台湾地区患者自我报告与医保理赔数据在临床诊断、用药情况及卫生系统利用方面的一致性。
Concordance between patient self-reports and claims data on clinical diagnoses, medication use, and health system utilization in Taiwan.
作者信息
Wu Chi-Shin, Lai Mei-Shu, Gau Susan Shur-Fen, Wang Sheng-Chang, Tsai Hui-Ju
机构信息
Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan; College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
College of Public Health, National Taiwan University, Taipei, Taiwan.
出版信息
PLoS One. 2014 Dec 2;9(12):e112257. doi: 10.1371/journal.pone.0112257. eCollection 2014.
PURPOSE
The aim of this study was to evaluate the concordance between claims records in the National Health Insurance Research Database and patient self-reports on clinical diagnoses, medication use, and health system utilization.
METHODS
In this study, we used the data of 15,574 participants collected from the 2005 Taiwan National Health Interview Survey. We assessed positive agreement, negative agreement, and Cohen's kappa statistics to examine the concordance between claims records and patient self-reports.
RESULTS
Kappa values were 0.43, 0.64, and 0.61 for clinical diagnoses, medication use, and health system utilization, respectively. Using a strict algorithm to identify the clinical diagnoses recorded in claims records could improve the negative agreement; however, the effect on positive agreement and kappa was diverse across various conditions.
CONCLUSION
We found that the overall concordance between claims records in the National Health Insurance Research Database and patient self-reports in the Taiwan National Health Interview Survey was moderate for clinical diagnosis and substantial for both medication use and health system utilization.
目的
本研究旨在评估国民健康保险研究数据库中的理赔记录与患者关于临床诊断、用药情况及卫生系统利用情况的自我报告之间的一致性。
方法
在本研究中，我们使用了从2005年台湾国民健康访问调查中收集的15574名参与者的数据。我们评估了阳性一致性、阴性一致性和科恩kappa统计量，以检验理赔记录与患者自我报告之间的一致性。
结果
临床诊断、用药情况和卫生系统利用情况的kappa值分别为0.43、0.64和0.61。使用严格算法识别理赔记录中记录的临床诊断可提高阴性一致性；然而，在不同情况下，对阳性一致性和kappa的影响各不相同。
结论
我们发现，国民健康保险研究数据库中的理赔记录与台湾国民健康访问调查中患者自我报告之间的总体一致性，对于临床诊断而言为中等，对于用药情况和卫生系统利用情况而言均为较高。
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