Malenka D J, McLerran D, Roos N, Fisher E S, Wennberg J E
Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH, USA.
J Clin Epidemiol. 1994 Sep;47(9):1027-32. doi: 10.1016/0895-4356(94)90118-x.
We compared the coding of comorbid conditions in an administrative database to that found in medical records for 485 men who had undergone a prostatectomy. Only a few specific conditions showed good agreement between charts and claims. Most showed poor agreement and appeared more frequently in the chart. A comorbidity index calculated from each of these sources was used to explore the differences in mortality for patients who had undergone transurethral vs open prostatectomy. The claims-based comorbidity index most often underestimated the index from the chart. Proportional hazards analysis showed that models including either comorbidity index were better than those without an index and models with information from both indices were best. No analysis eliminated the effect of type of prostatectomy on long-term mortality. Claims-based measures of comorbidity tend to underrepresent some conditions but may be an acceptable first step in controlling for differences across patient populations.
我们将行政数据库中并存疾病的编码与485例接受前列腺切除术男性的病历编码进行了比较。只有少数特定疾病在病历和理赔记录之间显示出良好的一致性。大多数疾病一致性较差，且在病历中出现得更为频繁。从这些来源计算出的并存疾病指数用于探讨经尿道前列腺切除术与开放性前列腺切除术患者的死亡率差异。基于理赔记录的并存疾病指数最常低估病历中的指数。比例风险分析表明，包含任一并存疾病指数的模型都优于不包含指数的模型，而同时包含两个指数信息的模型效果最佳。没有分析能够消除前列腺切除术类型对长期死亡率的影响。基于理赔记录的并存疾病测量方法往往会少报某些疾病，但可能是控制不同患者群体差异的可接受的第一步。
