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Damush TM, Jia H, Ried LD, Qin H, Cameon R, Plue L, Williams LS. Case-Finding Algorithm for Post Stroke Depression in the Veterans Health Administration. Poster session presented at: American Heart Association / American Stroke Association International Stroke Conference; 2007 Feb 8; San Francisco, CA.
Background: Post stroke depression (PSD) is prevalent, often undiagnosed, and undertreated. The accuracy of detecting patients with post-stroke depression in administrative databases has not been previously examined. Objectives: The objective of this study was to validate a case-finding algorithm for post stroke depression (PSD) among veteran stroke survivors receiving care in the Veterans Health Administration (VHA). Methods: We conducted a retrospective cohort study of veterans admitted to two local VHA medical centers respectively for an inpatient episode of care for acute ischemic stroke. Our cohort included all patients from the two medical centers who were identified in the fiscal year (FY) 2001 VHA and Medicare inpatient database using the high specificity stroke ICD-9 codes. FY 2002 VHA and Medicare inpatient, outpatient, and pharmacy data were used to examine the patients' 12-month PSD status by using ICD-9 depression codes and antidepressant use. The accuracy of our findings about the patients' PSD from the administrative databases were then assessed through standardized chart reviews. Results: Of our 185 subject cohort, 50 (27%) were identified by chart review as having PSD. The most sensitive case-finding algorithm for PSD included having an ICD-9 code diagnosis for depression or receiving a prescription for an approved-dosage of antidepressant medication. However, the algorithm of using ICD-9 code diagnosis for depression only revealed the largest positive predictive value. Conclusions: Although there was no overall exceptionally accurate algorithm, a case-finding algorithm using outpatient ICD-9 codes or medication was the most sensitive in identifying cases of PSD. The use of ICD-9 codes alone may be adequate for characterizing a cohort with PSD. Intention for use should be considered when choosing an algorithm to detect PSD.
