Accuracy of Diagnoses of Schizophrenia in Medicaid Claims

University of Minnesota, Minneapolis.
Hospital & community psychiatry 02/1992; 43(1):69-71. DOI: 10.1176/ps.43.1.69
Source: PubMed


Medical insurance claims are increasingly important as a source of data in monitoring health care utilization and patient outcomes and in identifying patient cohorts for research. In a study that attempted to verify that those with Medicaid claims for treatment of schizophrenia did indeed have the disorder, two psychiatrists evaluated clinical information obtained from primary mental health care providers in relation to DSM-III-R criteria. The psychiatrists classified 86.8 percent of 319 patients with claims for treatment of schizophrenia and 27.5 percent of 156 patients with claims for treatment of other psychiatric diagnoses as definitely or probably having schizophrenia. The authors conclude that most diagnoses of schizophrenia listed on Medicaid claims are accurate, but that a substantial number of individuals with schizophrenia may not be identified by claims data.

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Available from: Michael D Finch, Feb 26, 2014
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    • "lithium or anticonvulsants) and/or antipsychotic in the pretreatment period, defined as the 6 month period prior to the initial diagnosis of bipolar disorder. Previous diagnostic validation studies indicate that patients with two or more outpatient claims for bipolar disorder are likely to have the disorder (Lurie et al. 1992; Unützer et al. 2000). Excluded were youth who were pregnant (ICD-9-CM codes 650–676), those diagnosed with schizophrenia (ICD-9-CM codes 295), autistic spectrum disorders (ICD-9-CM codes 299.00, 299.8, 299.9), and mental retardation (ICD-9-CM codes 317–319), and those with seizure disorder who were on an anticonvulsant. "
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    ABSTRACT: This study examined conformance to clinical practice guidelines for children and adolescents with bipolar disorders and identified patient and provider factors associated with guideline concordant care. Administrative records were examined for 4,047 Medicaid covered youth aged 5-18 years with new episodes of bipolar disorder during 2006-2010. Main outcome measures included 5 claims-based quality of care measures reflecting national treatment guidelines. Measures addressed appropriate pharmacotherapy, therapeutic drug monitoring, and psychosocial treatment. The results indicated that current treatment practices for youth diagnosed with bipolar disorder typically fall short of recommended practice guidelines. Although the majority of affected youth are treated with recommended first-line pharmacotherapy, only a minority receive therapeutic drug monitoring and/or psychotherapy of recommended duration, underscoring the need for quality improvement initiatives.
    Full-text · Article · Apr 2014 · Administration and Policy in Mental Health and Mental Health Services Research
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    • "Consistently, administrative case definitions for schizophrenia have performed well, with agreement between hospital claims for schizophrenia and medical records of 93.9-100% [31,32]. In American Medicaid data, the case definition that we validated of either one hospital or two physician claims for schizophrenia in two years identified only 6% false positives (k = 0.76) [33].Collectively, this suggests that administrative data can accurately identify bipolar disorder and schizophrenia in the MS and general populations. "
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    ABSTRACT: Background While mental comorbidity is considered common in multiple sclerosis (MS), its impact is poorly defined; methods are needed to support studies of mental comorbidity. We validated and applied administrative case definitions for any mental comorbidities in MS. Methods Using administrative health data we identified persons with MS and a matched general population cohort. Administrative case definitions for any mental comorbidity, any mood disorder, depression, anxiety, bipolar disorder and schizophrenia were developed and validated against medical records using a a kappa statistic (k). Using these definitions we estimated the prevalence of these comorbidities in the study populations. Results Compared to medical records, administrative definitions showed moderate agreement for any mental comorbidity, mood disorders and depression (all k ≥ 0.49), fair agreement for anxiety (k = 0.23) and bipolar disorder (k = 0.30), and near perfect agreement for schizophrenia (k = 1.0). The age-standardized prevalence of all mental comorbidities was higher in the MS than in the general populations: depression (31.7% vs. 20.5%), anxiety (35.6% vs. 29.6%), and bipolar disorder (5.83% vs. 3.45%), except for schizophrenia (0.93% vs. 0.93%). Conclusions Administrative data are a valid means of surveillance of mental comorbidity in MS. The prevalence of mental comorbidities, except schizophrenia, is increased in MS compared to the general population.
    Full-text · Article · Feb 2013 · BMC Neurology
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    • "First, although unpublished, a recent analysis indicated high agreement for mental illness diagnoses recorded in Medicaid claims and mental health provider records [29]. Similarly, an analysis comparing diagnoses of schizophrenia in Medicaid claims to clinical information obtained from primary mental health providers found that most diagnoses of schizophrenia listed on Medicaid claims are accurate [30]. Finally, an indicator of moderate or high risk alcohol/drug use derived from administrative data was found to serve as an acceptable proxy for self-reported alcohol/drug use obtained from AUDIT /DAST screening scores [31]. "
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    ABSTRACT: Background Although brief intervention (BI) for alcohol and other drug problems has been associated with subsequent decreased levels of self-reported substance use, there is little information in the extant literature as to whether individuals with co-occurring hazardous substance use and mental illness would benefit from BI to the same extent as those without mental illness. This is an important question, as mental illness is estimated to co-occur in 37% of individuals with an alcohol use disorder and in more than 50% of individuals with a drug use disorder. The goal of this study was to explore differences in self-reported alcohol and/or drug use in patients with and without mental illness diagnoses six months after receiving BI in a hospital emergency department (ED). Methods This study took advantage of a naturalistic situation where a screening, brief intervention, and referral to treatment (SBIRT) program had been implemented in nine large EDs in the US state of Washington as part of a national SBIRT initiative. A subset of patients who received BI was interviewed six months later about current alcohol and drug use. Linear regression was used to assess whether change in substance use measures differed among patients with a mental illness diagnosis compared with those without. Data were analyzed for both a statewide (n = 828) and single-hospital (n = 536) sample. Results No significant differences were found between mentally ill and non-mentally ill subgroups in either sample with regard to self-reported hazardous substance use at six-month follow-up. Conclusion These results suggest that BI may not have a differing impact based on the presence of a mental illness diagnosis. Given the high prevalence of mental illness among individuals with alcohol and other drug problems, this finding may have important public health implications.
    Full-text · Article · Oct 2012 · Addiction science & clinical practice
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