TY - JOUR AU - Valkova, Silvia PY - 2017/05/02 Y2 - 2024/03/28 TI - Pregnant women with suspected Zika virus infection: A claims data analysis JF - Online Journal of Public Health Informatics JA - OJPHI VL - 9 IS - 1 SE - Data sources, standards, exchange, visualization, and quality DO - 10.5210/ojphi.v9i1.7627 UR - https://ojphi.org/ojs/index.php/ojphi/article/view/7627 SP - AB - <div style="left: 89.1818px; top: 317.842px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.08186);" data-canvas-width="63.1985303030303">Objective</div><div style="left: 104.045px; top: 332.657px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.974411);" data-canvas-width="374.206331060606">Demonstrate the value of consolidated claims data from community</div><div style="left: 89.1818px; top: 349.172px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.995614);" data-canvas-width="386.46420681818176">healthcare providers in Zika Virus Disease surveillance at local level.</div><div style="left: 89.1818px; top: 380.6px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.11811);" data-canvas-width="81.88294696969696">Introduction</div><div style="left: 104.045px; top: 395.415px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.06404);" data-canvas-width="379.4185954545455">Zika virus disease and Zika virus congenital infection are</div><div style="left: 89.1818px; top: 411.93px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01942);" data-canvas-width="390.6264378787877">nationally notifiable conditions that became prominent recently as a</div><div style="left: 89.1818px; top: 428.445px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.016);" data-canvas-width="390.54922954545464">growing number of travel-associated infections have been identified</div><div style="left: 89.1818px; top: 444.96px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.999877);" data-canvas-width="389.90208333333317">in the United States. The Centers for Disease Control and Prevention</div><div style="left: 89.1818px; top: 461.475px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00043);" data-canvas-width="389.83470151515144">(CDC) have dedicated significant time and effort on determining and</div><div style="left: 89.1818px; top: 477.991px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.995537);" data-canvas-width="389.8024143939394">addressing the risks and impact of Zika on pregnant women and their</div><div style="left: 89.1818px; top: 494.506px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.944691);" data-canvas-width="391.03915151515156">babies who are most vulnerable to the disease. CDC relies on two</div><div style="left: 89.1818px; top: 511.021px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00687);" data-canvas-width="390.1940712121213">sources of information, reported voluntarily by healthcare providers,</div><div style="left: 89.1818px; top: 527.536px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03345);" data-canvas-width="390.9535204545453">to monitor Zika virus disease: ArboNET and the newly established</div><div style="left: 89.1818px; top: 544.051px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.98474);" data-canvas-width="389.3826818181817">U.S. Zika Pregnancy Registry. A study by IMS Health compared U.S.</div><div style="left: 89.1818px; top: 560.566px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00866);" data-canvas-width="390.2179356060605">trends of the Zika virus disease in general and pregnant women with</div><div style="left: 89.1818px; top: 577.082px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.996632);" data-canvas-width="389.7827613636365">Zika virus disease in particular observed in an IMS healthcare claims</div><div style="left: 89.1818px; top: 593.597px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.989825);" data-canvas-width="389.54552121212106">database and the CDC ArboNET and the newly established U.S. Zika</div><div style="left: 89.1818px; top: 610.112px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01018);" data-canvas-width="113.84719696969697">Pregnancy Registry.</div><div style="left: 89.1818px; top: 641.539px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.07334);" data-canvas-width="57.70971969696969">Methods</div><div style="left: 104.045px; top: 656.354px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01901);" data-canvas-width="371.6163424242424">IMS used for this analysis claims for reimbursement from office-</div><div style="left: 89.1818px; top: 672.869px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01187);" data-canvas-width="392.63946969696946">based healthcare providers, which are widely accepted standard</div><div style="left: 89.1818px; top: 689.385px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.981215);" data-canvas-width="391.3086787878788">business practice records throughout the healthcare industry. IMS</div><div style="left: 89.1818px; top: 705.9px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00094);" data-canvas-width="389.8501431818181">claims data is collected daily from office-based providers throughout</div><div style="left: 89.1818px; top: 722.415px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.988216);" data-canvas-width="389.4725242424243">the U.S. and processed, stored and analyzed in a centralized database.</div><div style="left: 89.1818px; top: 738.93px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.05071);" data-canvas-width="391.2483159090908">The information is available at the patient and visit level, with the</div><div style="left: 89.1818px; top: 755.445px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02674);" data-canvas-width="392.8303848484849">ability to characterize deidentified patients by age, gender and</div><div style="left: 89.1818px; top: 771.96px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.966719);" data-canvas-width="391.37606060606043">ZIP3 location and to trace a patient’s history of visits, diagnoses,</div><div style="left: 89.1818px; top: 788.476px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00184);" data-canvas-width="341.09237878787866">procedures, drugs prescribed and tests performed or ordered.</div><div style="left: 104.045px; top: 804.991px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.992993);" data-canvas-width="374.77205757575746">The general IMS study sample captured all patients throughout the</div><div style="left: 89.1818px; top: 821.506px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.996649);" data-canvas-width="389.7729348484848">continental United States covered in claims between October 1, 2016</div><div style="left: 89.1818px; top: 838.021px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.9779);" data-canvas-width="389.53007954545467">and May 24, 2016 with ICD 10 diagnosis code A92.8, Other Specified</div><div style="left: 89.1818px; top: 854.536px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.994764);" data-canvas-width="392.2520242424243">Mosquito-Borne Viral Fevers. This sample was compared to the</div><div style="left: 89.1818px; top: 871.051px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.986329);" data-canvas-width="391.57259090909076">sample of laboratory-confirmed Zika virus disease cases reported</div><div style="left: 89.1818px; top: 887.566px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.04593);" data-canvas-width="391.2469121212122">to ArboNET by state or territory from the CDC Arboviral Disease</div><div style="left: 89.1818px; top: 904.082px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.96238);" data-canvas-width="391.31990909090894">Branch from January 1, 2015 through May 18, 2016. In addition,</div><div style="left: 89.1818px; top: 920.597px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02875);" data-canvas-width="390.822968181818">IMS compared the subset of patients with both a Zika virus disease</div><div style="left: 89.1818px; top: 937.112px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03425);" data-canvas-width="390.8959651515151">diagnosis and any ICD 10 pregnancy diagnosis to the CDC sample</div><div style="left: 89.1818px; top: 953.627px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.04063);" data-canvas-width="390.84262121212134">of patients captured by the U.S. Zika Pregnancy Registry with any</div><div style="left: 89.1818px; top: 970.142px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.967169);" data-canvas-width="391.5585530303032">laboratory evidence of possible Zika virus infection in the United</div><div style="left: 89.1818px; top: 986.657px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00237);" data-canvas-width="118.91487121212123">States and territories.</div><div style="left: 89.1818px; top: 1018.08px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.08498);" data-canvas-width="50.70481818181818">Results</div><div style="left: 104.045px; top: 1032.9px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03375);" data-canvas-width="376.06073484848474">Throughout the continental United States, the IMS claims-based</div><div style="left: 89.1818px; top: 1049.41px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.977333);" data-canvas-width="391.8940583333332">sample captured 875 patients with a Zika virus disease diagnosis</div><div style="left: 89.1818px; top: 1065.93px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.966277);" data-canvas-width="391.58382121212134">compared to 548 travel-associated cases reported by CDC. At the</div><div style="left: 89.1818px; top: 1082.45px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03002);" data-canvas-width="390.63486060606056">state level, especially in New York, New Jersey, Illinois and Texas,</div><div style="left: 89.1818px; top: 1098.96px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02826);" data-canvas-width="390.7373371212122">the IMS data captured a much larger number of cases that the CDC</div><div style="left: 89.1818px; top: 1115.48px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.955749);" data-canvas-width="390.9970378787877">reported cases. Most of these possible Zika cases are concentrated</div><div style="left: 89.1818px; top: 1131.99px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.999269);" data-canvas-width="392.2464090909091">in the large metropolitan areas around New York City, Chicago</div><div style="left: 89.1818px; top: 1148.51px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03443);" data-canvas-width="390.910003030303">and Houston. Many of them are diagnosed and treated by the same</div><div style="left: 89.1818px; top: 1165.02px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00217);" data-canvas-width="117.72165151515152">healthcare providers.</div><div style="left: 104.045px; top: 1181.54px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.957199);" data-canvas-width="376.4664295454547">The IMS sample captured 577 pregnant women with a possible</div><div style="left: 89.1818px; top: 1198.05px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.962914);" data-canvas-width="391.4083477272726">Zika virus infection compared to the 168 pregnant women with a</div><div style="left: 505.364px; top: 316.142px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.968513);" data-canvas-width="391.37606060606066">possible Zika virus infection reported in the U.S. Zika Pregnancy</div><div style="left: 505.364px; top: 332.657px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.974858);" data-canvas-width="389.42339166666665">Registry as of May 24, 2016. Many of the pregnant women in the IMS</div><div style="left: 505.364px; top: 349.172px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03058);" data-canvas-width="390.89877272727267">sample had multiple visits, often in consecutive months, associated</div><div style="left: 505.364px; top: 365.688px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.980038);" data-canvas-width="391.85194469696995">with the Zika virus disease diagnosis. Pregnant women are more</div><div style="left: 505.364px; top: 382.203px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03696);" data-canvas-width="391.0391515151516">likely to be tested and diagnosed with a Zika virus infection due to</div><div style="left: 505.364px; top: 398.718px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.0241);" data-canvas-width="390.6418795454546">the risk of fetal malformations from the disease. As many as 250 of</div><div style="left: 505.364px; top: 415.233px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.988805);" data-canvas-width="389.52306060606037">the 577 pregnant women with a possible Zika virus infection also had</div><div style="left: 505.364px; top: 431.748px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.04217);" data-canvas-width="390.95211666666677">a diagnosis of suspected fetal damage due to a viral disease. Of all</div><div style="left: 505.364px; top: 448.263px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.0252);" data-canvas-width="390.7190878787878">women with a possible Zika virus infection in the IMS sample, 120</div><div style="left: 505.364px; top: 464.779px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00205);" data-canvas-width="389.72941742424234">were in New Jersey, 111 in New York, 93 in Illinois and 74 in Texas,</div><div style="left: 505.364px; top: 481.294px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03874);" data-canvas-width="390.9128106060607">and most were concentrated in the large metropolitan areas around</div><div style="left: 505.364px; top: 497.809px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01236);" data-canvas-width="218.7382272727273">New York City, Chicago and Houston.</div><div style="left: 505.364px; top: 529.236px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.10288);" data-canvas-width="84.24131060606061">Conclusions</div><div style="left: 520.227px; top: 544.051px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.993404);" data-canvas-width="377.39433333333335">These findings suggest that all-payer claims data can be used</div><div style="left: 505.364px; top: 560.566px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.973784);" data-canvas-width="391.8505409090908">succesfully to monitor Zika transmission trends at local and state</div><div style="left: 505.364px; top: 577.082px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00452);" data-canvas-width="390.0873833333332">level, especially with a focus on pregnant women. Healthcare claims</div><div style="left: 505.364px; top: 593.597px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.989832);" data-canvas-width="392.4682075757575">data is fast, granular, relevant at local level and can be used to</div><div style="left: 505.364px; top: 610.112px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.993437);" data-canvas-width="389.6592280303029">supplement CDC ArboNET data for local and state level surveillance</div><div style="left: 505.364px; top: 626.627px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.98652);" data-canvas-width="392.1088378787876">and response to the evolving Zika virus infection outbreak. This</div><div style="left: 505.364px; top: 643.142px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.985921);" data-canvas-width="389.487965909091">study is an example of a novel approach to surveillance for Zika virus</div><div style="left: 505.364px; top: 659.657px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.0022);" data-canvas-width="306.8399545454545">disease and potentially many other infectious diseases.</div> ER -