验证一种间接关联算法，以将注册数据与医疗保险索赔相结合。
Validation of an indirect linkage algorithm to combine registry data with Medicare claims.
机构信息
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY.
Heart & Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
出版信息
J Vasc Surg. 2022 Jul;76(1):266-271.e2. doi: 10.1016/j.jvs.2022.01.132. Epub 2022 Feb 15.
BACKGROUND
The linkage of registries to Medicare claims data can help extend follow-up for patients receiving medical devices. In the present study, we tested and validated an algorithm that does not require patient identifiers to link data from a national vascular registry and Medicare claims data.
METHODS
We used data from the Vascular Quality Initiative (VQI), a registry capturing data from >600 centers for several different vascular procedures, and Medicare claims from 2003 to 2018. We restricted the study to patients aged ≥65 years who had fee-for-service entitlement at their procedure. We performed an indirect linkage to combine the VQI and Medicare data at the patient level using a sequential algorithm based on the patient's date of birth, sex, zip code, procedure date, and procedure facility. We compared the indirectly linked cohort against a reference standard of a cohort directly linked using Social Security numbers. We calculated the matching rate and accuracy overall and before and after October 2015 when the International Classification of Diseases, 10th revision (ICD-10) system was adopted in the United States.
RESULTS
A total of 144,045 VQI-Medicare-linked patients were in the reference standard cohort. Using the indirect linking algorithm, we matched 133,966 of the 144,045 VQI patients to their Medicare claims with a matching rate of 93.0%. Of the 133,966 patients, 133,104 were correctly matched (matching accuracy, 99.4%). The matching rate was higher when the indirect linkage was implemented using the ICD-10 coded data than using the ICD-9 coded data (94.0% vs 92.2%). The accuracy of the indirect linkage remained high for all procedure modules after the ICD-10 coding change (overall, 99.4%; range, 99.0%-99.7%).
CONCLUSIONS
In the present study, we successfully used indirect identifiers to link the VQI data to Medicare claims with >90% success and >99% accuracy. When direct linkage of the registry claims data using Social Security numbers is not possible because of availability or confidentiality, or both, our algorithm for indirect linkage provides a suitable alternative. The matching rate and accuracy will help ensure the accuracy of long-term follow-up and the completeness and representativeness of linked databases for relevant research and quality improvement initiatives.
背景
将注册系统与医疗保险索赔数据相链接有助于延长接受医疗器械治疗的患者的随访时间。本研究中，我们测试和验证了一种不需要患者标识符即可将来自国家血管注册系统和医疗保险索赔数据相链接的算法。
方法
我们使用了来自血管质量倡议（VQI）的数据，该注册系统从 2003 年至 2018 年从 600 多个中心收集了多种不同血管手术的数据，以及医疗保险索赔数据。我们将研究对象限定为在手术时享有收费服务权益且年龄≥65 岁的患者。我们使用基于患者出生日期、性别、邮政编码、手术日期和手术机构的顺序算法，在患者层面上对 VQI 和医疗保险数据进行间接链接。我们将间接链接队列与使用社会安全号码直接链接的参考标准队列进行比较。我们计算了总体以及 2015 年 10 月美国采用国际疾病分类第 10 版（ICD-10）系统前后的匹配率和准确率。
结果
参考标准队列中共有 144045 例 VQI-医疗保险链接患者。使用间接链接算法，我们成功匹配了 144045 例 VQI 患者中的 133966 例与医疗保险索赔数据，匹配率为 93.0%。在 133966 例患者中，有 133104 例患者的匹配是正确的（匹配准确率为 99.4%）。使用 ICD-10 编码数据进行间接链接的匹配率高于使用 ICD-9 编码数据（94.0%比 92.2%）。在 ICD-10 编码更改后，所有手术模块的间接链接准确性仍然很高（总体准确率为 99.4%，范围为 99.0%-99.7%）。
结论
在本研究中，我们成功地使用间接标识符将 VQI 数据与医疗保险索赔数据相链接，成功率超过 90%，准确率超过 99%。当由于可用性或保密性或两者兼而有之而无法使用社会安全号码直接链接注册索赔数据时，我们的间接链接算法提供了一种合适的替代方法。匹配率和准确率将有助于确保长期随访的准确性以及相关研究和质量改进计划中链接数据库的完整性和代表性。
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