Identifying Medicare beneficiaries with dementia.
Identifying Medicare beneficiaries with dementia.
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DOI：
10.1111/jgs.17183
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发表时间：
2021-08
影响因子：
6.3
通讯作者：
Hsu J
中科院分区：
文献类型：
--
作者：
Moura LMVR;Festa N;Price M;Volya M;Benson NM;Zafar S;Weiss M;Blacker D;Normand SL;Newhouse JP;Hsu J
没有关于国际疾病分类（ICD）-10痴呆症诊断对医疗保险索赔数据中临床医生裁定的参考标准的有效性的数据。我们使用一个新的数据库，在电子健康记录（EHR）和索赔之间建立个人层面的联系，研究了基于索赔的诊断与专家临床医生裁定的准确性。在这项回顾性观察性研究中，两名神经科医生和两名精神科医生对2016年1月至2018年12月的患者病历进行了标准化审查，并判定了痴呆状态。我们测量了三种基于索赔的痴呆症定义的准确性。Mass-General-Brigham Healthcare（MGB），马萨诸塞州，美国。从MGB责任医疗组织（ACO）内的40，690名65岁及以上的按服务收费（FFS）医疗保险受益人的合格人群中，我们随机抽取了1，002名患者，使用行政代理人按痴呆症的预测试可能性进行分层。没有。我们评估了三种基于ICD-10声明的痴呆定义的准确性（受试者工作曲线下面积[AUROC]）和校准（大范围校准[CITL]和校准斜率）。我们应用逆概率加权来重建合格人群，并使用10倍交叉验证（CV）报告所有性能特征的平均值和95%置信区间（95% CI）。受益人的平均年龄为75.3岁，主要是女性（59%）和非西班牙裔白色人（93%）。合格人群中判定的痴呆患病率为7%。表现最好的定义表现出极好的准确性（CV-AUC 0.94; 95%CI 0.92-0.96），并且与临床医生裁定的痴呆的参考标准（CV-CITL <0.001，CV斜率0.97）进行了良好的校准。这项研究是第一个验证ICD-10诊断代码对一个强大的和可复制的方法来确定痴呆症，使用现实世界的临床参考标准。表现最好的定义包括具有强表面有效性的诊断代码，并且优于先前验证的ICD-9痴呆定义的更新版本。
No data exist regarding the validity of International Classification of Disease (ICD)-10 dementia diagnoses against a clinician-adjudicated reference standard within Medicare claims data. We examined the accuracy of claims-based diagnoses with respect to expert clinician adjudication using a novel database with individual-level linkages between electronic health record (EHR) and claims. In this retrospective observational study, two neurologists and two psychiatrists performed a standardized review of patients’ medical records from January-2016 to December-2018, and adjudicated dementia status. We measured the accuracy of three claims-based definitions of dementia against the reference standard. Mass-General-Brigham Healthcare (MGB), Massachusetts, USA. From an eligible population of 40,690 fee-for-service (FFS) Medicare beneficiaries, aged 65-years and older, within the MGB Accountable Care Organization (ACO), we generated a random sample of 1,002 patients, stratified by the pretest likelihood of dementia using administrative surrogates. None. We evaluated the accuracy (area-under-receiver-operating-curve [AUROC]) and calibration (calibration-in-the-large [CITL] and calibration slope) of three ICD-10 claims-based definitions of dementia against clinician-adjudicated standards. We applied inverse probability weighting to reconstruct the eligible population and reported the mean and 95% confidence interval (95% CI) for all performance characteristics, using 10-fold cross-validation (CV). Beneficiaries had an average age of 75.3-years and were predominately female (59%) and non-Hispanic white (93%). The adjudicated prevalence of dementia in the eligible population was 7%. The best performing definition demonstrated excellent accuracy (CV-AUC 0.94; 95% CI 0.92-0.96) and was well-calibrated to the reference standard of clinician-adjudicated dementia (CV-CITL <0.001, CV-slope 0.97). This study is the first to validate ICD-10 diagnostic codes against a robust and replicable approach to dementia ascertainment, using a real-world clinical reference standard. The best performing definition includes diagnostic codes with strong face validity and outperforms an updated version of a previously validated ICD-9 definition of dementia.
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DOI：
10.1002/alz.12199
发表时间：
2020-10-08
期刊：
Alzheimer's & dementia : the journal of the Alzheimer's Association
影响因子：
--
作者：
Jain S;Rosenbaum PR;Reiter JG;Hoffman G;Small DS;Ha J;Hill AS;Wolk DA;Gaulton T;Neuman MD;Eckenhoff RG;Fleisher LA;Silber JH
通讯作者：
Silber JH
DOI：
10.1016/j.jalz.2011.03.005
发表时间：
2011-05
期刊：
Alzheimer's & dementia : the journal of the Alzheimer's Association
影响因子：
--
作者：
McKhann GM;Knopman DS;Chertkow H;Hyman BT;Jack CR Jr;Kawas CH;Klunk WE;Koroshetz WJ;Manly JJ;Mayeux R;Mohs RC;Morris JC;Rossor MN;Scheltens P;Carrillo MC;Thies B;Weintraub S;Phelps CH
通讯作者：
Phelps CH
影响因子：
5.4
作者：
Gianattasio, Kan Z.;Wu, Qiong;Power, Melinda C.
通讯作者：
Power, Melinda C.
影响因子：
3
作者：
Moura, Lidia M. V. R.;Smith, Jason R.;Hsu, John
通讯作者：
Hsu, John
影响因子：
14
作者：
通讯作者：
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