Our Grants

Evaluating and Improving the Accuracy of ICD-Coded Hospital Data Systems in Estimating the Incidence of Nonfatal Firearm Injuries by Intent Type

Overview

Estimates of nonfatal firearm injury drawn from routinely-collected hospital billing data underestimate assaults and overestimate unintentional injuries. This project will describe the extent to which these discrepancies occur across several states, identify the underlying reasons for biased estimates, and develop approaches that accurately classify hospital-treated firearm injuries.

Status

Awarded

Purpose

This project seeks to improve hospital data systems that track the incidence of nonfatal firearm injuries by type of incident (assault, unintentional, legal intervention, and self-inflicted).

Approach

We will review approximately 2,200 medical charts to establish a 'gold standard' classification of firearm injuries by intent type. Approximately 1800 will come from two hospitals that have electronic medical records 2000-2019. The gold standard will enable us to: 1) identify meaningful biases in routinely coded records and, after further interrogating the causes of discrepancies (e.g., by interrogating the algorithms used to assign intent in commercial coding software), propose practical solutions for current problems with ICD-coding and 2) develop a Natural Language Processing/Artificial Intelligence (NLP/AI) algorithm, applied to electronic medical records, that could be implemented by hospitals to accurately classify nonfatal firearm injuries seen in their emergency departments. We will share our findings with the committee that sets standards for ICD-coding practices nationwide and make the NLP/AI algorithms we develop publicly available via the Open Science Framework website.

Significance

Our project provides a way to improve current surveillance of hospital-treated firearm injuries by providing empirically developed guidelines that overcome systematic biases in existing data collection processes. It also provides hospitals with an AI tool to efficiently and accurately classify intent to firearm injuries seen in their emergency departments.

Investigator Bios

  • Matthew Miller, professor of health sciences and epidemiology at Northeastern University, adjunct professor of Epidemiology at the Harvard Chan School of Public Health, and co-director of the Harvard Injury Control Research Center, is a nationally recognized expert in injury and violence prevention, with expertise if firearm-related violence, self-harm, interpersonal firearm injury, and pharmacoepidemiology using hospital data systems.
  • Deborah Azrael, research director at the Harvard Injury Control Research Center, is an expert in firearm-related violence and injury surveillance, and, along with Catherine Barber, was instrumental in developing the National Violent Death Reporting System.
  • Catherine Barber, director of the Means Matter campaign at the Harvard Injury Control Research Center, is an expert in injury surveillance and firearm-injury prevention. Along with Deborah Azrael, she was instrumental in developing the National Violent Death Reporting System.
  • Eric Goralnick, medical director, Emergency Preparedness and Access Center, Brigham Health, and associate professor, Harvard Medical School, is an expert in firearm and other traumatic injuries.
  • Li Zhou, associate professor of medicine, Division of General Internal Medicine and Primary Care of the Brigham and Women’s Hospital. Dr. Zhou’s primary research areas include bioinformatics, natural language processing (NLP), temporal reasoning, knowledge representation, terminology standards, and clinical decision support.
Grant Amount
$741,067
Award Type
Research
Organization
Northeastern University, Harvard School of Public Health, Brigham and Women's Hospital
Investigators
Matthew Miller, professor of health sciences and epidemiology at Northeastern University; Deborah Azrael, research director at the Harvard Injury Control Research Center; Catherine Barber, director of the Means Matter campaign at the Harvard Injury Control Research Center; Eric Goralnick, medical director, Emergency Preparedness and Access Center, Brigham Health, and associate professor, Harvard Medical School; and Li Zhou, associate professor of medicine, Division of General Internal Medicine and Primary Care of the Brigham and Women’s Hospital.
Expected Completion Date
August 2022
Year Awarded
2020
Focus Areas
Non-Lethal Firearm Injuries