Identifying Medicare Beneficiaries With Delirium

Abstract

Background: Each year, thousands of older adults develop delirium, a serious, preventable condition. At present, there is no well-validated method to identify patients with delirium when using Medicare claims data or other large datasets. We developed and assessed the performance of classification algorithms based on longitudinal Medicare administrative data that included International Classification of Diseases, 10th Edition diagnostic codes. Methods: Using a linked electronic health record (EHR)-Medicare claims dataset, 2 neurologists and 2 psychiatrists performed a standardized review of EHR records between 2016 and 2018 for a stratified random sample of 1002 patients among 40,690 eligible subjects. Reviewers adjudicated delirium status (reference standard) during this 3-year window using a structured protocol. We calculated the probability that each patient had delirium as a function of classification algorithms based on longitudinal Medicare claims data. We compared the performance of various algorithms against the reference standard, computing calibration-in-the-large, calibration slope, and the area-under-receiver-operating-curve using 10-fold cross-validation (CV). Results: Beneficiaries had a mean age of 75 years, were predominately female (59%), and non-Hispanic Whites (93%); a review of the EHR indicated that 6% of patients had delirium during the 3 years. Although several classification algorithms performed well, a relatively simple model containing counts of delirium-related diagnoses combined with patient age, dementia status, and receipt of antipsychotic medications had the best overall performance [CV– calibration-in-the-large <0.001, CV-slope 0.94, and CV–area under the receiver operating characteristic curve (0.88 95% confidence interval: 0.84–0.91)]. Conclusions: A delirium classification model using Medicare administrative data and International Classification of Diseases, 10th Edition diagnosis codes can identify beneficiaries with delirium in large datasets.

Hip Fracture Treatment and Outcomes Among Community-Dwelling People Living With Dementia

“…We used the Master Beneficiary Summary File and Inpatient file to identify mortality. In-hospital delirium was identified in Inpatient files using established ICD-10 diagnosis codes . We defined hospice referral as a new hospice claim in the 180 days after discharge among patients discharged alive, and home health services as a new home health claim within 10 days after discharge among patients still alive at 10 days post discharge.…”