Validation of Parkinson's Disease Ascertainment in the Veterans Administration Electronic Medical Record

IF 7.4 1区医学 Q1 CLINICAL NEUROLOGY Movement Disorders Pub Date : 2024-12-04 DOI:10.1002/mds.30075

Samuel M. Goldman MD, MPH, Frances M. Weaver PhD, Lishan Cao MS, Beverly Gonzalez PhD, Kevin T. Stroupe PhD, Kalea Colletta DO, Shamil Jugnundan MD, MPH, Ethan G. Brown MD, Caroline M. Tanner MD, PhD

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Abstract

Background

Electronic medical record (EMR)–based studies hold great potential for epidemiologic investigations of Parkinson's disease (PD) causal factors and phenomenology, but diagnostic misclassification may obscure or bias inferences.

Objectives

The aims were to determine the validity of PD diagnostic codes in the Veterans Administration (VA) national electronic medical databases and develop recommendations for maximizing ascertainment accuracy.

Methods

We investigated a cohort of 146,776 veterans who utilized VA healthcare between 1999 and 2021. We reviewed the medical records of individuals with a PD International Classification of Diseases (ICD) code in outpatient, inpatient, or community care encounters to assign a gold-standard diagnosis. We determined diagnostic accuracy based on provider type, coding frequency, medications, and potentially exclusionary ICD codes overall and by race.

Results

A total of 377 of 810 (46.5%) with a PD ICD code had PD. Veterans whose PD was coded by a PD-specialist neurologist were most likely to have PD (83.6%), but sensitivity was low (15.0%). Diagnostic accuracy decreased for PD coded by any neurologist (66.9%), but sensitivity improved (69.4%). Requiring two or more PD codes in combination with two or more levodopa prescriptions improved accuracy, particularly among nonneurologists. Neuroleptic-induced parkinsonism was the most frequent diagnosis in those without PD (15.6%). Accuracy was lower in Black (29.0%) than White (50.5%) veterans regardless of provider type (miscoding odds ratio 2.5, 95% confidence interval 1.7–3.6).

Conclusions

These results highlight the limitations of EMR-based PD ascertainment. Researchers can maximize accuracy by considering provider specialty, coding frequency, pharmacy data, and exclusionary diagnoses, but some degree of record review is required to ensure high accuracy. Higher miscoding among Black veterans warrants further study. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

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退伍军人管理局电子病历中帕金森病诊断的验证。

背景：基于电子病历（EMR）的研究在帕金森病（PD）病因和现象学的流行病学调查中具有很大的潜力，但诊断分类错误可能会模糊或偏差推断。目的：目的是确定退伍军人管理局（VA）国家电子医学数据库中PD诊断代码的有效性，并提出最大限度地确定准确性的建议。方法：我们调查了1999年至2021年期间使用VA医疗保健的146,776名退伍军人。我们回顾了门诊、住院或社区护理中具有PD国际疾病分类（ICD）代码的个体的医疗记录，以分配黄金标准诊断。我们根据提供者类型、编码频率、药物和潜在的排除性ICD代码总体和种族来确定诊断的准确性。结果：810例PD ICD编码患者中有377例（46.5%）发生PD。由PD-专科神经科医生编码PD的退伍军人最有可能患有PD(83.6%)，但敏感性较低（15.0%）。任何神经科医生编码的PD诊断准确性下降（66.9%），但敏感性提高（69.4%）。要求两个或更多PD代码与两个或更多左旋多巴处方相结合可以提高准确性，特别是在非神经科医生中。在没有帕金森病的患者中，最常见的诊断是抗精神病药诱导的帕金森病（15.6%）。无论提供者类型如何，黑人退伍军人的准确率（29.0%）低于白人退伍军人（50.5%）（错误编码优势比为2.5,95%置信区间为1.7-3.6）。结论：这些结果突出了基于emr确定PD的局限性。研究人员可以通过考虑提供者专业、编码频率、药房数据和排除性诊断来最大限度地提高准确性，但需要一定程度的记录审查来确保高准确性。黑人退伍军人中较高的编码错误值得进一步研究。©2024作者。Wiley期刊有限责任公司代表国际帕金森和运动障碍学会出版的《运动障碍》。这篇文章是由美国政府雇员贡献的，他们的工作在美国属于公有领域。

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来源期刊

Movement Disorders 医学-临床神经学

CiteScore

13.30

自引率

8.10%

发文量

371

审稿时长

12 months

期刊介绍： Movement Disorders publishes a variety of content types including Reviews, Viewpoints, Full Length Articles, Historical Reports, Brief Reports, and Letters. The journal considers original manuscripts on topics related to the diagnosis, therapeutics, pharmacology, biochemistry, physiology, etiology, genetics, and epidemiology of movement disorders. Appropriate topics include Parkinsonism, Chorea, Tremors, Dystonia, Myoclonus, Tics, Tardive Dyskinesia, Spasticity, and Ataxia.