Background: Use of mental indication in health outcomes research is of growing interest to researchers. This study, as part of a larger research program, quantified agreement between administrative ICD-9 coding for, and 'gold standard' clinician documentation of, mental health issues (MHI) in hospitalized heart failure (HF) patients to determine the validity of mental health administrative data for use in HF outcomes research.
Methods:A 13% random sample (n=504) was selected from all unique patients (n=3769) hospitalized with a primary HF diagnosis at four San Diego County community hospitals between 2009-2012. MHI was defined as ICD-9 discharge diagnostic coding between 290-319. Records were audited for clinician documentation of MHI.Results: 43% (n=216) had mental health clinician documentation; 33% (n=164) had ICD-9 coding for MHI. ICD-9 code bundle 290-319 had 0.70 sensitivity, 0.97 specificity, and a Kappa of 0.69 (CI: 0.61-0.79). More specific ICD-9 MHI code bundles had Kappas ranging from 0.44 to 0.82 and sensitivities between 42-82%.
Conclusion:Agreement between ICD-9 coding and clinician documentation for a broadly defined MHI is substantial, and can validly 'rule in' MHI for hospitalized heart failure patients. More specific MHI code bundles had fair to almost-perfect agreement, with a wide range of sensitivities for identifying patients with a MHI.