Validating a case definition for chronic kidney disease using administrative data
Validating a case definition for chronic kidney disease using administrative data
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DOI：
10.1093/ndt/gfr598
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发表时间：
2012-05-01
影响因子：
6.1
通讯作者：
Hemmelgarn, Brenda R.
中科院分区：
文献类型：
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作者：
Ronksley, Paul E.;Tonelli, Marcello;Hemmelgarn, Brenda R.
背景。管理数据通常用于监测慢性病。本研究的目的是确定与估计肾小球滤过率 (eGFR) 的参考标准相比，从管理数据中得出的用于识别慢性肾脏病 (CKD) 的算法的有效性。方法。我们确定了来自艾伯塔省的成年人在一年内至少进行过两次门诊血清肌酐测量。使用长达 3 年的各种病例定义组合的管理数据（医生账单索赔和出院摘要）来估计 CKD 的有效性指数。对于每种算法，根据 CKD 的两个参考标准定义（两个 eGFR 测量值 < 60 mL/min/1.73m(2) 或平均 eGFR < 30 mL/min/1.73m(2)）计算灵敏度、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV)。结果。总共确定了 321 293 名符合条件的受试者。无论采用哪种算法，使用管理代码定义 CKD（eGFR < 60 mL/min/1.73m(2)）的敏感性都很低。采用两年内两次医生索赔或一次住院治疗的病例定义算法检测 CKD 的敏感性为 19.4%，特异性为 97.2%，PPV 为 60.1%，NPV 为 84.8%。当使用 < 30 mL/min/1.73m(2) 作为参考标准时，灵敏度估计较高，尽管 PPV 较低且始终低于 50%。结论。这些结果使用 eGFR 作为参考标准，表明管理数据对于 CKD 监测的敏感性和 PPV 不足，尽管当出于研究目的需要高度特定的算法时它们可能有用。
Background. Administrative data are commonly used for surveillance of chronic medical conditions. The purpose of this study was to determine the validity of an algorithm derived from administrative data for identifying chronic kidney disease (CKD) compared to the reference standard of estimated glomerular filtration rate (eGFR).Methods. We identified adults from the province of Alberta with at least two outpatient serum creatinine measurements within a 1-year time period. Validity indices were estimated for CKD using up to 3 years of administrative data (physician billing claims and hospital discharge abstracts) for various case-definition combinations. For each algorithm, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated against two reference standard definitions of CKD (two eGFR measurements < 60 mL/min/1.73m(2) or mean eGFR < 30 mL/min/1.73m(2)).Results. A total of 321 293 eligible subjects were identified. Irrespective of the algorithm, sensitivities for defining CKD (eGFR < 60 mL/min/1.73m(2)) using administrative codes were low. A case-definition algorithm employing two physician claims or one hospitalization within a 2-year period had sensitivity of 19.4%, specificity of 97.2%, PPV of 60.1% and NPV of 84.8% for detecting CKD. Estimates of sensitivity were higher when < 30 mL/min/1.73m(2) was used as the reference standard, although PPVs were lower and consistently less than 50%.Conclusion. These results, using eGFR as a reference standard, suggest that administrative data have insufficient sensitivity and PPV for CKD surveillance, although they may be useful when highly specific algorithms are required for research purposes.