Tinmouth Jill, Sutradhar Rinku, Liu Ning, Baxter Nancy N, Paszat Lawrence, Rabeneck Linda
Institute for Clinical Evaluative Sciences (Tinmouth, Sutradhar, Liu, Baxter, Paszat, Rabeneck); Prevention and Cancer Control, Cancer Care Ontario (Tinmouth, Baxter, Rabeneck); Sunnybrook Research Institute (Tinmouth, Paszat, Rabeneck); Li Ka Shing Knowledge Institute (Baxter), St. Michael's Hospital; Dalla Lana School of Public Health (Tinmouth, Sutradhar, Baxter, Paszat, Rabeneck), University of Toronto, Toronto, Ont.
CMAJ Open. 2018 Aug 13;6(3):E330-E338. doi: 10.9778/cmajo.20180013. Print 2018 Jul-Sep.
Colonoscopy is used widely, but its quality is highly variable, which may adversely affect patients. Research and quality-improvement initiatives in a variety of jurisdictions have sought to address this issue, often supported by the use of health administrative data. As these data are generally not collected for these purposes, it is critical to measure their validity before use. The aim of this study was to validate health administrative data definitions for 5 key colonoscopy elements through comparison to the clinical record.
In a cross-sectional study, we randomly sampled 1968 colonoscopy and noncolonoscopy procedures performed at 23 hospitals and 5 nonhospital endoscopy clinics between April 2008 and March 2009 in Ontario. We compared definitions for 5 key colonoscopy elements (colonoscopy case, colonoscopy setting, colonoscopy completeness, anesthesiologist assistance and polypectomy) derived from the health administrative data to the clinical record. We calculated weighted and unweighted sensitivity, specificity and positive predictive value, adjusted for clustering of patients within physicians, for each definition relative to the reference standard.
We abstracted 1845 records; in 1282 cases (69.5%), colonoscopy was intended or performed. The weighted sensitivity and specificity of colonoscopy case, nonhospital colonoscopy setting and anesthesiologist assistance exceeded 95%. The weighted sensitivity for colonoscopy completeness and polypectomy exceeded 95%, but specificity was less than 90%.
Ontario health administrative data definitions for 5 key colonoscopy data elements performed well, with sensitivity and specificity values acceptable for use in research and quality-improvement initiatives. In jurisdictions where health administrative data are similarly used for research or quality improvement, similar studies could be considered.
结肠镜检查应用广泛，但其质量差异很大，这可能对患者产生不利影响。不同辖区的研究和质量改进举措试图解决这一问题，通常借助卫生行政数据。由于这些数据一般并非为此目的收集，在使用前衡量其有效性至关重要。本研究旨在通过与临床记录对比，验证5个关键结肠镜检查要素的卫生行政数据定义。
在一项横断面研究中，我们于2008年4月至2009年3月在安大略省的23家医院和5家非医院内镜诊所随机抽取了1968例结肠镜检查和非结肠镜检查操作。我们将从卫生行政数据得出的5个关键结肠镜检查要素（结肠镜检查病例、结肠镜检查地点、结肠镜检查完整性、麻醉医生协助和息肉切除术）的定义与临床记录进行对比。我们针对每个相对于参考标准的定义，计算了加权和未加权的灵敏度、特异度及阳性预测值，并对医生内部患者的聚集情况进行了校正。
我们提取了1845份记录；在1282例（69.5%）病例中，计划或进行了结肠镜检查。结肠镜检查病例、非医院结肠镜检查地点和麻醉医生协助的加权灵敏度和特异度超过95%。结肠镜检查完整性和息肉切除术的加权灵敏度超过95%，但特异度低于90%。
安大略省5个关键结肠镜检查数据要素的卫生行政数据定义表现良好，其灵敏度和特异度值可接受用于研究和质量改进举措。在同样使用卫生行政数据进行研究或质量改进的辖区，可考虑开展类似研究。
