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Volume 29, Number 9—September 2023
Research

Validation of Claims-Based Algorithm for Lyme Disease, Massachusetts, USA

Noelle M. CocorosComments to Author , Sheryl A. Kluberg, Sarah J. Willis, Susan Forrow, Bradford D. Gessner, Cameron T. Nutt, Alejandro Cane, Nathan Petrou, Meera Sury, Chanu Rhee, Luis Jodar, Aaron Mendelsohn, Emma R. Hoffman, Robert Jin, John Aucott, Sarah J. Pugh, and James H. Stark
Author affiliations: Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (N.M. Cocoros, S.A. Kluberg, S.J. Willis, S. Forrow, C. Rhee, A. Mendelsohn, E.R. Hoffman, R. Jin); Pfizer Inc., New York, New York, USA (S.J. Willis); Pfizer Inc., Collegeville, Pennsylvania, USA (B.D. Gessner, A. Cane, L. Jodar, S.J. Pugh, J.H. Stark); Brigham and Women’s Hospital, Boston (C.T. Nutt, N. Petrou, M. Sury, C. Rhee); Johns Hopkins School of Medicine, Baltimore, Maryland, USA (J. Aucott)

Main Article

Table 1

Case classification, definitions, and instructions used by clinician adjudicators for chart review in study of validation of claims-based algorithm for Lyme disease, Massachusetts, USA*

Classification Definitions†
Confirmed
 Erythema migrans with known exposure in a high-incidence state (e.g., Massachusetts), erythema migrans with known exposure in a low-incidence state and laboratory-confirmed Lyme disease, or >1 late manifestation of Lyme disease and laboratory-confirmed Lyme disease
Probable
 Diagnosis of Lyme disease in clinical notes and laboratory-confirmed Lyme disease but no evidence of erythema migrans and no eligible late manifestations of disease
Suspected Diagnosis of Lyme disease in clinical notes and antimicrobial drugs ordered by healthcare provider to treat Lyme disease but no laboratory confirmation, no evidence of erythema migrans, and no eligible late manifestations of Lyme disease; or erythema migrans with no known exposure, no laboratory confirmation, and no eligible late manifestations of Lyme disease

*Definitions were based on the 2017 Council of State and Territorial Epidemiologists case definitions (15). †Laboratory-confirmed Lyme disease was indicated by positive Lyme cultures, PCR, or 2-tiered tests. For a positive 2-tiered test, if the patient experienced signs or symptoms for <30 d before a positive or equivocal enzyme immunoassay or immunofluorescence assay, they must have a positive IgG or IgM Western blot result; if the patient has experienced signs or symptoms for >30 d before a positive or equivocal enzyme immunoassay or immunofluorescence assay, they must have a positive IgG Western blot result (a positive IgM Western blot result does not confirm Lyme disease in this scenario). Late manifestations of Lyme disease include musculoskeletal involvement defined as inflammatory arthritis or recurrent and brief attacks of swelling in >1 joint that lasts for several weeks or months; nervous system involvement defined as lymphocytic meningitis, cranial neuritis, radiculoneuropathy, or encephalomyelitis (headache, fatigue, paresthesia, or mildly stiff neck alone did not meet criteria for neurologic involvement); or cardiovascular involvement defined as acute onset of high-grade atrioventricular conduction defects that resolve in days to weeks, such as complete heart block, third degree heart block, or high-grade atrioventricular block (palpitations, bradycardia, bundle branch block, or myocarditis alone did not meet criteria for cardiovascular involvement).

Main Article

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Page created: July 21, 2023
Page updated: August 21, 2023
Page reviewed: August 21, 2023
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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