Validity of Administrative Database Coding for Kidney Disease: A Systematic Review
Validity of Administrative Database Coding for Kidney Disease: A Systematic Review
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DOI：
10.1053/j.ajkd.2010.08.031
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发表时间：
2011-01-01
影响因子：
13.2
通讯作者：
Garg, Amit X.
中科院分区：
文献类型：
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作者：
Vlasschaert, Meghan E. O.;Bejaimal, Shayna A. D.;Garg, Amit X.
背景：卫生管理数据库中的信息越来越多地指导肾脏护理和政策。研究设计：对观察性研究进行系统评价。环境与人群：在任何司法管辖区的行政数据库中描述急性肾损伤（AKI）和慢性肾脏疾病（CKD）代码有效性的研究。选择标准：在检索了13个医学数据库后，我们纳入了从数据库建立到2009年6月发表的观察性研究，这些研究根据参考标准验证了AKI或CKD的肾脏诊断和程序代码。索引测试：肾脏诊断或程序管理数据代码。参考测试：患者图表回顾、实验室值或来自高质量患者登记的数据。结果：纳入了4个国家13个数据库的25项研究。9项研究验证了AKI的诊断和程序代码，19项研究验证了CKD。不同研究的敏感性不同，通常较差（AKI中位数为29%；范围为15%-81%；CKD中位数为41%；范围为3%-88%）。阳性预测值通常是合理的，但结果也有差异（AKI中位数为67%；范围为15%-96%；CKD中位数为78%；范围为29%-100%）。仅通过透析来定义AKI和CKD通常会导致更好的代码有效性。在多变量元回归中，与敏感性相关的研究特征是参考标准是否使用实验室值（P < 0.001）；当使用实验室值时，灵敏度降低39% （95% CI, 23%-56%）。局限性：初级研究数据的缺失限制了一些可以进行的分析。结论：管理数据库分析具有实用性，但必须谨慎地进行和解释，以避免因代码有效性差而产生的偏差。中华肾脏病杂志，57(1):29-43。(C) 2010年由国家肾脏基金会，公司。
Background: Information in health administrative databases increasingly guides renal care and policy.Study Design: Systematic review of observational studies.Setting & Population: Studies describing the validity of codes for acute kidney injury (AKI) and chronic kidney disease (CKD) in administrative databases operating in any jurisdiction.Selection Criteria: After searching 13 medical databases, we included observational studies published from database inception though June 2009 that validated renal diagnostic and procedural codes for AKI or CKD against a reference standard.Index Tests: Renal diagnostic or procedural administrative data codes.Reference Tests: Patient chart review, laboratory values, or data from a high-quality patient registry.Results: 25 studies of 13 databases in 4 countries were included. Validation of diagnostic and procedural codes for AKI was present in 9 studies, and validation for CKD was present in 19 studies. Sensitivity varied across studies and generally was poor (AKI median, 29%; range, 15%-81%; CKD median, 41%; range, 3%-88%). Positive predictive values often were reasonable, but results also were variable (AKI median, 67%; range, 15%-96%; CKD median, 78%; range, 29%-100%). Defining AKI and CKD by only the use of dialysis generally resulted in better code validity. The study characteristic associated with sensitivity in multivariable meta-regression was whether the reference standard used laboratory values (P < 0.001); sensitivity was 39% lower when laboratory values were used (95% CI, 23%-56%).Limitations: Missing data in primary studies limited some of the analyses that could be done.Conclusions: Administrative database analyses have utility, but must be conducted and interpreted judiciously to avoid bias arising from poor code validity. Am J Kidney Dis. 57(1): 29-43. (C) 2010 by the National Kidney Foundation, Inc.