基于医疗保健索赔数据库的方法识别化疗引起的发热性中性粒细胞减少症的技术评估。
Technical evaluation of methods for identifying chemotherapy-induced febrile neutropenia in healthcare claims databases.
机构信息
Policy Analysis Inc., Brookline, MA, USA.
出版信息
BMC Health Serv Res. 2013 Feb 13;13:60. doi: 10.1186/1472-6963-13-60.
BACKGROUND
Healthcare claims databases have been used in several studies to characterize the risk and burden of chemotherapy-induced febrile neutropenia (FN) and effectiveness of colony-stimulating factors against FN. The accuracy of methods previously used to identify FN in such databases has not been formally evaluated.
METHODS
Data comprised linked electronic medical records from Geisinger Health System and healthcare claims data from Geisinger Health Plan. Subjects were classified into subgroups based on whether or not they were hospitalized for FN per the presumptive "gold standard" (ANC <1.0×10(9)/L, and body temperature ≥38.3°C or receipt of antibiotics) and claims-based definition (diagnosis codes for neutropenia, fever, and/or infection). Accuracy was evaluated principally based on positive predictive value (PPV) and sensitivity.
RESULTS
Among 357 study subjects, 82 (23%) met the gold standard for hospitalized FN. For the claims-based definition including diagnosis codes for neutropenia plus fever in any position (n=28), PPV was 100% and sensitivity was 34% (95% CI: 24-45). For the definition including neutropenia in the primary position (n=54), PPV was 87% (78-95) and sensitivity was 57% (46-68). For the definition including neutropenia in any position (n=71), PPV was 77% (68-87) and sensitivity was 67% (56-77).
CONCLUSIONS
Patients hospitalized for chemotherapy-induced FN can be identified in healthcare claims databases--with an acceptable level of mis-classification--using diagnosis codes for neutropenia, or neutropenia plus fever.
背景
医疗保健索赔数据库已在多项研究中用于描述化疗引起的发热性中性粒细胞减少症（FN）的风险和负担，以及集落刺激因子对 FN 的有效性。以前用于识别此类数据库中 FN 的方法的准确性尚未得到正式评估。
方法
数据包括来自 Geisinger 卫生系统的电子病历记录和 Geisinger 健康计划的医疗保健索赔数据。根据是否根据推定的“黄金标准”（ANC <1.0×10(9)/L 和体温≥38.3°C 或接受抗生素）和基于索赔的定义（中性粒细胞减少症、发热和/或感染的诊断代码）住院治疗 FN，将受试者分为亚组。准确性主要基于阳性预测值（PPV）和灵敏度进行评估。
结果
在 357 名研究对象中，有 82 名（23%）符合 FN 的住院黄金标准。对于包括任何部位的中性粒细胞减少症加发热的诊断代码在内的基于索赔的定义（n=28），PPV 为 100%，灵敏度为 34%（95%CI：24-45）。对于包括主要部位中性粒细胞减少症的定义（n=54），PPV 为 87%（78-95），灵敏度为 57%（46-68）。对于包括任何部位中性粒细胞减少症的定义（n=71），PPV 为 77%（68-87），灵敏度为 67%（56-77）。
结论
可以使用中性粒细胞减少症或中性粒细胞减少症加发热的诊断代码，从医疗保健索赔数据库中识别出因化疗引起的 FN 而住院的患者，存在可接受的误分类水平。
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