Development of an algorithm for identifying rheumatoid arthritis in the Korean National Health Insurance claims database

Abstract

This study aimed to develop an identification algorithm for validating the International Classification of Diseases-Tenth diagnostic codes for rheumatoid arthritis (RA) in the Korean National Health Insurance (NHI) claims database. An individual copayment beneficiaries program for rare and intractable diseases, including seropositive RA (M05), began in South Korea in July 2009. Patients registered in this system pay only 10 % of their total medical costs, but registration requires an official report from a doctor documenting that the patient fulfills the 1987 ACR criteria. We regarded patients registered in this system as gold standard RA and examined the validity of several algorithms to define RA diagnosis using diagnostic codes and prescription data. We constructed nine algorithms using two highly specific prescriptions (positive predictive value >90 % and specificity >90 %) and one prescription with high sensitivity (>80 %) and accuracy (>75 %). A total of 59,823 RA patients were included in this validation study. Among them, 50,082 (83.7 %) were registered in the individual copayment beneficiaries program and considered true RA. We tested nine algorithms that incorporated two specific regimens [biologics and leflunomide alone, methotrexate plus leflunomide, or more than 3 disease-modifying anti-rheumatic drugs (DMARDs)] and one sensitive drug (any non-steroidal anti-inflammatory drug (NSAID), any DMARD, or any NSAID plus any DMARD). The algorithm that included biologics, more than 3 DMARDs, and any DMARD yielded the highest accuracy (91.4 %). Patients with RA diagnostic codes with prescription of biologics or any DMARD can be considered as accurate cases of RA in Korean NHI claims database.

Nutrient Intake in Postmenopausal Rheumatoid Arthritis Women with Osteoporosis: Results from the Korean National Health and Nutrition Examination Survey

“…Nevertheless, daily intake of nutrients in our study is largely comparable with previous studies [3]. In terms of prevalence of RA, that in K-NHANES was slightly lower than expected (0.26%) compared with previous reports [30]. Lastly, we were unable to look into disease duration or activity of RA, and concomitant medication especially glucocorticoids, taken by RA subjects in K-NHANES.…”

Pregnancy outcomes in women with inflammatory bowel disease: a 10‐year nationwide population‐based cohort study

“…The International Classification of Diseases and Injuries 10th Revision (ICD‐10) code was used to record diagnoses in this database. It has been shown that this database provides reliable estimates of the real prevalence of certain diseases in Korea …”

Chronic rhinosinusitis identification in administrative databases and health surveys: A systematic review

“…We suggest that further work be done to derive and validate accurate methods that use population‐based health administrative data to identify patients with CRS. This has been used to identify other diseases, for example rheumatoid arthritis, in large administrative databases with good accuracy . Improvements in natural language processing (NLP) technology could help identify key terms in CT reports, OR dictation summaries, and patient charts to improve efficiency and accuracy in developing CRS algorithms …”