Identifying musculoskeletal conditions in electronic medical records: A prevalence and validation study using the Deliver Primary Healthcare Information (DELPHI) database

Abstract

Background: Musculoskeletal (MSK) conditions are a common presentation in primary care. This study sought to determine the prevalence of MSK conditions in primary care in Ontario and to validate the extent to which health administrative date billing codes accurately represent MSK diagnoses. Methods: De-identified electronic medical records (EMR) from the DELPHI database in southwestern Ontario, which contains 2493 patients (55.6% female, mean age 50.3 years (SD = 22.2)) and 21,964 encounters (July 1, 2006-June 30, 2010) were used for the analyses. Outcomes included: validation measures of agreement between International Classification of Diseases (ICD-9) diagnostic codes (health administrative data) and International Classification of Primary Care (ICPC) diagnoses defined as the reference standard, time to first ICD-9 code, prevalence, and healthcare utilization. Results: There were 2940 true positive MSK encounters with primary care practitioners for 998 patients. Performance of the ICD-9 diagnostic codes included sensitivity = 76.5%, specificity = 95.2%, PPV = 94.6%, and NPV = 78.7%, compared to the ICPC reference standard. The majority of 998 patients were coded with both an ICPC and ICD-9 MSK code at their first or second encounter (67.4%). However, 23.5% of patients with the ICPC reference standard MSK were never coded with ICD-9. Four-year prevalence of MSK was 52.3% and varied by age (4.5% 0-17 years, 20.1% 18-44, 42.7% 45-64, and 32.7% 65+). Patients at MSK encounters had a higher number of: investigations (17.9% compared to 9.1%, p