The Kentucky Injury Prevention and Research Center is a bona fide agent for the Department for Public Health, Cabinet for Health and Family Services

Overdose Indicator Definitions: Case Confirmation Study

S. Slavova, J. Costich, D. Quesinberry, S. Eustice, T. Bunn

CDC Prevention for States (PfS) Grantee Meeting, Atlanta, GA, May 9 - 11, 2017

The CDC Prevention for States (PfS)Kentucky Program

PfS Required Morbidity Indicators:

Proposed ICD-10-CM Transition Guidance

0

500

1000

1500

2000

2500

3000

3500

Num

ber

Year-quarter, 2010 Q1 - 2016 Q3

PfS Indicators: Drug Overdose Emergency Department Visits, Kentucky Residents, Jan 1, 2010 -Sept 30, 2016

PfS indicator: Drug overdose

PfS Indicator: Opioids other than heroin

PfS Indicator: Heroin

Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. April 2017. Data source: Kentucky Outpatient Claims, 2010-2016, Office of Health Policy, Cabinet for Health and Family Services. Data are provisional and subject to change.

Oct 1, 2015

PfS Indicators: Opioid-related Drug Overdose Emergency Department Visits (any diagnosis),

by Type of Opioid, Jan 1, 2010 – Sept 30, 2016

35 31 59 90 60 81 56 79 110

205281 257 236

300 292 265330 347

453496

599678

612

847885

1,124

1428

207 232 240202 227 252

286 269 281 261 256180 187 179 207 191 218 205

242 224 226 257 275

369 346 379

465

39 41 39 50

0

200

400

600

800

1,000

1,200

1,400

1,600

Num

ber o

f ED

visit

s

Year-quarter

Heroin

Opioids other than heroin

Synthetic opioids other thanmethadone

Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. April 2017. Data source: Kentucky Outpatient Claims, 2010-2016, Office of Health Policy, Cabinet for Health and Family Services. Data are provisional and subject to change.

PfS Indicator Definitions: Case Confirmation Study

Medical chart review, abstraction, and dual coding of a sample of ED visits for 1) overdoses related to opioids other than heroin; 2) heroin-related overdoses.

Goals:

1. Estimate the Predictive Value Positive for the PfS Indicator “ED visits involving opioid overdose excluding heroin”, based on the principal diagnosis.

2. Estimate the Predictive Value Positive for the PfS Indicator “ED visits involving heroin overdose” based on the principal diagnosis.

PfS Indicator Definitions: Case Confirmation Study

Participating facilities: 12 ED facilities serving metropolitan, metropolitan- adjacent, and rural counties.

Indicator for drug overdose ED visits

Number of visits, Oct 1, 2015 - Sept 30, 2016

Drug Overdose (any diagnosis) 3,382Drug Overdose (principal diagnosis) 2,715 80%Opioid other than heroin (any diagnosis) 410Opioid other than heroin (principal diagnosis) 330 80%Heroin (any diagnosis) 1,781Heroin (principal diagnosis) 1,712 96%

PfS Indicator Definitions: Case Confirmation Study

Sample size calculations: PVP for PfS “Opioid other than heroin (principal diagnosis)”:

We have a total of 330 records identified by the PfS definition (test positive records).

Indicator for drug overdose ED visits

Number of visits, Oct 1, 2015 -Sept 30, 2016

Drug Overdose (any diagnosis) 3,382Drug Overdose (principal diagnosis) 2,715 80%Opioid other than heroin (any diagnosis) 410Opioid other than heroin (principal diagnosis) 330 80%Heroin (any diagnosis) 1,781Heroin (principal diagnosis) 1,712 96%

Sample size calculations: PVP for PfS “Opioid other than heroin (principal diagnosis)”:

We have a total of 330 records identified by the PfS definition (test positive records). Let us assume that the ER physicians will confirm 297 of the 330 cases as overdoses related to “opioids other than heroin”. Then the estimated Predictive Value Positive of the PfS definition is:

𝑃𝑃𝑃𝑃𝑃𝑃 = 𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐 𝑏𝑏𝑏𝑏 𝐸𝐸𝐸𝐸 𝑝𝑝𝑝𝑏𝑏𝑝𝑝𝑐𝑐𝑐𝑐𝑐𝑐𝑝𝑝𝑐𝑐𝑇𝑇𝑐𝑐𝑇𝑇𝑝𝑝𝑇𝑇 𝑇𝑇𝑐𝑐𝑝𝑝𝑇𝑇 𝑃𝑃𝑐𝑐𝑝𝑝𝑐𝑐𝑇𝑇𝑐𝑐𝑃𝑃𝑐𝑐

= 297330

= 90%

Overdoses related to "opioids other than heroin"

(Test = PfS definition- principal diagnosis)

Diagnosis for an overdose related to "opoid other than heroin" was confirmed by an ER physician Raw

TotalYes No

Test Positive(identified by the PfS definition ) 297 33 330

Test Negative (not identified by the PfS definition)* ? ? known

Total known

Sample size calculations: PVP for PfS “Opioid other than heroin (principal diagnosis)”:

𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚 𝑜𝑜𝑜𝑜 𝑒𝑒𝑚𝑚𝑚𝑚𝑜𝑜𝑚𝑚𝑜𝑜𝑜𝑜𝑚𝑚 𝑚𝑚 95% 𝐶𝐶𝐶𝐶 𝑜𝑜𝑜𝑜𝑚𝑚 𝑃𝑃𝑃𝑃𝑃𝑃 = 1.96 ∗𝑠𝑠𝑃𝑃𝑃𝑃𝑃𝑃 ∗ (1 − 𝑠𝑠𝑃𝑃𝑃𝑃𝑃𝑃)

𝑠𝑠𝑚𝑚𝑚𝑚𝑠𝑠𝑠𝑠𝑒𝑒 𝑠𝑠𝑚𝑚𝑠𝑠𝑒𝑒

If sample PVP (sPVP) = 0.6 0.7 0.8 0.9

Then margin of error for 95% CI with a sample size=330 is 0.053 0.049 0.043 0.032

Sample 1: PfS definition “opioid other than heroin” identifies 330 test positive cases. Assuming the ER physicians will confirm 60% of these (assuming sPVP=0.6), we will estimate the 95% confidence interval for PVP with margin of error=0.053. If the PVP is higher, the margin of error will be lower and the 95% confidence interval will be narrower (see example calculations above).

Measures: Definition 2-Overdoses involving opioids other than heroin(n1)*

Definition 3-Heroin-related overdoses(n2) *

Total number of cases in the reference dataset based on case confirmation criteria using data sources typically used by the medical coders according to coding guidelines and facility practices Initial sample (based on ICD10CM codes in the ED billing records)

Number of cases captured by each definitionPercentage of definition-captured cases that are confirmed cases in

the reference datasetProject-coded ICD10CM dataset

Number of cases captured by each definitionPercentage of definition-captured cases that are confirmed cases in

the reference datasetProject-coded ICD9CM dataset

Number of cases captured by each definitionPercentage of definition-captured cases that are confirmed cases in

the reference datasetNumber of cases that were captured in both dataset:

Hospital-coded ICD10CM data set AND Project-coded ICD10CM dataset

Project-coded ICD9CM data set AND Project-coded ICD10CM dataset

Svetla Slavovassslav2@email.uky.edu