Pooja Lagisetty1, Claire Garpestad2, Angela Larkin3, Colin Macleod4, Derek Antoku4, Stephanie Slat4, Jennifer Thomas4, Victoria Powell5, Amy S B Bohnert6, Lewei A Lin7. 1. Department of Internal Medicine, University of Michigan Medical School, University of Michigan, North Campus Research Center, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI, USA; Center for Clinical Management and Research, North Campus Research Center, Ann Arbor VA, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI 48109, USA. Electronic address: lagiset@med.umich.edu. 2. University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, USA. 3. Center for Clinical Management and Research, North Campus Research Center, Ann Arbor VA, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI 48109, USA. 4. Department of Internal Medicine, University of Michigan Medical School, University of Michigan, North Campus Research Center, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI, USA. 5. Department of Geriatrics and Palliative Care, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, USA. 6. Center for Clinical Management and Research, North Campus Research Center, Ann Arbor VA, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI 48109, USA; Department of Anesthesiology, University of Michigan Medical School, 1500 E. Medical Center Dr., Ann Arbor, MI, USA. 7. Center for Clinical Management and Research, North Campus Research Center, Ann Arbor VA, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Center, 2800 Plymouth Rd, Bldg 16, 2nd Fl, Ann Arbor, MI, USA. Electronic address: leweil@med.umich.edu.
Abstract
BACKGROUND: Policy evaluations and health system interventions often utilize International Classification of Diseases (ICD) codes of opioid use, dependence, and abuse to identify individuals with opioid use disorder (OUD) and assess receipt of evidence-based treatments. However, ICD codes may not map directly onto the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) OUD criteria. This study investigates the positive predictive value of ICD codes in identifying patients with OUD. METHODS: We conducted a clinical chart review on a national sample of 520 Veterans assigned ICD-9 or ICD-10 codes for opioid use, dependence, or abuse from 2012 to 2017. We extracted evidence of DSM-5 OUD criteria and opioid misuse from clinical documentation in the month preceding and three months following initial ICD code listing, and categorized patients into: 1) high likelihood of OUD, 2) limited aberrant opioid use, 3) prescribed opioid use without evidence of aberrant use, and 4) insufficient information. Positive predictive value was calculated as the percentage of individuals with these ICD codes meeting high likelihood of OUD criteria upon chart review. RESULTS: Only 57.7 % of patients were categorized as high likelihood of OUD; 16.5 % were categorized as limited aberrant opioid use, 18.9 % prescribed opioid use without evidence of aberrant use, and 6.9 % insufficient information. CONCLUSIONS: Patients assigned ICD codes for opioid use, dependence, or abuse often lack documentation of meeting OUD criteria. Many receive long-term opioid therapy for chronic pain without evidence of misuse. Robust methods of identifying individuals with OUD are crucial to improving access to clinically appropriate treatment.
BACKGROUND: Policy evaluations and health system interventions often utilize International Classification of Diseases (ICD) codes of opioid use, dependence, and abuse to identify individuals with opioid use disorder (OUD) and assess receipt of evidence-based treatments. However, ICD codes may not map directly onto the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) OUD criteria. This study investigates the positive predictive value of ICD codes in identifying patients with OUD. METHODS: We conducted a clinical chart review on a national sample of 520 Veterans assigned ICD-9 or ICD-10 codes for opioid use, dependence, or abuse from 2012 to 2017. We extracted evidence of DSM-5 OUD criteria and opioid misuse from clinical documentation in the month preceding and three months following initial ICD code listing, and categorized patients into: 1) high likelihood of OUD, 2) limited aberrant opioid use, 3) prescribed opioid use without evidence of aberrant use, and 4) insufficient information. Positive predictive value was calculated as the percentage of individuals with these ICD codes meeting high likelihood of OUD criteria upon chart review. RESULTS: Only 57.7 % of patients were categorized as high likelihood of OUD; 16.5 % were categorized as limited aberrant opioid use, 18.9 % prescribed opioid use without evidence of aberrant use, and 6.9 % insufficient information. CONCLUSIONS: Patients assigned ICD codes for opioid use, dependence, or abuse often lack documentation of meeting OUD criteria. Many receive long-term opioid therapy for chronic pain without evidence of misuse. Robust methods of identifying individuals with OUD are crucial to improving access to clinically appropriate treatment.
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