Coronary Artery Disease
Can cardiovascular clinical characteristics be identified and outcome models be developed from an in-patient claims database?

https://doi.org/10.1016/S0002-9149(99)00228-3Get rights and content

Abstract

The objective of this study was to assess whether administrative (claims) databases can be used to assess clinical variables and predict outcome. Although administrative databases are useful for assessing resource utilization, their utility for assessing clinical information is less certain. Prospectively gathered clinical databases, however, are expensive and not widely available. The UB92 formulation of the hospital bill was used as an administrative source of data and compared with the clinical cardiovascular database at Emory University. The claims database was compared with the clinical database for 11 variables. Outcome models were developed with multivariate methods. A total of 11,883 patients who underwent catheterization (5,255 underwent percutaneous transluminal coronary angioplasty [PTCA] and 3,794 underwent coronary artery bypass surgery [CABG]) between 1991 and 1995 were included. For some variables, the claims database correlated well (diabetes, sensitivity 87%, specificity 99%), whereas for others the claims database was less accurate (peripheral vascular disease, sensitivity 20%, specificity 99%). Uncertain coding in the claims database, which can result in the same code being used for co-morbid states and severity of disease, as well as complications, limited the ability of claims to predict outcome. Clinical databases may also be limited by lack of objectivity and missing data. The utility of claims databases to assess severity of disease and co-morbid states is limited, and outcome modeling and risk assessment from claims databases may be inappropriate and spurious. Developing better data standards and less expensive methods for acquisition of clinical data is necessary for improved outcome assessment.

Section snippets

Patient population

The patient population was comprised of 11,883 patients (63% men, mean age 63 ± 12 years) who underwent cardiac catheterization and/or coronary revascularization at Emory University Hospital between January 1991 and December 1995. Of this population, 5,255 patients underwent percutaneous transluminal coronary angioplasty (PTCA) and 3,794 patients underwent coronary artery bypass surgery (CABG).

Definitions in the clinical database

Multivessel disease: ≥50% diameter luminal narrowing in 2 or 3 of the major epicardial vessel systems.

Results

From the clinical database, 22% of patients had diabetes (36% of whom required insulin), 54% had hypertension, 83% had angina pectoris more than or equal to class II, 14% had heart failure, 45% had a prior myocardial infarction, 12% had peripheral vascular disease, 8.3% had cerebrovascular disease, 12% had chronic obstructive pulmonary disease, 6.9% had chronic renal failure, and 49% hyperlipidemia. Compared with the clinical database, the claims database specificity was relatively high,

Discussion

Data abstracted from an administrative claims database may not accurately reflect independently collected clinical data. Although a clinical database may also have deficiencies in data collection, clinical disease descriptors such as angina pectoris are more likely to be described correctly in the clinical database because: (1) it is being collected by and supervised by clinical rather than administrative personnel who should have a greater understanding of the data; (2) a symptom such as

Acknowledgements

The authors thank Lesley Wood for her careful editorial review.

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    This study was funded by a grant from Merck U.S. Human Health, West Point, Pennsylvania.

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