Developing Indicators of Inpatient Adverse Drug Events Through Nonlinear Analysis Using Administrative Data

Male Risk Management Data Collection Incidence Delirium Hemorrhage Blood Coagulation Disorders Middle Aged Hospital Records Psychoses, Substance-Induced 3. Good health 03 medical and health sciences 0302 clinical medicine Nonlinear Dynamics ROC Curve International Classification of Diseases Predictive Value of Tests Utah Adverse Drug Reaction Reporting Systems Humans Female Aged Retrospective Studies
DOI: 10.1097/mlr.0b013e3180616c2c Publication Date: 2009-03-04T23:50:38Z
ABSTRACT
Background: Because of uniform availability, hospital administrative data are appealing for surveillance adverse drug events (ADEs). Expert-generated rules that rely on the presence International Classification Diseases, 9th Revision Clinical Modification (ICD-9-CM) codes have limited accuracy. Rules based nonlinear associations among all types available may be more accurate. Objectives: By applying hierarchically optimal classification tree analysis (HOCTA) to data, derive and validate bleeding/anticoagulation problems delirium/psychosis. Research Design: Retrospective cohort design. Subjects: A random sample 3987 admissions drawn from 41 Utah acute-care hospitals in 2001 2003. Measures: Professional nurse reviewers identified ADEs using implicit chart review. Pharmacists assigned Medical Dictionary Regulatory Activities ADE descriptions identification clinical groups events. Hospitals provided patient demographic, admission, ICD9-CM data. Results: Incidence proportions were 0.8% drug-induced 1.0% The model bleeding had very good discrimination sensitivity at 0.87 86% fair positive predictive value (PPV) 12%. delirium excellent 94%, 0.83, but low PPV 3%. Poisoning event designed targeted sensitivities and, when forced in, degraded Conclusions: Hierarchically is a promising method rapidly developing clinically meaningful resultant anticoagulation useful retrospective screening rate estimation.
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