Hospital discharge records under-report the prevalence of diabetes in inpatients

Carral, Florentino; Olveira, Gabriel; Aguilar, Manuel; Ortego, José; Gavilán, I; Doménech, Inmaculada; Escobar, Luis Fernando Estrada

doi:10.1016/s0168-8227(02)00200-0

Cited by 49 publications

(28 citation statements)

References 20 publications

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“…This approach gives more value to the data and could, in part, explain the differences in earlier studies, finding that the presence of diabetes sometimes increased (5) or did not increase (8,9,11) the risk for mortality. Indeed, the prevalence of diabetes may be greatly underestimated if it is based solely on the clinical history or chart data (21). …”

Section: Discussionmentioning

confidence: 99%

Parenteral Nutrition–Associated Hyperglycemia in Non–Critically Ill Inpatients Increases the Risk of In-Hospital Mortality (Multicenter Study)

Olveira

Tapia²,

Ocón

et al. 2013

Diabetes Care

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OBJECTIVEHyperglycemia may increase mortality in patients who receive total parenteral nutrition (TPN). However, this has not been well studied in noncritically ill patients (i.e., patients in the nonintensive care unit setting). The aim of this study was to determine whether mean blood glucose level during TPN infusion is associated with increased mortality in noncritically ill hospitalized patients.RESEARCH DESIGN AND METHODSThis prospective multicenter study involved 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included prospectively, and data were collected on demographic, clinical, and laboratory variables as well as on in-hospital mortality.RESULTSThe study included 605 patients (mean age 63.2 ± 15.7 years). The daily mean TPN values were 1.630 ± 323 kcal, 3.2 ± 0.7 g carbohydrates/kg, 1.26 ± 0.3 g amino acids/kg, and 0.9 ± 0.2 g lipids/kg. Multiple logistic regression analysis showed that the patients who had mean blood glucose levels >180 mg/dL during the TPN infusion had a risk of mortality that was 5.6 times greater than those with mean blood glucose levels <140 mg/dL (95% CI 1.47–21.4 mg/dL) after adjusting for age, sex, nutritional state, presence of diabetes or hyperglycemia before starting TPN, diagnosis, prior comorbidity, carbohydrates infused, use of steroid therapy, SD of blood glucose level, insulin units supplied, infectious complications, albumin, C-reactive protein, and HbA1c levels.CONCLUSIONSHyperglycemia (mean blood glucose level >180 mg/dL) in noncritically ill patients who receive TPN is associated with a higher risk of in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Parenteral Nutrition–Associated Hyperglycemia in Non–Critically Ill Inpatients Increases the Risk of In-Hospital Mortality (Multicenter Study)

Olveira

Tapia²,

Ocón

et al. 2013

Diabetes Care

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“…There are several potential information gaps that can affect prevalence estimation from claims-based algorithms: first, regular patient use of the health care system is required for case identification; second, data coding for diabetes must be accurate and comprehensive; third, some physicians are not on a fee-for-service plan exclusively (i.e., they either receive a salary or are on a mixed remuneration plan) so visits to these physicians are not captured in some databases; and fourth, given that patients with diabetes commonly carry multiple comorbidities and are frequently managed by general practitioners [14], physicians may fill billing claims for conditions other than diabetes [15], [16].…”

Section: Introductionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Validation Studies on a Diabetes Case Definition from Health Administrative Records

et al. 2013

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ObjectivesHealth administrative data are frequently used for diabetes surveillance. We aimed to determine the sensitivity and specificity of a commonly-used diabetes case definition (two physician claims or one hospital discharge abstract record within a two-year period) and their potential effect on prevalence estimation.MethodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched Medline (from 1950) and Embase (from 1980) databases for validation studies through August 2012 (keywords: “diabetes mellitus”; “administrative databases”; “validation studies”). Reviewers abstracted data with standardized forms and assessed quality using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. A generalized linear model approach to random-effects bivariate regression meta-analysis was used to pool sensitivity and specificity estimates. We applied correction factors derived from pooled sensitivity and specificity estimates to prevalence estimates from national surveillance reports and projected prevalence estimates over 10 years (to 2018).ResultsThe search strategy identified 1423 abstracts among which 11 studies were deemed relevant and reviewed; 6 of these reported sensitivity and specificity allowing pooling in a meta-analysis. Compared to surveys or medical records, sensitivity was 82.3% (95%CI 75.8, 87.4) and specificity was 97.9% (95%CI 96.5, 98.8). The diabetes case definition underestimated prevalence when it was ≤10.6% and overestimated prevalence otherwise.ConclusionThe diabetes case definition examined misses up to one fifth of diabetes cases and wrongly identifies diabetes in approximately 2% of the population. This may be sufficiently sensitive and specific for surveillance purposes, in particular monitoring prevalence trends. Applying correction factors to adjust prevalence estimates from this definition may be helpful to increase accuracy of estimates.

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“…Health services administrative databases are frequently used to assess drug effectiveness and safety . Exposure and outcome misclassification in these databases may compromise results validity . A systematic review of a diabetes case definition from administrative databases reported sensitivities between 74.4% and 92.3% and specificities between 96.9% and 99.6% .…”

Section: Introductionmentioning

confidence: 99%

Correcting hazard ratio estimates for outcome misclassification using multiple imputation with internal validation data

Leong

Dasgupta

et al. 2017

Pharmacoepidemiology and Drug

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Objective Outcome misclassification may occur in observational studies using administrative databases. We evaluated a two‐step multiple imputation approach based on complementary internal validation data obtained from two subsamples of study participants to reduce bias in hazard ratio (HR) estimates in Cox regressions. Methods We illustrated this approach using data from a surveyed sample of 6247 individuals in a study of statin‐diabetes association in Quebec. We corrected diabetes status and onset assessed from health administrative data against self‐reported diabetes and/or elevated fasting blood glucose (FBG) assessed in subsamples. The association between statin use and new onset diabetes was evaluated using administrative data and the corrected data. By simulation, we assessed the performance of this method varying the true HR, sensitivity, specificity, and the size of validation subsamples. Results The adjusted HR of new onset diabetes among statin users versus non‐users was 1.61 (95% confidence interval: 1.09–2.38) using administrative data only, 1.49 (0.95–2.34) when diabetes status and onset were corrected based on self‐report and undiagnosed diabetes (FBG ≥ 7 mmol/L), and 1.36 (0.92–2.01) when corrected for self‐report and undiagnosed diabetes/impaired FBG (≥ 6 mmol/L). In simulations, the multiple imputation approach yielded less biased HR estimates and appropriate coverage for both non‐differential and differential misclassification. Large variations in the corrected HR estimates were observed using validation subsamples with low participation proportion. The bias correction was sometimes outweighed by the uncertainty introduced by the unknown time of event occurrence. Conclusion Multiple imputation is useful to correct for outcome misclassification in time‐to‐event analyses if complementary validation data are available from subsamples. Copyright © 2017 John Wiley & Sons, Ltd.

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Hospital discharge records under-report the prevalence of diabetes in inpatients

Cited by 49 publications

References 20 publications

Parenteral Nutrition–Associated Hyperglycemia in Non–Critically Ill Inpatients Increases the Risk of In-Hospital Mortality (Multicenter Study)

Parenteral Nutrition–Associated Hyperglycemia in Non–Critically Ill Inpatients Increases the Risk of In-Hospital Mortality (Multicenter Study)

Systematic Review and Meta-Analysis of Validation Studies on a Diabetes Case Definition from Health Administrative Records

Correcting hazard ratio estimates for outcome misclassification using multiple imputation with internal validation data

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