Ting Gladys, Schneeweiss Sebastian, Scranton Richard, Katz Jeffrey N, Weinblatt Michael E, Young Melissa, Avorn Jerry, Solomon Daniel H
Department of Medicine, Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
Arthritis Res Ther. 2008;10(4):R95. doi: 10.1186/ar2482. Epub 2008 Aug 21.
Health care utilisation ('claims') databases contain information about millions of patients and are an important source of information for a variety of study types. However, they typically do not contain information about disease severity. The goal of the present study was to develop a health care claims index for rheumatoid arthritis (RA) severity using a previously developed medical records-based index for RA severity (RA medical records-based index of severity [RARBIS]).
The study population consisted of 120 patients from the Veteran's Administration (VA) Health System. We previously demonstrated the construct validity of the RARBIS and established its convergent validity with the Disease Activity Score (DAS28). Potential claims-based indicators were entered into a linear regression model as independent variables and the RARBIS as the dependent variable. The claims-based index for RA severity (CIRAS) was created using the coefficients from models with the highest coefficient of determination (R2) values selected by automated modelling procedures. To compare our claims-based index with our medical records-based index, we examined the correlation between the CIRAS and the RARBIS using Spearman non-parametric tests.
The forward selection models yielded the highest model R2 for both the RARBIS with medications (R2 = 0.31) and the RARBIS without medications (R2 = 0.26). Components of the CIRAS included tests for inflammatory markers, number of chemistry panels and platelet counts ordered, rheumatoid factor, the number of rehabilitation and rheumatology visits, and Felty's syndrome diagnosis. The CIRAS demonstrated moderate correlations with the RARBIS with medication and the RARBIS without medication sub-scales.
We developed the CIRAS that showed moderate correlations with a previously validated records-based index of severity. The CIRAS may serve as a potentially important tool in adjusting for RA severity in pharmacoepidemiology studies of RA treatment and complications using health care utilisation data.
医疗保健利用（“索赔”）数据库包含数百万患者的信息，是各种研究类型的重要信息来源。然而，它们通常不包含疾病严重程度的信息。本研究的目的是使用先前开发的基于病历的类风湿性关节炎（RA）严重程度指数（基于类风湿性关节炎病历的严重程度指数[RARBIS]）来开发一个用于RA严重程度的医疗保健索赔指数。
研究人群包括来自退伍军人管理局（VA）医疗系统的120名患者。我们之前证明了RARBIS的结构效度，并建立了其与疾病活动评分（DAS28）的收敛效度。将潜在的基于索赔的指标作为自变量输入线性回归模型，将RARBIS作为因变量。使用自动建模程序选择的具有最高决定系数（R2）值的模型中的系数创建RA严重程度的基于索赔的指数（CIRAS）。为了将我们基于索赔的指数与基于病历的指数进行比较，我们使用Spearman非参数检验检查了CIRAS与RARBIS之间的相关性。
向前选择模型在有药物治疗的RARBIS（R2 = 0.31）和无药物治疗的RARBIS（R2 = 0.26）中均产生了最高的模型R2。CIRAS的组成部分包括炎症标志物检测、化学检查面板数量和血小板计数、类风湿因子、康复和风湿病就诊次数以及费尔蒂综合征诊断。CIRAS与有药物治疗的RARBIS和无药物治疗的RARBIS子量表显示出中等相关性。
我们开发了CIRAS，它与先前验证的基于记录的严重程度指数显示出中等相关性。CIRAS可能是在使用医疗保健利用数据进行RA治疗和并发症的药物流行病学研究中调整RA严重程度的潜在重要工具。
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