Concordance Between Clinical Diagnosis and Medicare Claims of Depression Among Older Primary Care Patients

Abstract

Objective To identify patient characteristics associated with concordance of Medicare claims with clinically identified depression. Design Cohort of 742 older primary care patients linked to Medicare claims data. Measurements Structured Clinical Interview for DSM-IV major depressive disorder (MDD) and clinically-significant minor depression. Results Among 474 patients with depression, 198 patients had a Medicare claim for depression (sensitivity: 42%, 95% confidence interval (CI) 37% to 46%). Among 268 patients who did not meet criteria for depression, 235 patients did not have a Medicare claim for depression (specificity: 88%, 95% CI 83% to 91%). After adjustment for demographic and clinical characteristics, non-white participants were nearly twice as likely not to have Medicare claims for depression among patients who met criteria for depression (“false negatives”). Smoking status, depression severity (HDRS), cardiovascular disease, and more primary care physician office visits were also significantly associated with decreased odds to be false negatives. In contrast, after covariate adjustment, white race and chronic pulmonary disease were associated with increased odds of a Medicare claim for depression among patients who did not meet criteria for depression (“false positives”). Using weights based on the screened sample, the positive predictive value of a Medicare claim for depression was 66% (95% CI [63%, 69%]), while the negative predictive value was 77% (95% CI [76%, 78%]). Conclusion Investigators using Medicare data to study depression must recognize that diagnoses of depression from Medicare data may be biased by patient ethnicity and the presence of medical comorbidity.

Influence of Depression on Utilization of Cardiac Rehabilitation Postmyocardial Infarction

“…15 A Canadian study in 2002 found no difference between depressed and non-depressed in enrollment in CR but did find that those with anxiety were 1.9 (CI: 1.0, 3.4) times more likely to enroll in CR compared to those without anxiety. 27 A more recent study of CR programs enrolled in the Wisconsin Cardiac Rehabilitation Outcomes Registry (WiCORE) observed that patients with depression were 44% less likely to enroll in CR compared to those without depression. 16 Patients in the study were those referred to CR and may be different than those not referred.…”

A Machine Learning Approach for Studying the Comorbidities of Complex Diagnoses

“…Some negative values can be found (especially in clusters 1 and 2), suggesting patients wrongly classified, but even those clusters have a fairly decent index. Cluster 1 (Chronic diseases, n = 1463) is a medium-sized cluster that has been built around a number of diagnoses previously associated with depression: endocrine diseases [26,27] and the circulatory [28][29][30][31], respiratory [6,29] and genitourinary systems [32]. Of all the clusters obtained, this is the one that includes the highest number of diagnoses with a prevalence greater than 25%, although none (with the exception of F32) is present in more than 66.2% of the patients.…”

Testing the chronic care model for depression in homebound older adults.

“…The fact that the Medicare Claims measure identified 12% of the sample as depressed and the PHQ-2 measure only identified 7% of the sample as depressed may indicate that the Medicare Claims variable is the more sensitive measure, although this is contradictory to studies examining the sensitivity and specificity of Medicare Claims (Hwang et al, 2015;Noyes et al, 2011). The PHQ-2 is less sensitive to types of depression other than major depression (Arroll et al, 2010).…”

“…This measure had a sensitivity of 42% and a specificity of 88%. when compared to SCID interviews to identify major and minor depression (Hwang et al, 2015). Hwang and colleagues also Claim depression data.…”

“…Also, the Medicare Claims sample may be capturing those who identify their depression somatically or cognitively, which the PHQ-2 does not evaluate (Birrer & Vemuri, 2004;Park & Unützer, 2011). Although, this possibility is contradictory to research that shows that Medicare Claims has also been found to have poor sensitivity in detecting minor depression (Hwang et al, 2015). The people identified as depressed by both samples are likely to have major depression, due to the sensitivity of the PHQ-2 at detecting this.…”