基于索赔的算法的性能,用于在商业保险的OSA患者中坚持积极的气道压力治疗
Naomi Alpert1, Kate V Cole1, R Benjamin Dexter2
1ResMed Science Center, San Diego, CA.
Chest
|January 12, 2024
概括
索赔数据很少反映商业保险的阻塞性睡眠呼吸暂停 (OSA) 患者实际使用的气道正压 (PAP) 装置. 这表明在这种人群中使用声明进行依从性评估时需要谨慎.
科学领域:
- 睡眠医学 睡眠医学
- 医疗信息学 医疗信息学
- 医疗器械技术 医疗器械技术
背景情况:
- 阳性气道压力 (PAP) 治疗是阻塞性睡眠呼吸暂停 (OSA) 的主要治疗方法.
- 持续使用PAP对于治疗疗效至关重要.
- 之前的遵守性研究依赖于医疗保险索赔数据,这可能不适用于具有不同保险规则的商业保险人群.
研究的目的:
- 评估基于索赔的算法与美国商业保险人口中客观PAP设备使用之间的一致性.
- 为了确定使用行政索赔作为这个人口群体中PAP坚持的代理人的准确性.
主要方法:
- 链接非识别的行政索赔数据与客观的PAP使用数据从云连接设备的18-64岁的OSA患者.
- 使用设备使用 (扩展CMS 90天标准) 和基于索赔的算法来定义合规性.
- 对比了两个坚持定义之间的指标,并确定了两种坚持定义之间的错误分类.
主要成果:
- 在213,341名患者中,48%的患者在第一年使用设备的基础上是坚持的.
- 基于索赔的坚持差异很大 (10%-84%),准确性低 (53%-68%),敏感性 (12%-95%),以及特异性 (26%-92%).
- 设备坚持的患者与声称坚持的患者相比,使用指标 (天数,每周使用,小时/天) 显著更高;许多一致的用户被声称错误地归类为非坚持者.
结论:
- 现有的基于索赔的算法与美国商业保险人口中客观PAP设备使用的一致性很低.
- 商业保险中的非标准化保险规则有助于这种差异.
- 建议在将传统的基于索赔的坚持算法应用于接受PAP治疗的商业保险患者时谨慎使用.
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