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Identifying hypertension-related comorbidities from administrative data: what's the optimal approach?

Ann M Borzecki1, Ashley T Wong, Elaine C Hickey

  • 1Department of Health Services, Boston University School of Public Health, Boston, Mass, USA. amb@bu.edu

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality
|November 10, 2004
PubMed

Insights

Identifying patients with hypertension requires careful data analysis. A strategy using two diagnoses over two years from Veterans Affairs (VA) administrative databases best identifies these outpatients.

Area of Science:

  • Health Informatics
  • Clinical Data Management
  • Epidemiology

Background:

  • Accurate identification of patients with hypertension is crucial for effective management.
  • Veterans Affairs (VA) administrative databases offer a large source of patient data.
  • Optimizing case-finding strategies within these databases is essential for research and clinical practice.

Purpose of the Study:

  • To evaluate the most effective strategy for identifying outpatients with hypertension-related diagnoses using VA administrative data.
  • To compare the accuracy of administrative data algorithms against a gold standard derived from chart reviews.

Main Methods:

  • A review of 1176 outpatient charts from 10 VA sites in 1999 was conducted.
  • Eleven diagnoses relevant to hypertension management were used as the gold standard.
  • Agreement, sensitivity, and specificity were calculated for various administrative data algorithms.

Main Results:

  • Using one administrative diagnosis in 1999, agreement ranged from 0.85 to 0.98, with high kappas.
  • Sensitivity varied widely (38% to 97%), while specificity exceeded 91% for most diagnoses.
  • Requiring two years of data and two diagnoses improved overall performance with minimal sensitivity loss.

Conclusions:

  • Agreement between VA administrative data and patient charts for hypertension-related diagnoses is good.
  • Administrative data accurately identify patients without a diagnosis but vary in identifying all patients with one.
  • The optimal strategy for case-finding involves using two diagnoses within a two-year period from VA administrative databases.

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