Department of Medicine, University of Toronto, Toronto, ON.
Can J Public Health. 2009 Nov-Dec;100(6):472-4. doi: 10.1007/BF03404347.
Use of physician service claims and other administrative data is increasingly being advocated for chronic disease surveillance. However, such data may be vulnerable to reimbursement policy changes. We sought to determine how non-fee-for-service (non-FFS) primary care affects the detection of diabetes using physician claims data.
Ontarians over age 66 with diabetes and receiving care in a non-FFS setting were identified using prescription claims for glucose-lowering drugs written by non-FFS physicians. We compared the date of incident treatment in this cohort with the diagnosis date in the Ontario Diabetes Database, a validated administrative data algorithm to detect persons with diabetes. We assessed the rate of detection and, among detected cases, whether detection was late (more than 6 months after the index prescription). Survival methods were used to assess detection over time.
Only 49.7% of prescription-defined diabetes cases were detected within six months of the index prescription; 23.7% remained undetected after up to nine years of follow-up. Detected individuals had higher rates of hospitalization for vascular complications than missed cases (15.1% vs 4.8%, p < 0.0001), suggesting that they were at a more advanced stage of disease.
Non-FFS reimbursement arrangements for primary care physicians appear to undermine the utility of administrative data for chronic disease surveillance, leading to both decreased sensitivity and biased detection. Provisions for alternative means to collect diagnostic information should be considered as these arrangements are introduced.
使用医生服务索赔和其他管理数据来进行慢性病监测的做法正日益得到提倡。然而，此类数据可能容易受到报销政策变化的影响。我们旨在确定非按服务收费（non-FFS）初级保健如何影响使用医生索赔数据来发现糖尿病。
通过非按服务收费医生开具的降血糖药物处方，在安大略省识别出年龄在 66 岁以上、在非按服务收费环境中接受治疗的糖尿病患者。我们将该队列中的新发病例治疗日期与安大略省糖尿病数据库（一种经过验证的用于发现糖尿病患者的管理数据算法）中的诊断日期进行了比较。我们评估了检出率，以及在已检出病例中，检测是否延迟（超过索引处方后 6 个月）。生存分析用于评估随时间推移的检出率。
仅 49.7%的处方定义的糖尿病病例在索引处方后 6 个月内被检出；在长达 9 年的随访后，仍有 23.7%的病例未被检出。与漏诊病例相比，已检出病例的血管并发症住院率更高（15.1%比 4.8%，p<0.0001），这表明他们处于疾病的更晚期。
为初级保健医生制定的非按服务收费报销安排似乎削弱了管理数据在慢性病监测方面的实用性，导致敏感性降低和检测存在偏差。在引入这些安排时，应考虑提供替代方法来收集诊断信息。
