TY  - JOUR
AU  - Shi, Jiaxiao M
AU  - Chiu, Vicki Y
AU  - Avila, Chantal C
AU  - Lewis, Sierra
AU  - Park, Daniella
AU  - Peltier, Morgan R
AU  - Getahun, Darios
PY  - 2024
DA  - 2024/5/14
TI  - Coding of Childhood Psychiatric and Neurodevelopmental Disorders in Electronic Health Records of a Large Integrated Health Care System: Validation Study
JO  - JMIR Ment Health
SP  - e56812
VL  - 11
KW  - autism
KW  - autism spectrum disorder
KW  - ASD
KW  - attention deficit hyperactivity disorder
KW  - ADHD
KW  - disruptive behavioral disorders
KW  - DBD
KW  - anxiety disorders
KW  - AD
KW  - major depression disorder
KW  - MDD
KW  - autistic
KW  - coding
KW  - neurodevelopmental
KW  - psychiatric
KW  - electronic health record
KW  - electronic health records
KW  - validation
KW  - accuracy
KW  - mental health
KW  - emotional
KW  - behavior
KW  - behaviors
KW  - behavioral
KW  - disorder
KW  - disorders
KW  - pediatric
KW  - pediatrics
KW  - paediatric
KW  - infant
KW  - paediatrics
KW  - infants
KW  - infancy
KW  - baby
KW  - babies
KW  - neonate
KW  - neotnates
KW  - neonatal
KW  - toddler
KW  - toddlers
KW  - child
KW  - children
KW  - hospital
KW  - hospitals
AB  - Background: Mental, emotional, and behavioral disorders are chronic pediatric conditions, and their prevalence has been on the rise over recent decades. Affected children have long-term health sequelae and a decline in health-related quality of life. Due to the lack of a validated database for pharmacoepidemiological research on selected mental, emotional, and behavioral disorders, there is uncertainty in their reported prevalence in the literature. Objectives: We aimed to evaluate the accuracy of coding related to pediatric mental, emotional, and behavioral disorders in a large integrated health care system’s electronic health records (EHRs) and compare the coding quality before and after the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding as well as before and after the COVID-19 pandemic. Methods: Medical records of 1200 member children aged 2-17 years with at least 1 clinical visit before the COVID-19 pandemic (January 1, 2012, to December 31, 2014, the ICD-9-CM coding period; and January 1, 2017, to December 31, 2019, the ICD-10-CM coding period) and after the COVID-19 pandemic (January 1, 2021, to December 31, 2022) were selected with stratified random sampling from EHRs for chart review. Two trained research associates reviewed the EHRs for all potential cases of autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), major depression disorder (MDD), anxiety disorder (AD), and disruptive behavior disorders (DBD) in children during the study period. Children were considered cases only if there was a mention of any one of the conditions (yes for diagnosis) in the electronic chart during the corresponding time period. The validity of diagnosis codes was evaluated by directly comparing them with the gold standard of chart abstraction using sensitivity, specificity, positive predictive value, negative predictive value, the summary statistics of the F-score, and Youden J statistic. κ statistic for interrater reliability among the 2 abstractors was calculated. Results: The overall agreement between the identification of mental, behavioral, and emotional conditions using diagnosis codes compared to medical record abstraction was strong and similar across the ICD-9-CM and ICD-10-CM coding periods as well as during the prepandemic and pandemic time periods. The performance of AD coding, while strong, was relatively lower compared to the other conditions. The weighted sensitivity, specificity, positive predictive value, and negative predictive value for each of the 5 conditions were as follows: 100%, 100%, 99.2%, and 100%, respectively, for ASD; 100%, 99.9%, 99.2%, and 100%, respectively, for ADHD; 100%, 100%, 100%, and 100%, respectively for DBD; 87.7%, 100%, 100%, and 99.2%, respectively, for AD; and 100%, 100%, 99.2%, and 100%, respectively, for MDD. The F-score and Youden J statistic ranged between 87.7% and 100%. The overall agreement between abstractors was almost perfect (κ=95%). Conclusions: Diagnostic codes are quite reliable for identifying selected childhood mental, behavioral, and emotional conditions. The findings remained similar during the pandemic and after the implementation of the ICD-10-CM coding in the EHR system. 
SN  - 2368-7959
UR  - https://mental.jmir.org/2024/1/e56812
UR  - https://doi.org/10.2196/56812
DO  - 10.2196/56812
ID  - info:doi/10.2196/56812
ER  -