Lentine Krista L, Schnitzler Mark A, Abbott Kevin C, Bramesfeld Kosha, Buchanan Paula M, Brennan Daniel C
Center for Outcomes Research and Division of Nephrology, School of Medicine, Saint Louis University, St. Louis, MO 63104, USA.
Clin J Am Soc Nephrol. 2009 Jul;4(7):1213-21. doi: 10.2215/CJN.00670109. Epub 2009 Jun 18.
Billing claims are increasingly examined beyond administrative functions as outcomes measures in observational research. Few studies have described the performance of billing claims as surrogate measures of clinical events among kidney transplant recipients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We investigated the sensitivity of Medicare billing claims for clinically verified cardiovascular diagnoses (five categories) and procedures (four categories) in a novel database linking Medicare claims to electronic medical records of one transplant program. Cardiovascular events identified in medical records for 571 Medicare-insured transplant recipients in 1991 through 2002 served as reference measures.
Within a claims-ascertainment period spanning +/-30 d of clinically recorded dates, aggregate sensitivity of single claims was higher for case definitions incorporating Medicare Parts A and B for diagnoses and procedures (90.9%) compared with either Part A (82.3%) or Part B (84.6%) alone. Perfect capture of the four procedures was possible within +/-30 d or with short claims window expansion, but sensitivity for the diagnoses trended lower with all study algorithms (91.2% with window up to +/-90 d). Requirement for additional confirmatory diagnosis claims did not appreciably reduce sensitivity. Sensitivity patterns were similar in the early compared with late periods of the study.
Combined use of Medicare Parts A and B billing claims composes a sensitive measure of cardiovascular events after kidney transplant. Further research is needed to define algorithms that maximize specificity as well as sensitivity of claims from Medicare and other insurers as research measures in this population.
在观察性研究中，计费索赔越来越多地被视为结果指标，而不仅仅用于行政功能。很少有研究描述计费索赔作为肾移植受者临床事件替代指标的表现。
设计、设置、参与者及测量方法：我们在一个将医疗保险索赔与一个移植项目的电子病历相链接的新型数据库中，调查了医疗保险计费索赔对经临床验证的心血管诊断（五类）和手术（四类）的敏感性。1991年至2002年期间，在571名参加医疗保险的移植受者的病历中确定的心血管事件作为参考指标。
在临床记录日期前后±30天的索赔确定期内，对于包含医疗保险A部分和B部分的诊断和手术病例定义，单项索赔的总体敏感性更高（90.9%），而单独使用A部分（82.3%）或B部分（84.6%）时敏感性较低。在±30天内或通过缩短索赔窗口扩展可以完全捕获这四种手术，但所有研究算法下诊断的敏感性呈下降趋势（窗口扩展至±90天时为91.2%）。额外的确诊诊断索赔要求并未明显降低敏感性。研究早期和晚期的敏感性模式相似。
联合使用医疗保险A部分和B部分的计费索赔是肾移植后心血管事件的敏感指标。需要进一步研究来确定算法，以最大限度地提高医疗保险和其他保险公司索赔作为该人群研究指标的特异性和敏感性。
