Evaluating the predictive value of osteoarthritis diagnoses in an administrative database

Arthritis Rheum. 2000 Aug;43(8):1881-5. doi: 10.1002/1529-0131(200008)43:8<1881::AID-ANR26>3.0.CO;2-#.


Objective: To assess the positive and negative predictive values of osteoarthritis (OA) diagnoses contained in an administrative database.

Methods: We identified all members (> or =18 years of age) of a Massachusetts health maintenance organization with documentation of at least one health care encounter associated with an OA diagnosis during the period 1994-1996. From this population, we randomly selected 350 subjects. In addition, we randomly selected 250 enrollees (proportionally by the age and sex of the 350 subjects) who did not have a health care encounter associated with an OA diagnosis. Trained nurse reviewers abstracted OA-related clinical, laboratory, and radiologic data from the medical records of both study groups (all but 1 chart was available for review). Pairs of physician reviewers evaluated the abstracted information for both groups of subjects and rated the evidence for the presence of OA according to 3 levels: definite, possible, and unlikely.

Results: Among the group of patients with an administrative diagnosis of OA, 215 (62%) were rated as having definite OA, 36 (10%) possible OA, and 98 (28%) unlikely OA, according to information contained in the medical record. The positive predictive value of an OA diagnosis was 62%. In those without an administrative OA diagnosis, 44 (18%) were assigned a rating of definite OA. The negative predictive value of the absence of an administrative OA diagnosis was 78%.

Conclusion: Use of administrative data in epidemiologic and health services research on OA may lead to both case misclassification and under ascertainment.

MeSH terms

  • Aged
  • Confidence Intervals
  • Databases, Factual / standards
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis / diagnosis*
  • Osteoarthritis / epidemiology
  • Predictive Value of Tests
  • Prevalence
  • Sex Ratio