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Browsing by Author "Patel, Chirag G."
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Item Gonorrhea testing, morbidity, and reporting using an integrated sexually transmitted disease registry in Indiana: 2004-2016(Sage, 2021-01) Ojo, Opeyemi C.; Arno, Janet N.; Tao, Guoyu; Patel, Chirag G.; Zhang, Zuoyi; Wang, Jane; Holderman, Justin; Dixon, Brian E.; Medicine, School of MedicineBackground: Surveillance of gonorrhea (GC), the second most common notifiable disease in the United States, depends on case reports. Population-level data that contain the number of individuals tested in addition to morbidity are lacking. Methods: We performed a cross-sectional analysis of data obtained from individuals tested for GC recorded in a STD registry. Descriptive statistics were performed, and a Poisson generalized linear model was used to evaluate the number of individuals tested for GC and the positivity rate. GC cases from a subset of the registry was compared to CDC to determine the completeness of the registry. Results: A total of 1,870,811 GC tests were linked to 627,870 unique individuals. Individuals tested for GC increased from 54,334 in 2004 to 269,701 in 2016; likewise, GC cases increased from 2,039 to 5,997. However, positivity rate decreased from 3.75% in 2004 to 2.22% in 2016. The difference in the number of GC cases captured by the registry and those reported to the CDC were not statistically significant (P= 0.0665). Conclusions: Population-level data from a STD registry combining electronic medical records and public health case data may inform STD control efforts. In Indiana, increased testing rates appeared to correlate with increased GC morbidity.Item Provider Adherence to Syphilis Testing Guidelines Among Stillbirth Cases(Wolters Kluwer, 2020-07) Ho, Yenling A.; Allen, Katie; Tao, Guoyo; Patel, Chirag G.; Arno, Janet N.; Broyles, Andrea A.; Dixon, Brian E.; Epidemiology, School of Public HealthBackground The Centers for Disease Control and Prevention (CDC) recommends that all women with a stillbirth have a syphilis test after delivery. Our study seeks to evaluate adherence to CDC guidelines for syphilis screening among women with a stillbirth delivery. Methods We utilized data recorded in electronic health records for women who gave birth between January 1, 2014 and December 31, 2016. Patients were included if they were 18-44 years old and possessed an ICD-9-CM or ICD-10-CM diagnosis of stillbirth. Stillbirth diagnoses were confirmed through a random sample of medical chart reviews. To evaluate syphilis screening, we estimated the proportion of women who received syphilis testing within 300 days before stillbirth, within 30 days after a stillbirth delivery, and women who received syphilis testing both before and after stillbirth delivery. Results We identified 1,111 stillbirths among a population of 865,429 unique women with encounter data available from electronic health records. Among a sample of 127 chart reviewed cases, only 35 (27.6%) were confirmed stillbirth cases, 45 (35.4%) possible stillbirth cases, 39 (30.7%) cases of miscarriage, and 8 (6.3%) cases of live births. Among confirmed stillbirth cases, 51.4% had any syphilis testing conducted, 31.4% had testing before their stillbirth delivery, 42.9% had testing after the delivery, and only 22.9% had testing before and after delivery. Conclusions A majority of women with a stillbirth delivery do not receive syphilis screening adherent to CDC guidelines. Stillbirth ICD codes do not accurately identify cases of stillbirth.Item Syphilis testing adherence among women with livebirth deliveries: Indianapolis 2014-2016(BMC, 2021-10-30) Ojo, Opeyemi C.; Arno, Janet N.; Tao, Guoyu; Patel, Chirag G.; Dixon, Brian E.; Epidemiology, School of Public HealthBackground: The number of congenital syphilis (CS) cases in the United States are increasing. Effective prevention of CS requires routine serologic testing and treatment of infected pregnant women. The Centers for Disease Control and Prevention (CDC) recommends testing all pregnant women at their first prenatal visit and subsequent testing at 28 weeks gestation and delivery for women at increased risk. Methods: We conducted a cross-sectional cohort study of syphilis testing among pregnant women with a livebirth delivery from January 2014 to December 2016 in Marion County, Indiana. We extracted and linked maternal and infant data from the vital records in a local health department to electronic health records available in a regional health information exchange. We examined syphilis testing rates and factors associated with non-testing among women with livebirth delivery. We further examined these rates and factors among women who reside in syphilis prevalent areas. Results: Among 21260 pregnancies that resulted in livebirths, syphilis testing in any trimester, including delivery, increased from 71.7% in 2014 to 86.6% in 2016. The number of maternal syphilis tests administered only at delivery decreased from 16.6% in 2014 to 4.04% in 2016. Among women living in areas with high syphilis rates, syphilis screening rates increased from 79.6% in 2014 to 94.2% in 2016. Conclusion: Improvement in prenatal syphilis screening is apparent and encouraging, yet roughly 1-in-10 women do not receive syphilis screening during pregnancy. Adherence to recommendations set out by CDC improved over time. Given increasing congenital syphilis cases, the need for timely diagnoses and prevention of transmission from mother to fetus remains a priority for public health.Item Validation of ICD-10-CM Codes for Identifying Cases of Chlamydia and Gonorrhea(Wolters Kluwer, 2020-07) Ho, Yenling A.; Rahurkar, Saurabh; Tao, Guoyu; Patel, Chirag G.; Arno, Janet N.; Wang, Jane; Broyles, Andrea A.; Dixon, Brian E.; Epidemiology, School of Public HealthBackground While researchers seek to use administrative health data to examine outcomes for individuals with sexually transmitted infections, the ICD-CM-10 codes used to identify persons with chlamydia and gonorrhea have not been validated. Objectives were to determine the validity of using ICD-10-CM codes to identify individuals with chlamydia and gonorrhea. Methods We utilized data from electronic health records gathered from public and private health systems from October 1, 2015 to December 31, 2016. Patients were included if they were aged 13-44 years and received either 1) laboratory testing for chlamydia or gonorrhea or 2) an ICD-10-CM diagnosis of chlamydia, gonorrhea, or an unspecified STI. To validate ICD-10-CM codes, we calculated positive and negative predictive values, sensitivity, and specificity based on the presence of a laboratory test result. We further examined the timing of clinical diagnosis relative to laboratory testing. Results The positive predictive values for chlamydia, gonorrhea, and unspecified STI ICD-10-CM codes were 87.6%, 85.0%, and 32.0%, respectively. Negative predictive values were high (>92%). Sensitivity for chlamydia diagnostic codes was 10.6% and gonorrhea was 9.7%. Specificity was 99.9% for both chlamydia and gonorrhea. The date of diagnosis occurred on or after the date of the laboratory result for 84.8% of persons with chlamydia, 91.9% for gonorrhea, and 23.5% for unspecified STI. Conclusions Disease specific ICD-10-CM codes accurately identify persons with chlamydia and gonorrhea. However, low sensitivities suggest that most individuals could not be identified in administrative data alone without laboratory test results.Item Validation of International Classification of Diseases, Tenth Revision, Clinical Modification Codes for Identifying Cases of Chlamydia and Gonorrhea(Wolters Kluwer, 2021) Ho, Yenling Andrew; Rahurkar, Saurabh; Tao, Guoyu; Patel, Chirag G.; Arno, Janet N.; Wang, Jane; Broyles, Andrea A.; Dixon, Brian E.; Epidemiology, School of Public HealthBackground: While researchers seek to use administrative health data to examine outcomes for individuals with sexually transmitted infections (STIs), the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes used to identify persons with chlamydia and gonorrhea have not been validated. Objectives were to determine the validity of using ICD-10-CM codes to identify individuals with chlamydia and gonorrhea. Methods: We used data from electronic health records gathered from public and private health systems from October 1, 2015, to December 31, 2016. Patients were included if they were aged 13 to 44 years and received either (1) laboratory testing for chlamydia or gonorrhea or (2) an ICD-10-CM diagnosis of chlamydia, gonorrhea, or an unspecified STI. To validate ICD-10-CM codes, we calculated positive and negative predictive values, sensitivity, and specificity based on the presence of a laboratory test result. We further examined the timing of clinical diagnosis relative to laboratory testing. Results: The positive predictive values for chlamydia, gonorrhea, and unspecified STI ICD-10-CM codes were 87.6%, 85.0%, and 32.0%, respectively. Negative predictive values were high (>92%). Sensitivity for chlamydia diagnostic codes was 10.6%, and gonorrhea was 9.7%. Specificity was 99.9% for both chlamydia and gonorrhea. The date of diagnosis occurred on or after the date of the laboratory result for 84.8% of persons with chlamydia, 91.9% for gonorrhea, and 23.5% for unspecified STI. Conclusions: Disease-specific ICD-10-CM codes accurately identify persons with chlamydia and gonorrhea. However, low sensitivities suggest that most individuals could not be identified in administrative data alone without laboratory test results.