Discrepancies Between Electronic Records and Clinical Interview Diagnosis of PTSD: Differences in Mental Health Care Utilization

Prior research suggests that a significant number of veterans with posttraumatic stress disorder (PTSD) do not have this diagnosis recognized in the electronic health record (EHR). Unfortunately, such diagnostic errors can lead to improper allocation of already scarce health care services and resources. In this study, we examined concordance between PTSD diagnoses in the Veterans Affairs (VA) EHR and PTSD diagnoses based on a semistructured diagnostic interview and mental health service use in a sample of veterans (N = 1,299) enrolled in VA healthcare. Results from negative binomial regressions showed that veterans with PTSD based on the diagnostic interview and the EHR (true positives) used the most mental health care services. There were no significant differences between those without PTSD based on the interview and the EHR (true negatives) and those with PTSD based on interview that was not recognized in the EHR (false negatives) on total nonemergent outpatient mental health visits. However, veterans in the false negative group had more mental health-related emergent care visits (i.e., emergency room, urgent care, hospitalization) than veterans in the true negative group. Our findings suggest that veterans with PTSD who are not coded as such in the EHR may not be utilizing needed outpatient care but are seeking and receiving costly emergent care. Thus, accurate recognition of PTSD in the EHR is essential for connecting patients to outpatient mental health services. Impact Statement This study suggests that veterans with PTSD that have not been recognized as having PTSD in the electronic health record underutilize outpatient mental health services but have greater emergency service use (e.g., hospitalizations) than veterans without PTSD. Therefore, accurate diagnosis and coding of PTSD in electronic health records is important for connecting veterans with needed care.