Veterans Health Administration multiple sclerosis surveillance registry: The problem of case-finding from administrative databases
Veterans Health Administration multiple sclerosis surveillance registry: The problem of case-finding from administrative databases
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DOI：
10.1682/jrrd.2004.09.0122
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发表时间：
2006-01-01
影响因子：
--
通讯作者：
Bradham, Douglas D.
中科院分区：
文献类型：
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作者：
Culpepper, William J., II;Ehrmantrant, Mary;Bradham, Douglas D.
建立国家多发性硬化症（MS）监测登记处（MSSR）是退伍军人事务部（VA）MS卓越中心的主要目标。退伍军人健康管理局（VHA）数据库的初始查询确定了1998至2002财政年度的25，712例患者（标记为“VHA MS用户队列”），其基于国际疾病分类第九版临床修改（ICD-9-CM）代码; MS的服务连接;和/或疾病修饰剂（DMA）使用。由于ICD-9-CM的局限性，最初的查询过于广泛，导致许多非MS病例。因此，我们需要一种更严格的病例发现方法。我们的黄金标准是对大西洋中部退伍军人管理局医疗中心的计算机化患者记录系统进行图表审查。在病历审查后，我们将患者分类为未患MS或患有MS/可能的MS。我们还应用统计算法，根据MS的服务连接、DMA使用和/或每年至少一次医疗保健就诊（MS编码为主要诊断）对病例进行分类。我们完成了两个分析与Kappa系数和敏感性分析。第一次分析（疗效）仅限于基于病历审查确定分类的病例（n = 600）。Kappa系数为0.85，敏感性为0.93，特异性为0.92。第二项分析（有效性）包括归类为MS/可能MS的未知病例（N = 682）。Kappa系数为0.82，敏感性为0.93，特异性为0.90。这些结果表明，该数据库算法可靠地从初始MSSR人群中排除了非MS病例，并且是MSSR开发中间阶段的合理病例发现方法。
Establishment of a national multiple sclerosis (MS) surveillance registry (MSSR) is a primary goal of the Department of Veterans Affairs (VA) MS Center of Excellence. The initial query of Veterans Health Administration (VHA) databases identified 25,712 patients (labeled "VHA MS User Cohort") from fiscal years 1998 to 2002 based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code; service-connection for MS; and/or disease-modifying agent (DMA) use. Because of ICD-9-CM limitations, the initial query was overinclusive and resulted in many non-MS cases. Thus, we needed a more rigorous case-finding method. Our gold standard was chart review of the Computerized Patient Record System for the mid-Atlantic VA medical centers. After chart review, we classified patients as not having MS or having MS/possible MS. We also applied a statistical algorithm to classify cases based on service-connection for MS, DMA use, and/or at least one healthcare encounter a year with MS coded as the primary diagnosis. We completed two analyses with kappa coefficient and sensitivity analysis. The first analysis (efficacy) was limited to cases with a definitive classification based on chart review (n = 600). The kappa coefficient was 0.85, sensitivity was 0.93, and specificity was 0.92. The second analysis (effectiveness) included unknown cases that were classified as MS/possible MS (N = 682). The kappa coefficient was 0.82, sensitivity was 0.93, and specificity was 0.90. These findings suggest that the database algorithm reliably eliminated non-MS cases from the initial MSSR population and is a reasonable case-finding method at this intermediate stage of MSSR development.