当前位置：
X-MOL 学术
›
Mov. Disord.
›
论文详情
Our official English website, www.x-mol.net, welcomes your
feedback! (Note: you will need to create a separate account there.)
Validation of Parkinson's Disease Ascertainment in the Veterans Administration Electronic Medical Record
Movement Disorders ( IF 7.4 ) Pub Date : 2024-12-04 , DOI: 10.1002/mds.30075 Samuel M. Goldman, Frances M. Weaver, Lishan Cao, Beverly Gonzalez, Kevin T. Stroupe, Kalea Colletta, Shamil Jugnundan, Ethan G. Brown, Caroline M. Tanner
Movement Disorders ( IF 7.4 ) Pub Date : 2024-12-04 , DOI: 10.1002/mds.30075 Samuel M. Goldman, Frances M. Weaver, Lishan Cao, Beverly Gonzalez, Kevin T. Stroupe, Kalea Colletta, Shamil Jugnundan, Ethan G. Brown, Caroline M. Tanner
BackgroundElectronic medical record (EMR)–based studies hold great potential for epidemiologic investigations of Parkinson's disease (PD) causal factors and phenomenology, but diagnostic misclassification may obscure or bias inferences.ObjectivesThe aims were to determine the validity of PD diagnostic codes in the Veterans Administration (VA) national electronic medical databases and develop recommendations for maximizing ascertainment accuracy.MethodsWe investigated a cohort of 146,776 veterans who utilized VA healthcare between 1999 and 2021. We reviewed the medical records of individuals with a PD International Classification of Diseases (ICD) code in outpatient, inpatient, or community care encounters to assign a gold‐standard diagnosis. We determined diagnostic accuracy based on provider type, coding frequency, medications, and potentially exclusionary ICD codes overall and by race.ResultsA total of 377 of 810 (46.5%) with a PD ICD code had PD. Veterans whose PD was coded by a PD‐specialist neurologist were most likely to have PD (83.6%), but sensitivity was low (15.0%). Diagnostic accuracy decreased for PD coded by any neurologist (66.9%), but sensitivity improved (69.4%). Requiring two or more PD codes in combination with two or more levodopa prescriptions improved accuracy, particularly among nonneurologists. Neuroleptic‐induced parkinsonism was the most frequent diagnosis in those without PD (15.6%). Accuracy was lower in Black (29.0%) than White (50.5%) veterans regardless of provider type (miscoding odds ratio 2.5, 95% confidence interval 1.7–3.6).ConclusionsThese results highlight the limitations of EMR‐based PD ascertainment. Researchers can maximize accuracy by considering provider specialty, coding frequency, pharmacy data, and exclusionary diagnoses, but some degree of record review is required to ensure high accuracy. Higher miscoding among Black veterans warrants further study. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
更新日期：2024-12-04
京公网安备 11010802027423号