Rawson N S, Malcolm E, D'Arcy C
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
Soc Psychiatry Psychiatr Epidemiol. 1997 May;32(4):191-9. doi: 10.1007/BF00788238.
Administrative data have long been used in psychiatric epidemiology and outcomes evaluation. This article examines the reliability of the recording of schizophrenia and depressive disorder in three Saskatchewan administrative health care utilization datafiles. Due to their comprehensive nature, these datafiles have been used in a wide range of epidemiologic studies. Close agreement was found between hospital computer data and patients' charts for personal and demographic factors (> or = 94.7%). Diagnostic concordance between computerized hospital data and medical charts was very good for schizophrenia (94%) but poor for depressive disorder (58%). Appropriate physician services were identified for 60% and 72% of hospital discharges for schizophrenia and depressive disorder, respectively, and exact diagnostic agreement between hospital and physician datafiles was 62% for schizophrenia and 66% for depressive disorder. Appropriate provincial mental health branch services were found for 83% and 38% of hospital discharges for schizophrenia and depressive disorder, respectively; exact diagnostic concordance between these datafiles was 75% for schizophrenia and 0% for depressive disorder. A significant number of patients with major or neurotic depression appeared to be wrongly coded as having depressive disorder in the hospital file. The differences in diagnostic agreement may also be partly a function of how the two conditions are differentially treated in the health system. These findings suggest that more specific and severe psychiatric diagnoses are likely to be recorded accurately and consistently in the Saskatchewan datafiles. However, disorders with multiple manifestations or those for which there are several possible codes should be examined with caution and ways sought to validate them. Attention should also be paid to which service sectors are involved in the treatment of specific disorders.
行政数据长期以来一直用于精神疾病流行病学和疗效评估。本文考察了萨斯喀彻温省三个行政医疗保健利用数据文件中精神分裂症和抑郁症记录的可靠性。由于这些数据文件具有全面性，已被广泛用于各种流行病学研究。研究发现，医院计算机数据与患者病历在个人和人口统计学因素方面的一致性较高（≥94.7%）。计算机化医院数据与病历之间的诊断一致性在精神分裂症方面非常好（94%），但在抑郁症方面较差（58%）。分别有60%和72%的精神分裂症和抑郁症出院患者获得了适当的医生服务，医院与医生数据文件之间的确切诊断一致性在精神分裂症方面为62%，在抑郁症方面为66%。分别有83%和38%的精神分裂症和抑郁症出院患者获得了适当的省级心理健康部门服务；这些数据文件之间的确切诊断一致性在精神分裂症方面为75%，在抑郁症方面为0%。大量患有重度或神经症性抑郁症的患者在医院文件中似乎被错误编码为患有抑郁症。诊断一致性的差异也可能部分取决于这两种疾病在卫生系统中的不同治疗方式。这些发现表明，在萨斯喀彻温省的数据文件中，更具体和严重的精神疾病诊断可能会被准确且一致地记录。然而，对于具有多种表现形式或有几种可能编码的疾病，应谨慎审查并寻求验证方法。还应关注哪些服务部门参与了特定疾病的治疗。
