Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Western Hospital Family Health Team, Toronto, Ontario, Canada.
Can J Cardiol. 2013 Nov;29(11):1388-94. doi: 10.1016/j.cjca.2013.07.676. Epub 2013 Sep 26.
Surveillance for stroke/transient ischemic attack (TIA) using administrative data has traditionally been limited to reporting patients who had an acute event and were hospitalized. This underestimates the true prevalence because many events do not result in hospitalization. We examined whether the accuracy of administrative data for identifying prevalent stroke/TIA could be improved by using data from both inpatient and outpatient visits.
An administrative data validation reference standard was developed through chart abstraction of 5000 adult patients randomly sampled from 73,014 patients of 83 family physicians who participate in the Electronic Medical Record Administrative Data Linked Database (EMRALD), in Ontario, Canada.
The prevalence of stroke/TIA in our adult population was 3.0%. An algorithm of 1 hospital record had a sensitivity of 35.3% (27.7%-43.0%) and specificity of 99.8% (99.7%-99.9%), whereas an algorithm of 2 physician billings within 1 year or 1 hospitalization had a sensitivity of 68.0% (95% confidence interval [CI], 60.5%-75.5%) and specificity of 98.9% (95% CI, 98.6%-99.2%) for the identification of patients who had ever had a stroke/TIA. We found that hospitalization data underestimated the prevalence of stroke by > 50% and TIA by > 66% compared with using both hospitalization and physician claims data.
The use of outpatient physician claims data in addition to hospitalization data improves the sensitivity of administrative data for the identification of prevalent stroke/TIA and may be used to estimate the prevalence of cerebrovascular events in large populations and over time.
传统上，使用行政数据对中风/短暂性脑缺血发作（TIA）进行监测仅限于报告急性发作并住院的患者。这低估了真实的患病率，因为许多事件不会导致住院。我们研究了通过使用住院和门诊就诊数据，是否可以提高行政数据识别常见中风/TIA 的准确性。
通过从参与加拿大安大略省电子病历行政数据链接数据库（EMRALD）的 83 位家庭医生的 73014 位患者中随机抽取的 5000 位成年患者的图表摘录，开发了行政数据验证参考标准。
我们的成年人群中风/TIA 的患病率为 3.0%。1 份住院记录的算法敏感性为 35.3%（27.7%-43.0%），特异性为 99.8%（99.7%-99.9%），而 1 年内或 1 次住院的 2 次医生账单的算法敏感性为 68.0%（95%置信区间[CI]，60.5%-75.5%），特异性为 98.9%（95%CI，98.6%-99.2%），用于识别曾经发生过中风/TIA 的患者。我们发现，与同时使用住院和医生就诊数据相比，住院数据低估了中风的患病率>50%，TIA 的患病率>66%。
除住院数据外，使用门诊医生就诊数据可提高行政数据识别常见中风/TIA 的敏感性，并可用于估计较大人群和随时间推移的脑血管事件的患病率。
