Study of Cardiovascular Health Outcomes in the Era of Claims Data: The Cardiovascular Health Study.
Study of Cardiovascular Health Outcomes in the Era of Claims Data: The Cardiovascular Health Study.
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DOI：
10.1161/circulationaha.115.018610
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发表时间：
2016-01-12
期刊：
影响因子：
37.8
通讯作者：
Longstreth WT Jr
中科院分区：
文献类型：
--
作者：
Psaty BM;Delaney JA;Arnold AM;Curtis LH;Fitzpatrick AL;Heckbert SR;McKnight B;Ives D;Gottdiener JS;Kuller LH;Longstreth WT Jr
越来越多的来自行政索赔数据的诊断代码被用作临床结果。来自心血管健康研究（CHS）的数据用于比较裁定的住院心血管事件和基于索赔的事件定义方法之间的事件发生率和风险因素相关性。心肌梗死（MI）、卒中和心力衰竭（HF）的结局以三种方式定义：1）CHS裁定的事件（CHS[adj]）; 2）仅在来自医疗保险和医疗补助服务中心（CMS[1st]）的医疗保险索赔数据的主要位置选择ICD 9诊断代码; 3）在任何位置选择相同的诊断代码（CMS[任何]）。传统的基于索赔的事件定义方法具有较高的阳性预测值（PPV），但灵敏度较低。例如，ICD 9代码410.×1的PPV对于第一位置的新发急性MI为90. 6%，但该代码仅识别了53. 8%的事件MI。观察到的事件发生率较低。对于MI，CHS[adj] MI的发生率为14.9起事件/1000人年，CMS[1st]为8.6起事件/1000人年，CMS[任何]为12.2起事件/1000人年。一般来说，CVD危险因素的相关性在三种定义事件的方法中是相似的。事实上，传统的心血管疾病危险因素也与所有非心肌梗死导致的首次住院相关。使用索赔数据中的诊断代码作为临床事件，特别是当仅限于初步诊断时，会导致低估事件发生率。此外，基于索赔的事件数据代表复合终点，包括关注的结局和选定（错误分类）的非事件住院治疗。
Increasingly, the diagnostic codes from administrative claims data are being used as clinical outcomes. Data from the Cardiovascular Health Study (CHS) were used to compare event rates and risk-factor associations between adjudicated hospitalized cardiovascular events and claims-based methods of defining events. The outcomes of myocardial infarction (MI), stroke, and heart failure (HF) were defined in three ways: 1) the CHS adjudicated event (CHS[adj]); 2) selected ICD9 diagnostic codes only in the primary position for Medicare claims data from the Center for Medicare and Medicaid Services (CMS[1st]); and 3) the same selected diagnostic codes in any position (CMS[any]). Conventional claims-based methods of defining events had high positive predictive values (PPVs) but low sensitivities. For instance, the PPV of an ICD9 code of 410.×1 for a new acute MI in the first position was 90.6%, but this code identified only 53.8% of incident MIs. The observed event rates were low. For MI, the incidence was 14.9 events per 1000 person years for CHS[adj] MI, 8.6 for CMS[1st] and 12.2 for CMS[any]. In general, CVD risk factor associations were similar across the three methods of defining events. Indeed, traditional CVD risk factors were also associated with all first hospitalizations not due to an MI. The use of diagnostic codes from claims data as clinical events, especially when restricted to primary diagnoses, leads to an underestimation of event rates. Additionally, claims-based events data represent a composite endpoint that includes the outcome of interest and selected (misclassified) non-event hospitalizations.