Optimizing administrative datasets to examine acute kidney injury in the era of big data: workgroup statement from the 15(th) ADQI Consensus Conference.
Optimizing administrative datasets to examine acute kidney injury in the era of big data: workgroup statement from the 15(th) ADQI Consensus Conference.
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DOI：
10.1186/s40697-016-0098-5
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发表时间：
2016-01-01
影响因子：
1.7
通讯作者：
Bagshaw, Sean M
中科院分区：
文献类型：
--
作者：
Siew, Edward D;Basu, Rajit K;Bagshaw, Sean M
审查目的：本次审查的目的是报告如何使用行政数据来研究 AKI，确定当前的局限性，并建议如何增强这些数据源以解决该领域的知识差距。目标：1) 审查关于如何跨行政数据集对 AKI 进行编码的现有证据基础，2) 确定与行政数据编码相关的 AKI 科学进展的局限性、差距和主要障碍，3) 讨论 AKI 的行政数据如何可能加强以实现行政管辖范围内和跨行政管辖区的“沟通”和“翻译”，以及 4) 建议如何配置行政数据库来为“基于登记的”实用研究提供信息。信息来源：通过 PubMed 搜索相关 AKI 文献对英语文章进行文献综述，重点是行政数据中 AKI 的验证或使用行政数据来描述 AKI 的流行病学。背景：急性透析质量倡议 (ADQI) 9 月共识会议2015 年 6 月 7 日，加拿大班夫。患者：患有 AKI 的住院患者。关键信息：许多管理数据集中 AKI 的编码结构限制了对真实疾病负担（尤其是不太严重的 AKI）、其时间趋势和临床表型的理解。存在改善 AKI 数据质量和编码的重要机会，以更好地解决 AKI 中的关键知识差距并改善护理。方法：通过一系列交替的分组会议和全体会议，开发了修改后的 Delphi 共识构建流程，包括文献综述和总结陈述。结果：AKI 的管理规范受到敏感性差、缺乏对严重程度进行分类的标准化以及较差的上下文表型的限制。由于提供者对 AKI 的认识降低以及报告的主观性，这些限制进一步受到阻碍。虽然 AKI 的理想化定义可能难以实施，但通过使用基于实验室的定义并提供有关 AKI 发生背景的补充信息来提高报告标准化是可能的。管理数据库还可能有助于加强基于临床或登记的实用研究的开展并为其提供信息。局限性：数据来源主要限于北美和欧洲。影响：管理数据正在快速增长和发展，并为解决 AKI 知识差距提供了前所未有的机会。要取得进展，需要继续努力提高对 AKI 对公共卫生影响的认识，吸引主要利益相关者，并制定切实的战略来重新配置基础设施，以改善 AKI 的报告和表型分析。为什么本次审查很重要？：管理数据的规模和可用性的快速增长增强了急性肾损伤（AKI）的临床研究。然而，编码存在重大局限性，阻碍了我们更好地了解其流行病学和解决知识差距的能力。以下基于共识的综述讨论了如何使用管理数据来研究 AKI，确定当前的局限性，并建议如何增强这些数据源以改进对该疾病的未来研究。关键信息是什么？：当前管理数据的编码结构因缺乏敏感性、缺乏正确分类严重性的标准化以及有限的临床表型而受到阻碍。这些限制加上对 AKI 认识的降低以及报告的主观性质限制了对不同环境和时间段疾病负担的理解。随着管理数据变得更加复杂和复杂，存在采用更客观的标准来诊断和分期 AKI 以及改善背景表型的重要机会，这有助于解决知识差距和改善护理。
PURPOSE OF REVIEW: The purpose of this review is to report how administrative data have been used to study AKI, identify current limitations, and suggest how these data sources might be enhanced to address knowledge gaps in the field.OBJECTIVES: 1) To review the existing evidence-base on how AKI is coded across administrative datasets, 2) To identify limitations, gaps in knowledge, and major barriers to scientific progress in AKI related to coding in administrative data, 3) To discuss how administrative data for AKI might be enhanced to enable "communication" and "translation" within and across administrative jurisdictions, and 4) To suggest how administrative databases might be configured to inform 'registry-based' pragmatic studies.SOURCE OF INFORMATION: Literature review of English language articles through PubMed search for relevant AKI literature focusing on the validation of AKI in administrative data or used administrative data to describe the epidemiology of AKI.SETTING: Acute Dialysis Quality Initiative (ADQI) Consensus Conference September 6-7(th), 2015, Banff, Canada.PATIENTS: Hospitalized patients with AKI.KEY MESSAGES: The coding structure for AKI in many administrative datasets limits understanding of true disease burden (especially less severe AKI), its temporal trends, and clinical phenotyping. Important opportunities exist to improve the quality and coding of AKI data to better address critical knowledge gaps in AKI and improve care.METHODS: A modified Delphi consensus building process consisting of review of the literature and summary statements were developed through a series of alternating breakout and plenary sessions.RESULTS: Administrative codes for AKI are limited by poor sensitivity, lack of standardization to classify severity, and poor contextual phenotyping. These limitations are further hampered by reduced awareness of AKI among providers and the subjective nature of reporting. While an idealized definition of AKI may be difficult to implement, improving standardization of reporting by using laboratory-based definitions and providing complementary information on the context in which AKI occurs are possible. Administrative databases mayalso help enhance the conduct of and inform clinical or registry-based pragmatic studies.LIMITATIONS: Data sources largely restricted to North American and Europe.IMPLICATIONS: Administrative data are rapidly growing and evolving, and represent an unprecedented opportunity to address knowledge gaps in AKI. Progress will require continued efforts to improve awareness of the impact of AKI on public health, engage key stakeholders, and develop tangible strategies to reconfigure infrastructure to improve the reporting and phenotyping of AKI. WHY IS THIS REVIEW IMPORTANT?: Rapid growth in the size and availability of administrative data has enhanced the clinical study of acute kidney injury (AKI). However, significant limitations exist in coding that hinder our ability to better understand its epidemiology and address knowledge gaps. The following consensus-based review discusses how administrative data have been used to study AKI, identify current limitations, and suggest how these data sources might be enhanced to improve the future study of this disease. WHAT ARE THE KEY MESSAGES?: The current coding structure of administrative data is hindered by a lack of sensitivity, standardization to properly classify severity, and limited clinical phenotyping. These limitations combined with reduced awareness of AKI and the subjective nature of reporting limit understanding of disease burden across settings and time periods. As administrative data become more sophisticated and complex, important opportunities to employ more objective criteria to diagnose and stage AKI as well as improve contextual phenotyping exist that can help address knowledge gaps and improve care.