Validity of physician billing claims to identify deceased organ donors in large healthcare databases

Abstract

Objective: We evaluated the validity of physician billing claims to identify deceased organ donors in large provincial healthcare databases.

Methods: We conducted a population-based retrospective validation study of all deceased donors in Ontario, Canada from 2006 to 2011 (n = 988). We included all registered deaths during the same period (n = 458,074). Our main outcome measures included sensitivity, specificity, positive predictive value, and negative predictive value of various algorithms consisting of physician billing claims to identify deceased organ donors and organ-specific donors compared to a reference standard of medical chart abstraction.

Results: The best performing algorithm consisted of any one of 10 different physician billing claims. This algorithm had a sensitivity of 75.4% (95% CI: 72.6% to 78.0%) and a positive predictive value of 77.4% (95% CI: 74.7% to 80.0%) for the identification of deceased organ donors. As expected, specificity and negative predictive value were near 100%. The number of organ donors identified by the algorithm each year was similar to the expected value, and this included the pre-validation period (1991 to 2005). Algorithms to identify organ-specific donors performed poorly (e.g. sensitivity ranged from 0% for small intestine to 67% for heart; positive predictive values ranged from 0% for small intestine to 37% for heart).

Interpretation: Primary data abstraction to identify deceased organ donors should be used whenever possible, particularly for the detection of organ-specific donations. The limitations of physician billing claims should be considered whenever they are used.

Figure 1. Number of deceased organ donors per year from 1991 to 2010 in Ontario.

Expected (blue line) represents the number of deceased organ donors as reported by the Canadian Organ Replacement Registry. Identified (red line) represents the number of deceased organ donors as reported by our physician billing algorithm. Reference (green line) represents the number of deceased organ donors as reported by manual chart reviews from 2006 to 2010.