 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
15 October 1993 | Volume 119 Issue 8 | Pages 844-850
Objective: To determine the suitability of insurance claims information for use in clinical outcomes research in ischemic heart disease.
Design: Concordance study of two databases.
Setting: Tertiary care referral center.
Patients: A total of 12 937 consecutive patients hospitalized for cardiac catheterization for suspected ischemic heart disease between July 1985 and May 1990.
Interventions: Two-by-two tables were used to compute overall and
Measurements: Kappa statistics (agreement adjusted for chance agreement) were used to quantify agreement rates.
Results: Agreement rates between the clinical and claims databases ranged from 0.83 for the diagnosis of diabetes to 0.09 for the diagnosis of unstable angina (
Conclusions: Our results suggest that insurance claims data lack important diagnostic and prognostic information when compared with concurrently collected clinical data in the study of ischemic heart disease. Thus, insurance claims data are not as useful as clinical data for identifying clinically relevant patient groups and for adjusting for risk in outcome studies, such as analyses of hospital mortality.
Author and Article Information
From Duke University Medical Center, Durham, North Carolina.
MEDICINE AND PUBLIC ISSUES
Discordance of Databases Designed for Claims Payment versus Clinical Information Systems: Implications for Outcomes Research
measures of agreement comparing clinical versus claims data for 12 important predictors of prognosis in patients with ischemic heart disease. values). Claims data failed to identify more than one half of the patients with prognostically important conditions, including mitral insufficiency, congestive heart failure, peripheral vascular disease, old myocardial infarction, hyperlipidemia, cerebrovascular disease, tobacco use, angina, and unstable angina, when compared with the clinical information system.
Requests for Reprints: James G. Jollis, MD, Box 3254, Duke University Medical Center, Durham, NC 27710.
Grant Support: By grants HS-06503 and HS-05635 from the Agency for Health Care Policy and Research; grant HL-17670 from the National Heart, Lung, and Blood Institute; and a grant from the Robert Wood Johnson Foundation. Dr. Jollis was an American College of Cardiology Merck Research Fellow during the course of this research.
Acknowledgments: The authors thank Patrick S. Romano, MD, MPH, and Leslie L. Roos, PhD, who designed the ICD-9-CM mapping system used in the Patient Outcomes Research Team for ischemic heart disease; the other members of the Patient Outcomes Research Team for ischemic heart disease for their comments on earlier versions of this work; and Lloyd Hedgpeth and his staff in the Duke Medical Center Information System for providing the insurance claims data for this study.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  E. Rahme PhD, K. Dasgupta MD MSc, M. Burman MD, H. Yin PhD, S. Bernatsky MD PhD, G. Berry MD, H. Nedjar MSc, and S. R. Kahn MD MSc Postdischarge thromboprophylaxis and mortality risk after hip-or knee-replacement surgery Can. Med. Assoc. J., June 3, 2008; 178(12): 1545 - 1554. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. L. Hannan Randomized Clinical Trials and Observational Studies: Guidelines for Assessing Respective Strengths and Limitations J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 211 - 217. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Stafoggia, F Forastiere, D Agostini, N Caranci, F de'Donato, M Demaria, P Michelozzi, R Miglio, M Rognoni, A Russo, et al. Factors affecting in-hospital heat-related mortality: a multi-city case-crossover analysis J. Epidemiol. Community Health, March 1, 2008; 62(3): 209 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. H. Curtis, D. J. Whellan, B. G. Hammill, A. F. Hernandez, K. J. Anstrom, A. M. Shea, and K. A. Schulman Incidence and Prevalence of Heart Failure in Elderly Persons, 1994-2003 Arch Intern Med, February 25, 2008; 168(4): 418 - 424. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. A. Ferraris, F. H. Edwards, D. M. Shahian, and S. P. Ferraris Risk Stratification and Comorbidity Card. Surg. Adult, January 1, 2008; 3(2008): 199 - 246. [Full Text]
|
|
|
|
 |
|
 H.-F. Chen, C.-A. Ho, and C.-Y. Li Increased Risks of Hip Fracture in Diabetic Patients of Taiwan: A population-based study Diabetes Care, January 1, 2008; 31(1): 75 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Banerjee, J. Z. Ma, A. J. Collins, and C. A. Herzog Long-Term Survival of Incident Hemodialysis Patients Who Are Hospitalized for Congestive Heart Failure, Pulmonary Edema, or Fluid Overload Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1186 - 1190. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. L. Roger Coronary disease surveillance: a public health imperative Eur. Heart J., September 1, 2007; 28(17): 2051 - 2052. [Full Text] [PDF]
|
|
|
|
 |
|
 S. I. Berndt, H. B. Carter, M. P. Schoenberg, and C. J. Newschaffer Disparities in Treatment and Outcome for Renal Cell Cancer Among Older Black and White Patients J. Clin. Oncol., August 20, 2007; 25(24): 3589 - 3595. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. O'Brien and E. D. Peterson Identifying High-Quality Hospitals: Consult the Ratings or Flip a Coin? Arch Intern Med, July 9, 2007; 167(13): 1342 - 1344. [Full Text] [PDF]
|
|
|
|
|
|
M. A. Bethel, F. A. Sloan, D. Belsky, and M. N. Feinglos Longitudinal Incidence and Prevalence of Adverse Outcomes of Diabetes Mellitus in Elderly Patients Arch Intern Med, May 14, 2007; 167(9): 921 - 927. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. L. Higgins Quantifying Risk and Benchmarking Performance in the Adult Intensive Care Unit J Intensive Care Med, May 1, 2007; 22(3): 141 - 156. [Abstract] [PDF]
|
|
|
|
 |
|
 J. L. Xue, P. W. Eggers, L. Y. Agodoa, R. N. Foley, and A. J. Collins Longitudinal Study of Racial and Ethnic Differences in Developing End-Stage Renal Disease among Aged Medicare Beneficiaries J. Am. Soc. Nephrol., April 1, 2007; 18(4): 1299 - 1306. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. J. Ryan To Understand Cardiac Surgical Report Cards: Look Both Ways Circulation, March 27, 2007; 115(12): 1508 - 1510. [Full Text] [PDF]
|
|
|
|
|
|
D. M. Shahian, T. Silverstein, A. F. Lovett, R. E. Wolf, and S.-L. T. Normand Comparison of Clinical and Administrative Data Sources for Hospital Coronary Artery Bypass Graft Surgery Report Cards Circulation, March 27, 2007; 115(12): 1518 - 1527. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Marelli, A. S. Mackie, R. Ionescu-Ittu, E. Rahme, and L. Pilote Congenital Heart Disease in the General Population: Changing Prevalence and Age Distribution Circulation, January 16, 2007; 115(2): 163 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Pine, H. S. Jordan, A. Elixhauser, D. E. Fry, D. C. Hoaglin, B. Jones, R. Meimban, D. Warner, and J. Gonzales Enhancement of Claims Data to Improve Risk Adjustment of Hospital Mortality JAMA, January 3, 2007; 297(1): 71 - 76. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. C. Tang, M. Ralston, M. F. Arrigotti, L. Qureshi, and J. Graham Comparison of Methodologies for Calculating Quality Measures Based on Administrative Data versus Clinical Data from an Electronic Health Record System: Implications for Performance Measures J. Am. Med. Inform. Assoc., January 1, 2007; 14(1): 10 - 15. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Linden, W. M. K. Trochim, and J. L. Adams Evaluating program effectiveness using the regression point displacement design. Eval Health Prof, December 1, 2006; 29(4): 407 - 423. [Abstract] [PDF]
|
|
|
|
|
|
H.-F. Chen, C.-A. Ho, and C.-Y. Li Age and Sex May Significantly Interact With Diabetes on the Risks of Lower-Extremity Amputation and Peripheral Revascularization Procedures: Evidence from a cohort of a half-million diabetic patients. Diabetes Care, November 1, 2006; 29(11): 2409 - 2414. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. B. Stein, C. R. Cantrell, M. C. Sokol, M. T. Eaddy, and M. B. Shah Antidepressant Adherence and Medical Resource Use Among Managed Care Patients With Anxiety Disorders Psychiatr Serv, May 1, 2006; 57(5): 673 - 680. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Krumholz, Y. Wang, J. A. Mattera, Y. Wang, L. F. Han, M. J. Ingber, S. Roman, and S.-L. T. Normand An Administrative Claims Model Suitable for Profiling Hospital Performance Based on 30-Day Mortality Rates Among Patients With an Acute Myocardial Infarction Circulation, April 4, 2006; 113(13): 1683 - 1692. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Krumholz, Y. Wang, J. A. Mattera, Y. Wang, L. F. Han, M. J. Ingber, S. Roman, and S.-L. T. Normand An Administrative Claims Model Suitable for Profiling Hospital Performance Based on 30-Day Mortality Rates Among Patients With Heart Failure Circulation, April 4, 2006; 113(13): 1693 - 1701. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Xue, F. Daniels, R. A. Star, P. L. Kimmel, P. W. Eggers, B. A. Molitoris, J. Himmelfarb, and A. J. Collins Incidence and Mortality of Acute Renal Failure in Medicare Beneficiaries, 1992 to 2001 J. Am. Soc. Nephrol., April 1, 2006; 17(4): 1135 - 1142. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. R. Ernst, W. N. Malatestinic, and W. T. Linde-Zwirble Evaluating the clinical and financial impact of severe sepsis with Medicare or other administrative hospital data Am. J. Health Syst. Pharm., March 15, 2006; 63(6): 575 - 581. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Froom and Z. Shimoni Prediction of Hospital Mortality Rates by Admission Laboratory Tests Clin. Chem., February 1, 2006; 52(2): 325 - 328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Krumholz, R. G. Brindis, J. E. Brush, D. J. Cohen, A. J. Epstein, K. Furie, G. Howard, E. D. Peterson, S. S. Rathore, S. C. Smith Jr, et al. Standards for Statistical Models Used for Public Reporting of Health Outcomes: An American Heart Association Scientific Statement From the Quality of Care and Outcomes Research Interdisciplinary Writing Group: Cosponsored by the Council on Epidemiology and Prevention and the Stroke Council Endorsed by the American College of Cardiology Foundation Circulation, January 24, 2006; 113(3): 456 - 462. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Forastiere, M. Stafoggia, S. Picciotto, T. Bellander, D. D'Ippoliti, T. Lanki, S. von Klot, F. Nyberg, P. Paatero, A. Peters, et al. A Case-Crossover Analysis of Out-of-Hospital Coronary Deaths and Air Pollution in Rome, Italy Am. J. Respir. Crit. Care Med., December 15, 2005; 172(12): 1549 - 1555. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Berger, J. Edelsberg, T. T Li, J. R Maclean, and G. Oster Dose Intensification with Infliximab in Patients with Rheumatoid Arthritis Ann. Pharmacother., December 1, 2005; 39(12): 2021 - 2025. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Aronsky, P. J. Haug, C. Lagor, and N. C. Dean Accuracy of Administrative Data for Identifying Patients With Pneumonia American Journal of Medical Quality, November 1, 2005; 20(6): 319 - 328. [Abstract] [PDF]
|
|
|
|
|
|
A. G. Bertoni, J. K. Kirk, L. D. Case, C. Kay, D. C. Goff Jr, K.M. V. Narayan, and R. A. Bell The Effects of Race and Region on Cardiovascular Morbidity Among Elderly Americans With Diabetes Diabetes Care, November 1, 2005; 28(11): 2620 - 2625. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Kostylova, B Swaine, and D Feldman Concordance between childhood injury diagnoses from two sources: an injury surveillance system and a physician billing claims database Inj. Prev., June 1, 2005; 11(3): 186 - 190. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Slinin, R. N. Foley, and A. J. Collins Calcium, Phosphorus, Parathyroid Hormone, and Cardiovascular Disease in Hemodialysis Patients: The USRDS Waves 1, 3, and 4 Study J. Am. Soc. Nephrol., June 1, 2005; 16(6): 1788 - 1793. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Parekh, L. Zhang, B. A. Fivush, and M. J. Klag Incidence of Atherosclerosis by Race in the Dialysis Morbidity and Mortality Study: A Sample of the US ESRD Population J. Am. Soc. Nephrol., May 1, 2005; 16(5): 1420 - 1426. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Kimmel, J. A. Berlin, M. Reilly, J. Jaskowiak, L. Kishel, J. Chittams, and B. L. Strom Patients Exposed to Rofecoxib and Celecoxib Have Different Odds of Nonfatal Myocardial Infarction Ann Intern Med, February 1, 2005; 142(3): 157 - 164. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. A. Ferraris INVITED COMMENTARY Ann. Thorac. Surg., January 1, 2005; 79(1): 217 - 218. [Full Text] [PDF]
|
|
|
|
 |
|
 V. L. Roger Invited Commentary: Will Heart Attacks Be "Gone with the Century"? Am. J. Epidemiol., December 15, 2004; 160(12): 1147 - 1149. [Full Text] [PDF]
|
|
|
|
 |
|
 A. F. Hernandez, D. J. Whellan, S. Stroud, J. L. Sun, C. M. O'Connor, and J. G. Jollis Outcomes in heart failure patients after major noncardiac surgery J. Am. Coll. Cardiol., October 6, 2004; 44(7): 1446 - 1453. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. L. Roger, S. A. Weston, M. M. Redfield, J. P. Hellermann-Homan, J. Killian, B. P. Yawn, and S. J. Jacobsen Trends in Heart Failure Incidence and Survival in a Community-Based Population JAMA, July 21, 2004; 292(3): 344 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Miller, M. M. Safford, and L. M. Pogach Who Has Diabetes? Best Estimates of Diabetes Prevalence in the Department of Veterans Affairs Based on Computerized Patient Data Diabetes Care, May 1, 2004; 27(suppl_2): B10 - B21. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. Bertoni, W. G. Hundley, M. W. Massing, D. E. Bonds, G. L. Burke, and D. C. Goff Jr. Heart Failure Prevalence, Incidence, and Mortality in the Elderly With Diabetes Diabetes Care, March 1, 2004; 27(3): 699 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Beddhu, L. M. Pappas, N. Ramkumar, and M. H. Samore Malnutrition and Atherosclerosis in Dialysis Patients J. Am. Soc. Nephrol., March 1, 2004; 15(3): 733 - 742. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. Bertoni, A. Tsai, E. K. Kasper, and F. L. Brancati Diabetes and Idiopathic Cardiomyopathy: A nationwide case-control study Diabetes Care, October 1, 2003; 26(10): 2791 - 2795. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Gill, A. G. Mainous III, J. J. Diamond, and M. J. Lenhard Impact of Provider Continuity on Quality of Care for Persons With Diabetes Mellitus Ann. Fam. Med, September 1, 2003; 1(3): 162 - 170. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. J. Murff, A. J. Forster, J. F. Peterson, J. M. Fiskio, H. L. Heiman, and D. W. Bates Electronically Screening Discharge Summaries for Adverse Medical Events J. Am. Med. Inform. Assoc., July 1, 2003; 10(4): 339 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Bates, R. S. Evans, H. Murff, P. D. Stetson, L. Pizziferri, and G. Hripcsak Detecting Adverse Events Using Information Technology J. Am. Med. Inform. Assoc., March 1, 2003; 10(2): 115 - 128. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.C. Pressley, E.D. Louis, M.-X. Tang, L. Cote, P.D. Cohen, S. Glied, and R. Mayeux The impact of comorbid disease and injuries on resource use and expenditures in parkinsonism Neurology, January 14, 2003; 60(1): 87 - 93. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Price, C. A. Estrada, and D. Thompson Case Study: Administrative Data Versus Corrected Administrative Data American Journal of Medical Quality, January 1, 2003; 18(1): 38 - 45. [Abstract] [PDF]
|
|
|
|
|
|
V. A. Ferraris and S. P. Ferraris Risk Stratification and Comorbidity Card. Surg. Adult, January 1, 2003; 2(2003): 187 - 224. [Full Text]
|
|
|
|
 |
|
 G. Hripcsak, J. H. M. Austin, P. O. Alderson, and C. Friedman Use of Natural Language Processing to Translate Clinical Information from a Database of 889,921 Chest Radiographic Reports Radiology, July 1, 2002; 224(1): 157 - 163. [Abstract] [Full Text]
|
|
|
|
|
|
A. Gandjour, F. Kleinschmit, K.W. Lauterbach, and INTERCARE Iternational Investigators European comparison of costs and quality in the treatment of acute myocardial infarction (2000-2001) Eur. Heart J., June 1, 2002; 23(11): 858 - 868. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. G. Vickrey, T. S. Rector, S. L. Wickstrom, P. M. Guzy, E. M. Sloss, P. B. Gorelick, S. Garber, D. F. McCaffrey, M. D. Dake, and R. A. Levin Occurrence of Secondary Ischemic Events Among Persons With Atherosclerotic Vascular Disease Stroke, April 1, 2002; 33(4): 901 - 906. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Herzog, J. Z. Ma, and A. J. Collins Long-Term Survival of Dialysis Patients in the United States With Prosthetic Heart Valves: Should ACC/AHA Practice Guidelines on Valve Selection Be Modified? Circulation, March 19, 2002; 105(11): 1336 - 1341. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. Bertoni, J. S. Krop, G. F. Anderson, and F. L. Brancati Diabetes-Related Morbidity and Mortality in a National Sample of U.S. Elders Diabetes Care, March 1, 2002; 25(3): 471 - 475. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. B. Bach, L. D. Cramer, D. Schrag, R. J. Downey, S. E. Gelfand, and C. B. Begg The Influence of Hospital Volume on Survival after Resection for Lung Cancer N. Engl. J. Med., July 19, 2001; 345(3): 181 - 188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. V. Tu, P. C. Austin, and B. T. B. Chan Relationship Between Annual Volume of Patients Treated by Admitting Physician and Mortality After Acute Myocardial Infarction JAMA, June 27, 2001; 285(24): 3116 - 3122. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Paltiel, E. Salakhov, I. Ronen, D. Berg, and A. Israeli Management of Severe Hypokalemia in Hospitalized Patients: A Study of Quality of Care Based on Computerized Databases Arch Intern Med, April 23, 2001; 161(8): 1089 - 1095. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Cimino, V. L. Patel, and A. W. Kushniruk Studying the Human- Computer-Terminology Interface J. Am. Med. Inform. Assoc., March 1, 2001; 8(2): 163 - 173. [Abstract] [Full Text]
|
|
|
|
|
|
S. K. Pandey, M. G. Mussman, H. W. Moore, J. G. Folkemer, a |
Article
