Taneja Charu, Berger Ariel, Inglese Gary W, Lamerato Lois, Sloand James A, Wolff Greg G, Sheehan Michael, Oster Gerry
Policy Analysis Inc.(PAI), Brookline, MA, USA; Baxter Healthcare Corporation, McGaw Park, IL, USA; and Henry Ford Health System, Detroit, MI, USA.
Perit Dial Int. 2014 Sep-Oct;34(6):643-51. doi: 10.3747/pdi.2012.00328. Epub 2014 Feb 4.
While health insurance claims data are often used to estimate the costs of renal replacement therapy in patients with end-stage renal disease (ESRD), the accuracy of methods used to identify patients receiving dialysis - especially peritoneal dialysis (PD) and hemodialysis (HD) - in these data is unknown.
The study population consisted of all persons aged 18 - 63 years in a large US integrated health plan with ESRD and dialysis-related billing codes (i.e., diagnosis, procedures) on healthcare encounters between January 1, 2005, and December 31, 2008. Using billing codes for all healthcare encounters within 30 days of each patient's first dialysis-related claim ("index encounter"), we attempted to designate each study subject as either a "PD patient" or "HD patient." Using alternative windows of ± 30 days, ± 90 days, and ± 180 days around the index encounter, we reviewed patients' medical records to determine the dialysis modality actually received. We calculated the positive predictive value (PPV) for each dialysis-related billing code, using information in patients' medical records as the "gold standard."
We identified a total of 233 patients with evidence of ESRD and receipt of dialysis in healthcare claims data. Based on examination of billing codes, 43 and 173 study subjects were designated PD patients and HD patients, respectively (14 patients had evidence of PD and HD, and modality could not be ascertained for 31 patients). The PPV of codes used to identify PD patients was low based on a ± 30-day medical record review window (34.9%), and increased with use of ± 90-day and ± 180-day windows (both 67.4%). The PPV for codes used to identify HD patients was uniformly high - 86.7% based on ± 30-day review, 90.8% based on ± 90-day review, and 93.1% based on ± 180-day review.
While HD patients could be accurately identified using billing codes in healthcare claims data, case identification was much more problematic for patients receiving PD.
虽然医疗保险理赔数据常被用于估算终末期肾病（ESRD）患者的肾脏替代治疗费用，但在这些数据中用于识别接受透析治疗的患者——尤其是腹膜透析（PD）和血液透析（HD）患者——的方法的准确性尚不清楚。
研究人群包括美国一家大型综合健康计划中所有年龄在18至63岁之间且患有ESRD并在2005年1月1日至2008年12月31日期间的医疗就诊中有透析相关计费代码（即诊断、程序）的人员。利用每位患者首次透析相关理赔（“索引就诊”）后30天内所有医疗就诊的计费代码，我们试图将每位研究对象指定为“PD患者”或“HD患者”。利用索引就诊前后±30天、±90天和±180天的不同时间窗，我们查阅患者的病历以确定实际接受的透析方式。我们以患者病历中的信息作为“金标准”，计算每个透析相关计费代码的阳性预测值（PPV）。
我们在医疗理赔数据中总共识别出233例有ESRD证据且接受透析治疗的患者。根据计费代码检查，分别有43例和173例研究对象被指定为PD患者和HD患者（14例患者有PD和HD的证据，31例患者的透析方式无法确定）。基于±30天的病历审查窗口，用于识别PD患者的代码的PPV较低（34.9%），而使用±90天和±180天窗口时PPV增加（均为67.4%）。用于识别HD患者的代码的PPV始终较高——基于±30天审查为86.7%，基于±90天审查为90.8%，基于±180天审查为93.1%。
虽然利用医疗理赔数据中的计费代码可以准确识别HD患者，但对于接受PD治疗的患者，病例识别问题要大得多。
