DISCORDANCE OF DATABASES DESIGNED FOR CLAIMS PAYMENT VERSUS CLINICAL INFORMATION-SYSTEMS - IMPLICATIONS FOR OUTCOMES RESEARCH
DISCORDANCE OF DATABASES DESIGNED FOR CLAIMS PAYMENT VERSUS CLINICAL INFORMATION-SYSTEMS - IMPLICATIONS FOR OUTCOMES RESEARCH
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DOI：
10.7326/0003-4819-119-8-199310150-00011
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发表时间：
1993-10-15
影响因子：
39.2
通讯作者：
MARK, DB
中科院分区：
文献类型：
--
作者：
JOLLIS, JG;ANCUKIEWICZ, M;MARK, DB
目的：确定保险索赔信息在缺血性心脏病临床结果研究中的适用性。设计：两个数据库的一致性研究。设置：三级护理转诊中心。患者：1985年7月至1990年5月期间，共有12937名连续患者因疑似缺血性心脏病住院接受心导管检查。干预措施：使用2 × 2表格计算总体和Kappa一致性指标，比较缺血性心脏病患者预后的12个重要预测因素的临床与索赔数据。（一致性调整机会一致性）用于量化一致率。临床和索赔数据库之间的一致率范围为糖尿病诊断的0.83至不稳定型心绞痛诊断的0.09（kappa值）。当与临床信息系统比较时，索赔数据未能识别出超过一半的患者患有重要疾病，包括二尖瓣关闭不全、充血性心力衰竭、外周血管疾病、陈旧性心肌梗死、高脂血症、脑血管疾病、吸烟、心绞痛和不稳定型心绞痛。我们的研究结果表明，保险索赔数据缺乏重要的诊断和预后信息相比，同时收集的临床数据在缺血性心脏病的研究。因此，保险索赔数据在识别临床相关患者群体和调整结局研究（如医院死亡率分析）中的风险方面不如临床数据有用。
Objective: To determine the suitability of insurance claims information for use in clinical outcomes research in ischemic heart disease.Design: Concordance study of two databases.Setting: Tertiary care referral center.Patients: A total of 12 937 consecutive patients hospitalized for cardiac catheterization for suspected ischemic heart disease between July 1985 and May 1990.Interventions: Two-by-two tables were used to compute overall and kappa measures of agreement comparing clinical versus claims data for 12 important predictors of prognosis in patients with ischemic heart disease.Measurements: Kappa statistics (agreement adjusted for chance agreement) were used to quantify agreement rates.Results: Agreement rates between the clinical and claims databases ranged from 0.83 for the diagnosis of diabetes to 0.09 for the diagnosis of unstable angina (kappa values). Claims data failed to identify more than one half of the patients with prognostically important conditions, including mitral insufficiency, congestive heart failure, peripheral vascular disease, old myocardial infarction, hyperlipidemia, cerebrovascular disease, tobacco use, angina, and unstable angina, when compared with the clinical information system.Conclusions: Our results suggest that insurance claims data lack important diagnostic and prognostic information when compared with concurrently collected clinical data in the study of ischemic heart disease. Thus, insurance claims data are not as useful as clinical data for identifying clinically relevant patient groups and for adjusting for risk in outcome studies, such as analyses of hospital mortality.