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Medicare claims can identify post-stroke epilepsy.

Lidia M V R Moura1, Jason R Smith2, Deborah Blacker3

  • 1Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Department of Neurology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.

Epilepsy Research
|February 20, 2019
PubMed
Summary

Validated Medicare claims algorithms can accurately identify post-stroke epilepsy (PSE) in elderly individuals. This advancement aids future epidemiological surveillance of epilepsy by etiology.

Keywords:
AlgorithmsEpidemiologyEpilepsyMedicareStroke

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Area of Science:

  • Gerontology
  • Neurology
  • Health Informatics

Background:

  • No validated Medicare claims-based algorithms exist to identify post-stroke epilepsy (PSE) in elderly individuals.
  • Increasing availability of large healthcare datasets necessitates such tools for research and surveillance.

Purpose of the Study:

  • To validate Medicare claims-based algorithms for accurately identifying post-stroke epilepsy (PSE) in community-dwelling elderly individuals.
  • To develop and assess the performance of algorithms using linked electronic health records (EHR) and Medicare claims.

Main Methods:

  • Linked EHR data with Medicare claims for patients aged 65+ from a Medicare Pioneer ACO.
  • A neurologist adjudicated EHR data to create a reference standard for PSE diagnosis.
  • Developed and validated algorithms using half the sample and confirmed performance in the other half, employing inverse probability sampling weights.

Main Results:

  • The best algorithm identified PSE with 100.0% specificity and 86.5% positive predictive value (PPV).
  • The algorithm achieved 20.6% sensitivity and 98.8% negative predictive value (NPV).
  • Prevalence of PSE in the study population was 0.28% over three years, with 3% in the stroke subpopulation.

Conclusions:

  • Medicare claims data can be effectively utilized to identify elderly Medicare beneficiaries with PSE with high accuracy.
  • Incorporating these validated algorithms into future epidemiological surveillance can improve the accurate identification of epilepsy by specific etiologies.