Quam L, Ellis L B, Venus P, Clouse J, Taylor C G, Leatherman S
Center for Health Care Policy and Evaluation, United HealthCare Corporation, Minneapolis, MN.
Med Care. 1993 Jun;31(6):498-507.
In this study, a method was developed to identify health plan members with hypertension from insurance claims, using medical records and a patient survey for validation. A sample of 2,079 patients from two study sites with medical service or pharmacy claims indicating a diagnosis of essential hypertension were surveyed, and the medical records of 182 of the 1,275 survey respondents were reviewed. Where the criteria to identify hypertensive patients used both the medical and pharmacy claims, there was 96% agreement with either the medical record or the patient survey. Where the criteria relied on medical claims alone, the agreement rate decreased to 74% with the medical record and 64% with the patient survey. Where the criteria relied on the pharmacy claims alone, the agreement rate was 67% with the medical record and 75% with the patient survey. Combined evidence from medical service and pharmacy claims yielded a high level of agreement with alternative, more costly sources of data in identifying patients with essential hypertension. As it is more thoroughly investigated, claims data should become a more widely accepted resource for epidemiologic research.
在本研究中，开发了一种从保险理赔记录中识别患有高血压的健康计划成员的方法，并使用病历和患者调查进行验证。对来自两个研究地点的2079名有医疗服务或药房理赔记录且显示患有原发性高血压诊断的患者进行了调查，并对1275名调查受访者中的182人的病历进行了审查。在使用医疗和药房理赔记录来识别高血压患者的标准方面，与病历或患者调查的一致性为96%。在仅依赖医疗理赔记录的标准方面，与病历的一致率降至74%，与患者调查的一致率为64%。在仅依赖药房理赔记录的标准方面，与病历的一致率为67%，与患者调查的一致率为75%。医疗服务和药房理赔记录的综合证据在识别原发性高血压患者方面与其他更昂贵的数据来源具有高度一致性。随着对理赔数据的更深入研究，它应该成为流行病学研究中更广泛接受的资源。
