利用医疗保健利用数据评估骨质疏松症质量指标。
Osteoporosis quality indicators using healthcare utilization data.
机构信息
Leslie Dan Faculty of Pharmacy, University of Toronto, Leslie L. Dan Pharmacy Building, 144 College Street, Toronto, ON M5S 3M2, Canada.
出版信息
Osteoporos Int. 2011 May;22(5):1335-42. doi: 10.1007/s00198-010-1329-8. Epub 2010 Jun 25.
SUMMARY
Healthcare utilization data may be used to examine the quality of osteoporosis management by identifying dual-energy X-ray absorptiometry (DXA) testing (sensitivity = 98%, specificity = 93%) and osteoporosis pharmacotherapy (κ = 0.81) with minimal measurement error.
INTRODUCTION
In osteoporosis, key quality indicators among older women include risk assessment by DXA and/or pharmacotherapy within 6 months following fracture.
METHODS
The purpose of this study was to examine healthcare utilization data for use as quality indicators of osteoporosis management. We linked data from 858 community-dwelling women aged over 65 years who completed a standardized telephone interview about osteoporosis management to their healthcare utilization (medical and pharmacy claims) data. Agreement between self-report of osteoporosis pharmacotherapy and pharmacy claims was examined using kappa statistics. We examined the sensitivity and specificity of medical claims to identify DXA testing as well as the sensitivity and specificity of medical and pharmacy claims to identify those with DXA-documented osteoporosis (T-score ≤ -2.5).
RESULTS
Participants were aged 75 (SD = 6) years on average; 96% were Caucasian. Agreement between self-report and claims-based osteoporosis pharmacotherapy was very good (κ = 0.81; 95% CI = 0.76, 0.86). The sensitivity of medical claims to identify DXA testing was 98% (95% CI = 95.9, 99.1), with estimated specificity of 93% (95% CI = 89.8, 95.4). We abstracted DXA results from test reports of 359 women, of whom 114 (32%) were identified with osteoporosis. Medical (osteoporosis diagnosis) and pharmacy (osteoporosis pharmacotherapy) claims within a year after DXA testing had a sensitivity of 80% (95% CI = 71.3, 86.8) and specificity of 72% (95% CI = 66.2, 77.8) to identify DXA-documented osteoporosis.
CONCLUSION
Healthcare utilization data may be used to examine the quality of osteoporosis management by identifying DXA testing and osteoporosis pharmacotherapy (care processes) with minimal measurement error. However, medical and pharmacy claims alone do not provide a good means for identifying women with underlying osteoporosis.
摘要
通过识别双能 X 射线吸收法 (DXA) 检测（灵敏度=98%，特异性=93%）和骨质疏松症药物治疗（κ=0.81），并结合最小的测量误差，利用医疗保健利用数据可以检查骨质疏松症管理的质量。
引言
在骨质疏松症中，老年女性的关键质量指标包括骨折后 6 个月内通过 DXA 进行风险评估和/或药物治疗。
方法
本研究旨在探讨医疗保健利用数据作为骨质疏松症管理质量指标的用途。我们将 858 名年龄在 65 岁以上、完成了关于骨质疏松症管理的标准化电话访谈的社区居住女性的数据与她们的医疗保健利用（医疗和药房理赔）数据进行了关联。使用 Kappa 统计来检查自我报告的骨质疏松症药物治疗与药房理赔之间的一致性。我们检查了医疗索赔识别 DXA 检测的灵敏度和特异性，以及医疗和药房索赔识别有 DXA 记录的骨质疏松症（T 评分≤-2.5）的灵敏度和特异性。
结果
参与者的平均年龄为 75（SD=6）岁；96%为白种人。自我报告和基于索赔的骨质疏松症药物治疗之间的一致性非常好（κ=0.81；95%CI=0.76，0.86）。医疗索赔识别 DXA 检测的灵敏度为 98%（95%CI=95.9，99.1），估计特异性为 93%（95%CI=89.8，95.4）。我们从 359 名女性的测试报告中提取了 DXA 结果，其中 114 名（32%）被诊断为骨质疏松症。DXA 检测后一年内的医疗（骨质疏松症诊断）和药房（骨质疏松症药物治疗）理赔对识别有 DXA 记录的骨质疏松症的灵敏度为 80%（95%CI=71.3，86.8），特异性为 72%（95%CI=66.2，77.8）。
结论
通过识别 DXA 检测和骨质疏松症药物治疗（护理过程），并结合最小的测量误差，医疗保健利用数据可用于检查骨质疏松症管理的质量。然而，医疗和药房理赔本身并不能很好地识别潜在的骨质疏松症女性。
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