Ohlmeier C, Hoffmann F, Giersiepen K, Rothgang H, Mikolajczyk R, Appelrat H-J, Elsässer A, Garbe E
Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS GmbH.
Zentrum für Sozialpolitik, Universität Bremen.
Gesundheitswesen. 2015 Feb;77(2):e8-e14. doi: 10.1055/s-0034-1395644. Epub 2015 Jan 26.
Administrative data are increasingly being linked with other data sources for research purposes in the field of epidemiology and health services research abroad. In Germany, the direct linkage of routine data of statutory health insurance (SHI) providers with other data sources is complicated due to strict data protection requirements. The aim of this analysis was to evaluate an indirect linkage of SHI routine data with data of a hospital information system (HIS).
The dataset comprised data from 2004 to 2010 from 2 sickness funds and one HIS. In both data sources, hospitalisations were restricted to admissions into one hospital with at least one diagnosis of heart failure. The 2 data sources were linked, in cases of the agreement of the admission and discharge dates, as well as the agreement of at least a certain percentage of diagnoses in HIS data when compared to SHI data (full coding depth). Based on the direct linkage using the pseudonymised insurance number as gold standard, the proposed linkage approach was evaluated by means of test statistics. Furthermore, the completeness of relevant information of the HIS was described.
The dataset contained 3 731 hospitalisations from the HIS and 8 172 hospitalisations from the SHI routine data. The sensitivity of the linkage approach was 86.7% in the case of an agreement of at least 30% of the diagnoses and decreased to 41.7% in the case of 100% agreement in the diagnoses. The specificity was almost 100% at all studied cut-offs of agreement. Anthropometric measures and diagnostic information were available only for a small fraction of cases in the data of the HIS, whereas information on the health status and on laboratory information was comparatively complete.
For the linkage of SHI routine data with complementary data sources, indirect linkage methods can be a valuable alternative in comparison to direct linkage, which is time-consuming with regard to planning and application. Since the proposed approach was used in a relatively small sample and a restricted patient population, a replication using nation-wide data without respective restrictions would require an extension of the algorithm. Furthermore, the large administrative effort seems questionable considering the comparatively high amount of missing values in interesting information in the HIS.
在国外流行病学和卫生服务研究领域，行政数据越来越多地与其他数据源相链接用于研究目的。在德国，由于严格的数据保护要求，法定医疗保险（SHI）提供者的常规数据与其他数据源的直接链接很复杂。本分析的目的是评估SHI常规数据与医院信息系统（HIS）数据的间接链接。
数据集包括2004年至2010年来自2个疾病基金和1个HIS的数据。在这两个数据源中，住院仅限于入住一家医院且至少有一项心力衰竭诊断的情况。当入院和出院日期一致，以及与SHI数据相比HIS数据中至少有一定比例的诊断一致（完整编码深度）时，将这两个数据源相链接。以使用化名化保险号码作为金标准的直接链接为基础，通过检验统计量评估所提出的链接方法。此外，描述了HIS相关信息的完整性。
数据集包含来自HIS的3731例住院病例和来自SHI常规数据的8172例住院病例。在至少30%的诊断一致的情况下，链接方法的敏感性为86.7%，在诊断100%一致的情况下降至41.7%。在所有研究的一致临界值下，特异性几乎为100%。人体测量指标和诊断信息在HIS数据中仅适用于一小部分病例，而关于健康状况和实验室信息的信息相对完整。
对于SHI常规数据与补充数据源的链接，与直接链接相比，间接链接方法可能是一种有价值的替代方法，直接链接在规划和应用方面很耗时。由于所提出的方法是在相对较小的样本和受限的患者群体中使用的，因此使用无相应限制的全国性数据进行复制将需要扩展算法。此外，考虑到HIS中有趣信息中缺失值的比例相对较高，大量的行政工作似乎值得怀疑。
