Validity of early-onset dementia diagnoses in VA electronic medical record administrative data

Abstract

Objective

To determine the validity of diagnoses indicative of early-onset dementia (EOD) obtained from an algorithm using administrative data, we examined Veterans Health Administration (VHA) electronic medical records (EMRs).

Method

A previously used method of identifying cases of dementia using administrative data was applied to a random sample of 176 cases of Post-9/11 deployed veterans under 65 years of age. Retrospective, cross-sectional examination of EMRs was conducted, using a combination of administrative data, chart abstraction, and review/consensus by board-certified neuropsychologists.

Results

Approximately 73% of EOD diagnoses identified using existing algorithms were identified as false positives in the overall sample. This increased to approximately 76% among those with mental health conditions and approximately 85% among those with mild traumatic brain injury (TBI; i.e. concussion). Factors related to improved diagnostic accuracy included more severe TBI, diagnosing clinician type, presence of neuroimaging data, absence of a comorbid mental health condition diagnosis, and older age at time of diagnosis.

Conclusions

A previously used algorithm for detecting dementia using VHA administrative data was not supported for use in the younger adult samples and resulted in an unacceptably high number of false positives. Based on these findings, there is concern for possible misclassification in population studies using similar algorithms to identify rates of EOD among veterans. Further, we provide suggestions to develop an enhanced algorithm for more accurate dementia surveillance among younger populations.

Keywords:

• Dementia
• epidemiology
• health administrative data
• TBI
• veterans

Data availability statement

The dataset underlying our study is a third-party dataset from VA, which is not owned or collected by the authors. The dataset was provided to our team after approval by the South Texas Veterans Health Care System Research and Development committee in accordance with VA data security regulations. For others to access these data, the same process is required based on VA Data Security and privacy regulations. The authors did not have any special access privileges that others would not have. To inquire about and initiate the process of accessing the date, a request should be sent to the following point of contact: VA Information Resource Center (VIReC) Email: [email protected] Building 18 Hines VA Hospital (151 V) 5000 S. 5th Avenue Hines, IL 60141-3030 708-202-2413 708-202-2415 (fax). Data from the medical chart abstraction was developed and collected by our team and is too complex to de-identify; data are available to investigators who can access the dataset on a VA research server.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by VA Rehabilitation Research and Development Service under Grant number I21 RX002060-01. The primary investigator also received research funding from Brain Sentinel LLC.