The Hospital For Sick Children, Toronto, Ontario, Canada.
COPD. 2009 Oct;6(5):388-94. doi: 10.1080/15412550903140865.
Chronic Obstructive Pulmonary Disease (COPD) is a common chronic respiratory disease responsible for significant morbidity and mortality. Population-based health administrative databases provide a powerful and unbiased way of studying COPD in the population, however, their ability to accurately identify patients with this disease must first be confirmed. The objective was to validate population-based health administrative definitions of COPD. Previously abstracted medical records of adults over the age of 35 randomly selected from primary care practices in Ontario, Canada were reviewed by an expert panel to establish if an individual did or did not have a diagnosis of COPD. These reference designations were then linked to each individual's respective health administrative database record and compared with predefine health administrative data definitions of COPD. Concepts of diagnostic test evaluation were used to calculate and compare their test characteristics. The most sensitive health administrative definition of COPD was 1 or more ambulatory claims and/or 1 or more hospitalizations for COPD that yielded a sensitivity of 85.0% (95% confidence interval 77.0 to 91.0) and a specificity of 78.4% (95% confidence interval 73.6 to 82.7). As number of ambulatory claims in the definition increased, sensitivity decreased and specificity increased. Individuals with COPD can be accurately identified in health administrative data, and therefore it may be used to create an unbiased population cohort for surveillance and research. This offers a powerful means of generating evidence to inform strategies that optimize the prevention and management of COPD.
慢性阻塞性肺疾病（COPD）是一种常见的慢性呼吸道疾病，可导致严重的发病率和死亡率。基于人群的健康管理数据库为研究人群中的 COPD 提供了一种强大且无偏倚的方法，但是，首先必须确认其准确识别患有该病的患者的能力。目的是验证基于人群的健康管理 COPD 定义。先前从加拿大安大略省的初级保健实践中随机选择的 35 岁以上成年人的病历摘要由专家小组进行了审查，以确定该个体是否患有 COPD 诊断。然后，将这些参考指定与每个人各自的健康管理数据库记录相关联，并与 COPD 的预定义健康管理数据定义进行比较。诊断测试评估的概念用于计算和比较其测试特征。最敏感的 COPD 健康管理定义是 1 次或多次门诊就诊和/或 1 次或多次 COPD 住院治疗，其敏感性为 85.0％（95％置信区间为 77.0 至 91.0），特异性为 78.4％（95％置信区间为 73.6 至 82.7）。随着定义中门诊就诊次数的增加，敏感性降低，特异性增加。可以在健康管理数据中准确识别 COPD 患者，因此可以将其用于创建用于监测和研究的无偏倚人群队列。这为生成证据提供了一种有力的手段，可用于制定优化 COPD 预防和管理的策略。
