Validity of incident opioid use disorder (OUD) diagnoses in administrative data: a chart verification study.
Open accessAbstract
Background An important strategy to address the opioid overdose epidemic involves identifying people at elevated risk of overdose, particularly those with opioid use disorder (OUD). However, it is unclear to what degree OUD diagnoses in administrative data are inaccurate.Objective To estimate the prevalence of inaccurate diagnoses of OUD among patients with incident OUD diagnoses.Subjects A random sample of 90 patients with incident OUD diagnoses associated with an index in-person encounter between October 1, 2016, and June 1, 2018, in three Veterans Health Administration medical centers.Design Direct chart review of all encounter notes, referrals, prescriptions, and laboratory values within a 120-day window before and after the index encounter. Using all available chart data, we determined whether the diagnosis of OUD was likely accurate, likely inaccurate, or of indeterminate accuracy. We then performed a bivariate analysis to assess demographic or clinical characteristics associated with likely inaccurate diagnoses.Key results We identified 1337 veterans with incident OUD diagnoses. In the chart verification subsample, we assessed 26 (29%) OUD diagnoses as likely inaccurate; 20 due to systems error and 6 due to clinical error; additionally, 8 had insufficient information to determine accuracy. Veterans with likely inaccurate diagnoses were more likely to be younger and prescribed opioids for pain. Clinical settings associated with likely inaccurate diagnoses were non-mental health clinical settings, group visits, and non-patient care settings.Conclusions Our study identified significant levels of likely inaccurate OUD diagnoses among veterans with incident OUD diagnoses. The majority of these cases reflected readily addressable systems errors. The smaller proportion due to clinical errors and those with insufficient documentation may be addressed by increased training for clinicians. If these inaccuracies are prevalent throughout the VHA, they could complicate health services research and health systems responses.
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Administrative records may inaccurately capture SUDs.
“Administrative records may inaccurately capture SUDs.12”
From Medical Costs of Substance Use Disorders in the US Employer-Sponsored Insurance Population (2023) · cites this paper as [12]
The study relied on ICD-10-CM codes to capture SUD identified during the hospital encounter, and administrative records can inaccurately capture SUD.
“This study relied on ICD-10-CM codes to capture SUD identified during the hospital encounter; however, administrative records can inaccurately capture SUD.18”
From Assessment of Annual Cost of Substance Use Disorder in US Hospitals (2021) · cites this paper as [18]
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- Authors
- Howell, B. A., Abel, E. A., Park, D., Edmond, S. N., Leisch, L. J., & Becker, W. C.
- Affiliations
- Yale University (US)
- Boston University (US)
- Corresponding author
- Howell, Benjamin A.
- Venue
- Journal of General Internal Medicine
- Published
- 2020-11-11
- Volume
- 36
- Issue
- 5
- Pages
- 1264-1270
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC8131432
- OpenAlex
- W3105791171
- Cited by
- 75
- References
- 32
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 14 · 2023: 20 · 2022: 14 · 2021: 8
- FWCI
- 7.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Quality Enhancement Research Initiative (QUE PII 18-180)
- National Institute on Drug Abuse (5K12DA033312)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- opioid use disorder, diagnostic accuracy, administrative data validity, medical records review, veterans, opioid overdose epidemic, medical errors, Veterans Health Administration
- MeSH terms
- Analgesics, Opioid, Humans, Opioid-Related Disorders, Pain, Veterans, Drug Overdose
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