Martin Brook I, Lurie Jon D, Tosteson Anna N A, Deyo Richard A, Tosteson Tor D, Weinstein James N, Mirza Sohail K
*Dartmouth Institute for Health Policy & Clinical Practice, and the Department of Orthopaedic Surgery, Geisel School of Medicine at Dartmouth, Lebanon, NH †Departments of Medicine and Orthopaedics, The Dartmouth Institute, Lebanon, NH ‡Departments of Medicine and Community and Family Medicine, The Dartmouth Institute, Lebanon, NH §Departments of Family Medicine, Medicine, and Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR ¶Departments of Community and Family Medicine, The Dartmouth Institute, Lebanon, NH ‖Departments of Orthopaedics and Community and Family Medicine, The Dartmouth Institute, Lebanon, NH; and **Department of Orthopaedics, The Dartmouth Institute, Lebanon, NH.
Spine (Phila Pa 1976). 2014 Apr 20;39(9):769-79. doi: 10.1097/BRS.0000000000000275.
Retrospective analysis of Medicare claims linked to a multicenter clinical trial.
The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenosis, and degenerative spondylolisthesis. We compared the surgical indication derived from Medicare claims with that provided by SPORT surgeons, the "gold standard."
Administrative data are frequently used to report procedure rates, surgical safety outcomes, and costs in the management of spinal surgery. However, the accuracy of using diagnosis codes to classify patients by surgical indication has not been examined.
Medicare claims were link to beneficiaries enrolled in SPORT. The sensitivity and specificity of 3 claims-based approaches to group patients on the basis of surgical indications were examined: (1) using the first listed diagnosis; (2) using all diagnoses independently; and (3) using a diagnosis hierarchy on the basis of the support for fusion surgery.
Medicare claims were obtained from 376 SPORT participants, including 21 with disc herniation, 183 with spinal stenosis, and 172 with degenerative spondylolisthesis. The hierarchical coding algorithm was the most accurate approach for classifying patients by surgical indication, with sensitivities of 76.2%, 88.1%, and 84.3% for disc herniation, spinal stenosis, and degenerative spondylolisthesis cohorts, respectively. The specificity was 98.3% for disc herniation, 83.2% for spinal stenosis, and 90.7% for degenerative spondylolisthesis. Misclassifications were primarily due to codes attributing more complex pathology to the case.
Standardized approaches for using claims data to group patients accurately by surgical indications have widespread interest. We found that a hierarchical coding approach correctly classified more than 90% of spine patients into their respective SPORT cohorts. Therefore, claims data seem to be a reasonably valid approach to classifying patients by surgical indication.
对与一项多中心临床试验相关的医疗保险索赔数据进行回顾性分析。
脊柱患者预后研究试验（SPORT）提供了一个独特的机会，用以检验一种基于索赔数据的算法按手术指征对患者进行分组的有效性。SPORT纳入了腰椎间盘突出症、椎管狭窄症和退行性椎体滑脱患者。我们将医疗保险索赔数据得出的手术指征与SPORT外科医生提供的“金标准”手术指征进行了比较。
行政数据经常用于报告脊柱手术管理中的手术率、手术安全结果和成本。然而，使用诊断编码按手术指征对患者进行分类的准确性尚未得到检验。
将医疗保险索赔数据与SPORT登记的受益人相关联。研究了基于手术指征对患者进行分组的3种基于索赔数据的方法的敏感性和特异性：（1）使用首个列出的诊断；（2）独立使用所有诊断；（3）基于融合手术支持情况使用诊断层级。
获取了376名SPORT参与者的医疗保险索赔数据，其中包括21例腰椎间盘突出症患者、183例椎管狭窄症患者和172例退行性椎体滑脱患者。分层编码算法是按手术指征对患者进行分类的最准确方法，对于腰椎间盘突出症、椎管狭窄症和退行性椎体滑脱队列，其敏感性分别为76.2%、88.1%和84.3%。腰椎间盘突出症的特异性为98.3%，椎管狭窄症为83.2%，退行性椎体滑脱症为90.7%。错误分类主要是由于将更复杂的病理情况归因于病例的编码。
利用索赔数据按手术指征准确对患者进行分组的标准化方法受到广泛关注。我们发现，分层编码方法能将超过90%的脊柱患者正确分类到各自的SPORT队列中。因此，索赔数据似乎是按手术指征对患者进行分类的一种合理有效的方法。
3级。
