Medical Information Center, Kyushu University Hospital, Maidashi 3-1-1 Higashi-ku, Fukuoka City, Fukuoka Prefecture, 812-8582, Japan.
Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan.
BMC Med Inform Decis Mak. 2021 Feb 11;21(1):52. doi: 10.1186/s12911-021-01422-z.
No case definition of Type 1 diabetes (T1D) for the claims data has been proposed in Japan yet. This study aimed to evaluate the performance of candidate case definitions for T1D using Electronic health care records (EHR) and claims data in a University Hospital in Japan.
The EHR and claims data for all the visiting patients in a University Hospital were used. As the candidate case definitions for claims data, we constructed 11 definitions by combinations of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. (ICD 10) code of T1D, the claims code of insulin needles for T1D patients, basal insulin, and syringe pump for continuous subcutaneous insulin infusion (CSII). We constructed a predictive model for T1D patients using disease names, medical practices, and medications as explanatory variables. The predictive model was applied to patients of test group (validation data), and performances of candidate case definitions were evaluated.
As a result of performance evaluation, the sensitivity of the confirmed disease name of T1D was 32.9 (95% CI: 28.4, 37.2), and positive predictive value (PPV) was 33.3 (95% CI: 38.0, 38.4). By using the case definition of both the confirmed diagnosis of T1D and either of the claims code of the two insulin treatment methods (i.e., syringe pump for CSII and insulin needles), PPV improved to 90.2 (95% CI: 85.2, 94.4).
We have established a case definition with high PPV, and the case definition can be used for precisely detecting T1D patients from claims data in Japan.
日本尚未提出用于理赔数据的 1 型糖尿病（T1D）病例定义。本研究旨在使用日本某大学医院的电子健康记录（EHR）和理赔数据评估 T1D 的候选病例定义的性能。
使用大学医院所有就诊患者的 EHR 和理赔数据。作为理赔数据的候选病例定义，我们通过组合国际疾病分类第十版（ICD-10）T1D 编码、T1D 患者胰岛素针头的理赔代码、基础胰岛素和连续皮下胰岛素输注（CSII）的注射器泵构建了 11 种定义。我们使用疾病名称、医疗实践和药物作为解释变量为 T1D 患者构建了预测模型。将预测模型应用于测试组（验证数据）中的患者，评估候选病例定义的性能。
在性能评估中，T1D 确诊疾病名称的灵敏度为 32.9（95%CI：28.4，37.2），阳性预测值（PPV）为 33.3（95%CI：38.0，38.4）。使用 T1D 确诊诊断和两种胰岛素治疗方法（即 CSII 的注射器泵和胰岛素针头）中任一种理赔代码的病例定义，PPV 提高到 90.2（95%CI：85.2，94.4）。
我们建立了一个具有高 PPV 的病例定义，该病例定义可用于从日本的理赔数据中准确检测 T1D 患者。
