Comorbidity measurement in elderly female breast cancer patients with administrative and medical records data
Comorbidity measurement in elderly female breast cancer patients with administrative and medical records data
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DOI：
10.1016/s0895-4356(97)00050-4
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发表时间：
1997-06-01
影响因子：
7.2
通讯作者：
Penberthy, LT
中科院分区：
文献类型：
--
作者：
Newschaffer, CJ;Bush, TL;Penberthy, LT
评估者间的可靠性，跨源（医疗保险索赔与医疗记录）的协议，并在一组404名老年人，从弗吉尼亚州癌症登记处确定的乳腺癌事件的情况下，与医疗保险管理数据文件的三个总合并症指数预测全因死亡率的能力进行了评估。Comorbidity基于医疗记录和Medicare索赔数据，使用Charlson et al（1987），Satariano和Ragland（1994）以及Kaplan和Feinstein（1974）的指数。所有指标的评分者间一致性良好（kappas ≥ 0.80）。通过索赔和医疗记录测量的合并症指数之间的一致性相当差（kappas在0.30和0.40之间）。然而，基于索赔和基于医疗记录的合并症指数与死亡率相似。对于Charlson指数，最能预测生存的指数，根据医疗记录，从较低到较高合并症类别增加的调整后相对风险为1.48（95%置信区间1.23，1.78），而根据医疗保险索赔为1.53（95%置信区间1.23，1.93）。在控制了基于病历的评分后，基于索赔的Charlson指数评分似乎仍与生存率相关（相对风险= 1.30; 95%置信区间= 1.00，1.70）。这表明，两种合并症数据来源都增加了有价值的预后信息，相反，单独使用任何一种来源都会导致合并症的一些错误分类。(C)1997年爱思唯尔科学公司
The inter-rater reliability, cross-source (Medicare claims versus medical record) agreement, and ability to predict all-cause mortality of three aggregate comorbidity indices were evaluated in a group of 404 elderly, incident breast cancer cases identified from the Virginia Cancer Registry and linked to Medicare administrative data files. Comorbidity was based on both medical records and Medicare claims data using indices from Charlson et al (1987), Satariano and Ragland (1994), and Kaplan and Feinstein (1974). Inter-rater agreement was good for all indices (kappas greater than or equal to 0.80). Agreement between comorbidity indices measured by claims and medical records was considerably poorer (kappas between 0.30 and 0.40). However, claims-based and medical records-based comorbidity indices were similarly associated with mortality. For the Charlson index, the index best predicting survival, the adjusted relative risk for an increase from a lower to higher comorbidity category was 1.48 (95% confidence interval 1.23, 1.78) based on medical records compared to 1.53 (95% confidence interval 1.23, 1.93) based on Medicare claims. The claims based Charlson index score still appeared to be associated with survival (relative risk = 1.30; 95% confidence interval = 1.00, 1.70) after controlling for the medical records-based score. This suggests that both comorbidity data sources add valuable prognostic information and, conversely, that the use of either source alone will result in some misclassification of comorbidity. (C) 1997 Elsevier Science Inc.