Validity of gout diagnoses in administrative data
Validity of gout diagnoses in administrative data
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DOI：
10.1002/art.22474
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发表时间：
2007-02-15
期刊：
影响因子：
--
通讯作者：
Platt, Richard
中科院分区：
文献类型：
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作者：
Harrold, Leslie R.;Saag, Kenneth G.;Platt, Richard
objective.通过检查索赔数据中痛风诊断的有效性，确定使用行政数据进行痛风流行病学研究的效用。我们从4个管理式护理计划的800，000名成员中，确定了在1999年1月1日至2003年12月31日期间至少有2次门诊痛风诊断的患者。从这一组中，随机抽取200名患者进行病历审查。经过培训的病历审查员从病历中提取痛风相关的临床、实验室和放射学数据。两名风湿病学家独立评价了提取的信息，并评估了痛风诊断是很可能/明确还是不太可能/信息不足。不一致的医生评级由共识裁定。根据记录回顾，患者还根据美国风湿病学会（ACR）、罗马和纽约痛风标准进行分类，并将这些结果与医生的总体评估进行比较。有121名患者被医生一致评定为可能/明确的痛风，导致>= 2个痛风编码诊断的阳性预测值为61%（95%置信区间53 - 67）。医生评估与已建立的痛风标准包括ACR、罗马和纽约标准之间的一致性较低（kappa值分别为0.17、0.16和0.20）。在痛风的流行病学和卫生服务研究中，仅使用行政数据可能导致错误分类。医疗记录审查索赔数据的验证可能提供了一个不充分的金标准，以确认痛风的诊断。
Objective. To determine the utility of using administrative data for epidemiologic studies of gout by examining the validity of gout diagnoses in claims data.Methods. From a population of similar to 800,000 members from 4 managed care plans, we identified patients who had at least 2 ambulatory claims for a diagnosis of gout between January 1, 1999 and December 31, 2003. From this group, a random sample of 200 patients was chosen for medical record review. Trained medical record reviewers abstracted gout-related clinical, laboratory, and radiologic data from the medical records. Two rheumatologists independently evaluated the abstracted information and assessed whether the gout diagnosis was probable/definite or unlikely/insufficient information. Discordant physician ratings were adjudicated by consensus. Based on record reviews, patients were also classified according to the American College of Rheumatology (ACR), Rome, and New York gout criteria and these results were compared with the physician global assessments.Results. There were 121 patients rated as having probable/definite gout by physician consensus, leading to a positive predictive value of >= 2 coded diagnoses of gout of 61% (95% confidence interval 53-67). There was low concordance between physician assessments and established gout criteria including ACR, Rome, and New York criteria (kappa = 0.17, 0.16, and 0.20, respectively).Conclusion. Use of administrative data alone in epidemiologic and health services research on gout may lead to misclassification. Medical record reviews for validation of claims data may provide an inadequate gold standard to confirm gout diagnoses.