Identifying Neck and Back Pain in Administrative Data

Abstract

Structured AbstractStudy design-We reviewed existing methods for identifying patients with neck and back pain in administrative data. We compared these methods using data from the Department of Veterans Affairs.Objective-To answer the following questions: 1) what diagnosis codes should be used to identify patients with neck and back pain in administrative data; 2) because the majority of complaints are characterized as non-specific or mechanical, what diagnosis codes should be used to identify patients with non-specific or mechanical problems in administrative data; and 3) what procedure and surgical codes should be used to identify patients who have undergone a surgical procedure on the neck or back.Summary of background data-Musculoskeletal neck and back pain are pervasive problems, associated with chronic pain, disability, and high rates of healthcare utilization. Administrative data have been widely used in formative research which has largely relied on the original work of Volinn, Cherkin, Deyo and Einstadter and the Back Pain Patient Outcomes Assessment Team first published in 1992. Significant variation in reports of incidence, prevalence, and morbidity associated with these problems may be due to non standard or conflicting methods to define study cohorts.Methods-A literature review produced seven methods for identifying neck and back pain in administrative data. These code lists were used to search VA data for patients with back and neck problems, and to further categorize each case by spinal segment involved, as non-specific/ mechanical and as surgical or not.Results-There is considerable overlap in most algorithms. However, gaps remain.Conclusions-Gaps are evident in existing methods and a new framework to identify patients with neck and back pain in administrative data is proposed.Correspondence to: Patricia L. Sinnott. U.S. Department of Veterans AffairsPublic Access Author manuscript Spine (Phila Pa 1976 Neck and back pain are highly prevalent problems and administrative data are commonly used to describe the incidence, prevalence, and geographic variation in practice for these conditions. [1][2][3][4][5][6][7][8][9][10][11] This work has largely relied on the methods published in 1992 by Volinn, Cherkin, Deyo and Einstadter and the Back Pain Patient Outcomes Assessment Team (BOAT) 12, 13, 14 that identified neck and back pain from ICD-9 15 codes and used hospitalization as a proxy for morbidity. 12-14, 16, 17 This original work has led to a broad range of research on neck and back problems using hospital, workers' compensation and Medicare data. [18][19][20][21][22][23][24][25] More recently, the International Society for Pharmacoeconomics and Outcomes Research 26 has adopted guidelines for conducting and reviewing research using retrospective administrative databases, but this guideline, while successful in creating an international standard for doing this type research, does not address the idiosyncracies of spine data. With these new guidelines and two decades of changes in medical practice 24...

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

“…codeine) may have been for cough. That a substantial proportion of both HIV-infected patients and uninfected patients lacked a documented pain-related diagnosis, may in part be explained by the limitations of administrative data, 42 but the difference by HIV status was unexpected. The ICD-9 codes we included may have missed some pain syndromes which more commonly affect HIVinfected patients, such as herpes zoster or avascular necrosis.…”

“…Second, ICD-9 codes may lead to under-reporting of conditions, which we used to identify pain-related diagnoses and comorbidities. 42 Third, as our data were restricted to opioids obtained from a VHA pharmacy, we were unable to assess opioid analgesics received from outside sources. The VHA, however, offers generous pharmacy benefits 28 and almost all HIV-infected patients receive their antiretroviral agents through the VHA.…”

Classification of patients with incident non-specific low back pain: implications for research

“…The methodology for identifying non-specific low back pain using administrative data is fairly well established, with researchers largely agreeing on which codes should be used [22]. There is consensus on the use of complete, five-digit International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for their specificity.…”

Pain research using Veterans Health Administration electronic and administrative data sources

“…Because of reliability and validity issues using ICD-9 codes to identify patients, including those with pain [38], researchers have developed identification algorithms to improve accuracy (e.g., using a specific number of inpatient and/or outpatient ICD-9 codes within a given time frame) [12,38]. Pain researchers have developed and evaluated identification algorithms that use ICD-9 codes (along with other data) to identify patients with pain [4,[6][7]22].…”

“…For example, Sinnott et al evaluated several methods for identifying individuals with neck and back pain [22]. They identified seven unique published algorithms and outlined the similarities and differences in the structure and definitions of the algorithms.…”