Sorry, I sent the CPT codes to the participating sites' contacts individually.
To share with the whole group, the CPT codes for amputation of lower limb is 27888, 27889, 27880-27886. Yes, I have reviewed the sites' query reports and had numerous email exchanges with the sites' contacts. Some learning points from the experience: 1. The queries were built on KUMC terminology instead of master GPC terminology, resulted in query variations across sites. As an example, not all sites have clinical service information, thus size of the base population (primary care) is not comparable across sites. Also, some sites used diagnoses ICD9 V-codes or status codes to encode lower limb amputation, which is not correct because it specifies history of amputation that are frequently found in problem list (actual date and location of the service cannot be reliably determined). Not all sites have CPT codes loaded in i2b2 (MU and IU). MU is expected to load it into i2b2 by mid-September. 2. UTSW had a specific problem with inclusion of their affiliated Parkland hospital where they only receive CPT codes instead of inpatient procedure codes, yielding larger denominator (Q2 = eligible patients) but smaller numerator (Q4 = patients had lower limb amputation procedure). Inclusion of CPT codes increased amputation numbers significantly for UTSW. It also increased the number a little for other sites. This may be due to physicians performing amputation procedures at facilities not owned by the site. 3. The queries were complex with multiple panel queries and time specific querying. With the updated queries, NYC CDRN's updated number seemed consistent with other sites (KUMC, MU, MCW). IU's updated number is half of what was originally reported (rate is reduced significantly), but is still much higher than other sites. UTSW's amputation numbers still seem to be off. By limiting the denominator to outpatient UTSW clinics, their base population denominator dropped significantly, from >40,000 to ~9500, while all other centers have at least 11,000 patients. Given the size of UTSW, it is hard to believe the number. Further investigation is still needed, but we may not have the time for this proposal submission. Thanks, Mei From: Dan Connolly Sent: Monday, July 25, 2016 11:24 AM To: Mei Liu; <[email protected]> Subject: RE: Feasibility Query: National Diabetes Amputation Prevention Study (NDAMPS) Mei, you were going to send the CPT codes. Did I miss them? Perhaps you sent them somewhere other than gpc-dev? Please share with the whole group. Did you get the printed queries from MU, MCW, UTSW, and IU? Have you resolved the issue of very high and very low rates? -- Dan ________________________________ From: [email protected]<mailto:[email protected]> [[email protected]] on behalf of Mei Liu [[email protected]] Sent: Monday, July 18, 2016 10:26 AM To: <[email protected]<mailto:[email protected]>> Subject: Feasibility Query: National Diabetes Amputation Prevention Study (NDAMPS) Thank you all for submitting the patient count for the NDAMPS feasibility query. Based on the submitted numbers, we observed very large variations in the amputation rates between participating sites (KUMC, MU, MCW, UTSW, IU, and NYC CDRN), with UTSW and NYC being very low, IU being very high, and KUMC, MCW, and MU being in the middle. Before we can perform power calculation with confidence, we need to make sure that the queries were ran consistently and whether the sites are counting amputations differently. This is urgent because we cannot submit the proposal (due July 31) without a reliable power calculation. I hope to discuss this over the dev call tomorrow. Thanks, Mei ------------------------------------------------- Mei Liu, PhD Assistant Professor Department of Internal Medicine Division of Medical Informatics University of Kansas Medical Center Office: 913-945-6446 Fax: 913-588-4880
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