Abstract
This analysis was performed to examine whether Medicare claims accurately document
underlying rheumatologic diagnoses in total hip replacement (THR) recipients. We obtained
data on rheumatologic diagnoses including rheumatoid arthritis (RA), avascular necrosis
(AVN), and osteoarthritis (OA) from medical records and from Medicare claims data.
To examine the accuracy of claims data we calculated sensitivity and positive predictive
value using medical records data as the “gold standard” and assessed bias due to misclassification
of claims-based diagnoses. The sensitivities of claims-based diagnoses of RA, AVN,
and OA were 0.65, 0.54, and 0.96, respectively; the positive predictive values were
all in the 0.86–0.89 range. The sensitivities of RA and AVN varied substantially across
hospital volume strata, but in different directions for the two diagnoses. We conclude
that inaccuracies in claims coding of diagnoses are frequent, and are potential sources
of bias. More studies are needed to examine the magnitude and direction of bias in
health outcomes research due to inaccuracy of claims coding for specific diagnoses.
Keywords
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Article info
Publication history
Accepted:
January 17,
2003
Received in revised form:
December 31,
2002
Received:
October 6,
2002
Identification
Copyright
© 2003 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
