Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: Estimating positive predictive value on the basis of review of hospital records
Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: Estimating positive predictive value on the basis of review of hospital records
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DOI：
10.1016/j.ahj.2004.02.013
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发表时间：
2004-07-01
影响因子：
4.8
通讯作者：
Solomon, DH
中科院分区：
文献类型：
--
作者：
Kiyota, Y;Schneeweiss, S;Solomon, DH
背景许多心血管流行病学研究依赖于医疗保健索赔数据库中的诊断代码。尽管在急性心肌梗死(AMI)的护理和诊断方面有了重要的变化，但最近还没有对美国医疗保险系统中的AMI出院诊断代码的有效性进行检查。我们的目的是检查国际疾病分类-第九版-临床修改(ICD-9-CM)出院诊断代码和诊断相关组(DRG)代码在医疗保险索赔数据库中对急性心肌梗死的准确性。方法我们抽样了1999年和2000年宾夕法尼亚州医疗保险受益人的住院病例。我们使用Medicare数据来识别具有急性心肌梗死指标(ICD-9-CM诊断代码410.X0和410.X1或DRG代码121、122和123)的住院患者。这些事件的医院记录由训练有素的抽象师根据世界卫生组织的急性心肌梗死诊断标准进行审查。结果在2200例医疗保险诊断编码提示急性心肌梗死的住院病例中，获得2022例住院记录(91.9%)。基于初级医疗保险索赔的定义的阳性预测值为94.1%(95%可信区间，93.0%-95.2%)。基于替代索赔的定义的阳性预测值略有不同，包括DRG代码和逗留时间限制的定义产生了最高的阳性预测值，95.4%(95%可信区间，94.3%-96.4%)。有心肌梗死病史的患者的阳性预测值显著低于无心肌梗死病史的患者(88.1%比94.6%，P<；.001)。结论在这项研究中，我们观察到基于医疗保险索赔的急性心肌梗死诊断和基于结构化病历回顾的诊断具有较高的阳性预测价值。
Background Many cardiovascular epidemiologic studies rely on diagnosis codes in health care claims databases. Despite important changes in the care and diagnosis of acute myocardial infarction (AMI), the validity of hospital discharge diagnosis codes for AMI in the US Medicare system has not been recently examined. Our objective was to examine the accuracy of International Classification of Diseases-ninth revision-Clinical Modifications (ICD-9-CM) discharge diagnosis codes and diagnosis-related groups (DRG) codes for AMI in a Medicare claims database.Methods We sampled hospitalization episodes from Medicare beneficiaries in Pennsylvania during 1999, 2000, or both. We used Medicare data to identify patients with hospitalizations containing indicators of AMI (ICD-9-CM diagnosis codes 410.X0 and 410.X1 or DRG codes 121, 122, and 123). Hospital records for these episodes were reviewed by trained abstractors using World Health Organization criteria for diagnosing AMI. We then calculated the positive predictive value of Medicare claims-based definitions of AMI.Results Of 2200 hospitalization episodes with Medicare diagnosis codes suggestive of AMI, 2022 hospital records (91.9%) were obtained. The positive predictive value for a primary Medicare claims-based definition was 94.1% (95% CI, 93.0%-95.2%). Positive predictive values for alternative claims-based definitions ranged slightly, with the definition including DRG codes and length-of-stay restrictions yielding the highest positive predictive value, 95.4% (95% CI, 94.3%96.4%). Subjects with a history of myocardial infarction had a significantly lower positive predictive value than subjects without a history of myocardial infarction (88.1% vs 94.6%, P < .001).Conclusions In this study, we observed high positive predictive values for a Medicare claims-based diagnosis of AMI and a diagnosis based on structured hospital record review.