Specificity and Sensitivity of Claims‐Based Algorithms for Identifying Members of Medicare+Choice Health Plans That Have Chronic Medical Conditions

Rector, Thomas S.; Wickstrom, Steven L.; Shah, Mona; Greeenlee, N Thomas; Rheault, Paula; Rogowski, Jeannette; Freedman, Vicki A.; Adams, John; Escarce, José J.

doi:10.1111/j.1475-6773.2004.00321.x

Cited by 174 publications

(160 citation statements)

References 9 publications

Supporting

Mentioning

151

Contrasting

Unclassified

Order By: Relevance

“…2,[37][38][39][40][41] It is important to note that this criterion is not the same as the "gold standard" established by the American Diabetes Association and World Health Organization, which requires laboratory results and patient symptoms 42,43 that are not available in the USRDS data sets. A consistently high level of accuracy and concordance between cases that were identified by this method and the American Diabetes Association/World Health Organization criteria 38,40,41 has been established. Our definition has a sensitivity of 0.75, a specificity of 0.97, and a positive predictive value of 0.88 compared with selfreported diabetes.…”

Section: Clinical Epidemiology Wwwjasnorgmentioning

confidence: 99%

Sirolimus Is Associated with New-Onset Diabetes in Kidney Transplant Recipients

Johnston

Rose

Webster

et al. 2008

Journal of the American Society of Nephrology

380

238

View full text Add to dashboard Cite

New-onset diabetes (NOD) is associated with transplant failure. A few single-center studies have suggested that sirolimus is associated with NOD, but this is not well established. With the use of data from the United States Renal Data System, this study evaluated the association between sirolimus use at the time of transplantation and NOD among 20,124 adult recipients of a first kidney transplant without diabetes. Compared with patients treated with cyclosporine and either mycophenolate mofetil or azathioprine, sirolimus-treated patients were at increased risk for NOD, whether it was used in combination with cyclosporine (adjusted hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.36 to 1.90), tacrolimus (adjusted HR 1.66; 95% CI 1.42 to 1.93), or an antimetabolite (mycophenolate mofetil or azathioprine; adjusted HR 1.36; 95% CI 1.09 to 1.69). Similar results were obtained in a subgroup analysis that included the 16,861 patients who did not have their immunosuppressive regimen changed throughout the first posttransplantation year. In conclusion, sirolimus is independently associated with NOD. Given the negative impact of NOD on posttransplantation outcomes, these findings should be confirmed in prospective studies or in meta-analyses of existing trials that involved sirolimus.

show abstract

Section: Clinical Epidemiology Wwwjasnorgmentioning

confidence: 99%

Sirolimus Is Associated with New-Onset Diabetes in Kidney Transplant Recipients

Johnston

Rose

Webster

et al. 2008

Journal of the American Society of Nephrology

380

238

View full text Add to dashboard Cite

show abstract

“…One study (14) linked multiple administrative data sources (facility, physician claims and pharmacy).…”

Section: Literature Reviewmentioning

confidence: 99%

Administrative data have high variation in validity for recording heart failure

Quach

Blais

Quan

2010

Canadian Journal of Cardiology

129

View full text Add to dashboard Cite

H eart failure (HF) has been widely studied because of its high mortality and morbidity rates (1-4). Studies on HF have relied on multiple data sources such as surveys, disease registries, hospital charts and administrative data. Of these sources, administrative data have been increasingly used for health services utilization and outcome evaluation.Administrative data result from implementing health care delivery, enrolling members into health insurance plans and reimbursing health care providers for services (5). The types of administrative data depend on the health care system and the funding structure. For example, Canada has a nationally funded health care system that collects hospital discharge data at a national level, while insurance registry, physician services and emergency room visit information is collected at a provincial level. Although these data are not intended for research, they are widely used in surveillance and outcome studies. Therefore, the validity of the research results rely on the quality of the data. Data quality is critical for interpreting variation across studies from different geographical areas.The purpose of the present study was to systematically review the literature pertaining to the validity of administrative data for recording HF and apply the International Classification of Diseases (ICD) HF definitions to Canadian hospital discharge abstract data to explore the prevalence of HF across ICD code definitions. METHODSLiterature review Search strategy: Only English language articles that compared the validity of ICD codes in administrative databases (eg, physician claims data, hospital discharge) with a reference standard (eg, chart review, registry, survey, case notes) were included. The literature search focused on articles published from 1990 to 2008. To identify peerreviewed journal articles, both the Ovid MEDLINE database and EMBASE were searched. Because validation studies were not indexed consistently with standard MeSH terms, the following key search terms were used: 'admin data', 'administrative data', 'population surveillance', 'heart failure', 'congestive heart failure', 'hospital data', 'physician claims', 'claims', 'hospital discharge', 'validation' and 'registries'. Next, Boolean operators were used to join search terms within the database search engines to locate articles. The reference lists from these articles were scanned to identify any additional articles that met heAlth outcomes/public policy ©2010 Pulsus Group Inc. All rights reserved Twenty-one studies validated hospital discharge abstract data; three studies validated physician claims and two studies validated ambulatory care data. Eighteen studies reported sensitivity (range 29% to 89%). Specificity and negative predictive value were greater than 70% across 17 studies. Nineteen studies reported positive predictive values (range 12% to 100%). Ten studies reported kappa values (range 0.39 to 0.84).

show abstract

“…We defined NOD from Medicare claims data according to a previously published and validated method (9,(15)(16)(17)(18)(19). This method requires at least one in-patient claim or two outpatient Medicare claims for diabetes during the first posttransplantation year to establish a diagnosis of NOD (9,(15)(16)(17)(18)(19).…”

Section: Definitionsmentioning

confidence: 99%

Impact of Acute Rejection and New-Onset Diabetes on Long-Term Transplant Graft and Patient Survival

Cole¹,

Johnston²,

Rose³

et al. 2008

Clinical Journal of the American Society of Nephrology

216

169

View full text Add to dashboard Cite

Background and objectives: Development of new therapeutic strategies to improve long-term transplant outcomes requires improved understanding of the mechanisms by which these complications limit long-term transplant survival.Design, setting, participants, & measurements: The association of acute rejection and new-onset diabetes was determined in the first posttransplantation year with the outcomes of transplant failure from any cause, death-censored graft loss, and death with a functioning graft in 27,707 adult recipients of first kidney-only transplants, with graft survival of at least 1 yr, performed between 1995 and 2002 in the United States.Results: In multivariate analyses, patients who developed acute rejection or new-onset diabetes had a similar risk for transplant failure from any cause, but the mechanisms of transplant failure were different: Acute rejection was associated with death-censored graft loss but only weakly associated with death with a functioning graft. In contrast new-onset diabetes was not associated with death-censored graft loss but was associated with an increased risk for death with a functioning graft.Conclusions: Acute rejection and new-onset diabetes have a similar impact on long-term transplant survival but lead to transplant failure through different mechanisms. The mechanisms by which new-onset diabetes leads to transplant failure should be prospectively studied. Targeted therapeutic strategies to minimize the impact of various early posttransplantation complications may lead to improved long-term outcomes.

show abstract

Specificity and Sensitivity of Claims‐Based Algorithms for Identifying Members of Medicare+Choice Health Plans That Have Chronic Medical Conditions

Abstract: Varying claims criteria improved the performance of case-finding algorithms for six chronic conditions. Highly specific, and sometimes sensitive, algorithms for identifying members of health plans with several chronic conditions can be developed using claims data.

Cited by 174 publications

References 9 publications

Sirolimus Is Associated with New-Onset Diabetes in Kidney Transplant Recipients

Sirolimus Is Associated with New-Onset Diabetes in Kidney Transplant Recipients

Administrative data have high variation in validity for recording heart failure

Impact of Acute Rejection and New-Onset Diabetes on Long-Term Transplant Graft and Patient Survival

Contact Info

Product

Resources

About