Every N R, Frederick P D, Robinson M, Sugarman J, Bowlby L, Barron H V
Northwest Health Services Research and Development Program, Puget Sound VA Healthcare System, University of Washington, Seattle, USA.
J Am Coll Cardiol. 1999 Jun;33(7):1886-94. doi: 10.1016/s0735-1097(99)00113-8.
This study was performed to evaluate whether or not the simpler case identification and data abstraction processes used in National Registry of Myocardial Infarction two (NRMI 2) are comparable with the more rigorous processes utilized in the Cooperative Cardiovascular Project (CCP).
The increased demand for quality of care and outcomes data in hospitalized patients has resulted in a proliferation of databases of varying quality. For patients admitted with myocardial infarction, there are two national databases that attempt to capture critical process and outcome data using different case identification and abstraction processes.
We compared case ascertainment and data elements collected in Medicare-eligible patients included in the industry-sponsored NRMI 2 with Medicare enrollees included in the Health Care Financing Administration-sponsored CCP who were admitted during identical enrollment periods. Internal and external validity of NRMI 2 was defined using the CCP as the "gold standard."
Demographic and procedure use data obtained independently in each database were nearly identical. There was a tendency for NRMI 2 to identify past medical histories such as prior infarct (29% vs. 31%, p < 0.001) or heart failure (21% vs. 25%, p < 0.001) less frequently than the CCP. Hospital mortality was calculated to be higher in NRMI 2 (19.7% vs. 18.1%, p < 0.001) due mostly to the inclusion of noninsured patients 65 years and older in NRMI 2.
We conclude that the simpler case ascertainment and data collection strategies employed by NRMI 2 result in process and outcome measures that are comparable to the more rigorous methods utilized by the CCP. Outcomes that are more difficult to measure from retrospective chart review such as stroke and recurrent myocardial infarction must be interpreted cautiously.
本研究旨在评估心肌梗死国家注册系统二期（NRMI 2）中使用的更简单的病例识别和数据提取流程，是否与合作心血管项目（CCP）中使用的更严格的流程具有可比性。
住院患者对医疗质量和结局数据的需求增加，导致了质量参差不齐的数据库大量涌现。对于因心肌梗死入院的患者，有两个国家数据库试图使用不同的病例识别和提取流程来获取关键的过程和结局数据。
我们将行业赞助的NRMI 2中符合医疗保险资格的患者的病例确定情况和收集的数据元素，与医疗保健财务管理局赞助的CCP中在相同登记期间入院的医疗保险参保者进行了比较。以CCP为“金标准”来定义NRMI 2的内部和外部效度。
每个数据库独立获取的人口统计学和手术使用数据几乎相同。NRMI 2识别既往病史（如既往梗死，29%对31%，p<0.001；或心力衰竭，21%对25%，p<0.001）的频率往往低于CCP。NRMI 2中的医院死亡率计算结果更高（19.7%对18.1%，p<0.001），这主要是因为NRMI 2纳入了65岁及以上的未参保患者。
我们得出结论，NRMI 2采用的更简单的病例确定和数据收集策略，所产生的过程和结局指标与CCP使用的更严格方法具有可比性。对于从回顾性病历审查中更难测量的结局，如中风和复发性心肌梗死，必须谨慎解读。
