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Identification of Helicobacter pylori infected patients, using administrative data

2008; Wiley; Volume: 28; Issue: 11-12 Linguagem: Inglês

10.1111/j.1365-2036.2008.03845.x

1365-2036

Selvi Thirumurthi, Ranil DeSilva, Diana Castillo, Peter Richardson, Neena S. Abraham,

Gastroesophageal reflux and treatments

Summary Background Helicobacter pylori is a prevalent organism implicated in peptic ulcer disease. Aim To validate administrative data for diagnosis of H. pylori‐ infected patients. Methods Administrative data identified patients with ICD‐9 code for H. pylori (041.86) or prescription of eradication therapy; diagnosis was confirmed by chart abstraction. Multivariable regression assessed predictors of infection considering drug therapy, ICD‐9 code 041.86, procedure code, in‐patient or out‐patient diagnostic code, age, gender and race to generate an algorithm for validation. Results The test cohort of 531 patients (361 potential cases; 170 random controls) was primarily male (94%), Caucasian (59%) and elderly [67 years (s.d. 10)]. The positive predictive value (PPV) of ICD‐9 code 041.86 was 100% and 97.4% if from an in‐patient or out‐patient encounter, respectively. Eradication drug therapy had a PPV of 73.7% (triple therapy) and 97.7% (quadruple therapy). The strongest predictors were out‐patient ICD‐9 code 041.86 (OR 8.1; 95% CI: 7.0–9.1); eradication drug therapy (OR 7.4; 95% CI: 6.6–8.3); oesophagogastroduodenoscopy (OR 3.5; 95% CI: 3.3–3.6); and age ≥70 (OR 1.2; 95% CI: 1.1–1.4). An algorithm including these data elements yielded a c‐statistic of 0.93 and PPV of 97.9%. Conclusions Administrative data can diagnose H. pylori ‐infected patients. The diagnostic algorithm includes presence of eradication drug therapy overlapping with an out‐patient ICD‐9 code 041.86 among elderly adults.