Positive predictive value between medical-chart body-mass-index category and obesity versus codes in a claims-data warehouse

Abstract

Objective: To evaluate the positive predictive value of claims-based V85 codes for identifying individuals with varying degrees of BMI relative to their measured BMI obtained from medical record abstraction.

Methods: This was a retrospective validation study utilizing administrative claims and medical chart data from 1 January 2009 to 31 August 2015. Randomly selected samples of patients enrolled in a Medicare Advantage Prescription Drug (MAPD) or commercial health plan and with a V85 claim were identified. The claims-based BMI category (underweight, normal weight, overweight, obese class I–III) was determined via corresponding V85 codes and compared to the BMI category derived from chart abstracted height, weight and/or BMI. The positive predictive values (PPVs) of the claims-based BMI categories were calculated with the corresponding 95% confidence intervals (CIs).

Results: The overall PPVs (95% CIs) in the MAPD and commercial samples were 90.3% (86.3%–94.4%) and 91.1% (87.3%–94.9%), respectively. In each BMI category, the PPVs (95% CIs) for the MAPD and commercial samples, respectively, were: underweight, 71.0% (55.0%–87.0%) and 75.9% (60.3%–91.4%); normal, 93.8% (85.4%–100%) and 87.8% (77.8%–97.8%); overweight, 97.4% (92.5%–100%) and 93.5% (84.9%–100%); obese class I, 96.9 (90.9%–100%) and 97.2% (91.9%–100%); obese class II, 97.0% (91.1%–100%) and 93.0% (85.4%–100%); and obese class III, 85.0% (73.3%–96.1%) and 97.1% (91.4%–100%).

Conclusions: BMI categories derived from administrative claims, when available, can be used successfully particularly in the context of obesity research.

Keywords:

• Obesity
• body mass index
• claims analysis
• validation studies

Transparency

Declaration of funding

This research was funded Novo Nordisk Inc., and conducted as part of the Novo Nordisk–Humana Research Collaboration.

Author contributions: All authors contributed to the conception and/or design and analysis, interpretation of data, and drafting of the paper or revising it critically. All authors have approved this manuscript and agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

E.O.C., P.S.K. and R.A.H. have disclosed that they are employees of Comprehensive Health Insights, a subsidiary of Humana, which received funding from Novo Nordisk for this study. B.G.S. has disclosed that he is an employee of Novo Nordisk Inc., in which he reports holding significant equity. J.C.H. and J.R.B. have disclosed that they were employees of Novo Nordisk at the time of manuscript preparation. A.R. has disclosed that he is an employee of Humana.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

Previous presentation: Portions of this study were presented as a poster at AMCP Nexus 2016, National Harbor, MD, USA, 3–6 October 2016.