Estimating prevalence, incidence, and disease-related mortality for patients with epilepsy in managed care organizations
Estimating prevalence, incidence, and disease-related mortality for patients with epilepsy in managed care organizations
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DOI：
10.1111/j.0013-9580.2005.30604.x
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发表时间：
2005-02-01
期刊：
影响因子：
5.6
通讯作者：
Thurman, DJ
中科院分区：
文献类型：
--
作者：
Holden, EW;Nguyen, HT;Thurman, DJ
目的.本研究的目的是应用计算机算法的管理数据集，以确定癫痫的患病率，癫痫的发病率，癫痫相关的死亡率的患者在管理式医疗机构（MCO）。研究人群包括入组Lovelace Health Plan的成员，Lovelace Health Systems是总部位于新墨西哥州阿尔伯克基的全州MCO的一个组成部分。获得了1996年7月至2001年6月的患者记录。将具有高灵敏度和特异性的四种逻辑回归模型应用于成员连续入组MCO的1年、3年和5年时间范围。发病率定义为首次诊断前18个月内没有癫痫相关代码的患者。死亡率估计在人口中也进行了评估，通过使用匹配的对照组和链接到全州范围内的死亡registration.Results：数据产生的估计患病率为7-10每1,000人，这取决于年龄，性别，种族和时间间隔。连续入组3年的成员年发病率为47/100，000，连续入组5年的成员年发病率为71/100，000。使用算法识别的癫痫患者的粗死亡率比匹配的对照组高2-2.5倍。条件Logistic回归分析显示，癫痫患者与对照组相比，死亡的OR值为1.24 ~ 2.06。准确估计癫痫的患病率、发病率和死亡率是MCO疾病管理的重要组成部分。该项目中的算法可用于监测患病率，发病率和死亡率的趋势，以告知对改善癫痫患者的医疗保健需求和生活质量至关重要的决策。
Purpose. The purpose of the present study was to apply computer algorithms to an administrative data set to identify the prevalence of epilepsy, incidence of epilepsy, and epilepsy-related mortality of patients in a managed care organization (MCO).Methods. The study population consisted of members enrolled in Lovelace Health Plan, a component of Lovelace Health Systems, a statewide MCO headquartered in Albuquerque, New Mexico. Patient records were obtained from July 1996 to June 2001. Four logistic regression models with high sensitivity and specificity were applied to 1-, 3-, and 5-year time frames in which members were continuously enrolled in the MCO. Incidence was defined for patients who did not have an epilepsy-associated code in the 18 months before the first diagnosis entry. Mortality estimates in the population also were assessed by using a matched control group and linkage to a statewide death registry.Results: The data yielded estimated prevalence rates of 7-10 per 1,000, depending on age, sex, ethnicity, and time interval. Annualized incidence was 47 per 100,000 for members continuously enrolled for 3 years and 71 per 100,000 for members continuously enrolled for 5 years. Crude mortality rates were 2-2.5 times higher for epilepsy patients identified with the algorithms than for the matched controls. Conditional logistic regression indicated that the odds of death for epilepsy patients as compared with controls ranged from 1.24 to 2.06.Conclusions. Accurate estimation of prevalence, incidence, and mortality rates for epilepsy is an essential component of disease management in MCOs. The algorithms in this project can be used to monitor trends in prevalence, incidence, and mortality to inform decisions critical to improving the health care needs and quality of life for patients with epilepsy.