Identifying neonatal intensive care (NICU) admissions using administrative claims data.

BACKGROUND: To define a method for identifying neonatal intensive care unit (NICU) admissions using administrative claims data. METHODS: This was a retrospective cohort study using claims from Optum's de-identified Clinformatics® Data Mart Database (CDM) from 2016 -2020. We developed a definition to identify NICU admissions using a list of codes from the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT), and revenue codes frequently associated with NICU admissions. We compared agreement between codes using Kappa statistics and calculated positive predictive values (PPV) and 95% confidence intervals (CI). RESULTS: On average, revenue codes (3.3%) alone identified more NICU hospitalizations compared to CPT codes alone (1.5%), whereas the use of CPT and revenue (8.9%) and CPT or revenue codes (13.7%) captured the most NICU hospitalizations, which aligns with rates of preterm birth. Gestational age alone (4.2%) and birthweight codes alone (2.0%) identified the least number of potential NICU hospitalizations. Setting CPT codes as the standard and revenue codes as the "test,", revenue codes resulted in identifying 86% of NICU admissions (sensitivity) and 97% of non-NICU admissions (specificity). CONCLUSIONS: Using administrative data, we developed a robust definition for identifying neonatal admissions. The identified definition of NICU codes is easily adaptable, repeatable, and flexible for use in other datasets.

Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.

INTRODUCTION: Antenatal depression and suicidal ideation represent serious pregnancy-related complications, yet comprehensive estimates of the prevalence and predictors of these diagnoses among birthing people remain unclear. OBJECTIVE: This study aimed to characterize trends in the prevalence of depression and suicidal ideation diagnoses identified among pregnant individuals prior to giving birth. METHODS: This study included 536,647 individuals aged 15-44 years continuously enrolled in a single commercial health insurance plan for one year before childbirth from 2008 to 2018. The primary outcomes included depression or suicidal ideation based on identification of the relevant ICD-9 and ICD-10 diagnosis codes during pregnancy. RESULTS: Rates (95 % CIs) of depression increased by 39 % from 540 (520-560) per 10,000 individuals in 2008 to 750 (730-770) per 10,000 individuals in 2018. Suicidal ideation increased by 100 % from 15 (12-18) per 10,000 individuals in 2008 to 44 (39-50) per 10,000 individuals in 2018. Black birthing people experiencing the sharpest proportional increases. CONCLUSIONS: The prevalence of depression and suicidal ideation occurring during pregnancy substantially increased over a ten-year period. Further, suicidal ideation diagnosis increased the most for among Black birthing people compared to all groups, resulting in a need for future studies in this area to determine the reasons for an increase in diagnosis and any change in resulting treatment of follow up.

Significance of self-reported sleep quality (SQ) in chronic kidney disease (CKD): the Renal Research Institute (RRI)-CKD study.

BACKGROUND: There has been limited research on sleep quality (SQ) in CKD. METHODS: This prospective cohort study of adults with CKD Stages 3 - 5 at four US centers collected self-reported SQ information from the Kidney Disease Quality of Life (KDQOL) instrument, including an estimated SQ score (0 - 100), and 3 SQ-related questions. "Poor" SQ was defined as SQ score < or = 60. Logistic and multiple linear regression assessed associations between SQ and its potential predictors. Times to death and end stage renal disease (ESRD) were examined using Cox regression. A comparison with SQ in ESRD patients from the Dialysis Outcomes and Practice Patterns Study (DOPPS), was additionally performed. RESULTS: Mean SQ score was 59.4 +/- 23.6 (n = 689), and "poor" SQ was reported by 57%. Mean estimated glomerular filtration rate (eGFR) was 24.9 +/- 10.6 ml/min/1.73 m2. Higher SQ significantly correlated with KDQOL mental and physical component summary scales. Significant predictors of lower SQ score included--younger age, presence of dyspnea, self-reported depression, pain, and itchness. There were no significant pairwise differences in SQ from CKD Stage 3 through ESRD. Self-reported daytime sleepiness was significantly associated with higher risk of mortality prior to ESRD (HR = 1.85, p = 0.02). CONCLUSION: Self-reported "poor" SQ was common in a CKD cohort (Stages 3 - 5) and was not only associated with lower quality of life scores and several modifiable symptoms, but also with higher risk of pre-ESRD mortality. Greater attention to this clinical problem is highly recommended in this high-risk population.