Identifying persons with diabetes using Medicare claims data.
Identifying persons with diabetes using Medicare claims data.
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DOI：
10.1177/106286069901400607
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发表时间：
1999-11-01
期刊：
影响因子：
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通讯作者：
McBean, A M
中科院分区：
文献类型：
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作者：
Hebert, P L;Geiss, L S;McBean, A M
本研究的目的是开发和验证一种通过使用医疗保险索赔数据来识别患有糖尿病的医疗保险受益人的方法。我们使用医疗保险当前受益人调查参与者的糖尿病状况自我报告来确定疾病状况，然后我们检查了这些参与者的医疗保险索赔。我们使用自我报告的糖尿病状况作为“金标准”，确定了索赔数据在识别糖尿病受益人方面的敏感性、特异性和可靠性。我们发现，要构建一种足够敏感（>或= 70％）、高度特异性（>或= 97.5％）和可靠（kappa>或= 0.80）的方法，研究人员必须结合不同类型医疗保险索赔文件的信息，使用2年的数据来识别病例，并要求在涉及门诊护理的索赔中至少有2次糖尿病诊断。由于不止一种方法可以满足这些标准，因此方法的选择应根据研究目标以及更实际的问题来决定。
The objective of this study was to develop and validate a method for identifying Medicare beneficiaries with diabetes by using Medicare claims data. We used self-reports of diabetes status from participants in the Medicare Current Beneficiary Survey to determine disease status, and then we examined these participants' Medicare claims. Using self-reported diabetes status as the "gold standard," we determined the sensitivity, specificity, and reliability of claims data in identifying beneficiaries with diabetes. We found that to construct a method that is adequately sensitive (> or = 70%), highly specific (> or = 97.5%), and reliable (kappa > or = 0.80), researchers must combine information from different types of Medicare claims files, use 2 years of data to identify cases, and require at least 2 diagnoses of diabetes among claims involving ambulatory care. Since these criteria are met by more than one method, the choice of method should be governed by the goals of the research as well as more practical concerns.