{"doi":"10.1016/j.jamda.2024.105440","title":"Evaluation of COVID-19 Diagnosis Codes for Identification of SARS-CoV-2 Infections in a Nursing Home Cohort, 2022–2023","abstract":"OBJECTIVES: This study aimed to evaluate the utility of electronic health record (EHR) diagnosis codes for monitoring SARS-CoV-2 infections among nursing home residents. DESIGN: A retrospective cohort study design was used to analyze data collected from nursing homes operating under the tradename Signature Healthcare between January 2022 and June 2023. SETTING AND PARTICIPANTS: Data from 31,136 nursing home residents across 76 facilities in Kentucky, Tennessee, Indiana, Ohio, North Carolina, Georgia, Alabama, and Virginia were included. METHODS: Resident demographics, diagnosis codes associated with clinical diagnoses (including COVID-19), and SARS-CoV-2 testing information were collected from the EHR and supplemental testing data sources. We described the rates of infection and the clinical characteristics of residents with incident-positive SARS-CoV-2 tests and new-onset COVID-19 diagnoses. Positive predictive values (PPVs) of COVID-19 diagnosis codes were calculated for residents stratified by whether a resident was continuously present in a facility for ±3 days from the diagnosis onset date listed in EHRs, using positive SARS-CoV-2 tests to confirm infection. RESULTS: A total of 4876 incident-positive SARS-CoV-2 tests and 6346 new-onset COVID-19 diagnoses were recorded during the study period. Weekly rates of new-onset diagnoses were significantly higher than positive test rates, although trends followed similar trajectories. Among residents continuously present in the nursing home ±3 days from the diagnosis onset date, the PPV of COVID-19 diagnosis codes was high (3395 of 3685 = 92%; 95% CI, 91%-93%). The PPV among this group significantly varied by study quarter (P < .001). The PPV was substantially lower for 2661 diagnoses among residents not continuously present in the nursing home (24%; 95% CI, 22%-26%). CONCLUSIONS AND IMPLICATIONS: This study demonstrates the utility of diagnosis codes for assessment of COVID-19 epidemiology and trends when testing data are unavailable for residents during their stay in a nursing home. Future research should explore strategies to evaluate the utility of diagnosis codes at admission and discharge to nursing homes to enhance surveillance efforts.","journal":"Journal of the American Medical Directors Association","year":2025,"id":542750,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":22.178386323199504,"corpus_rank":9377,"citation_count":1,"citer_count":1,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.7708,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":271554,"name":"Amanda B. Payne","orcid":"0000-0003-1027-7639","position":1,"is_corresponding":false},{"id":687965,"name":"Dustin W. Currie","orcid":"0000-0003-2061-2672","position":2,"is_corresponding":false},{"id":1270912,"name":"Thomas Franceschini","orcid":null,"position":3,"is_corresponding":false},{"id":1270913,"name":"Amber Gensheimer","orcid":null,"position":4,"is_corresponding":false},{"id":497558,"name":"Joseph D. Lutgring","orcid":"0000-0001-5723-8317","position":5,"is_corresponding":false},{"id":225444,"name":"Sujan Reddy","orcid":"0000-0002-3267-7011","position":6,"is_corresponding":false},{"id":225440,"name":"Kelly M Hatfield","orcid":"0000-0003-1035-8420","position":7,"is_corresponding":false},{"id":1270519,"name":"Arshiya Patel","orcid":"0000-0003-1553-5844","position":0,"is_corresponding":true}],"reference_count":15,"raw_metadata":null,"created_at":"2026-07-19T02:53:00.171379Z","pmid":"39788487","pmcid":"PMC11890922","fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}