Background/Purpose:

Gout outcome studies have used administrative and claims databases. It is unknown whether administrative-derived data are accurate for gout-related utilization.  The goal of the study was to assess the accuracy of Veterans Affairs (VA) administrative and clinical claims databases for gout-related health care utilization.

Methods:

This retrospective study utilized the VA administrative and clinical claims databases for the fiscal year 2006.  A cohort consisting of randomly mixed sample of two types of visits was identified that included visits with gout as primary or secondary diagnosis versus other diagnoses.  An experienced senior epidemiologist (JS) blinded to the database information related to the visit performed review of electronic medical records (EMR).  The gold standard was medical record documentation of gout or gout-related terms (gouty arthritis, tophaceous gout, acute gout, chronic gout, podagra, urate renal stones) in the chief complaint, history of present illness or assessment and plan for the visit.  This indicated that gout was the main reason or one of the main reasons for the visit. We assessed the accuracy of database-derived gout-related utilization by calculating sensitivity, specificity, and positive and negative predictive values (PPV and NPV). 

Results:

Of the 108 potential visits, 85 visits to a health care provider (in 85 patients: 84 men, 1 woman with mean age of 63 years) in one of the three settings (outpatient, inpatient or urgent care/emergency room), and retrievable data from medical records, constituted the analyzed dataset.  According to the gold standard of chart documentation, 21 visits were related to gout and 64 were not.  Administrative claims for visits related to gout were accurate with excellent PPV of 86%, sensitivity of 86%, specificity of 95% and NPV of 95%.  There were three visits coded as gout-related visit in databases that did not have medical record documentation related to gout: one visit each to discuss blood pressure medication, for regular follow-up of multiple medical problems, and for increased blood sugar.  Three visits coded as not related to gout in administrative databases were related to gout based on medical record documentation: one patient each with continuing acute gout flare, a new diagnosis with documentation of urate crystals in knee joint fluid, and chronic gout stable on allopurinol. 

Conclusion:

VA databases can be used to identify gout-related visits with good accuracy.  This finding supports the use of VA databases for studies of health services outcomes to identify gout-related utilization.  It remains to be seen if findings are generalizable to other clinical and/or claims databases.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/accuracy-of-veterans-affairs-database-for-gout-related-health-care-utilization/