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[Linking Interventional Cardiology clinical registry data with French hospital administrative data: Development and
E Lesaine1, N-M Belhamri2, J-P Legrand1
1University Bordeaux, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France; Service d'information médicale, CHU de Bordeaux, pôle de santé publique, 33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France.
Insights
A new algorithm successfully linked French hospital data (ACIRA and PMSI) to reconstruct patient care pathways for coronary procedures. This deterministic merging method achieved high accuracy, validating its use for healthcare pathway analysis.
Area of Science:
- Health Informatics
- Cardiovascular Epidemiology
- Data Linkage
Background:
- Reconstructing patient healthcare pathways is crucial for understanding treatment efficacy and resource utilization.
- Existing databases like the interventional cardiology registry (ACIRA) and hospital medical information system (PMSI) are complementary but require linkage.
- The Aquitaine region in France provides a valuable setting for this data linkage study.
Purpose of the Study:
- To develop and validate a deterministic algorithm for merging the ACIRA registry with the PMSI database.
- To accurately recreate the in-hospital healthcare pathway for patients undergoing coronary angiography or percutaneous coronary intervention.
Main Methods:
- A deterministic merging algorithm was developed using 11 standardized linking variables from ACIRA and PMSI databases (2011-2014).
- The algorithm involved 12 successive linking steps, starting with strict matching of all variables.
- Performance was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV); complementary strategies were tested.
Main Results:
- The algorithm successfully linked 97.2% of 31,621 ACIRA hospital stays.
- High performance metrics were achieved: sensitivity 99.9%, specificity 97.9%, PPV 99.9%, and NPV 96.9%.
- Unmerged patients were older and primarily hospitalized in 2012 across two centers, indicating potential data gaps or specific patient characteristics.
Conclusions:
- The study demonstrates the feasibility and validity of using deterministic pairing to link practice registries with medico-administrative databases.
- This method effectively reconstructs patient hospital healthcare pathways for interventional cardiology procedures.
- The approach is extensible to other health events requiring hospitalization, offering a robust tool for epidemiological research and healthcare management.
Background:
To recreate the in-hospital healthcare pathway for patients treated with coronary angiography or percutaneous coronary intervention, we linked the interventional cardiology registry (ACIRA) and the pseudonymized French hospital medical information system database (PMSI) in the Aquitaine region. The objective of this study was to develop and validate a deterministic merging algorithm between these exhaustive and complementary databases.
Methods:
After a pre-treatment phase of the databases to standardize the 11 identified linking variables, a deterministic linking algorithm was developed on ACIRA hospital stays between December 2011 and December 2014 in nine interventional cardiology centers as well as the data from the consolidated PMSI databases of the Aquitaine region from 2011 to 2014. Merging was carried out through 12 successive steps, the first consisting in strict linking of the 11 variables. The performance of the algorithm was analyzed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Strategies complementary to the initial algorithm (change in the order of variables and base preprocessing) were tested. Comparative analysis of merged/unmerged patients explored potential causes of mismatch.
Results:
The algorithm found 97.2% of the 31,621 ACIRA stays to have sensitivity of 99.9% (95% CI [99.9; 99.9]), specificity of 97.9% (95% CI [97.7; 98.1]), PPV of 99.9% (95% CI [99.9; 99.9]) and NPV of 96.9% (95% CI [96.7; 97.1]). Complementary strategies did not yield better results. The unmerged patients were older, and hospitalized mostly in 2012 in two interventional cardiology centers.
Conclusion:
This study underscored the feasibility and validity of an indirect deterministic pairing to routinely link a registry of practices using hospital data to pseudonymized medico-administrative databases. This method, which can be extrapolated to other health events leading to hospitalization, renders it possible to effectively reconstruct patients' hospital healthcare pathway.
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