在索赔时代研究心血管健康结果数据:心血管健康研究
Bruce M Psaty1, Joseph A Delaney2, Alice M Arnold2
1From Cardiovascular Health Research Unit, Department of Medicine (B.M.P.), Department of Epidemiology (B.M.P., J.A.D., S.R.H.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A., B.M.), Department of Global Health (A.L.F.), Department of Family Medicine (A.L.F.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P., S.R.H.); Department of Medicine, Duke University, Durham, NC (L.H.C.); Department of Epidemiology, University of Pittsburgh, PA (D.I., L.H.K.); and Department of Medicine, University of Maryland, Baltimore (J.S.G.). psaty@u.washington.edu.
从行政索赔数据中使用诊断代码来定义临床结果,特别是仅限于初级诊断时,低估了事件率. 这种方法还包括非事件住院,创建一个复合的终点.
科学领域:
- 心血管流行病学
- 医疗服务研究
- 生物统计学
背景情况:
- 行政声明数据越来越多地用于临床结果评估.
- 来自索赔数据的诊断代码为识别健康事件提供了一种方便但可能不准确的方法.
- 基于声明的结果与判定事件的验证对于可靠的研究至关重要.
研究的目的:
- 将基于声明的诊断代码的准确性与确定心血管结果的事件进行比较.
- 通过使用不同的索赔数据分析方法来评估事件率和风险因素关联.
- 评估代码位置 (主要与任何) 对结果确定的影响.
主要方法:
- 使用心血管健康研究 (CHS) 的数据.
- 使用三种方法定义心肌梗塞 (MI),中风和心力衰竭:CHS判定事件 (CHS[adj]),国际疾病分类,第九版代码在主要位置 (CMS[1st]),和代码在任何位置 (CMS[any]).
- 在三种定义中比较发生率和心血管疾病风险因素的关联.
主要成果:
- 基于索赔的方法显示出高的积极预测值,但对于识别事件的敏感性较低.
- 与CHS[adj]相比,CMS[1st]方法显著低估了事件发生率 (例如,每1000人/年的MI发病率:8.6与14.9).
- 在三种事件定义方法中,心血管疾病风险因素的相关性通常一致.
结论:
- 将诊断代码限制在索赔数据中的首要位置导致心血管事件率的低估.
- 基于索赔的事件数据可以作为一个复合的终点,包括真实事件和错误分类的非事件住院.
- 在用于临床结果研究的声明数据时,需要仔细考虑方法.
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