Lesaine E, Belhamri N-M, Legrand J-P, Domecq S, Coste P, Lacroix A, Saillour-Glenisson F
University Bordeaux, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France; Service d'information médicale, CHU de Bordeaux, pôle de santé publique, 33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France.
University Bordeaux, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France.
Rev Epidemiol Sante Publique. 2021 Apr;69(2):78-87. doi: 10.1016/j.respe.2021.01.008. Epub 2021 Mar 9.
To recreate the in-hospital healthcare pathway for patients treated with coronary angiography or percutaneous coronary intervention, we linked the interventional cardiology registry (ACIRA) and the pseudonymized French hospital medical information system database (PMSI) in the Aquitaine region. The objective of this study was to develop and validate a deterministic merging algorithm between these exhaustive and complementary databases.
After a pre-treatment phase of the databases to standardize the 11 identified linking variables, a deterministic linking algorithm was developed on ACIRA hospital stays between December 2011 and December 2014 in nine interventional cardiology centers as well as the data from the consolidated PMSI databases of the Aquitaine region from 2011 to 2014. Merging was carried out through 12 successive steps, the first consisting in strict linking of the 11 variables. The performance of the algorithm was analyzed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Strategies complementary to the initial algorithm (change in the order of variables and base preprocessing) were tested. Comparative analysis of merged/unmerged patients explored potential causes of mismatch.
The algorithm found 97.2% of the 31,621 ACIRA stays to have sensitivity of 99.9% (95% CI [99.9; 99.9]), specificity of 97.9% (95% CI [97.7; 98.1]), PPV of 99.9% (95% CI [99.9; 99.9]) and NPV of 96.9% (95% CI [96.7; 97.1]). Complementary strategies did not yield better results. The unmerged patients were older, and hospitalized mostly in 2012 in two interventional cardiology centers.
This study underscored the feasibility and validity of an indirect deterministic pairing to routinely link a registry of practices using hospital data to pseudonymized medico-administrative databases. This method, which can be extrapolated to other health events leading to hospitalization, renders it possible to effectively reconstruct patients' hospital healthcare pathway.
为重现接受冠状动脉造影或经皮冠状动脉介入治疗患者的院内医疗路径，我们将介入心脏病学登记系统（ACIRA）与阿基坦地区化名的法国医院医疗信息系统数据库（PMSI）相链接。本研究的目的是开发并验证这两个详尽且互补的数据库之间的确定性合并算法。
在对数据库进行预处理以标准化11个确定的链接变量之后，基于2011年12月至2014年12月期间九个介入心脏病学中心的ACIRA住院病例以及2011年至2014年阿基坦地区合并后的PMSI数据库数据，开发了一种确定性链接算法。合并通过12个连续步骤进行，第一步是严格链接11个变量。从敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）方面分析了该算法的性能。测试了与初始算法互补的策略（变量顺序改变和基础预处理）。对合并/未合并患者的比较分析探索了不匹配的潜在原因。
该算法在31,621例ACIRA住院病例中发现了97.2%，其敏感性为99.9%（95%可信区间[99.9; 99.9]），特异性为97.9%（95%可信区间[97.7; 98.1]），PPV为99.9%（95%可信区间[99.9; 99.9]），NPV为96.9%（95%可信区间[96.7; 97.1]）。互补策略未产生更好的结果。未合并的患者年龄较大，且大多于2012年在两个介入心脏病学中心住院。
本研究强调了间接确定性配对在常规情况下将使用医院数据的实践登记系统与化名的医疗管理数据库相链接的可行性和有效性。这种方法可外推至导致住院的其他健康事件，从而有可能有效地重建患者的院内医疗路径。
