Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 133-792, South Korea.
Rheumatol Int. 2013 Dec;33(12):2985-92. doi: 10.1007/s00296-013-2833-x. Epub 2013 Aug 6.
This study aimed to develop an identification algorithm for validating the International Classification of Diseases-Tenth diagnostic codes for rheumatoid arthritis (RA) in the Korean National Health Insurance (NHI) claims database. An individual copayment beneficiaries program for rare and intractable diseases, including seropositive RA (M05), began in South Korea in July 2009. Patients registered in this system pay only 10 % of their total medical costs, but registration requires an official report from a doctor documenting that the patient fulfills the 1987 ACR criteria. We regarded patients registered in this system as gold standard RA and examined the validity of several algorithms to define RA diagnosis using diagnostic codes and prescription data. We constructed nine algorithms using two highly specific prescriptions (positive predictive value >90 % and specificity >90 %) and one prescription with high sensitivity (>80 %) and accuracy (>75 %). A total of 59,823 RA patients were included in this validation study. Among them, 50,082 (83.7 %) were registered in the individual copayment beneficiaries program and considered true RA. We tested nine algorithms that incorporated two specific regimens [biologics and leflunomide alone, methotrexate plus leflunomide, or more than 3 disease-modifying anti-rheumatic drugs (DMARDs)] and one sensitive drug (any non-steroidal anti-inflammatory drug (NSAID), any DMARD, or any NSAID plus any DMARD). The algorithm that included biologics, more than 3 DMARDs, and any DMARD yielded the highest accuracy (91.4 %). Patients with RA diagnostic codes with prescription of biologics or any DMARD can be considered as accurate cases of RA in Korean NHI claims database.
本研究旨在开发一种鉴别算法，以验证韩国国家健康保险（NHI）理赔数据库中类风湿关节炎（RA）的国际疾病分类第十版诊断代码。 2009 年 7 月，韩国开始实施针对包括血清阳性 RA（M05）在内的罕见和疑难疾病的个人自费患者计划。在此系统中注册的患者只需支付其总医疗费用的 10％，但注册需要医生的正式报告，证明患者符合 1987 年 ACR 标准。我们将在此系统中注册的患者视为 RA 的金标准，并检查了使用诊断代码和处方数据定义 RA 诊断的几种算法的有效性。我们使用两种高度特异性处方（阳性预测值> 90％，特异性> 90％）和一种高灵敏度（> 80％）和准确性（> 75％）的处方构建了 9 种算法。共有 59,823 名 RA 患者纳入本验证研究。其中，50,082（83.7％）人在个人自费患者计划中注册，被认为是真正的 RA。我们测试了包含两种特定方案[单独使用生物制剂和来氟米特，甲氨蝶呤加来氟米特，或 3 种以上疾病修饰抗风湿药物（DMARDs）]和一种敏感药物（任何非甾体抗炎药（NSAID），任何 DMARD 或任何 NSAID 加任何 DMARD）的 9 种算法。包含生物制剂，3 种以上 DMARD 和任何 DMARD 的算法具有最高的准确性（91.4％）。在韩国 NHI 理赔数据库中，具有生物制剂或任何 DMARD 处方的 RA 诊断代码的患者可被视为 RA 的准确病例。
