Validation of an ICD-Code-Based Case Definition for Psychotic Illness Across Three Health Systems.

bipolar detection prediction schizoaffective schizophrenia

Journal

Schizophrenia bulletin
ISSN: 1745-1701
Titre abrégé: Schizophr Bull
Pays: United States
ID NLM: 0236760

Informations de publication

Date de publication:
10 May 2024
Historique:
medline: 10 5 2024
pubmed: 10 5 2024
entrez: 10 5 2024
Statut: aheadofprint

Résumé

Psychosis-associated diagnostic codes are increasingly being utilized as case definitions for electronic health record (EHR)-based algorithms to predict and detect psychosis. However, data on the validity of psychosis-related diagnostic codes is limited. We evaluated the positive predictive value (PPV) of International Classification of Diseases (ICD) codes for psychosis. Using EHRs at 3 health systems, ICD codes comprising primary psychotic disorders and mood disorders with psychosis were grouped into 5 higher-order groups. 1133 records were sampled for chart review using the full EHR. PPVs (the probability of chart-confirmed psychosis given ICD psychosis codes) were calculated across multiple treatment settings. PPVs across all diagnostic groups and hospital systems exceeded 70%: Mass General Brigham 0.72 [95% CI 0.68-0.77], Boston Children's Hospital 0.80 [0.75-0.84], and Boston Medical Center 0.83 [0.79-0.86]. Schizoaffective disorder PPVs were consistently the highest across sites (0.80-0.92) and major depressive disorder with psychosis were the most variable (0.57-0.79). To determine if the first documented code captured first-episode psychosis (FEP), we excluded cases with prior chart evidence of a diagnosis of or treatment for a psychotic illness, yielding substantially lower PPVs (0.08-0.62). We found that the first documented psychosis diagnostic code accurately captured true episodes of psychosis but was a poor index of FEP. These data have important implications for the case definitions used in the development of risk prediction models designed to predict or detect undiagnosed psychosis.

Sections du résumé

BACKGROUND AND HYPOTHESIS OBJECTIVE
Psychosis-associated diagnostic codes are increasingly being utilized as case definitions for electronic health record (EHR)-based algorithms to predict and detect psychosis. However, data on the validity of psychosis-related diagnostic codes is limited. We evaluated the positive predictive value (PPV) of International Classification of Diseases (ICD) codes for psychosis.
STUDY DESIGN METHODS
Using EHRs at 3 health systems, ICD codes comprising primary psychotic disorders and mood disorders with psychosis were grouped into 5 higher-order groups. 1133 records were sampled for chart review using the full EHR. PPVs (the probability of chart-confirmed psychosis given ICD psychosis codes) were calculated across multiple treatment settings.
STUDY RESULTS RESULTS
PPVs across all diagnostic groups and hospital systems exceeded 70%: Mass General Brigham 0.72 [95% CI 0.68-0.77], Boston Children's Hospital 0.80 [0.75-0.84], and Boston Medical Center 0.83 [0.79-0.86]. Schizoaffective disorder PPVs were consistently the highest across sites (0.80-0.92) and major depressive disorder with psychosis were the most variable (0.57-0.79). To determine if the first documented code captured first-episode psychosis (FEP), we excluded cases with prior chart evidence of a diagnosis of or treatment for a psychotic illness, yielding substantially lower PPVs (0.08-0.62).
CONCLUSIONS CONCLUSIONS
We found that the first documented psychosis diagnostic code accurately captured true episodes of psychosis but was a poor index of FEP. These data have important implications for the case definitions used in the development of risk prediction models designed to predict or detect undiagnosed psychosis.

Identifiants

DOI: 10.1093/schbul/sbae064 PMID: 38728421
pubmed: 38728421
pii: 7668407
doi: 10.1093/schbul/sbae064
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : NIH HHS
ID : KL2TR003018
Pays : United States
Organisme : NIMH NIH HHS
ID : K23MH132766
Pays : United States

Informations de copyright

© The Author(s) 2024. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

Auteurs

Anthony J Deo (AJ)

Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ, USA.
Psychiatric Evaluation of Adolescent and Child Experiences (P.E.A.C.E.) Program, Rutgers University Behavioral Health Care, Piscataway, NJ, USA.

Victor M Castro (VM)

Research Information Science and Computing, Mass General Brigham, Somerville, MA, USA.

Ashley Baker (A)

Ascend Integrative Medicine LLC, MA, USA.

Devon Carroll (D)

Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
College of Nursing, University of Rhode Island, Providence, RI, USA.

Joseph Gonzalez-Heydrich (J)

Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Early Psychosis Investigation Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

David C Henderson (DC)

Boston Medical Center, Boston, MA, USA.
Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.

Daphne J Holt (DJ)

Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA.

Kimberly Hook (K)

Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.

Rakesh Karmacharya (R)

Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
Chemical Biology and Therapeutic Science Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA.

Joshua L Roffman (JL)

Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA.

Emily M Madsen (EM)

Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

Eugene Song (E)

Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.

William G Adams (WG)

Boston Medical Center, Boston, MA, USA.

Luisa Camacho (L)

Boston Medical Center, Boston, MA, USA.

Sarah Gasman (S)

Boston Medical Center, Boston, MA, USA.

Jada S Gibbs (JS)

Rutgers New Jersey Medical School, Newark, NJ, USA.

Rebecca G Fortgang (RG)

Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Department of Psychology, Harvard University, Cambridge, MA, USA.

Chris J Kennedy (CJ)

Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

Galina Lozinski (G)

Boston Medical Center, Boston, MA, USA.

Daisy C Perez (DC)

Boston Medical Center, Boston, MA, USA.
Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.

Marina Wilson (M)

Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

Ben Y Reis (BY)

Predictive Medicine Group, Harvard Medical School, Boston, MA, USA.
Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA.

Jordan W Smoller (JW)

Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA.

Classifications MeSH