Kiyota Yuka, Schneeweiss Sebastian, Glynn Robert J, Cannuscio Carolyn C, Avorn Jerry, Solomon Daniel H
Division of Pharmacoepidemiology and Pharmacoeconomics, Boston, Mass USA.
Am Heart J. 2004 Jul;148(1):99-104. doi: 10.1016/j.ahj.2004.02.013.
Many cardiovascular epidemiologic studies rely on diagnosis codes in health care claims databases. Despite important changes in the care and diagnosis of acute myocardial infarction (AMI), the validity of hospital discharge diagnosis codes for AMI in the US Medicare system has not been recently examined. Our objective was to examine the accuracy of International Classification of Diseases--ninth revision--Clinical Modifications (ICD-9-CM) discharge diagnosis codes and diagnosis-related groups (DRG) codes for AMI in a Medicare claims database.
We sampled hospitalization episodes from Medicare beneficiaries in Pennsylvania during 1999, 2000, or both. We used Medicare data to identify patients with hospitalizations containing indicators of AMI (ICD-9-CM diagnosis codes 410.X0 and 410.X1 or DRG codes 121, 122, and 123). Hospital records for these episodes were reviewed by trained abstractors using World Health Organization criteria for diagnosing AMI. We then calculated the positive predictive value of Medicare claims-based definitions of AMI.
Of 2200 hospitalization episodes with Medicare diagnosis codes suggestive of AMI, 2022 hospital records (91.9%) were obtained. The positive predictive value for a primary Medicare claims-based definition was 94.1% (95% CI, 93.0%-95.2%). Positive predictive values for alternative claims-based definitions ranged slightly, with the definition including DRG codes and length-of-stay restrictions yielding the highest positive predictive value, 95.4% (95% CI, 94.3%-96.4%). Subjects with a history of myocardial infarction had a significantly lower positive predictive value than subjects without a history of myocardial infarction (88.1% vs 94.6%, P <.001).
In this study, we observed high positive predictive values for a Medicare claims-based diagnosis of AMI and a diagnosis based on structured hospital record review.
许多心血管流行病学研究依赖于医疗保健理赔数据库中的诊断编码。尽管急性心肌梗死（AMI）的治疗和诊断有了重要变化，但美国医疗保险系统中AMI的出院诊断编码的有效性最近尚未得到检验。我们的目的是在医疗保险理赔数据库中检验国际疾病分类第九版临床修订本（ICD-9-CM）出院诊断编码和诊断相关分组（DRG）编码对AMI的准确性。
我们从1999年、2000年或这两年期间宾夕法尼亚州医疗保险受益人的住院病例中进行抽样。我们使用医疗保险数据来识别住院患者中含有AMI指标的患者（ICD-9-CM诊断编码410.X0和410.X1或DRG编码121、122和123）。这些病例的医院记录由经过培训的摘要员使用世界卫生组织诊断AMI的标准进行审查。然后我们计算了基于医疗保险理赔的AMI定义的阳性预测值。
在2200例有提示AMI的医疗保险诊断编码的住院病例中，获得了2022份医院记录（91.9%）。基于主要医疗保险理赔定义的阳性预测值为94.1%（95%可信区间，93.0%-95.2%）。基于替代理赔定义的阳性预测值略有不同，包括DRG编码和住院时间限制的定义产生了最高的阳性预测值，为95.4%（95%可信区间，94.3%-96.4%）。有心肌梗死病史的受试者的阳性预测值显著低于无心肌梗死病史的受试者（88.1%对94.6%，P<.001）。
在本研究中，我们观察到基于医疗保险理赔的AMI诊断和基于结构化医院记录审查的诊断具有较高的阳性预测值。
