Validity of diagnostic and drug data in standardized nursing home resident assessments - Potential for geriatric pharmacoepidemiology
Validity of diagnostic and drug data in standardized nursing home resident assessments - Potential for geriatric pharmacoepidemiology
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DOI：
10.1097/00005650-199802000-00006
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发表时间：
1998-02-01
期刊：
影响因子：
3
通讯作者：
Bernabei, R
中科院分区：
文献类型：
--
作者：
Gambassi, G;Landi, F;Bernabei, R
目标.卫生保健融资管理局要求，入住认证疗养院的患者必须使用最小数据集进行评估，这是一种包含300多个人口统计学，诊断，临床和治疗变量的数据收集工具。长期护理数据库可能被用于评估特定治疗的结果以及药物effectiveness.作者试图确定的可靠性和有效性的诊断和药物数据的数据库中获得的合并最小数据集与详细信息的药物消耗由每个居民。1992年至1994年，来自堪萨斯、缅因州、密西西比、纽约和南达科他州的1,492家养老院的296,379名居民参加了这项研究。最小数据集临床诊断与选定的居民特征和各种症状和治疗进行了对比。仅限于首次评估前6个月内住院的个人，将最小数据集诊断与医疗保险提供者分析和审查数据库中维护的出院索赔进行比较。最后，估计所选药物的使用预测相应性别特异性、年龄特异性或独特标签适应症的概率。最小数据集诊断与性别或功能测量相比的阳性预测值超过0.9，特定症状为0.8，几乎所有其他比较为0.6。最小数据集诊断的阳性预测值与医院索赔的阳性预测值相比，对于所有慢性疾病，除抑郁症和哮喘/慢性阻塞性肺疾病/肺气肿外，均约为0.7。住院期间可能消退的急性/亚急性诊断（如肺炎、尿路感染、贫血）的阳性预测值小于0.5。除雌激素外，所选药物与年龄和性别相比的阳性预测值在所有病例中均接近1.0。当与其标签适应症相比时，所有药物的阳性预测值均大于0.6，他克林与阿尔茨海默病、抗糖尿病药与糖尿病、左旋多巴与帕金森病的阳性预测值分别为0.97、0.91和0.87。这些发现表明了该基于最小数据集的数据集中药物和临床数据的总体有效性。额外的验证工作将确定该数据集是否可用于老年药物流行病学研究以及不同政策和实践对居民结果的影响分析。
OBJECTIVES. The Health Care Financing Administration requires that patients admitted to certified nursing homes be assessed with the Minimum Data Set, a data collection instrument containing more than 300 demographic, diagnostic, clinical, and treatment variables. Long-term care databases potentially may be used to assess the outcomes of specific treatments as well as drug effectiveness.The authors sought to ascertain reliability and validity of diagnostic and drug data in a database obtained by merging the Minimum Data Set with detailed information on drugs consumed by each resident.METHODS. A population of 296,379 residents of 1,492 nursing homes in Kansas, Maine, Mississippi, New York, and South Dakota participated in the study between 1992 and 1994. Minimum Data Set clinical diagnoses were contrasted with selected resident characteristics and a variety of symptoms and treatments. Limited to individuals who had been hospitalized in the 6 months preceding the first assessment, Minimum Data Set diagnoses were compared with those on the hospital discharge claims maintained in the Medicare Provider Analysis and Review database. Finally, the probability that the use of selected drugs predicted the correspondent gender-specific, age-specific, or unique labeled indication was estimated.RESULTS. The positive predictive value for Minimum Data Set diagnoses compared with gender or function measures exceeded 0.9, and it was 0.8 for specific symptoms and 0.6 for virtually all other comparisons. The positive predictive value for Minimum Data Set diagnoses compared with those from hospital claims was approximately 0.7 for all chronic medical conditions, except for depression and asthma/chronic obstructive pulmonary disease/emphysema. The positive predictive value for acute/subacute diagnoses tie, pneumonia, urinary tract infection, anemia) that may resolve during hospital stay was less than 0.5. The positive predictive value for selected drugs, except estrogens, compared with age and gender was close to 1.0 in all cases. When compared to their labeled indication, the positive predictive value was more than 0.6 for all drugs considered, with 0.97, 0.91, and 0.87 for tacrine and Alzheimer's disease, antidiabetics and diabetes mellitus, and L-dopa and Parkinson's disease, respectively.CONCLUSIONS. These findings point to the overall validity of the drug and clinical data in this Minimum Data Set-based data set. Additional validation efforts will determine whether this data set can be used for studies of geriatric pharmacoepidemiology and for analyses of the influence of different policies and practices on residents' outcomes.