Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy.
Division of Cardiology, Santa Maria della Misericordia Hospital, University of Perugia School of Medicine, Perugia, Italy.
PLoS One. 2019 Jul 8;14(7):e0218919. doi: 10.1371/journal.pone.0218919. eCollection 2019.
BACKGROUND: Administrative healthcare databases are useful and inexpensive tools that can provide a comprehensive assessment of the burden of diseases in terms of major outcomes, such as mortality, hospital readmissions, and use of healthcare resources. However, a crucial issue is the reliability of information gathered. The aim of this study was to validate ICD-9 codes for several major cardiovascular conditions, i.e., acute myocardial infarction (AMI), atrial fibrillation/flutter (AF), and heart failure (HF), in order to use them for epidemiological, outcome, and health services research. METHODS: Data from the centralised administrative database of the Umbria Region (890,000 residents, located in Central Italy) were considered. Patients with a first hospital discharge for AMI, AF/flutter, and HF, between 2012 and 2014, were identified using ICD-9-CM codes in primary position. A sample of cases and non-cases was randomly selected, and the corresponding medical charts reviewed by specifically trained investigators. For each disease, case ascertainment was based on all clinical, laboratory, and instrumental examinations available in medical charts. Sensitivity, specificity, and predictive values with 95% confidence intervals (CIs), were calculated. RESULTS: We reviewed 458 medical charts, 128 for AMI, 127 for AF/flutter, 127 for HF, and 76 of non-cases for each condition. Diagnostic accuracy measures of the original discharge diagnosis were as follows. AMI: sensitivity 98% (95% CI, 94-100%), specificity 91% (95% CI, 83-97%), positive predictive value (PPV) 95% (95% CI, 89-98%), negative predictive value (NPV) 97% (95% CI, 91-100%). AF/flutter: sensitivity 95% (95% CI, 90-98%), specificity 95% (95% CI, 87-99%), PPV 97% (95% CI, 92-99%), NPV 92% (95% CI, 84-97%). HF: sensitivity 96% (95% CI, 91-99%), specificity 90% (95% CI, 81-96%), PPV 94% (95% CI, 88-97%), NPV 93% (95% CI, 85-98%). CONCLUSION: The case ascertainment for AMI, AF and flutter, and HF, showed a high level of accuracy (≥ 90%). The healthcare administrative database of the Umbria Region can be confidently used for epidemiological, outcome, and health services research.
背景：行政医疗保健数据库是一种有用且廉价的工具，可以从死亡率、住院再入院和医疗资源使用等主要结局方面全面评估疾病负担。然而，一个关键问题是所收集信息的可靠性。本研究的目的是验证 ICD-9 代码在几种主要心血管疾病中的应用，即急性心肌梗死（AMI）、心房颤动/扑动（AF）和心力衰竭（HF），以便将其用于流行病学、结局和卫生服务研究。
方法：考虑使用意大利中部翁布里亚地区集中行政数据库的数据（890000 名居民）。使用 ICD-9-CM 代码在主要位置识别 2012 年至 2014 年期间首次因 AMI、AF/flutter 和 HF 住院的患者。随机选择病例和非病例样本，并由专门培训的调查员审查相应的病历。对于每种疾病，病例确定均基于病历中提供的所有临床、实验室和仪器检查。计算了敏感性、特异性和预测值，置信区间为 95%。
结果：我们共审查了 458 份病历，其中 AMI 为 128 份，AF/flutter 为 127 份，HF 为 127 份，每种疾病的非病例为 76 份。原始出院诊断的诊断准确性测量结果如下。AMI：敏感性 98%（95%CI，94-100%），特异性 91%（95%CI，83-97%），阳性预测值（PPV）95%（95%CI，89-98%），阴性预测值（NPV）97%（95%CI，91-100%）。AF/flutter：敏感性 95%（95%CI，90-98%），特异性 95%（95%CI，87-99%），PPV 97%（95%CI，92-99%），NPV 92%（95%CI，84-97%）。HF：敏感性 96%（95%CI，91-99%），特异性 90%（95%CI，81-96%），PPV 94%（95%CI，88-97%），NPV 93%（95%CI，85-98%）。
结论：AMI、AF 和 flutter 以及 HF 的病例确定具有较高的准确性（≥90%）。翁布里亚地区的医疗保健行政数据库可用于流行病学、结局和卫生服务研究。
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