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Volume 5, Number 6—December 1999

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 3

Reasons for meeting screening criteria among individuals without incident tuberculosis (TB) who had automated ambulatory-patient records

Screening criteria that include a TB diagnosis code or multiple anti-TB drugs
Reasons why non-TB cases met screening criteria Two or more anti-TB drugsa Diagnosis codeb for active TB Diagnosis codeb for pulmonary TB Diagnosis codeb for TB, a microbiology codec, and a radiology coded At least one anti-TB druga and an ICD-9 diagnosis code for TB
Active TB diagnosed outside study window 9 (13%) 0 0 0 0
Suspected active TB 26 (37%) 2 (67%) 4 (5%) 19 (58%) 6 (86%)
TB prophylaxis 11 (15%) 0 0 0 0
Prenatal TB screening 0 0 57 (76%) 0 0
Prior history of TB 0 0 5 (7%) 7 (21%) 0
Other mycobacterial infections 23 (32%) 0 0 0 0
Treatment of other conditions 2 (3%) 0 0 0 0
No documentation of reason in HMO medical record 0 1 (33%) 9 (12%) 7 (21%) 1 (14%)
Total no. without incident active TB 71 3 75 33 7

aPharmacy dispensing data; antituberculosis drugs include isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin,capreomycin, kanamycin, ethionamide, para-aminosalicyclic acid, and cycloserine.
bAmbulatory codes were obtained from automated ambulatory records in the staff model division and from claims in the network and group model division.
cMicrobiology 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.
dRadiology 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).

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