TABLE 2.
Algorithm Validation Results: PPV
| Algorithm | Excluding patients with insufficient EHR notesa (n = 273) | Including patients with insufficient EHR notesa (n = 303) | ||||
|---|---|---|---|---|---|---|
| Identified from claims, n | Confirmed in EHR, n | PPV, % (95% CI) | Identified from claims, n | Confirmed in EHR, n | PPV, % (95% CI) | |
| DMD diagnosis | ||||||
| Among all patients | ||||||
| Broad DMD definitionb | 202 | 174 | 86.1(80.6-90.6) | 222 | 174 | 78.4(72.4-83.6) |
| Narrow DMD definitionc | 145 | 132 | 91.0 (85.2-95.1) | 157 | 132 | 84.1(77.4-89.4) |
| More restrictive narrow DMD definitiond | 143 | 131 | 91.6(85.8-95.6) | 155 | 131 | 84.5(77.8-89.8) |
| Excluding patients with insufficient EHR notes (n = 248) | Including patients with insufficient EHR notese (n = 303) | |||||
| Ambulation status | ||||||
| Nonambulatory definitionf | ||||||
| Broad DMD definitionb | 95 | 84 | 88.4(80.2-94.1) | 106 | 84 | 79.3(70.3-86.5) |
| Narrow DMD definitionc | 69 | 59 | 85.5(75.0-92.8) | 79 | 59 | 74.7 (63.6-83.8) |
| More restrictive narrow DMD definitiond | 69 | 59 | 85.5(75.0-92.8) | 79 | 59 | 74.7 (63.6-83.8) |
| Ventilation status | ||||||
| Ventilation-dependent definitiong | ||||||
| Broad DMD definitionb | 45 | 35 | 77.8(62.9-88.8) | 48 | 35 | 72.9(58.2-84.7) |
| Narrow DMD definitionc | 38 | 28 | 73.7 (56.9-86.6) | 41 | 28 | 68.3 (51.9-81.9) |
| More restrictive narrow DMD definitiond | 38 | 28 | 73.7 (56.9-86.6) | 41 | 28 | 68.3 (51.9-81.9) |
b At least 2 claims with a diagnosis code for DBMD, male, and aged 40 years or younger.
c At least 2 claims with a diagnosis code for DBMD, male, and aged 40 years or younger; prescription for glucocorticoids or exon-skipping therapy or evidence of ambulation assistance/support or nonambulatory status at 12 years of age or younger or evidence of ventilation support; and evidence of ventilation support required if aged 30 years or older.
d At least 2 claims with a diagnosis code for DBMD, male, and aged 40 years or younger; prescription for glucocorticoids or exon-skipping therapy or evidence of ambulation assistance/support or nonambulatory status at 12 years of age or younger or evidence of ventilation support; and evidence of ventilation support required if aged 20 years or older.
e For 55 patients, EHR contained insufficient notes; 30 patients had insufficient notes to confirm the DMD diagnosis and an additional 25 patients had insufficient notes to determine ambulation/ventilation status.
f At least 1 claim for a power wheelchair or bed confinement or at least 1 claim indicating ventilation dependence.
g At least 1 claim for ventilation dependence, chronic or unknown respiratory failure, mechanical ventilation or ventilator, permanent tracheostomy, ongoing care for tracheostomy, or complications of ventilation.
DBMD = Duchenne/Becker muscular dystrophy; DMD = Duchenne muscular dystrophy; EHR = electronic health record; PPV = positive predictive value.