Administrative Coding in Electronic Health Care Record-Based Research of NAFLD: An Expert Panel Consensus Statement

Authors

Hannes Hagström
Leon A Adams
Alina M Allen
Christopher D Byrne
Yoosoo Chang
Henning Grønbaek
Mona Ismail
Peter Jepsen
Fasiha Kanwal
Jennifer Kramer
Jeffrey V Lazarus
Michelle T Long
Rohit Loomba
Philip N Newsome
Ian A Rowe
Seungho Ryu
Jörn M Schattenberg
Marina Serper
Nick Sheron
Tracey G Simon
Elliot B Tapper
Sarah Wild
Vincent Wai-Sun Wong
Yusuf Yilmaz
Shira Zelber-Sagi
Fredrik Åberg

Publication Date

7-1-2021

Journal

Hepatology

DOI

10.1002/hep.31726

PMID

33486773

PMCID

PMC8515502

PubMedCentral® Posted Date

7-1-2022

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Biomedical Research, Clinical Coding, Consensus, Electronic Health Records, Humans, Non-alcoholic Fatty Liver Disease, Reference Standards, cirrhosis, epidemiology, health information, hepatocellular carcinoma, MAFLD, NAFLD, registry-based research, steatosis

Abstract

BACKGROUND AND AIMS: Electronic health record (EHR)-based research allows the capture of large amounts of data, which is necessary in NAFLD, where the risk of clinical liver outcomes is generally low. The lack of consensus on which International Classification of Diseases (ICD) codes should be used as exposures and outcomes limits comparability and generalizability of results across studies. We aimed to establish consensus among a panel of experts on ICD codes that could become the reference standard and provide guidance around common methodological issues.

APPROACH AND RESULTS: Researchers with an interest in EHR-based NAFLD research were invited to collectively define which administrative codes are most appropriate for documenting exposures and outcomes. We used a modified Delphi approach to reach consensus on several commonly encountered methodological challenges in the field. After two rounds of revision, a high level of agreement (>67%) was reached on all items considered. Full consensus was achieved on a comprehensive list of administrative codes to be considered for inclusion and exclusion criteria in defining exposures and outcomes in EHR-based NAFLD research. We also provide suggestions on how to approach commonly encountered methodological issues and identify areas for future research.

CONCLUSIONS: This expert panel consensus statement can help harmonize and improve generalizability of EHR-based NAFLD research.

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