Institute for Clinical Evaluative Sciences, Toronto, Canada.
Med Care. 2010 Aug;48(8):745-50. doi: 10.1097/MLR.0b013e3181e419fd.
The use of administrative health data and other secondary data sources to conduct research are increasing, and the quality of these data requires careful scrutiny to ensure that findings of studies based on them are accurate.
We conducted a multicenter, chart-abstraction study in Ontario, Canada to evaluate the ability of linked administrative databases to identify important baseline demographic and treatment information, changes in dialysis treatment modality over time, and the occurrence of important outcome events in incident dialysis patients. The medical record was considered the reference standard.
Within administrative databases, demographic information was very well coded, as was the location where individuals started dialysis, the first treatment modality, the first outpatient modality, and the treatment that was in use 90 days after the start of therapy. The ability to accurately recreate an individual patient's entire dialysis treatment history using physician billing claims was somewhat limited. The treatment changes were often identified in the correct temporal sequence, but the dates that the events occurred did not agree well. Finally, important outcomes including the death and kidney transplantation were captured well, although the recovery of kidney function could not be evaluated because of poor inter-rater reliability.
This validation study provides important information concerning the ability to detect variables related to dialysis care using administrative datasets. Validation work should focus not only on the ability of secondary data to identify baseline comorbidities, but should also attempt to verify that other key variables required to conduct analyses are reliably captured.
使用行政健康数据和其他二级数据源进行研究的情况越来越多，这些数据的质量需要仔细审查，以确保基于这些数据的研究结果是准确的。
我们在加拿大安大略省进行了一项多中心的图表提取研究，以评估链接的行政数据库识别重要基线人口统计学和治疗信息、随时间变化的透析治疗方式的变化以及发生在新透析患者中的重要结局事件的能力。病历被认为是参考标准。
在行政数据库中，人口统计学信息编码得非常好，个人开始透析的地点、最初的治疗方式、最初的门诊方式以及治疗开始后 90 天内使用的治疗方式也编码得很好。使用医生计费索赔准确重现个体患者整个透析治疗史的能力有些有限。治疗变化通常按正确的时间顺序识别，但发生事件的日期并不一致。最后，包括死亡和肾移植在内的重要结局都很好地捕捉到了，尽管由于评分者间可靠性差，无法评估肾功能的恢复情况。
这项验证研究提供了有关使用行政数据集检测与透析护理相关变量的能力的重要信息。验证工作不仅应侧重于二级数据识别基线合并症的能力，还应尝试验证进行分析所需的其他关键变量是否可靠地捕获。
