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Identification of Axial Spondyloarthritis Patients in a Large Dataset: The Development and Validation of Novel Methods.

Authors
  • Walsh, Jessica A1, 2
  • Pei, Shaobo3, 4
  • Penmetsa, Gopi3, 4
  • Hansen, Jared Lareno3, 4
  • Cannon, Grant W3, 4
  • Clegg, Daniel O3, 4
  • Sauer, Brian C3, 4
  • 1 From the Salt Lake City Veteran Affairs Medical Center; the University of Utah Medical Center, Salt Lake City, Utah, USA. [email protected]
  • 2 J.A. Walsh, MD, Salt Lake City Veteran Affairs Medical Center, and University of Utah Medical Center; S. Pei, PhD, Salt Lake City Veteran Affairs Medical Center; G. Penmetsa, MD, University of Utah Medical Center; J.L. Hansen, MStat, Salt Lake City Veteran Affairs Medical Center; G.W. Cannon, MD, Salt Lake City Veteran Affairs Medical Center, and University of Utah Medical Center; D.O. Clegg, MD, Salt Lake City Veteran Affairs Medical Center, and University of Utah Medical Center; B.C. Sauer, PhD, Salt Lake City Veteran Affairs Medical Center, and University of Utah Medical Center. [email protected]
  • 3 From the Salt Lake City Veteran Affairs Medical Center; the University of Utah Medical Center, Salt Lake City, Utah, USA.
  • 4 J.A. Walsh, MD, Salt Lake City Veteran Affairs Medical Center, and University of Utah Medical Center; S. Pei, PhD, Salt Lake City Veteran Affairs Medical Center; G. Penmetsa, MD, University of Utah Medical Center; J.L. Hansen, MStat, Salt Lake City Veteran Affairs Medical Center; G.W. Cannon, MD, Salt Lake City Veteran Affairs Medical Center, and University of Utah Medical Center; D.O. Clegg, MD, Salt Lake City Veteran Affairs Medical Center, and University of Utah Medical Center; B.C. Sauer, PhD, Salt Lake City Veteran Affairs Medical Center, and University of Utah Medical Center.
Type
Published Article
Journal
The Journal of rheumatology
Publication Date
Jan 01, 2020
Volume
47
Issue
1
Pages
42–49
Identifiers
DOI: 10.3899/jrheum.181005
PMID: 30877217
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Observational axial spondyloarthritis (axSpA) research in large datasets has been limited by a lack of adequate methods for identifying patients with axSpA, because there are no billing codes in the United States for most subtypes of axSpA. The objective of this study was to develop methods to accurately identify patients with axSpA in a large dataset. The study population included 600 chart-reviewed veterans, with and without axSpA, in the Veterans Health Administration between January 1, 2005, and June 30, 2015. AxSpA identification algorithms were developed with variables anticipated by clinical experts to be predictive of an axSpA diagnosis [demographics, billing codes, healthcare use, medications, laboratory results, and natural language processing (NLP) for key SpA features]. Random Forest and 5-fold cross validation were used for algorithm development and testing in the training subset (n = 451). The algorithms were additionally tested in an independent testing subset (n = 149). Three algorithms were developed: Full algorithm, High Feasibility algorithm, and Spond NLP algorithm. In the testing subset, the areas under the curve with the receiver-operating characteristic analysis were 0.96, 0.94, and 0.86, for the Full algorithm, High Feasibility algorithm, and Spond NLP algorithm, respectively. Algorithm sensitivities ranged from 85.0% to 95.0%, specificities from 78.0% to 93.6%, and accuracies from 82.6% to 91.3%. Novel axSpA identification algorithms performed well in classifying patients with axSpA. These algorithms offer a range of performance and feasibility attributes that may be appropriate for a broad array of axSpA studies. Additional research is required to validate the algorithms in other cohorts.

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