Does a claims diagnosis of autism mean a true case?. (April 2014)

• Record Type: Journal Article
• Authors: Burke, James P; Jain, Anjali; Yang, Wenya; Kelly, Jonathan P; Kaiser, Marygrace; Becker, Laura; Lawer, Lindsay; Newschaffer, Craig J
• Is Part Of: Autism. Volume 18:Number 3(2014)
• Page Start: 321
• Page End: 330
• Publication Date: 2014-04
• Subjects: Administrative data -- autism -- chart review -- validation study; Autism -- Periodicals; Autism in children -- Periodicals; 616.85882005
• DOI: 10.1177/1362361312467709
• Languages: English
• ISSNs: 1362-3613

Abstract

The purpose of this study was to validate autism spectrum disorder cases identified through claims-based case identification algorithms against a clinical review of medical charts. Charts were reviewed for 432 children who fell into one of the three following groups: (a) more than or equal to two claims with an autism spectrum disorder diagnosis code (n = 182), (b) one claim with an autism spectrum disorder diagnosis code (n = 190), and (c) those who had no claims for autism spectrum disorder but had claims for other developmental or neurological conditions (n = 60). The algorithm-based diagnoses were compared with documented autism spectrum disorders in the medical charts. The algorithm requiring more than or equal to two claims for autism spectrum disorder generated a positive predictive value of 87.4%, which suggests that such an algorithm is a valid means to identify true autism spectrum disorder cases in claims data.