Community-acquired pneumonia: can it be defined with claims data? Am J Med Qual 1997;12(4):187-93
Date
01/01/1997Pubmed ID
9385729DOI
10.1177/0885713X9701200404Scopus ID
2-s2.0-0031434891 (requires institutional sign-in at Scopus site) 78 CitationsAbstract
The use of administrative data to study pneumonia is limited because International Classification of Diseases, 9th revision, Clinical Modification (ICD9-CM) diagnosis codes do not specify whether pneumonia is community-acquired (CAP), a key clinical distinction. We classified 212 patients discharged with a diagnosis code for pneumonia as to whether or not they had CAP, using three administrative data-based systems (Diagnosis Related Groups (DRGs) alone, principal diagnosis alone, and a complex algorithm). We examined agreement with classification by clinician chart review. We also compared the length of stay (LOS) and mortality among the CAP populations identified with different methods. Agreement between the clinical review and the three administrative data methods ranged from 86 to 80%. Classification by DRG performed least well. Populations defined by claims data had similar mortality but shorter mean LOS (9.70, 9.40, and 7.91 days for the algorithm, principal diagnosis and DRG methods, respectively) than the clinically defined population (10.85 days). We conclude that studies of CAP using populations identified by claims may underestimate LOS.
Author List
Whittle J, Fine MJ, Joyce DZ, Lave JR, Young WW, Hough LJ, Kapoor WNAuthor
Jeffrey Whittle MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Algorithms
Community-Acquired Infections
Diagnosis-Related Groups
Female
Health Services Research
Hospital Bed Capacity, 500 and over
Hospitals, University
Humans
Insurance Claim Reporting
Length of Stay
Male
Medical Records
Middle Aged
Pennsylvania
Pneumonia
Sensitivity and Specificity
Utilization Review
