Evaluation of Medicare claims data to ascertain peripheral vascular events in the Women's Health Initiative
Evaluation of Medicare claims data to ascertain peripheral vascular events in the Women's Health Initiative
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DOI：
10.1016/j.jvs.2014.01.056
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发表时间：
2014-07-01
影响因子：
4.3
通讯作者：
Burwen, Dale R.
中科院分区：
文献类型：
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作者：
Mell, Matthew W.;Pettinger, Mary;Burwen, Dale R.
目的：通过使用索赔数据从大型临床数据库中获取长期结果是提高效率同时降低研究成本的潜在策略。我们试图比较使用的医疗保险数据与妇女健康倡议（WHI）的数据，以确定外周血管事件，定义的WHI研究design.Methods：我们研究了参与者从WHI与裁定的结果和链接到医疗保险的招生和利用数据，通过2007年。关注的结局包括因治疗腹主动脉瘤（AAA）、下肢外周动脉疾病（LE PAD）和颈动脉狭窄（CAS）而住院。将WHI裁定确定的事件与使用来自医疗保险数据的诊断和程序代码的编码算法定义的事件进行比较，然后使用测试数据集进行验证。我们通过Kappa统计量评估了一致性，并评估了不一致的原因。结果：在试点集中，对50,511名参与者的记录进行了分析。医疗保险和医疗补助服务中心与WHI之间对诊断为血管疾病但未进行治疗程序的入院率的一致性较差（kappa，0.02-0.18）。根据WHI结局数据收集，29名参与者因AAA、204名参与者因LE PAD事件和281名参与者因CAS接受了血管治疗手术。医疗保险医院索赔记录了41例AAA治疗，255例LE PAD治疗，317例CAS治疗。对于参与医疗保险和医疗补助服务中心捕获的血管手术和WHI裁定的记录的参与者，AAA治疗程序的kappa值为0.81，PAD为0.77，CAS为0.93。对于由WHI识别但不由医疗保险医院数据识别的血管手术（n = 82），55%由医疗保险医生索赔捕获。相反，对于由医疗保险医院数据确定但未被WHI裁定捕获的治疗（n = 57），74%的医生声明与程序一致。15名在医院索赔中接受AAA或LE PAD手术的参与者有医疗记录可供审查，其中9人有WHI裁定过程未记录的手术的明确记录。Medicare数据的估计阳性预测值为AAA的91%至94%，LE PAD的92%至95%，CAS的94%至99%。可用的测试集数据（n = 50，253）产生了大致相似的结果与kappa值为0.77 AAA，0.79 LE PAD，和0.94 CAS.Conclusions：医疗保险的数据似乎是有用的识别血管治疗程序WHI参与者。医疗保险医院的索赔确定了比WHI更多的程序，具有较高的阳性预测值，但也可能无法捕获WHI中确定的一些程序。
Objective: Capturing long-term outcomes from large clinical databases by use of claims data is a potential strategy for improving efficiency while reducing study costs. We sought to compare the use of Medicare data with data from the Women's Health Initiative (WHI) to determine peripheral vascular events, as defined by the WHI study design.Methods: We studied participants from the WHI with both adjudicated outcomes and links to Medicare enrollment and utilization data through 2007. Outcomes of interest included hospitalizations for treatment of abdominal aortic aneurysm (AAA), lower extremity peripheral artery disease (LE PAD), and carotid artery stenosis (CAS). Events determined by WHI adjudication were compared with events defined by coding algorithms using diagnosis and procedure codes from Medicare data with a pilot data set and then validated with a test data set. We assessed agreement by a kappa statistic and evaluated reasons for disagreement.Results: In the pilot set, records from 50,511 participants were analyzed. Agreement between the Centers for Medicare and Medicaid Services and WHI for admissions with a diagnosis but no treatment procedures for vascular conditions was poor (kappa, 0.02-0.18). On the basis of WHI outcome data collection, vascular treatment procedures occurred in 29 participants for AAA, 204 for LE PAD events, and 281 for CAS. Medicare hospital claims recorded 41 treatments for AAA, 255 for LE PAD, and 317 for CAS. For participants with a Centers for Medicare and Medicaid Services-captured vascular procedure and a record adjudicated by WHI, kappa values for treatment procedures were 0.81 for AAA, 0.77 for PAD, and 0.93 for CAS. For vascular procedures identified by WHI but not by Medicare hospital data (n = 82), 55% were captured by Medicare physician claims. Conversely, for treatments identified by Medicare hospital data but not captured by WHI adjudication (n = 57), 74% had physician claims consistent with the procedure. Fifteen participants with AAA or LE PAD procedures in hospital claims had medical records available for review, and nine of these had definitive documentation of procedures that were not captured by the WHI adjudication process. Estimated positive predictive value of Medicare data was 91% to 94% for AAA, 92% to 95% for LE PAD, and 94% to 99% for CAS. Available test set data (n = 50,253) yielded generally similar results with kappa of 0.77 for AAA, 0.79 for LE PAD, and 0.94 for CAS.Conclusions: Medicare data appear useful for identifying vascular treatment procedures for WHI participants. Medicare hospital claims identify more procedures than WHI does, with high positive predictive value, but also may not capture some procedures identified in WHI.