[德国法定医疗保险理赔数据中痴呆症的诊断与诊断编码]
[Diagnosing and diagnosis coding of dementias in claims data from German statutory health insurance].
作者信息
Kaduszkiewicz Hanna, Wiese Birgitt, Steinmann Susanne, Schön Gerhard, Hoffmann Falk, van den Bussche Hendrik
机构信息
Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf.
Institut für Allgemeinmedizin, Medizinische Hochschule Hannover.
出版信息
Psychiatr Prax. 2014 Sep;41(6):319-23. doi: 10.1055/s-0033-1349505. Epub 2013 Sep 23.
OBJECTIVE
On the basis of data from one German Sickness Fund we analyzed which medical discipline coded the incident diagnosis of dementia in ambulatory medical care in Germany, which type of dementia was coded and how the initial code eventually changed during the year of incidence.
METHODS
Claims data of 1,848 insured people aged ≥ 65 years in 2004 with incident dementia were analyzed by means of descriptive statistics.
RESULTS
The diagnosis within the first quarter of the incidence year was coded by the GP in 71%, by a psychiatrist or neurologist in 14%, by both in 6% and by other disciplines in 9% of the cases. The percentage of unspecified diagnoses was 62% among GPs and 46% among psychiatrists or neurologists, a number differing largely from epidemiological studies. In 27% of the cases patients received two or more different dementia diagnoses during the incidence year.
CONCLUSION
Studies and care concepts regarding dementia on the basis of diagnosis codes in ambulatory claims data should be interpreted with great caution.
目的
基于一家德国疾病基金的数据，我们分析了在德国门诊医疗中，痴呆症的首次诊断由哪个医学学科编码、编码的痴呆症类型以及在发病当年初始编码最终如何变化。
方法
采用描述性统计方法分析了2004年1848名年龄≥65岁的患有新发痴呆症的参保人的理赔数据。
结果
在发病当年第一季度，71%的病例诊断由全科医生编码，14%由精神科医生或神经科医生编码，6%由两者共同编码，9%由其他学科编码。全科医生中未明确诊断的比例为62%，精神科医生或神经科医生中为46%，这一数字与流行病学研究有很大差异。在27%的病例中，患者在发病当年接受了两种或更多不同的痴呆症诊断。
结论
基于门诊理赔数据中的诊断编码进行的痴呆症研究和护理概念应谨慎解读。
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