Jensen Kristin M, Cooke Colin R, Davis Matthew M
*Department of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, MI †Department of Pediatrics & Internal Medicine, University of Colorado School of Medicine, Aurora, CO ‡Division of Pulmonary and Critical Care Medicine and Center for Healthcare Outcomes & Policy §Ford School of Public Policy, University of Michigan, Ann Arbor, MI.
Med Care. 2014 Aug;52(8):e52-7. doi: 10.1097/MLR.0b013e31827631d2.
To compare the fidelity of administrative data with clinical data when researching Down syndrome (DS).
From outpatient, inpatient, and emergency department administrative claims within our institution, we identified 252 patients aged 18-45 years with encounters coded for DS by the ICD9=758.0 from 2000 to 2008. We evaluated these cases for false-positive errors-cases in which DS was not actually present in clinical descriptions. Subsequently, we identified false-negative errors (cases in which DS was present without encounters coded as such) by examination of the medical records for all patients within our study frame who had one of several common DS comorbidities, including congenital heart disease, hypothyroidism, and atlantoaxial instability.
Among the 252 people with an administrative code for DS, 53 (21%) did not have DS documented in their medical record (false-positive error). While searching for false-negative errors, 29 additional patients were discovered with DS documented in the medical record who had not been previously identified. This led to a final cohort of 228 patients with DS. The presence of a billing code for DS had moderate sensitivity (87%) and positive predictive value (79%), but high specificity (99.9%).
Administrative claims misclassify a sizeable proportion of patients with DS. Judgments about quality of care on the basis of samples identified using administrative claims may not accurately reflect the experience of patients with the conditions in question. When using administrative databases to study the quality of care for patients with DS, diagnostic verification within the clinical record is advisable whenever possible.
在研究唐氏综合征（DS）时，比较行政数据与临床数据的准确性。
从我们机构的门诊、住院和急诊科行政索赔记录中，我们识别出252名年龄在18至45岁之间的患者，他们在2000年至2008年期间因ICD9编码为758.0而被诊断为DS。我们评估这些病例是否存在假阳性错误——即临床描述中实际不存在DS的病例。随后，通过检查我们研究范围内所有患有几种常见DS合并症（包括先天性心脏病、甲状腺功能减退和寰枢椎不稳定）之一的患者的病历，我们识别出假阴性错误（即存在DS但未编码为此类的病例）。
在252名有DS行政编码的患者中，53名（21%）在其病历中未记录有DS（假阳性错误）。在寻找假阴性错误时，又发现了29名病历中有DS记录但之前未被识别的患者。这导致最终确定了228名患有DS的患者队列。DS计费代码的存在具有中等敏感性（87%）和阳性预测值（79%），但特异性较高（99.9%）。
行政索赔将相当一部分DS患者错误分类。基于使用行政索赔识别出的样本对医疗质量进行的判断可能无法准确反映相关疾病患者的实际情况。在使用行政数据库研究DS患者的医疗质量时，尽可能在临床记录中进行诊断验证是可取的。
