Validation of diagnostic codes of major clinical outcomes in a National Health Insurance database

Background and objectives The Korean National Health Insurance Service (NHIS) database has been widely used for cardiovascular research. We validated the primary diagnostic codes of major clinical outcomes, including acute myocardial infarction (AMI), gastrointestinal bleeding (GIB), stroke, and intracranial hemorrhage (ICH) used for Korea NHIS claims. Subjects and methods From 2016 to 2017, 800 patients with primary diagnostic codes of AMI, GIB, stroke, or ICH at discharge were randomly selected from a single tertiary medical center in Korea (200 patients per each diagnosis). The positive predictive value (PPV), sensitivity, and specificity of the primary diagnostic codes were calculated using hospital medical record review as the gold standard. Further improvement in the diagnostic validity of the codes was assessed by combining clinical information such as duration of hospitalization, blood transfusion, brain imaging studies, or prescription records of antithrombotic agents. Results Among 200 patients with AMI as the primary discharge diagnosis, 184 patients were clinically confirmed (PPV of 92.0%). For GIB, 184 (92.0%) patients with the primary discharge diagnosis were verified to have true GIB events, showing PPV of 92%. For stroke, 181 (90.5%) patients were clinically confirmed with true stroke events. For ICH, 143 (71.5%) patients were verified to be true ICH events. In stroke and ICH, the PPV and specificity improved after combining with the hospitalization duration, imaging studies, and prescription of antithrombotic agents. Conclusions For major clinical outcomes in the NHIS database, the primary diagnostic codes showed favorable reliability. For stroke and ICH, considerations of relevant clinical information could improve the accuracy of diagnosis.