电子健康记录数据中药物信息与医疗保险索赔数据的一致性：生物疾病修正抗风湿药物的分析。
Agreement of Medication Information Derived From EHR Data Compared to Medicare Insurance Claims: An Analysis of Biologic Disease-Modifying Antirheumatic Drugs.
机构信息
Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
University of Alabama at Birmingham, Birmingham, Alabama, USA.
出版信息
Pharmacoepidemiol Drug Saf. 2024 Oct;33(10):e70020. doi: 10.1002/pds.70020.
PURPOSE
Few studies have reported the agreement between medication information derived from ambulatory EHR data compared to administrative claims for high-cost specialty drugs. We used data from a national EHR-enabled registry, the Rheumatology Informatics System for Effectiveness (RISE), with linked Medicare claims in a population of patients with rheumatoid arthritis (RA) to investigate variations in agreement for different biologic disease-modifying agents (bDMARDs) between two data sources (RISE EHR data vs. Medicare claims), categorized by drug, route of administration, and patient insurance factors (dual eligibility).
METHODS
Patients ≥ 65 years old, with ≥ 2 visits in RISE with RA ICD codes ≥ 30 days apart, and continuous enrollment in Medicare Parts B and D in 2017-2018 were included. We classified patients as bDMARD users or nonusers in Medicare claims or EHR data in 2018, and we calculated sensitivity, specificity, positive predicted value (PPV), and negative predicted value (NPV) of EHR data for identifying bDMARD users, using Medicare as the reference standard. We also calculated these metrics after stratifying by clinic-administered (Part B) versus. pharmacy-dispensed (Part D) bDMARDs and by patient dual-eligibility.
RESULTS
A total of 26 097 patients were included in the study. Using Medicare claims as the reference standard, EHR data had a sensitivity of 75.0%-90.8% for identifying patients with the same medication and route. PPV for Part B bDMARDs was higher compared with Part D bDMARDs (range 94.3%-97.3% vs. 51.0%-69.6%). We observed higher PPVs for Part D bDMARDs among patients who were dual-eligible (range 82.4%-95.1%).
CONCLUSION
The risk of misclassification of drug exposure based on EHR data sources alone is small for Medicare Part B bDMARDs but could be as high as 50% for Part D bDMARDs, in particular for patients who are not dually eligible for Medicare and Medicaid.
目的
很少有研究报告过从门诊电子健康记录 (EHR) 数据中获取的药物信息与高成本专科药物的行政索赔之间的一致性。我们使用来自全国性 EHR 启用的登记处 Rheumatology Informatics System for Effectiveness (RISE) 的数据，以及与医疗保险索赔相关联，在类风湿关节炎 (RA) 患者人群中调查了两种数据源 (RISE EHR 数据与 Medicare 索赔) 之间不同生物疾病修正剂 (bDMARD) 的一致性变化，这些变化按药物、给药途径和患者保险因素 (双重资格) 进行分类。
方法
纳入年龄≥65 岁、在 RISE 中有≥2 次 RA ICD 代码≥30 天的就诊记录、并且在 2017-2018 年中连续参加医疗保险 B 部分和 D 部分的患者。我们在 2018 年根据 Medicare 索赔或 EHR 数据将患者归类为 bDMARD 用户或非用户，并使用 Medicare 作为参考标准计算 EHR 数据识别 bDMARD 用户的敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV)。我们还根据诊所管理 (B 部分) 与药房配药 (D 部分) 的 bDMARD 以及患者双重资格进行分层后计算了这些指标。
结果
共有 26097 名患者纳入研究。使用 Medicare 索赔作为参考标准，EHR 数据在识别具有相同药物和途径的患者方面的敏感性为 75.0%-90.8%。B 部分 bDMARD 的 PPV 高于 D 部分 bDMARD(范围为 94.3%-97.3%与 51.0%-69.6%)。我们观察到，在同时具有 Medicare 和 Medicaid 双重资格的患者中，D 部分 bDMARD 的 PPV 更高(范围为 82.4%-95.1%)。
结论
仅基于 EHR 数据源，Medicare B 部分 bDMARD 药物暴露的分类错误风险很小，但对于 D 部分 bDMARD 药物，特别是对于不具有 Medicare 和 Medicaid 双重资格的患者，错误风险可能高达 50%。
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