Use of electronic health data to identify patients with moderate-to-severe osteoarthritis of the hip and/or knee and inadequate response to pain medications

Table 4 Performance of predefined algorithms to identify patients with inadequate response to two or more pain-related medications (Step 3, total N = 490 with available claims data)

Algorithm	TP	FP	TN	FN	Sensitivity	Specificity	NPV	PPV	Accuracy
1. Receipt of HA, IA corticosteroid, and/or nerve block preceded by receipt of 2 different classes of analgesics (i.e., NSAIDs [including COX-2 inhibitors], opioids)	10	0	127	353	0.03	1.00	0.26	1.00	0.28
2. Receipt of ≥ 3 analgesic classes	44	1	126	319	0.12	0.99	0.28	0.98	0.35
3. Receipt of knee or hip arthroplasty (partial or complete; original or revision)	258	6	121	105	0.71	0.95	0.54	0.98	0.77
4. Receipt of nerve block	210	19	108	153	0.58	0.85	0.41	0.92	0.65
5. Receipt of ≥ 2 different opioids within a 90-day period	24	4	123	339	0.07	0.97	0.27	0.86	0.30
6. Receipt of a mobility aid (as described above) within 90-day period subsequent to receipt of an opioid	12	0	127	351	0.03	1.00	0.27	1.00	0.28
Combined algorithm (using OR function)
Combinations of all algorithms with performance ≥ 0.98 PPV	21	0	127	342	0.06	1.00	0.27	1.00	0.30
Combinations of all algorithms with performance ≥ 0.95 PPV	262	6	121	101	0.72	0.95	0.55	0.98	0.78
Combinations of all algorithms with performance ≥ 0.90 PPV	290	23	104	73	0.80	0.82	0.59	0.93	0.80
Combinations of all algorithms with performance ≥ 0.85 PPV	291	25	102	72	0.80	0.80	0.59	0.92	0.80
Combinations of all algorithms with performance ≥ 0.80 PPV	291	25	102	72	0.80	0.80	0.59	0.92	0.80

Abbreviations: COX-2 Cyclooxygenase-2, FN False negative, FP False positive, HA Hyaluronic acid, IA Intraarticular, NPV Negative predictive value, NSAIDs Nonsteroidal anti-inflammatory drugs, OA Osteoarthritis, PPV Positive predictive value, TN True negative, TP True positive

ISSN: 1471-2288