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Volume 5, Number 6—December 1999
Research

Supplementing Tuberculosis Surveillance with Automated Data from Health Maintenance Organizations

Deborah S. Yokoe*Comments to Author , Girish S. Subramanyan*, Edward Nardell†, Sharon Sharnprapai†, Eugene McCray‡, and Richard Platt*§
Author affiliations: *Brigham and Women's Hospital, Boston, Massachusetts, USA; †Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA; ‡Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and §Harvard Medical School, Harvard Pilgrim Health Care, Boston, Massachusetts, USA

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Table 2

Performance of health maintenance organization-based screening criteria for tuberculosis (TB)

Screening criteria No. meeting screening criteria No. TB cases detected using screening criteria No. TB cases unknown to public health dept Sensitivity (95% CI) Positive predictive value (95% CI)
All patients (45 incident TB cases)
Two or more anti-TB drugsa 133 40 7 89 (76,96) 30 (22, 39)
Two or more anti-TB drugsa dispensed on the same date 108 39 7 87 (73,95) 36 (27,50)
Three or more anti-TB drugsa 76 38 7 84 (71,94) 50 (38,62)
Only patients with automated medical records (41 incident TB cases)
One or more anti-TB drugs,a a microbiology code,b and a radiology codec 132 21 2 51 (35, 67) 16 (10, 23)
At least one anti-TB druga and a CPTc code for mycobacterial culture/stain 106 17 2 42 (26,58) 16 (10,24)
Diagnosis coded for tuberculosis, a microbiology code,b and a radiology codec 49 16 0 39 (24,56) 33 (20,48)
Diagnosis coded for positive PPD,e a microbiology code,b and a radiology codec 157 8 1 20 (9,35) 5 (2,10)
At least one anti-TB druga and an ICD-9 diagnosis code for tuberculosis 14 7 1 17 (7,32) 50 (23,77)
ICD-9 procedure code for bronchoscopy, a microbiology code,b and a radiology codec 15 1 0 2 (0.1,13) 7 (0.2,32)
Diagnosis coded for active tuberculosis 4 1 0 2 (0.1,13) 25 (1,81)
Diagnosis coded for pulmonary tuberculosis 75 0 0 0 0
Diagnosis coded for tuberculin conversion, a microbiology code,b and a radiology codec 1 0 0 0 0
Only patients without automated medical records (4 incident TB cases)
ICD-9 diagnosis code for tuberculosis 251 4 2 100 (40, 100) 2 (0.4, 40)
A CPT code relating to mycobacterial culture/stain or a radiology code 92 2 1 50 (7, 93) 2 (0.3, 8)

aPharmacy dispensing data; antituberculosis drugs include isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin, capreomycin, kanamycin, ethionamide, para-aminosalicyclic acid, and cycloserine.
bMicrobiology codes include COSTAR (coding system for automated ambulatory-patient records [10]) or ICD-9CM (International Classification of Diseases, 9th Revision Clinical Modification) procedure codes for acid fast bacilli smear, culture and sensitivities and microscopy examination of sputum.
cRadiology codes include current procedures terminology (CPT), COSTAR, or ICD-9 procedure codes for chest radiograph, thoracic computer assisted tomography (CT), or thoracic magnetic resonance imaging (MRI).
dAmbulatory codes were obtained from automated ambulatory-patient records in the staff model division and from claims in the network and group model division.
ePPD, purified protein derivative.

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