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Evaluation of Administrative Data for Identifying Maternal Opioid Use at Delivery in Florida
Objectives Studies have shown significant increases in the prevalence of maternal opioid use. Most prevalence estimates are based on unverified ICD-10-CM diagnoses. This study determined the accuracy of ICD-10-CM opioid-related diagnosis codes documented during delivery and examined potential associ...
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| Published in: | Maternal and child health journal 2023-12, Vol.27 (Suppl 1), p.44-51 |
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| container_end_page | 51 |
| container_issue | Suppl 1 |
| container_start_page | 44 |
| container_title | Maternal and child health journal |
| container_volume | 27 |
| creator | Elmore, Amanda L. Salemi, Jason L. Kirby, Russell S. Sappenfield, William M. Lowry, Joseph Dixon, Ashley Lake-Burger, Heather Tanner, Jean Paul |
| description | Objectives
Studies have shown significant increases in the prevalence of maternal opioid use. Most prevalence estimates are based on unverified ICD-10-CM diagnoses. This study determined the accuracy of ICD-10-CM opioid-related diagnosis codes documented during delivery and examined potential associations between maternal/hospital characteristics and diagnosis with an opioid-related code.
Methods
To identify people with prenatal opioid use, we identified a sample of infants born during 2017–2018 in Florida with a NAS related diagnosis code (P96.1) and confirmatory NAS characteristics (N = 460). Delivery records were scanned for opioid-related diagnoses and prenatal opioid use was confirmed through record review. The accuracy of each opioid-related code was measured using positive predictive value (PPV) and sensitivity. Modified Poisson regression was used to calculate adjusted relative risks (aRR) and 95% confidence intervals (CI).
Results
We found the PPV was nearly 100% for all ICD-10-CM opioid-related codes (98.5–100%) and the sensitivity was 65.9%. Non-Hispanic Black mothers were 1.8 times more likely than non-Hispanic white mothers to have a missed opioid-related diagnosis at delivery (aRR:1.80, CI 1.14–2.84). Mothers who delivered at a teaching status hospital were less likely to have a missed opioid-related diagnosis (p |
| doi_str_mv | 10.1007/s10995-023-03669-6 |
| format | article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10692249</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A775208690</galeid><sourcerecordid>A775208690</sourcerecordid><originalsourceid>FETCH-LOGICAL-c611t-b7e84554c57cf245e1702310f244bee1a5f30cc757f40bf2698f9d968db620823</originalsourceid><addsrcrecordid>eNp9kl9vFCEUxSdGY2v1C_hgSEwaX6YCM8DwZDb9o01q-mLfTAgzc5mlYWGFmU3228u4te2ajeEBAr9zuBxuUbwn-IxgLD4ngqVkJaZViSvOZclfFMeEiarknDYv8xpLWopGsKPiTUr3GGcZrl8XR5UgUjZMHBc_LzfaTXq0waNg0KJfWW_TGPPOBtCFHjUyIaLrHvxozdb6AX3XI0SvHbpd22B7dJcA6RFdgMuSuEXWoysXou312-KV0S7Bu4f5pLi7uvxx_q28uf16fb64KTtOyFi2ApqasbpjojO0ZkBEfhPBeV23AEQzU-GuE0yYGreGctkY2Uve9C2nuKHVSfFl57ue2hX0Xa41aqfW0a503Kqgrdo_8XaphrBRBHNJaS2zw6cHhxh-TZBGtbKpA-e0hzAlRRvCKMNVwzP68R_0PkxzHjMlOZa8qusnatAOlPUm5Iu72VQthGC5bC5xpsoD1AAecpXBg7F5e48_O8Dn0cPKdgcFp88ES9BuXKbgpvm_0z5Id2AXQ0oRzGN6BKu529Su21T-GfWn29QcxYfnuT9K_rZXBqodkPKRHyA-ZfUf29-Kid0L</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2896096344</pqid></control><display><type>article</type><title>Evaluation of Administrative Data for Identifying Maternal Opioid Use at Delivery in Florida</title><source>Springer Link</source><creator>Elmore, Amanda L. ; Salemi, Jason L. ; Kirby, Russell S. ; Sappenfield, William M. ; Lowry, Joseph ; Dixon, Ashley ; Lake-Burger, Heather ; Tanner, Jean Paul</creator><creatorcontrib>Elmore, Amanda L. ; Salemi, Jason L. ; Kirby, Russell S. ; Sappenfield, William M. ; Lowry, Joseph ; Dixon, Ashley ; Lake-Burger, Heather ; Tanner, Jean Paul</creatorcontrib><description>Objectives
Studies have shown significant increases in the prevalence of maternal opioid use. Most prevalence estimates are based on unverified ICD-10-CM diagnoses. This study determined the accuracy of ICD-10-CM opioid-related diagnosis codes documented during delivery and examined potential associations between maternal/hospital characteristics and diagnosis with an opioid-related code.
Methods
To identify people with prenatal opioid use, we identified a sample of infants born during 2017–2018 in Florida with a NAS related diagnosis code (P96.1) and confirmatory NAS characteristics (N = 460). Delivery records were scanned for opioid-related diagnoses and prenatal opioid use was confirmed through record review. The accuracy of each opioid-related code was measured using positive predictive value (PPV) and sensitivity. Modified Poisson regression was used to calculate adjusted relative risks (aRR) and 95% confidence intervals (CI).
Results
We found the PPV was nearly 100% for all ICD-10-CM opioid-related codes (98.5–100%) and the sensitivity was 65.9%. Non-Hispanic Black mothers were 1.8 times more likely than non-Hispanic white mothers to have a missed opioid-related diagnosis at delivery (aRR:1.80, CI 1.14–2.84). Mothers who delivered at a teaching status hospital were less likely to have a missed opioid-related diagnosis (p < 0.05).
Conclusions for Practice
We observed high accuracy of maternal opioid-related diagnosis codes at delivery. However, our findings suggest that over 30% of mothers with opioid use may not be diagnosed with an opioid-related code at delivery, although their infant had a confirmed NAS diagnosis. This study provides information on the utility and accuracy of ICD-10-CM opioid-related codes at delivery among mothers of infants with NAS.
Significance
From 2010 to 2017, maternal opioid-related diagnoses at delivery increased by 100% in the US. Most prevalence estimates are based on unverified ICD-10-CM diagnosis codes. Evaluations of maternal opioid-related diagnoses at delivery are extremely limited but essential for utilizing prevalence estimates generated from administrative data.</description><identifier>ISSN: 1092-7875</identifier><identifier>EISSN: 1573-6628</identifier><identifier>DOI: 10.1007/s10995-023-03669-6</identifier><identifier>PMID: 37199857</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Accuracy ; Analgesics, Opioid - adverse effects ; Babies ; Birth defects ; Brief Report ; Childrens health ; Codes ; Drug abuse in pregnancy ; Ethnicity ; Evaluation ; Female ; Florida - epidemiology ; Gynecology ; Health surveillance ; Hispanic people ; Hospitals ; Humans ; Infant ; Infant, Newborn ; Infants ; Maternal & child health ; Maternal and Child Health ; Medical records ; Medicine ; Medicine & Public Health ; Mothers ; Narcotics ; Neonatal abstinence syndrome ; Neonatal Abstinence Syndrome - diagnosis ; Opioid-Related Disorders - diagnosis ; Opioid-Related Disorders - epidemiology ; Pediatrics ; Population Economics ; Pregnancy ; Prenatal care ; Prescription drugs ; Public Health ; Sociology ; Substance use disorder</subject><ispartof>Maternal and child health journal, 2023-12, Vol.27 (Suppl 1), p.44-51</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>COPYRIGHT 2023 Springer</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c611t-b7e84554c57cf245e1702310f244bee1a5f30cc757f40bf2698f9d968db620823</citedby><cites>FETCH-LOGICAL-c611t-b7e84554c57cf245e1702310f244bee1a5f30cc757f40bf2698f9d968db620823</cites><orcidid>0000-0003-3316-2797</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37199857$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Elmore, Amanda L.</creatorcontrib><creatorcontrib>Salemi, Jason L.</creatorcontrib><creatorcontrib>Kirby, Russell S.</creatorcontrib><creatorcontrib>Sappenfield, William M.</creatorcontrib><creatorcontrib>Lowry, Joseph</creatorcontrib><creatorcontrib>Dixon, Ashley</creatorcontrib><creatorcontrib>Lake-Burger, Heather</creatorcontrib><creatorcontrib>Tanner, Jean Paul</creatorcontrib><title>Evaluation of Administrative Data for Identifying Maternal Opioid Use at Delivery in Florida</title><title>Maternal and child health journal</title><addtitle>Matern Child Health J</addtitle><addtitle>Matern Child Health J</addtitle><description>Objectives
Studies have shown significant increases in the prevalence of maternal opioid use. Most prevalence estimates are based on unverified ICD-10-CM diagnoses. This study determined the accuracy of ICD-10-CM opioid-related diagnosis codes documented during delivery and examined potential associations between maternal/hospital characteristics and diagnosis with an opioid-related code.
Methods
To identify people with prenatal opioid use, we identified a sample of infants born during 2017–2018 in Florida with a NAS related diagnosis code (P96.1) and confirmatory NAS characteristics (N = 460). Delivery records were scanned for opioid-related diagnoses and prenatal opioid use was confirmed through record review. The accuracy of each opioid-related code was measured using positive predictive value (PPV) and sensitivity. Modified Poisson regression was used to calculate adjusted relative risks (aRR) and 95% confidence intervals (CI).
Results
We found the PPV was nearly 100% for all ICD-10-CM opioid-related codes (98.5–100%) and the sensitivity was 65.9%. Non-Hispanic Black mothers were 1.8 times more likely than non-Hispanic white mothers to have a missed opioid-related diagnosis at delivery (aRR:1.80, CI 1.14–2.84). Mothers who delivered at a teaching status hospital were less likely to have a missed opioid-related diagnosis (p < 0.05).
Conclusions for Practice
We observed high accuracy of maternal opioid-related diagnosis codes at delivery. However, our findings suggest that over 30% of mothers with opioid use may not be diagnosed with an opioid-related code at delivery, although their infant had a confirmed NAS diagnosis. This study provides information on the utility and accuracy of ICD-10-CM opioid-related codes at delivery among mothers of infants with NAS.
Significance
From 2010 to 2017, maternal opioid-related diagnoses at delivery increased by 100% in the US. Most prevalence estimates are based on unverified ICD-10-CM diagnosis codes. Evaluations of maternal opioid-related diagnoses at delivery are extremely limited but essential for utilizing prevalence estimates generated from administrative data.</description><subject>Accuracy</subject><subject>Analgesics, Opioid - adverse effects</subject><subject>Babies</subject><subject>Birth defects</subject><subject>Brief Report</subject><subject>Childrens health</subject><subject>Codes</subject><subject>Drug abuse in pregnancy</subject><subject>Ethnicity</subject><subject>Evaluation</subject><subject>Female</subject><subject>Florida - epidemiology</subject><subject>Gynecology</subject><subject>Health surveillance</subject><subject>Hispanic people</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infants</subject><subject>Maternal & child health</subject><subject>Maternal and Child Health</subject><subject>Medical records</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mothers</subject><subject>Narcotics</subject><subject>Neonatal abstinence syndrome</subject><subject>Neonatal Abstinence Syndrome - diagnosis</subject><subject>Opioid-Related Disorders - diagnosis</subject><subject>Opioid-Related Disorders - epidemiology</subject><subject>Pediatrics</subject><subject>Population Economics</subject><subject>Pregnancy</subject><subject>Prenatal care</subject><subject>Prescription drugs</subject><subject>Public Health</subject><subject>Sociology</subject><subject>Substance use disorder</subject><issn>1092-7875</issn><issn>1573-6628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kl9vFCEUxSdGY2v1C_hgSEwaX6YCM8DwZDb9o01q-mLfTAgzc5mlYWGFmU3228u4te2ajeEBAr9zuBxuUbwn-IxgLD4ngqVkJaZViSvOZclfFMeEiarknDYv8xpLWopGsKPiTUr3GGcZrl8XR5UgUjZMHBc_LzfaTXq0waNg0KJfWW_TGPPOBtCFHjUyIaLrHvxozdb6AX3XI0SvHbpd22B7dJcA6RFdgMuSuEXWoysXou312-KV0S7Bu4f5pLi7uvxx_q28uf16fb64KTtOyFi2ApqasbpjojO0ZkBEfhPBeV23AEQzU-GuE0yYGreGctkY2Uve9C2nuKHVSfFl57ue2hX0Xa41aqfW0a503Kqgrdo_8XaphrBRBHNJaS2zw6cHhxh-TZBGtbKpA-e0hzAlRRvCKMNVwzP68R_0PkxzHjMlOZa8qusnatAOlPUm5Iu72VQthGC5bC5xpsoD1AAecpXBg7F5e48_O8Dn0cPKdgcFp88ES9BuXKbgpvm_0z5Id2AXQ0oRzGN6BKu529Su21T-GfWn29QcxYfnuT9K_rZXBqodkPKRHyA-ZfUf29-Kid0L</recordid><startdate>20231201</startdate><enddate>20231201</enddate><creator>Elmore, Amanda L.</creator><creator>Salemi, Jason L.</creator><creator>Kirby, Russell S.</creator><creator>Sappenfield, William M.</creator><creator>Lowry, Joseph</creator><creator>Dixon, Ashley</creator><creator>Lake-Burger, Heather</creator><creator>Tanner, Jean Paul</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3316-2797</orcidid></search><sort><creationdate>20231201</creationdate><title>Evaluation of Administrative Data for Identifying Maternal Opioid Use at Delivery in Florida</title><author>Elmore, Amanda L. ; Salemi, Jason L. ; Kirby, Russell S. ; Sappenfield, William M. ; Lowry, Joseph ; Dixon, Ashley ; Lake-Burger, Heather ; Tanner, Jean Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c611t-b7e84554c57cf245e1702310f244bee1a5f30cc757f40bf2698f9d968db620823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Accuracy</topic><topic>Analgesics, Opioid - adverse effects</topic><topic>Babies</topic><topic>Birth defects</topic><topic>Brief Report</topic><topic>Childrens health</topic><topic>Codes</topic><topic>Drug abuse in pregnancy</topic><topic>Ethnicity</topic><topic>Evaluation</topic><topic>Female</topic><topic>Florida - epidemiology</topic><topic>Gynecology</topic><topic>Health surveillance</topic><topic>Hispanic people</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infants</topic><topic>Maternal & child health</topic><topic>Maternal and Child Health</topic><topic>Medical records</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mothers</topic><topic>Narcotics</topic><topic>Neonatal abstinence syndrome</topic><topic>Neonatal Abstinence Syndrome - diagnosis</topic><topic>Opioid-Related Disorders - diagnosis</topic><topic>Opioid-Related Disorders - epidemiology</topic><topic>Pediatrics</topic><topic>Population Economics</topic><topic>Pregnancy</topic><topic>Prenatal care</topic><topic>Prescription drugs</topic><topic>Public Health</topic><topic>Sociology</topic><topic>Substance use disorder</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Elmore, Amanda L.</creatorcontrib><creatorcontrib>Salemi, Jason L.</creatorcontrib><creatorcontrib>Kirby, Russell S.</creatorcontrib><creatorcontrib>Sappenfield, William M.</creatorcontrib><creatorcontrib>Lowry, Joseph</creatorcontrib><creatorcontrib>Dixon, Ashley</creatorcontrib><creatorcontrib>Lake-Burger, Heather</creatorcontrib><creatorcontrib>Tanner, Jean Paul</creatorcontrib><collection>SpringerOpen</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Maternal and child health journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Elmore, Amanda L.</au><au>Salemi, Jason L.</au><au>Kirby, Russell S.</au><au>Sappenfield, William M.</au><au>Lowry, Joseph</au><au>Dixon, Ashley</au><au>Lake-Burger, Heather</au><au>Tanner, Jean Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of Administrative Data for Identifying Maternal Opioid Use at Delivery in Florida</atitle><jtitle>Maternal and child health journal</jtitle><stitle>Matern Child Health J</stitle><addtitle>Matern Child Health J</addtitle><date>2023-12-01</date><risdate>2023</risdate><volume>27</volume><issue>Suppl 1</issue><spage>44</spage><epage>51</epage><pages>44-51</pages><issn>1092-7875</issn><eissn>1573-6628</eissn><abstract>Objectives
Studies have shown significant increases in the prevalence of maternal opioid use. Most prevalence estimates are based on unverified ICD-10-CM diagnoses. This study determined the accuracy of ICD-10-CM opioid-related diagnosis codes documented during delivery and examined potential associations between maternal/hospital characteristics and diagnosis with an opioid-related code.
Methods
To identify people with prenatal opioid use, we identified a sample of infants born during 2017–2018 in Florida with a NAS related diagnosis code (P96.1) and confirmatory NAS characteristics (N = 460). Delivery records were scanned for opioid-related diagnoses and prenatal opioid use was confirmed through record review. The accuracy of each opioid-related code was measured using positive predictive value (PPV) and sensitivity. Modified Poisson regression was used to calculate adjusted relative risks (aRR) and 95% confidence intervals (CI).
Results
We found the PPV was nearly 100% for all ICD-10-CM opioid-related codes (98.5–100%) and the sensitivity was 65.9%. Non-Hispanic Black mothers were 1.8 times more likely than non-Hispanic white mothers to have a missed opioid-related diagnosis at delivery (aRR:1.80, CI 1.14–2.84). Mothers who delivered at a teaching status hospital were less likely to have a missed opioid-related diagnosis (p < 0.05).
Conclusions for Practice
We observed high accuracy of maternal opioid-related diagnosis codes at delivery. However, our findings suggest that over 30% of mothers with opioid use may not be diagnosed with an opioid-related code at delivery, although their infant had a confirmed NAS diagnosis. This study provides information on the utility and accuracy of ICD-10-CM opioid-related codes at delivery among mothers of infants with NAS.
Significance
From 2010 to 2017, maternal opioid-related diagnoses at delivery increased by 100% in the US. Most prevalence estimates are based on unverified ICD-10-CM diagnosis codes. Evaluations of maternal opioid-related diagnoses at delivery are extremely limited but essential for utilizing prevalence estimates generated from administrative data.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37199857</pmid><doi>10.1007/s10995-023-03669-6</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-3316-2797</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Accuracy Analgesics, Opioid - adverse effects Babies Birth defects Brief Report Childrens health Codes Drug abuse in pregnancy Ethnicity Evaluation Female Florida - epidemiology Gynecology Health surveillance Hispanic people Hospitals Humans Infant Infant, Newborn Infants Maternal & child health Maternal and Child Health Medical records Medicine Medicine & Public Health Mothers Narcotics Neonatal abstinence syndrome Neonatal Abstinence Syndrome - diagnosis Opioid-Related Disorders - diagnosis Opioid-Related Disorders - epidemiology Pediatrics Population Economics Pregnancy Prenatal care Prescription drugs Public Health Sociology Substance use disorder |
| title | Evaluation of Administrative Data for Identifying Maternal Opioid Use at Delivery in Florida |
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