Lovelace Clinic Foundation, 2309 Renard Pl SE, Ste 103, Albuquerque, NM 87106-4264, USA.
Am J Manag Care. 2010 Jul;16(7):505-12.
To develop and validate a method for identifying persons with undiagnosed chronic obstructive pulmonary disease (COPD) using outpatient pharmacy data.
Case-control analysis of managed care administrative data with clinical validation by spirometry and standardized questionnaires.
Patients with a new diagnosis of COPD were matched to 3 control subjects by age and sex. Outpatient pharmacy utilization for the 2 years prior to the initial diagnosis was captured. Drugs associated with an eventual diagnosis of COPD were identified using conditional logistic regression, and then entered into a predictive algorithm using discriminant function analysis. The algorithm was tested in a second population from the same health plan and externally validated using 2 large multicenter databases. This system was clinically validated by testing 100 individuals identified by the algorithm with spirometry plus health status and respiratory symptoms questionnaires.
COPD patients used significantly more antibiotics, cardiac medications, and respiratory drugs than their matched controls. The final algorithm identified COPD patients with a sensitivity of 60% and specificity of 70%, without the benefit of knowing any patient's smoking history. Of the first 100 persons identified by the algorithm as being at risk and recruited for testing, 25 were proven to have previously undiagnosed COPD.
Pharmacy utilization increases in the years prior to initial COPD diagnosis. Algorithms based on pharmacy utilization can efficiently identify persons at risk for undiagnosed COPD.
利用门诊药房数据开发并验证一种用于识别未确诊慢性阻塞性肺疾病（COPD）患者的方法。
对管理式医疗的行政数据进行病例对照分析，并通过肺活量测定和标准化问卷进行临床验证。
根据年龄和性别，将新诊断为 COPD 的患者与 3 名对照患者相匹配。记录初始诊断前 2 年的门诊药房用药情况。使用条件逻辑回归识别与最终 COPD 诊断相关的药物，然后使用判别函数分析将这些药物纳入预测算法。该算法在来自同一健康计划的第二个人群中进行了测试，并使用 2 个大型多中心数据库进行了外部验证。通过对该算法识别的 100 名个体进行肺活量测定以及健康状况和呼吸道症状问卷测试，对该系统进行了临床验证。
COPD 患者比其匹配的对照组使用了更多的抗生素、心脏药物和呼吸道药物。最终的算法识别 COPD 患者的敏感性为 60%，特异性为 70%，而无需了解任何患者的吸烟史。在根据算法确定的有风险并招募进行测试的前 100 人中，有 25 人被证实患有先前未确诊的 COPD。
在初始 COPD 诊断前的几年中，用药量会增加。基于药房使用情况的算法可以有效地识别出患有未确诊 COPD 的高危人群。
