Review Suggests Approaches for Identifying COPD Should Be Combined

A review evaluating the methodological approaches of identifying chronic obstructive pulmonary disease (COPD) found that when more criteria is combined, the more accurate the detection of COPD in terms of sensitivity and specificity.

Researchers conducted a systematic literature review using Medline via PubMed and Google Scholar from January 2000 through October 2018 and then a manual review of the collected studies with at least 2 independent raters. Studies involving methodological approaches for the identification of COPD patients through routine data were collected.

In total, 151 publications were compiled from the systemic search. Following the title and abstract screening, 39 publications were assessed, according to the results. The most frequently used criteria set to identify COPD patients included International Classification of Diseases (ICD) codes, hospitalization, and ambulatory visits.

“The most commonly practiced approach to filter affected beneficiaries from large datasets (e.g., claims databases) is to apply filter algorithms referring to the International Classification of Diseases (ICD) system, a standard tool in clinical medicine, epidemiology, and health management. Epidemiologists use the ICD system to monitor the incidence and prevalence of diseases and disorders, gaining an insight in the possible health situation of populations and countries. Medical practitioners and clinicians use ICD to identify and to document diseases or other health conditions,” the authors explained.

While only 4 out of the 38 studies used other methods than ICD coding, the results revealed that age range of the target population and hospitalization were provided in a significant proportion of the studies. Additionally, ambulatory data were included in 34, physician claims in 22, and pharmaceutical data in 18 studies.

“A variety of different criteria have been used to identify COPD. In general, it can be concluded that the more criteria are combined, the more accurate is the detection of COPD patients in terms of sensitivity and specificity. Drug data is by far the most comprehensive source of information if used alone,” concluded the authors. “In order to obtain more substantial insights on reliable detection of COPD patients from routine datasets, further research should focus on the application of internal and/or external validation approaches.”

Reference

Gothe H, Rajsic S, et al. Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review [published online October 22, 2019]. BMC Health Services Research. doi: 10.1186/s12913-019-4574-3.