Identification of Pediatric Autism Spectrum Disorder Cases Using Health Administrative Data.
Billing codes alone mislabel kids, so always confirm autism status with ADOS or ADI-R.
01Research in Context
What this study did
Lotfizadeh et al. (2020) tested whether billing and hospital codes alone can spot autism. They compared the codes to gold-standard ADOS or ADI-R results in kids.
The team wanted to know if administrative data is good enough for research or service planning without extra checks.
What they found
The codes had high positive predictive value but still misclassified many kids. Other developmental disorders were often labeled as autism.
Overall accuracy was too low to trust the codes by themselves.
How this fits with other research
Avchen et al. (2011) saw the same pattern: records-review missed about 40 % of true cases. Both studies warn that high specificity or PPV alone is not enough.
Worsham et al. (2015) found high agreement when Utah used both school and health records. Adding education data fixed the problem D et al. saw with billing codes alone.
Stadnick et al. (2015) showed community clinics can run ADOS well. Their result supports the fix D et al. recommend: always check codes against gold-standard tools.
Why it matters
If you build caseloads from insurance lists, you risk wrong labels and wasted hours. Pair every administrative flag with an ADOS or ADI-R before you write the treatment plan. Your funding stream and the child’s services depend on it.
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02At a glance
03Original abstract
Administrative data are frequently used to identify Autism Spectrum Disorder (ASD) cases in epidemiological studies. However, validation studies on this mode of case ascertainment have lacked access to high-quality clinical diagnostic data and have not followed published reporting guidelines. We report on the diagnostic accuracy of using readily available health administrative data for pediatric ASD case ascertainment. The validation cohort included almost all the ASD-positive children born in British Columbia, Canada from April 1, 2000 to December 31, 2009 and consisted of 8,670 children in total. 4,079 ASD-positive and 2,787 ASD-negative children were identified using Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R) assessments done through the British Columbia Autism Assessment Network (BCAAN). An additional 1,804 ADOS/ADI-R assessed ASD-positive children were identified using Ministry of Education records. This prospectively collected clinical data (the diagnostic gold standard) was then linked to each child's physician billing and hospital discharge data. The diagnostic accuracy of 11 algorithms that used the administrative data to assign ASD case status was assessed. For all algorithms, high positive predictive values (PPVs) were observed alongside low values for other measures of diagnostic accuracy illustrating that PPVs alone are not an adequate measure of diagnostic accuracy. We show that British Columbia's health administrative data cannot reliably be used to discriminate between children with ASD and children with other developmental disorders. Utilizing these data may result in misclassification bias. Methodologically sound, region-specific validation studies are needed to support the use of administrative data for ASD case ascertainment. Autism Res 2020, 13: 456-463. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Health administrative data are frequently used to identify Autism Spectrum Disorder (ASD) cases for research purposes. However, previous validation studies on this sort of case identification have lacked access to high-quality clinical diagnostic data and have not followed published reporting guidelines. We show that British Columbia's health administrative data cannot reliably be used to discriminate between children with ASD and children with other developmental disorders.
Autism research : official journal of the International Society for Autism Research, 2020 · doi:10.1002/aur.2252