Evaluation of COVID-19 Diagnosis Codes for Identification of SARS-CoV-2 Infections in a Nursing Home Cohort, 2022-2023.
Arshiya Patel, Amanda B Payne, Dustin W Currie and 5 others
PMID 39788487WHAT IT FOUND
For nursing home residents staying in the facility, EHR diagnosis codes matched positive tests 92% of the time.
But for residents admitted or discharged within three days of diagnosis, only 24% had a matching test. Codes are reliable for long-term residents but miss infections at transitions of care.
Key findings
01Among residents continuously present in the nursing home, 92% of new-onset COVID-19 diagnosis codes had a corresponding positive SARS-CoV-2 test within seven days.
02For residents who were not continuously present around the diagnosis date, the positive predictive value of the diagnosis code dropped to 24%.
03The overall code-based infection rate was significantly higher than the test-based rate across the study period.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study focused on a single corporation of nursing homes in the southeastern US, which may limit generalizability to other regions or healthcare systems. The analysis lacked data on tests performed outside the nursing home, so it could not verify if the 24% PPV in non-continuously present residents was due to false positives or true infections diagnosed elsewhere. Symptom data were not available, so the study could not distinguish between symptomatic and asymptomatic cases, which may affect how clinicians decide to code diagnoses. The gold standard for confirmation was a positive test within the nursing home, but antigen tests are less sensitive than PCR, potentially leading to misclassification of true infections as unconfirmed.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume that a high positive predictive value for diagnosis codes applies to all residents. The accuracy drops dramatically from 92% to 24% for residents who are not continuously present in the facility around the time of diagnosis. Using these codes for quality improvement or infection control metrics without accounting for admission and discharge timing will misrepresent the source of infection.