Disease identification based on ambulatory drugs dispensation and in-hospital ICD-10 diagnoses: a comparison
Disease identification based on ambulatory drugs dispensation and in-hospital ICD-10 diagnoses: a comparison
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DOI：
10.1186/1472-6963-13-453
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发表时间：
2013-10-31
影响因子：
2.8
通讯作者：
Seker, Erol
中科院分区：
文献类型：
--
作者：
Halfon, Patricia;Eggli, Yves;Seker, Erol
背景：基于药物的病例组合测量是相对稀缺的门诊诊断数据的另一种信息来源。但大多数已发表的工具使用国家药物命名法，并没有提供与药物相关的类别和基于诊断的类别之间的直接比较。本研究的目的是测试的准确性，基于药物的发病率组来自世界卫生组织解剖学治疗化学分类的药物检查他们对诊断为基础的groups.Methods：我们比较了基于药物的类别与他们的诊断为基础的类似物使用匿名数据的108,915个人投保的四家公司之一。他们在2005年和2006年接受了随访，在此期间至少住院一次。两种方法之间的一致性通过加权kappa系数来衡量。在2年以上的药物为基础的发病率测量的再现性进行了评估所有enrollees.Results：百分之八十使用的药物与至少一个60发病率类别来自药物分配。在考虑住院患者编码不足后，15种情况与基于诊断的对应物充分一致，被视为诊断的替代策略。此外，它们显示出良好的可重复性，并允许根据国家估计数对流行率进行估计。对于22个条件，基于药物的信息准确地确定了一个子集的人口定义的diagnosis.Conclusions：大多数类别提供保险公司的健康状况信息，可以利用医疗保健支出预测或门诊成本控制，特别是当门诊诊断是不可用的。然而，由于与基于诊断的类似物的一致性不足，它们作为发病率指标的使用受到限制。
Background: Pharmacy-based case mix measures are an alternative source of information to the relatively scarce outpatient diagnoses data. But most published tools use national drug nomenclatures and offer no head-to-head comparisons between drugs-related and diagnoses-based categories. The objective of the study was to test the accuracy of drugs-based morbidity groups derived from the World Health Organization Anatomical Therapeutic Chemical Classification of drugs by checking them against diagnoses-based groups.Methods: We compared drugs-based categories with their diagnoses-based analogues using anonymous data on 108,915 individuals insured with one of four companies. They were followed throughout 2005 and 2006 and hospitalized at least once during this period. The agreement between the two approaches was measured by weighted kappa coefficients. The reproducibility of the drugs-based morbidity measure over the 2 years was assessed for all enrollees.Results: Eighty percent used a drug associated with at least one of the 60 morbidity categories derived from drugs dispensation. After accounting for inpatient under-coding, fifteen conditions agreed sufficiently with their diagnoses-based counterparts to be considered alternative strategies to diagnoses. In addition, they exhibited good reproducibility and allowed prevalence estimates in accordance with national estimates. For 22 conditions, drugs-based information identified accurately a subset of the population defined by diagnoses.Conclusions: Most categories provide insurers with health status information that could be exploited for healthcare expenditure prediction or ambulatory cost control, especially when ambulatory diagnoses are not available. However, due to insufficient concordance with their diagnoses-based analogues, their use for morbidity indicators is limited.