1
|
Merali Z, Malhotra AK, Balas M, Lorello GR, Flexman A, Kiran T, Witiw CD. Gender-based differences in physician payments within the fee-for-service system in Ontario: a retrospective, cross-sectional study. CMAJ 2021; 193:E1584-E1591. [PMID: 34663601 PMCID: PMC8547248 DOI: 10.1503/cmaj.210437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Differences in physician income by gender have been described in numerous jurisdictions, but few studies have looked at a Canadian cohort with adjustment for confounders. In this study, we aimed to understand differences in fee-for-service payments to men and women physicians in Ontario. Methods: We conducted a cross-sectional analysis of all Ontario physicians who submitted claims to the Ontario Health Insurance Plan (OHIP) in 2017. For each physician, we gathered demographic information from the College of Physicians and Surgeons of Ontario registry. We compared differences in physician claims between men and women in the entire cohort and within each specialty using multivariable linear regressions, controlling for length of practice, specialty and practice location. Results: We identified a cohort of 30 167 physicians who submitted claims to OHIP in 2017, including 17 992 men and 12 175 women. When controlling for confounding variables in a linear mixed-effects regression model, annual physician claims were $93 930 (95% confidence interval $88 434 to $99 431) higher for men than for women. Women claimed 74% as much as men when adjusting for covariates. This discrepancy was present in nearly all specialty categories. Men claimed more than women throughout their careers, with the greatest gap 10–15 years into practice. Interpretation: We found a gender gap in fee-for-service claims in Ontario, with women claiming less than men overall and in nearly every specialty. Further work is required to understand the root causes of the gender pay gap.
Collapse
Affiliation(s)
- Zamir Merali
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Armaan K Malhotra
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Michael Balas
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Gianni R Lorello
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Alana Flexman
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Tara Kiran
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Christopher D Witiw
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont.
| |
Collapse
|
2
|
Diaz RL, Moss SJ, Amin KB, Harper AS, Henning JW, Logie N, Schulte F, McKillop SJ, Lang MJ, Fidler-Benaoudia MM. Data Resource Profile: The Alberta Adolescent and Young Adult Cancer Survivor Study. Int J Epidemiol 2021; 51:e55-e64. [PMID: 34635912 DOI: 10.1093/ije/dyab193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ruth L Diaz
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Stephana J Moss
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Khalid B Amin
- Department of Surveillance and Reporting, Cancer Research and Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB, Canada
| | - Andrew S Harper
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Jan-Willem Henning
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Natalie Logie
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Fiona Schulte
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Sarah J McKillop
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Michael J Lang
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Miranda M Fidler-Benaoudia
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
3
|
Quinn AE, Hemmelgarn BR, Tonelli M, McBrien KA, Edwards A, Senior P, Faris P, Au F, Ma Z, Weaver RG, Manns BJ. Association of Specialist Physician Payment Model With Visit Frequency, Quality, and Costs of Care for People With Chronic Disease. JAMA Netw Open 2019; 2:e1914861. [PMID: 31702800 PMCID: PMC6902778 DOI: 10.1001/jamanetworkopen.2019.14861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Specialist physicians are key members of chronic care management teams; to date, however, little is known about the association between specialist payment models and outcomes for patients with chronic diseases. OBJECTIVE To examine the association of payment model with visit frequency, quality of care, and costs for patients with chronic diseases seen by specialists. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using propensity-score matching in patients seen by a specialist physician was conducted between April 1, 2011, and September 31, 2014. The study was completed on March 31, 2015, and data analysis was conducted from June 2017 to February 2018 and finalized in August 2019. In a population-based design, 109 839 adults with diabetes or chronic kidney disease newly referred to specialists were included. Because patients seen by independent salary-based and fee-for-service (FFS) specialists were significantly different in observed baseline characteristics, patients were matched 1:1 on demographic, illness, and physician characteristics. EXPOSURES Specialist physician payment model (salary-based or FFS). MAIN OUTCOMES AND MEASURES Follow-up outpatient visits, guideline-recommended care delivery, adverse events, and costs. RESULTS A total of 90 605 patients received care from FFS physicians and 19 234 received care from salary-based physicians. Before matching, the patients seen by salary-based physicians had more advanced chronic kidney disease (2630 of 14 414 [18.2%] vs 6627 of 54 489 [12.2%]), and a higher proportion had 5 or more comorbidities (5989 of 19 234 [31.3%] vs 23 326 of 90 605 [25.7%]). Propensity-score matching resulted in a cohort of 31 898 patients (15 949 FFS, 15 949 salary-based) seeing 489 specialists. In the matched cohort, patients were similar (mean [SD] age, 61.3 [18.2] years; 17 632 women [55.3%]; 29 251 residing in urban settings [91.7%]). Patients seen by salary-based specialists had a higher follow-up visit rate compared with those seen by FFS specialists (1.74 visits; 95% CI, 1.58-1.92 visits vs 1.54 visits; 95% CI, 1.41-1.68 visits), but the difference was not significant (rate ratio, 1.13; 95% CI, 0.99-1.28; P = .06). There was no statistical difference in guideline-recommended care delivery, hospital or emergency department visits for ambulatory care-sensitive conditions, or costs between patients seeing FFS and salary-based specialists. The median association of physician clustering with health care use and quality outcomes was consistently greater than the association with the physician payment, suggesting variation between physicians (eg, median rate ratio for follow-up outpatient visit rate was 1.74, which is greater than the rate ratio of 1.13). CONCLUSIONS AND RELEVANCE Specialist physician payment does not appear to be associated with variation in visits, quality, and costs for outpatients with chronic diseases; however, there is variation in outcomes between physicians. This finding suggests the need to consider other strategies to reduce physician variation to improve the value of care and outcomes for people with chronic diseases.
Collapse
Affiliation(s)
- Amity E. Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R. Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kerry A. McBrien
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alun Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Peter Senior
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Flora Au
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zhihai Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert G. Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Braden J. Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
4
|
Quinn AE, Edwards A, Senior P, McBrien KA, Hemmelgarn BR, Tonelli M, Au F, Ma Z, Weaver RG, Manns BJ. The association between payment model and specialist physicians' selection of patients with diabetes: a descriptive study. CMAJ Open 2019; 7:E109-E116. [PMID: 30782774 PMCID: PMC6380900 DOI: 10.9778/cmajo.20180171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As the number of people with chronic diseases increases, understanding the impact of payment model on the types of patients seen by specialists has implications for improving the quality and value of care. We sought to determine if there is an association between specialist physician payment model and the types of patients seen. METHODS In this descriptive study, we used administrative data to compare demographic characteristics, illness severity and visit indication of patients with diabetes seen by fee-for-service and salary-based internal medicine and diabetes specialists in Calgary and Edmonton between April 2011 and September 2014. The study cohort included all newly referred adults with diabetes (no appointment with a specialist in prior 4 yr). Diabetes was identified using a validated algorithm that excludes gestational diabetes. RESULTS Patients managed by salary-based physicians (n = 2736) were sicker than those managed by fee-for-service physicians (n = 21 218). Patients managed by salary-based specialists were more likely to have 5 or more comorbidities (23.0% [n = 628] v. 18.1% [n = 3843]) and to have been admitted to hospital or seen in an emergency department for an ambulatory care sensitive condition in the year before their index visit, probably reflecting poorer disease control or barriers to optimal outpatient care. A higher proportion of visits to salary-based physicians were for appropriate indications (65.2% [n = 744] v. 55.6% [n = 5553]; risk ratio 1.17, 95% confidence interval 1.09-1.27). INTERPRETATION Salary-based specialists were more likely to see patients with a clear indication for a specialist visit, while fee-for-service specialists were more likely to see healthier patients. Future research is needed to determine if the differences in types of patients are attributable to payment model or other provider- or system-level factors.
Collapse
Affiliation(s)
- Amity E Quinn
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Alun Edwards
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Peter Senior
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Kerry A McBrien
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Brenda R Hemmelgarn
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Marcello Tonelli
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Flora Au
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Zhihai Ma
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Robert G Weaver
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Braden J Manns
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta.
| |
Collapse
|
5
|
Vasiliadis HM, Diallo FB, Rochette L, Smith M, Langille D, Lin E, Kisely S, Fombonne E, Thompson AH, Renaud J, Lesage A. Temporal Trends in the Prevalence and Incidence of Diagnosed ADHD in Children and Young Adults between 1999 and 2012 in Canada: A Data Linkage Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:818-826. [PMID: 28616934 PMCID: PMC5714116 DOI: 10.1177/0706743717714468] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There is a need for the routine monitoring of treated attention-deficit hyperactivity disorder (ADHD) for timely policy making. The objective is to report and assess over a decade the prevalence and incidence of diagnosed ADHD in Canada. METHODS Administrative linked patient data from the provinces of Manitoba, Ontario, Quebec, and Nova Scotia were obtained from the same sources as the Canadian Chronic Diseases Surveillance Systems to assess the prevalence and incidence of a primary physician diagnosis of ADHD ( ICD-9 and ICD-10 codes: 314, F90.x) for consultations in outpatient and inpatient settings (Med-Echo in Quebec, the Canadian Institute of Health Information Discharge Abstract Database in the 3 other provinces, plus the Ontario Mental Health Reporting System). Dates of service, diagnosis, and physician specialty were retained. The estimates were presented in yearly brackets between 1999-2000 and 2011-2012 by age and sex groups. RESULTS The prevalence of ADHD between 1999 and 2012 increased in all provinces and for all groups. The prevalence was approximately 3 times higher in boys than in girls, and the highest prevalence was observed in the 10- to 14-year age group. The incidence increased between 1999 and 2012 in Manitoba, Quebec, and Nova Scotia but remained stable in Ontario. Incident cases were more frequently diagnosed by general practitioners followed by either psychiatrists or paediatricians depending on the province. CONCLUSION The prevalence and incidence of diagnosed ADHD did not increase similarly across all provinces in Canada between 1999 and 2012. Over half of cases were diagnosed by a general practitioner.
Collapse
Affiliation(s)
- Helen-Maria Vasiliadis
- University of Sherbrooke, Faculty of Medicine and Health Sciences, Research Center–Hôpital Charles LeMoyne, Longueuil, Québec
| | - Fatoumata Binta Diallo
- Bureau d’information et d’études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec
| | | | - Mark Smith
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba
| | - Donald Langille
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Elizabeth Lin
- Department of Psychiatry, Centre for Addiction and Mental Health, Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario
| | - Steve Kisely
- School of Medicine, The University of Queensland, Queensland, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Eric Fombonne
- Oregon Health and Sciences University, Portland, Oregon
| | | | - Johanne Renaud
- Department of Psychiatry, CIUSSS Douglas Mental Health University Institute, McGill University, Montreal, Québec
| | - Alain Lesage
- Université de Montréal, Institut Universitaire de Santé Mentale Montréal, Montréal, Québec
| |
Collapse
|
6
|
Fathima S, Simmonds KA, Drews SJ, Svenson LW, Kwong JC, Mahmud SM, Quach S, Johnson C, Schwartz KL, Crowcroft NS, Russell ML. How well do ICD-9 physician claim diagnostic codes identify confirmed pertussis cases in Alberta, Canada? A Canadian Immunization Research Network (CIRN) Study. BMC Health Serv Res 2017; 17:479. [PMID: 28701222 PMCID: PMC5508611 DOI: 10.1186/s12913-017-2321-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/19/2017] [Indexed: 12/16/2022] Open
Abstract
Background Rates of Bordetella pertussis have been increasing in Alberta, Canada despite vaccination programs. Waning immunity from existing acellular component vaccines may be contributing to this. Vaccine effectiveness can be estimated using a variety of data sources including diagnostic codes from physician billing claims, public health records, reportable disease and laboratory databases. We sought to determine if diagnostic codes from billing claims (administrative data) are adequately sensitive and specific to identify pertussis cases among patients who had undergone disease-specific laboratory testing. Methods Data were extracted for 2004–2014 from a public health communicable disease database that contained data on patients under investigation for B. pertussis (both those who had laboratory tests and those who were epidemiologically linked to laboratory-confirmed cases) in Alberta, Canada. These were deterministically linked using a unique lifetime person identifier to the provincial billing claims database, which contains International Classification of Disease version 9 (ICD-9) diagnostic codes for physician visits. We examined visits within 90 days of laboratory testing. ICD-9 codes 033 (whooping cough), 033.0 (Bordetella pertussis), 033.1 (B. parapertussis), 033.8 (whooping cough, other specified organism), and 033.9 (whooping cough, other unspecified organism) in any of the three diagnostic fields for a claim were classified as being pertussis-specific codes. We calculated sensitivity, specificity, positive (PPV) and negative (NPV) predictive values. Results We identified 22,883 unique patients under investigation for B. pertussis. Of these, 22,095 underwent laboratory testing. Among those who had a laboratory test, 2360 tested positive for pertussis. The sensitivity of a pertussis-specific ICD-9 code for identifying a laboratory-confirmed case was 38.6%, specificity was 76.9%, PPV was 16.0%, and NPV was 91.6%. Conclusion ICD-9 codes from physician billing claims data have low sensitivity and moderate specificity to identify laboratory-confirmed pertussis among persons tested for pertussis. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2321-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sumana Fathima
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kimberley A Simmonds
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Steven J Drews
- Provincial Laboratory (ProvLab) for Public Health, Edmonton, Alberta, Canada.,University of Alberta, Edmonton, Alberta, Canada
| | - Lawrence W Svenson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Ministry of Health, Edmonton, Alberta, Canada.,University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey C Kwong
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Kevin L Schwartz
- The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Natasha S Crowcroft
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| | - Margaret L Russell
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Community Health Sciences, University of Calgary, 3rd Floor TRW, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | | |
Collapse
|