Validation of insurance claims data on aetiology, surgical type and prosthesis for isolated valve surgery: a retrospective observational surgery
Objectives Administrative database research is pivotal for developing guidelines in cardiovascular surgery and valvular heart disease. However, validation studies specific to Asia are lacking. This study validated the coding of valvular heart repair and replacement surgeries in Taiwan’s National Hea...
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/2/e084197.full |
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| author | Shao-Wei Chen Victor Chien-Chia Wu Pao-Hsien Chu An-Hsun Chou Chun-Yu Chen Feng-Cheng Chang Yi‐Hsin Chan Chia-Pin Lin Yu-Ting Cheng Bo-Cheng Hou Jo-Ting Huang |
| author_facet | Shao-Wei Chen Victor Chien-Chia Wu Pao-Hsien Chu An-Hsun Chou Chun-Yu Chen Feng-Cheng Chang Yi‐Hsin Chan Chia-Pin Lin Yu-Ting Cheng Bo-Cheng Hou Jo-Ting Huang |
| author_sort | Shao-Wei Chen |
| collection | DOAJ |
| description | Objectives Administrative database research is pivotal for developing guidelines in cardiovascular surgery and valvular heart disease. However, validation studies specific to Asia are lacking. This study validated the coding of valvular heart repair and replacement surgeries in Taiwan’s National Health Insurance (NHI) Research Database using International Classification of Diseases, Clinical Modification (ICD-CM) codes.Methods This retrospective observational study used data from the Chang Gung Research Database between 2015 and 2018, identifying 1171 patients using Taiwanese NHI reimbursement codes. The gold standard was defined as a blinded retrospective review of operation notes. Claims data, including ICD diagnostic codes, ICD procedural codes and NHI supply codes for surgical materials, were validated. Positive predictive values (PPVs) were calculated as the number of true positives divided by the total claims data.Results The PPVs (95% CI) for aortic valve (AV) surgery aetiologies were as follows: infectious endocarditis (IE), 94.1% (87.6%–97.7%); rheumatic heart disease (RHD), 88.2% (67.3%–97.5%); bicuspid AV, 93.3% (83.3%–98.1%); and degeneration, 91.7% (85.3%–95.8%). For mitral valve surgery, the surgery aetiologies and PPVs were IE, 93.2% (87.9%–96.6%); RHD, 94.9% (88.3%–98.2%); ischaemic mitral regurgitation, 87.5% (73.0%–95.6%); and degeneration, 88.4% (83.9%–92.0%). Surgical types generally exhibited higher PPVs, except for mechanical prostheses (<90%). The accuracy of mechanical prosthesis identification improved with the inclusion of supply codes along with ICD procedural codes.Conclusions The PPVs for both aetiologies and surgical types of valvular heart disease were generally satisfactory. The inclusion of supply codes for mechanical valve replacements enhanced accuracy but led to fewer eligible patients being included in the sample. This study provides a potentially optimal framework for future research on valve diseases and surgeries using claims databases. |
| format | Article |
| id | doaj-art-e8a4e4ce4889476bada786b765bbb783 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-e8a4e4ce4889476bada786b765bbb7832025-02-09T05:00:12ZengBMJ Publishing GroupBMJ Open2044-60552025-02-0115210.1136/bmjopen-2024-084197Validation of insurance claims data on aetiology, surgical type and prosthesis for isolated valve surgery: a retrospective observational surgeryShao-Wei Chen0Victor Chien-Chia Wu1Pao-Hsien Chu2An-Hsun Chou3Chun-Yu Chen4Feng-Cheng Chang5Yi‐Hsin Chan6Chia-Pin Lin7Yu-Ting Cheng8Bo-Cheng Hou9Jo-Ting Huang10Chang Gung Memorial Hospital Linkou Branch, Taoyuan, TaiwanCardiology, Chang Gung Memorial Hospital Linkou, Taoyuan, Taoyuan, TaiwanCardiology, Chang Gung Memorial Hospital Linkou, Taoyuan, Taoyuan, TaiwanAnesthesiology, Chang Gung Memorial Hospital Linkou, Taoyuan, TaiwanAnesthesiology, Chang Gung Memorial Hospital Linkou, Taoyuan, TaiwanAnesthesiology, Chang Gung Memorial Hospital Linkou, Taoyuan, TaiwanChang Gung Memorial Hospital Linkou Main Branch, Taoyuan, TaiwanChang Gung Memorial Hospital Linkou Main Branch, Taoyuan, TaiwanChang Gung Memorial Hospital Linkou Main Branch, Taoyuan, TaiwanRadiology, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi, TaiwanChang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, TaiwanObjectives Administrative database research is pivotal for developing guidelines in cardiovascular surgery and valvular heart disease. However, validation studies specific to Asia are lacking. This study validated the coding of valvular heart repair and replacement surgeries in Taiwan’s National Health Insurance (NHI) Research Database using International Classification of Diseases, Clinical Modification (ICD-CM) codes.Methods This retrospective observational study used data from the Chang Gung Research Database between 2015 and 2018, identifying 1171 patients using Taiwanese NHI reimbursement codes. The gold standard was defined as a blinded retrospective review of operation notes. Claims data, including ICD diagnostic codes, ICD procedural codes and NHI supply codes for surgical materials, were validated. Positive predictive values (PPVs) were calculated as the number of true positives divided by the total claims data.Results The PPVs (95% CI) for aortic valve (AV) surgery aetiologies were as follows: infectious endocarditis (IE), 94.1% (87.6%–97.7%); rheumatic heart disease (RHD), 88.2% (67.3%–97.5%); bicuspid AV, 93.3% (83.3%–98.1%); and degeneration, 91.7% (85.3%–95.8%). For mitral valve surgery, the surgery aetiologies and PPVs were IE, 93.2% (87.9%–96.6%); RHD, 94.9% (88.3%–98.2%); ischaemic mitral regurgitation, 87.5% (73.0%–95.6%); and degeneration, 88.4% (83.9%–92.0%). Surgical types generally exhibited higher PPVs, except for mechanical prostheses (<90%). The accuracy of mechanical prosthesis identification improved with the inclusion of supply codes along with ICD procedural codes.Conclusions The PPVs for both aetiologies and surgical types of valvular heart disease were generally satisfactory. The inclusion of supply codes for mechanical valve replacements enhanced accuracy but led to fewer eligible patients being included in the sample. This study provides a potentially optimal framework for future research on valve diseases and surgeries using claims databases.https://bmjopen.bmj.com/content/15/2/e084197.full |
| spellingShingle | Shao-Wei Chen Victor Chien-Chia Wu Pao-Hsien Chu An-Hsun Chou Chun-Yu Chen Feng-Cheng Chang Yi‐Hsin Chan Chia-Pin Lin Yu-Ting Cheng Bo-Cheng Hou Jo-Ting Huang Validation of insurance claims data on aetiology, surgical type and prosthesis for isolated valve surgery: a retrospective observational surgery BMJ Open |
| title | Validation of insurance claims data on aetiology, surgical type and prosthesis for isolated valve surgery: a retrospective observational surgery |
| title_full | Validation of insurance claims data on aetiology, surgical type and prosthesis for isolated valve surgery: a retrospective observational surgery |
| title_fullStr | Validation of insurance claims data on aetiology, surgical type and prosthesis for isolated valve surgery: a retrospective observational surgery |
| title_full_unstemmed | Validation of insurance claims data on aetiology, surgical type and prosthesis for isolated valve surgery: a retrospective observational surgery |
| title_short | Validation of insurance claims data on aetiology, surgical type and prosthesis for isolated valve surgery: a retrospective observational surgery |
| title_sort | validation of insurance claims data on aetiology surgical type and prosthesis for isolated valve surgery a retrospective observational surgery |
| url | https://bmjopen.bmj.com/content/15/2/e084197.full |
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