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Validity of ICD codes to identify do-not-resuscitate orders among older adults with heart failure: A single center study

BACKGROUND: Observational research on the advance care planning (ACP) process is limited by a lack of easily accessible ACP variables in many large datasets. The objective of this study was to determine whether International Classification of Disease (ICD) codes for do-not-resuscitate (DNR) orders a...

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Autores principales: Callahan, Katherine, Acharya, Yubraj, Hollenbeak, Christopher S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10010557/
https://www.ncbi.nlm.nih.gov/pubmed/36913366
http://dx.doi.org/10.1371/journal.pone.0283045
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author Callahan, Katherine
Acharya, Yubraj
Hollenbeak, Christopher S.
author_facet Callahan, Katherine
Acharya, Yubraj
Hollenbeak, Christopher S.
author_sort Callahan, Katherine
collection PubMed
description BACKGROUND: Observational research on the advance care planning (ACP) process is limited by a lack of easily accessible ACP variables in many large datasets. The objective of this study was to determine whether International Classification of Disease (ICD) codes for do-not-resuscitate (DNR) orders are valid proxies for the presence of a DNR recorded in the electronic medical record (EMR). METHODS: We studied 5,016 patients over the age of 65 who were admitted to a large, mid-Atlantic medical center with a primary diagnosis of heart failure. DNR orders were identified in billing records from ICD-9 and ICD-10 codes. DNR orders were also identified in the EMR by a manual search of physician notes. Sensitivity, specificity, positive predictive value and negative predictive value were calculated as well as measures of agreement and disagreement. In addition, estimates of associations with mortality and costs were calculated using the DNR documented in EMR and the DNR proxy identified in ICD codes. RESULTS: Relative to the gold standard of the EMR, DNR orders identified in ICD codes had an estimated sensitivity of 84.6%, specificity of 96.6%, positive predictive value of 90.5%, and negative predictive value of 94.3%. The estimated kappa statistic was 0.83, although McNemar’s test suggested there was some systematic disagreement between the DNR from ICD codes and the EMR. CONCLUSIONS: ICD codes appear to provide a reasonable proxy for DNR orders among hospitalized older adults with heart failure. Further research is necessary to determine if billing codes can identify DNR orders in other populations.
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spelling pubmed-100105572023-03-14 Validity of ICD codes to identify do-not-resuscitate orders among older adults with heart failure: A single center study Callahan, Katherine Acharya, Yubraj Hollenbeak, Christopher S. PLoS One Research Article BACKGROUND: Observational research on the advance care planning (ACP) process is limited by a lack of easily accessible ACP variables in many large datasets. The objective of this study was to determine whether International Classification of Disease (ICD) codes for do-not-resuscitate (DNR) orders are valid proxies for the presence of a DNR recorded in the electronic medical record (EMR). METHODS: We studied 5,016 patients over the age of 65 who were admitted to a large, mid-Atlantic medical center with a primary diagnosis of heart failure. DNR orders were identified in billing records from ICD-9 and ICD-10 codes. DNR orders were also identified in the EMR by a manual search of physician notes. Sensitivity, specificity, positive predictive value and negative predictive value were calculated as well as measures of agreement and disagreement. In addition, estimates of associations with mortality and costs were calculated using the DNR documented in EMR and the DNR proxy identified in ICD codes. RESULTS: Relative to the gold standard of the EMR, DNR orders identified in ICD codes had an estimated sensitivity of 84.6%, specificity of 96.6%, positive predictive value of 90.5%, and negative predictive value of 94.3%. The estimated kappa statistic was 0.83, although McNemar’s test suggested there was some systematic disagreement between the DNR from ICD codes and the EMR. CONCLUSIONS: ICD codes appear to provide a reasonable proxy for DNR orders among hospitalized older adults with heart failure. Further research is necessary to determine if billing codes can identify DNR orders in other populations. Public Library of Science 2023-03-13 /pmc/articles/PMC10010557/ /pubmed/36913366 http://dx.doi.org/10.1371/journal.pone.0283045 Text en © 2023 Callahan et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Callahan, Katherine
Acharya, Yubraj
Hollenbeak, Christopher S.
Validity of ICD codes to identify do-not-resuscitate orders among older adults with heart failure: A single center study
title Validity of ICD codes to identify do-not-resuscitate orders among older adults with heart failure: A single center study
title_full Validity of ICD codes to identify do-not-resuscitate orders among older adults with heart failure: A single center study
title_fullStr Validity of ICD codes to identify do-not-resuscitate orders among older adults with heart failure: A single center study
title_full_unstemmed Validity of ICD codes to identify do-not-resuscitate orders among older adults with heart failure: A single center study
title_short Validity of ICD codes to identify do-not-resuscitate orders among older adults with heart failure: A single center study
title_sort validity of icd codes to identify do-not-resuscitate orders among older adults with heart failure: a single center study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10010557/
https://www.ncbi.nlm.nih.gov/pubmed/36913366
http://dx.doi.org/10.1371/journal.pone.0283045
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