Computerized definitions showed high positive predictive values for identifying hospitalizations for congestive heart failure and selected infections in Medicaid enrollees with rheumatoid arthritis
Computerized definitions showed high positive predictive values for identifying hospitalizations for congestive heart failure and selected infections in Medicaid enrollees with rheumatoid arthritis
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DOI：
10.1002/pds.1625
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发表时间：
2008-09-01
影响因子：
2.6
通讯作者：
Griffin, Marie R.
中科院分区：
文献类型：
--
作者：
Grijalva, Carlos G.;Chung, Cecilia P.;Griffin, Marie R.
目的在药物安全性研究中，计算机定义用于识别导致住院的严重感染和充血性心力衰竭。然而，关于其准确性的信息有限。我们评估的能力，计算机化的定义，以确定这些条件诊断为类风湿性关节炎（RA）的患者入院的原因。方法医疗图表随机选择的医疗补助RA患者队列的选定条件住院的系统样本。我们计算了阳性预测值（PPV）的计算机化定义社区获得性肺炎，侵袭性肺炎球菌疾病，败血症，机会性真菌病，充血性心力衰竭使用图表审查作为金标准和计算审查员之间的协议statistics.Results从2667住院，336（13%）的记录被选中进行审查。共有277张图表（82%）可用。基于任何出院诊断，因社区获得性肺炎、侵袭性肺炎球菌病、败血症和机会性真菌病住院的PPV分别为84%、100%、80%和62%。将定义限制于主要诊断产生了更高的PPV，肺炎为95%，其他诊断为100%。充血性心力衰竭主要诊断的PPV为100%。审查员之间的协议是至少77%的所有outcome.Conclusion这些研究结果表明，计算机化的定义可以识别充血性心力衰竭和选定的感染导致住院治疗的医疗补助RA患者。版权所有（C）2008约翰威利父子有限公司
Purpose Computerized definitions are used to identify serious infections and congestive heart failure leading to hospitalizations in studies of medication safety. However, information on their accuracy is limited. We evaluated the ability of computerized definitions to identify these conditions as the reason for admission among patients diagnosed with rheumatoid arthritis (RA).Methods Medical charts were randomly selected from a systematic sample of hospitalizations for selected conditions ill a cohort of Medicaid patients with RA. We calculated positive predictive values (PPVs) for computerized definitions for community-acquired pneumonia, invasive pneumococcal disease, sepsis, opportunistic mycoses, and congestive heart failure using charts reviews as gold standard and computed inter-reviewer agreement statistics.Results From 2667 hospitalizations, 336 (13%) records were selected for review. A total of 277 charts (82%) were available. Based on any discharge diagnosis, PPVs for hospitalizations due to community-acquired pneumonia, invasive pneumococcal disease, sepsis, and opportunistic mycoses were 84, 100, 80, and 62%, respectively. Restricting definitions to principal diagnoses yielded higher PPVs, 95% for pneumonia and 100% for other diagnoses. The PPV of a principal diagnosis for congestive heart failure was 100%. Inter-reviewer agreement was at least 77% for all outcomes.Conclusion These findings suggest that computerized definitions can identify congestive heart failure and selected infections leading to hospitalization in Medicaid patients with RA. Copyright (C) 2008 John Wiley & Sons, Ltd.