Validation of the ICD-9 Diagnostic Code for Palliative Care in Patients Hospitalized With Heart Failure Within the Veterans Health Administration

Shelli L. Feder, Nancy S. Redeker, Sangchoon Jeon, Dena Schulman-Green, Julie A. Womack, Janet P. Tate, Roger J. Bedimo, Matthew J. Budoff, Adeel A. Butt, Kristina Crothers, Kathleen M. Akgün

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Patients with heart failure (HF) are at increased risk of unmet palliative care needs. The International Classification of Diseases, Ninth Revision (ICD-9) code, V66.7, can identify palliative care services. However, code validity for specialist palliative care in the Veterans Health Administration (VHA) has not been determined. Objective: To validate the ICD-9 code for specialist palliative care and determine common reasons for specialist palliative care consultation among VHA patients hospitalized with HF. Design: Electronic health record review of data from the Veterans Aging Cohort Study. Setting/Participants: The sample included 100 patients hospitalized with HF from 2003 to 2012. Measurements: Data from 50 patients with V66.7 were matched by age, race, site of care, hospital length of stay, intensive care unit admission, and fiscal year of study discharge to 50 patients with HF without V66.7 who had died within a year of hospitalization. We calculated positive and negative predictive values (PPV, NPV), sensitivity, and specificity. Results: All patients included in the sample were male, 66% black ethnicity, and mean age = 65 years (standard deviations [SD] ± 10.5 for cases; SD ± 9.8 for matches). Specialist palliative care was documented for 49 of 50 patients with V66.7 (PPV = 98%, 95% confidence interval [CI]: 88-99) and 9 of 50 patients without the code (NPV = 82%, 95% CI: 68-91). Sensitivity was 84% (95% CI: 72-92), and specificity was 98% (95% CI: 86-99). Establishing goals of care was the most frequent reason for palliative care consultation (43% of the sample). Conclusion: The ICD-9 code V66.7 identifies specialist palliative care for hospitalized patients with HF in the VHA. Replication of findings in other data sources and populations is needed.

Original languageEnglish (US)
Pages (from-to)959-965
Number of pages7
JournalAmerican Journal of Hospice and Palliative Medicine
Volume35
Issue number7
DOIs
StatePublished - Jul 1 2018

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Veterans Health
United States Department of Veterans Affairs
International Classification of Diseases
Palliative Care
Heart Failure
Confidence Intervals
Length of Stay
Referral and Consultation
Patient Care Planning
Electronic Health Records
Information Storage and Retrieval
Veterans
Intensive Care Units
Hospitalization
Cohort Studies
Sensitivity and Specificity

Keywords

  • heart failure
  • hospice
  • hospitalization
  • International Classification of Diseases
  • Ninth Revision (ICD-9) code
  • palliative care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Validation of the ICD-9 Diagnostic Code for Palliative Care in Patients Hospitalized With Heart Failure Within the Veterans Health Administration. / Feder, Shelli L.; Redeker, Nancy S.; Jeon, Sangchoon; Schulman-Green, Dena; Womack, Julie A.; Tate, Janet P.; Bedimo, Roger J.; Budoff, Matthew J.; Butt, Adeel A.; Crothers, Kristina; Akgün, Kathleen M.

In: American Journal of Hospice and Palliative Medicine, Vol. 35, No. 7, 01.07.2018, p. 959-965.

Research output: Contribution to journalArticle

Feder, Shelli L. ; Redeker, Nancy S. ; Jeon, Sangchoon ; Schulman-Green, Dena ; Womack, Julie A. ; Tate, Janet P. ; Bedimo, Roger J. ; Budoff, Matthew J. ; Butt, Adeel A. ; Crothers, Kristina ; Akgün, Kathleen M. / Validation of the ICD-9 Diagnostic Code for Palliative Care in Patients Hospitalized With Heart Failure Within the Veterans Health Administration. In: American Journal of Hospice and Palliative Medicine. 2018 ; Vol. 35, No. 7. pp. 959-965.
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abstract = "Background: Patients with heart failure (HF) are at increased risk of unmet palliative care needs. The International Classification of Diseases, Ninth Revision (ICD-9) code, V66.7, can identify palliative care services. However, code validity for specialist palliative care in the Veterans Health Administration (VHA) has not been determined. Objective: To validate the ICD-9 code for specialist palliative care and determine common reasons for specialist palliative care consultation among VHA patients hospitalized with HF. Design: Electronic health record review of data from the Veterans Aging Cohort Study. Setting/Participants: The sample included 100 patients hospitalized with HF from 2003 to 2012. Measurements: Data from 50 patients with V66.7 were matched by age, race, site of care, hospital length of stay, intensive care unit admission, and fiscal year of study discharge to 50 patients with HF without V66.7 who had died within a year of hospitalization. We calculated positive and negative predictive values (PPV, NPV), sensitivity, and specificity. Results: All patients included in the sample were male, 66{\%} black ethnicity, and mean age = 65 years (standard deviations [SD] ± 10.5 for cases; SD ± 9.8 for matches). Specialist palliative care was documented for 49 of 50 patients with V66.7 (PPV = 98{\%}, 95{\%} confidence interval [CI]: 88-99) and 9 of 50 patients without the code (NPV = 82{\%}, 95{\%} CI: 68-91). Sensitivity was 84{\%} (95{\%} CI: 72-92), and specificity was 98{\%} (95{\%} CI: 86-99). Establishing goals of care was the most frequent reason for palliative care consultation (43{\%} of the sample). Conclusion: The ICD-9 code V66.7 identifies specialist palliative care for hospitalized patients with HF in the VHA. Replication of findings in other data sources and populations is needed.",
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AU - Schulman-Green, Dena

AU - Womack, Julie A.

AU - Tate, Janet P.

AU - Bedimo, Roger J.

AU - Budoff, Matthew J.

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