Accuracy of Medicare claims data for rheumatologic diagnoses in total hip replacement recipients
Accuracy of Medicare claims data for rheumatologic diagnoses in total hip replacement recipients
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DOI：
10.1016/s0895-4356(03)00056-8
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发表时间：
2003-06-01
影响因子：
7.2
通讯作者：
Katz, JN
中科院分区：
文献类型：
--
作者：
Losina, E;Barrett, J;Katz, JN
这项分析是为了检查医疗保险索赔是否准确地记录了全髋关节置换术（THR）受者的潜在风湿病诊断。我们从医疗记录和医疗保险索赔数据中获得风湿病诊断数据，包括类风湿关节炎（RA）、缺血性坏死（AVN）和骨关节炎（OA）。为了检验索赔数据的准确性，我们使用医疗记录数据作为“金标准”计算敏感性和阳性预测值，并评估由于基于索赔的诊断错误分类而产生的偏差。RA、AVN和OA的诊断敏感性分别为0.65、0.54和0.96；阳性预测值均在0.86 ~ 0.89之间。RA和AVN的敏感性在医院容量层中有很大差异，但两种诊断的方向不同。我们得出结论，诊断的索赔编码不准确是常见的，并且是潜在的偏见来源。由于特定诊断的索赔编码不准确，需要更多的研究来检查健康结果研究中偏倚的程度和方向。(C) 2003 Elsevier Inc.版权所有。
This analysis was performed to examine whether Medicare claims accurately document underlying rheumatologic diagnoses in total hip replacement (THR) recipients. We obtained data on rheumatologic diagnoses including rheumatoid arthritis (RA), avascular necrosis (AVN), and osteoarthritis (OA) from medical records and from Medicare claims data. To examine the accuracy of claims data we calculated sensitivity and positive predictive value using medical records data as the "gold standard" and assessed bias due to misclassification of claims-based diagnoses. The sensitivities of claims-based diagnoses of RA, AVN, and OA were 0.65, 0.54, and 0.96, respectively; the positive predictive values were all in the 0.86-0.89 range. The sensitivities of RA and AVN varied substantially across hospital volume strata, but in different directions for the two diagnoses. We conclude that inaccuracies in claims coding of diagnoses are frequent, and are potential sources of bias. More studies are needed to examine the magnitude and direction of bias in health outcomes research due to inaccuracy of claims coding for specific diagnoses. (C) 2003 Elsevier Inc. All rights reserved.