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1.  Validation of ICD-9-CM Codes to Identify Gastrointestinal Perforation Events in Administrative Claims Data among Hospitalized Rheumatoid Arthritis Patients 
Pharmacoepidemiology and drug safety  2011;20(11):1150-1158.
Purpose
To validate, using physician review of abstracted medical chart data as a gold standard, a claims-based algorithm developed to identify gastrointestinal (GI) perforation cases among rheumatoid arthritis (RA) patients.
Methods
Patients with established RA, aged 18 years or older with hospital admissions between January 2004 and September 2009, were selected from a large US hospital-based database. An algorithm with ICD-9-CM diagnosis codes for GI perforation and combinations of GI-related diagnosis codes and CPT-4 procedure codes for relevant GI surgeries was used to identify potential GI perforation cases. Two senior experienced specialist physicians independently reviewed abstracted chart data and classified cases as “confirmed” or “unconfirmed” GI perforations. Positive predictive values (PPVs) to identify “confirmed” GI perforation were calculated and stratified by upper versus lower GI tract.
Results
Overall, 86 of 92 GI perforation cases were confirmed, yielding an overall PPV of 94% (95% CI: 86–98%). PPV was 100% (95% CI: 100–100%) for upper GI perforation (esophagus, stomach) and 91% (95% CI: 90–97%) for lower GI perforation (small intestine, PPV=100%; large intestine, PPV= 94%; unspecified lower GI, PPV=89%).
Conclusions
This algorithm, consisting of a combination of ICD-9-CM diagnosis and CPT-4 codes, could be used in future safety studies to evaluate GI perforation risk factors in RA patients.
doi:10.1002/pds.2215
PMCID: PMC3227025  PMID: 22020901
gastrointestinal perforation; validation; administrative claims; rheumatoid arthritis
2.  Hospitalized cardiovascular events in patients with diabetic macular edema 
BMC Ophthalmology  2012;12:11.
Background
Microvascular and macrovascular complications in diabetes stem from chronic hyperglycemia and are thought to have overlapping pathophysiology. The aim of this study was to investigate the incidence rate of hospitalized myocardial infarctions (MI) and cerebrovascular accidents (CVA) in patients with diabetic macular edema (DME) compared with diabetic patients without retinal diseases.
Methods
This was a retrospective cohort study of a commercially insured population in an administrative claims database. DME subjects (n = 3519) and diabetes controls without retinal disease (n = 10557) were matched by age and gender. Healthcare claims were analyzed for the study period from 1 January 2002 to 31 December 2005. Incidence and adjusted rate ratios of hospitalized MI and CVA events were then calculated.
Results
The adjusted rate ratio for MI was 2.50 (95% CI: 1.83-3.41, p < 0.001) for DME versus diabetes controls. Predictors of MI events were heart disease, history of acute MI, and prior use of antiplatelet or anticoagulant drugs. The adjusted rate ratio for CVA was 1.98 (95% CI: 1.39-2.83, p < 0.001) for DME versus diabetes controls. Predictors of CVA events were cardiac arrhythmia, Charlson comorbidity scores, history of CVA, hyperlipidemia, and other cerebrovascular diseases.
Conclusion
Event rates of MI or CVA were higher in patients with DME than in diabetes controls. This study is one of few with sufficient sample size to accurately estimate the relationship between DME and cardiovascular outcomes.
doi:10.1186/1471-2415-12-11
PMCID: PMC3395554  PMID: 22646811

Results 1-2 (2)