were confirmed through a random sample of medical chart reviews. To evaluate syphilis screening, we estimated the proportion of women who received syphilis testing within 300 days before stillbirth, within 30 days after a stillbirth delivery, and women who received syphilis testing both before and after stillbirth delivery. Results We identified 1,111 stillbirths among a population of 865,429 unique women with encounter data available from electronic health records. Among a sample of 127 chart reviewed cases, only 35 (27.6%) were confirmed stillbirth cases, 45 (35.4%) possible stillbirth cases, 39 (30.7%) cases of miscarriage, and 8 (6.3%) cases of live births. Among confirmed stillbirth cases, 51.4% had any syphilis testing conducted, 31.4% had testing before their stillbirth delivery, 42.9% had testing after the delivery, and only 22.9% had testing before and after delivery. Conclusions A majority of women with a stillbirth delivery do not receive syphilis screening adherent to CDC guidelines. Stillbirth ICD codes do not accurately identify cases of stillbirth

Validation of ICD-10-CM Codes for Identifying Cases of Chlamydia and Gonorrhea

Background While researchers seek to use administrative health data to examine outcomes for individuals with sexually transmitted infections, the ICD-CM-10 codes used to identify persons with chlamydia and gonorrhea have not been validated. Objectives were to determine the validity of using ICD-10-CM codes to identify individuals with chlamydia and gonorrhea. Methods We utilized data from electronic health records gathered from public and private health systems from October 1, 2015 to December 31, 2016. Patients were included if they were aged 13-44 years and received either 1) laboratory testing for chlamydia or gonorrhea or 2) an ICD-10-CM diagnosis of chlamydia, gonorrhea, or an unspecified STI. To validate ICD-10-CM codes, we calculated positive and negative predictive values, sensitivity, and specificity based on the presence of a laboratory test result. We further examined the timing of clinical diagnosis relative to laboratory testing. Results The positive predictive values for chlamydia, gonorrhea, and unspecified STI ICD-10-CM codes were 87.6%, 85.0%, and 32.0%, respectively. Negative predictive values were high (>92%). Sensitivity for chlamydia diagnostic codes was 10.6% and gonorrhea was 9.7%. Specificity was 99.9% for both chlamydia and gonorrhea. The date of diagnosis occurred on or after the date of the laboratory result for 84.8% of persons with chlamydia, 91.9% for gonorrhea, and 23.5% for unspecified STI. Conclusions Disease specific ICD-10-CM codes accurately identify persons with chlamydia and gonorrhea. However, low sensitivities suggest that most individuals could not be identified in administrative data alone without laboratory test results

Accuracy of ICD Codes for Identification: Review of Chlamydia, Gonorrhea and Syphilis

ObjectiveThe purpose of this study is to review the extant literature for evidence on the validity of ICD-9-CM and -10-CM codes for the purpose of identifying cases of chlamydia, gonorrhea, and syphilis.IntroductionAdministrative data refers to data generated during the processes of health care. These data are a rich source of patient health information, including diagnoses and problem lists, laboratory and diagnostic tests, and medications. Established standards are used to code each data into the appropriate coding systems. The International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9-CM and ICD-10-CM) codes are the coding standard for diagnoses and have been frequently used to identify cases for the creation of cohorts in examining care delivery, screening, prevalence, and risk factors1,2. However, while some studies have assessed the validity and reliability of ICD-CM codes to identify various conditions such as cerebral palsy and rheumatoid arthritis3,4, the evidence for using ICD codes to accurately identify sexually transmitted infection (STI) cases is largely unexamined. The purpose of this study is to review the extant literature for evidence on the validity of ICD codes for identifying cases of chlamydia, gonorrhea, and syphilis. Our findings will inform efforts to improve the use of administrative data for STI-related health service and surveillance researches.MethodsOur systematic review followed a protocol consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We comprehensively searched PubMed and Scopus databases for peer-reviewed articles published before February 2018. Articles were identified with search terms related to our STIs of interest (chlamydia, syphilis or gonorrhea), pelvic inflammatory disease (PID), administrative codes, and validation studies. PID was included as 33%-50% of PID cases are due to chlamydia or gonorrhea5. Only empirical publications appearing in peer-reviewed English language journals were included. Further, we excluded articles classified as letters to the editor, policy briefs, perspectives, commentaries, summaries of future research plans, and grey literature. Additionally, articles without abstracts were also excluded. The screening process used by our review is outlined in Figure 1. Briefly, all articles were subjected to a two-step screening process. First, we reviewed articles based on title and abstract. We eliminated studies that did not focus on STIs or on validation in the context of STIs. Articles were included if they focused on any combination of the STIs of interest, or on PID, and were validation studies on diagnostic testing or administrative codes. Second, selected articles were then reviewed in full to identify studies which included the STIs of interest, assessed and listed ICD-9-CM or -10-CM codes, and measured validity. The snowball technique was used on included articles, whereby we reviewed all references found in the references of the included articles.ResultsOur search strategy identified 1,754 articles to be screened by title and abstract. Of these, only five (0.29%) articles met the initial inclusion criteria. After full text review, only two articles6,7 met the final inclusion criteria to be included in the systematic review. Both articles focused on PID with no assessment of syphilis. They utilized ICD-9-CM codes to identify cases with PID and performed chart reviews to determine true PID status. Results of both articles found positive predictive value (PPV) of PID to be between 18%–79%. Only one article7 examined the PPV of chlamydia (56%; 5/9 cases) and gonorrhea (100%; 4/4 cases) separately.ConclusionsWe identified just two studies that evaluated the validity of ICD codes in identifying the STIs of interest. Both studies focused on PID cases in which chlamydia and gonorrhea diagnoses and tests might be documented. Additionally, since both studies were published before 2015, neither evaluates the use of administrative data following the U.S. transition to ICD-10 codes. Given these findings, further studies are required to examine the predictive value of ICD-9 and -10 codes for all three diseases in the general population.References1. Tao G, Zhang CX. HIV Testing of Commercially Insured Patients Diagnosed With Sexually Transmitted Diseases. Sexually Transmitted Diseases. 2008;35(1):43-6.2. Evans HE, Mercer CH, Rait G, et al. Trends in HIV testing and recording of HIV status in the UK primary care setting: a retrospective cohort study 1995-2005. Sexually Transmitted Infections. 2009.3. Oskoui M, Ng P, Dorais M, et al. Accuracy of administrative claims data for cerebral palsy diagnosis: a retrospective cohort study. CMAJ open. 2017 Jul 18;5(3):E570-e5.4. Sauer BC, Teng C-C, Accortt NA, et al. Models solely using claims-based administrative data are poor predictors of rheumatoid arthritis disease activity. Arthritis Research & Therapy. 2017 2017/05/08;19(1):86.5. Haggerty CL, Ness RB. Epidemiology, pathogenesis and treatment of pelvic inflammatory disease. Expert review of anti-infective therapy. 2006 Apr;4(2):235-47.6. Satterwhite CL, Yu O, Raebel MA, et al. Detection of Pelvic Inflammatory Disease: Development of an Automated Case-Finding Algorithm Using Administrative Data. Infect Dis Obstet Gynecol. 2011;2011:7.7. Ratelle S, Yokoe D, Blejan C, et al. Predictive value of clinical diagnostic codes for the CDC case definition of pelvic inflammatory disease (PID): implications for surveillance. Sex Transm Dis. 2003 Nov;30(11):866-70