Coronary Artery DiseaseCan cardiovascular clinical characteristics be identified and outcome models be developed from an in-patient claims database?☆
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.
References (27)
- et al.
How much change in the case mix index is DRG creep?
J Health Econ
(1990) - et al.
Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases
J Clin Epidemiol
(1992) - et al.
Using administrative data to describe casemixa comparison with the medical record
J Clin Epidemiol
(1994) - et al.
A comparison of administrative versus clinical datacoronary artery bypass surgery as an example
J Clin Epidemiol
(1994) Using risk-adjusted outcomes to assess clinical practicean overview of issues pertaining to risk adjustment
Ann Thorac Surg
(1994)- et al.
Validation of a combined comorbidity index
J Clin Epidemiol
(1994) Grading of angina pectoris
Circulation
(1975)Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels
(1979)- Weintraub WS, McKay CR, Riner RN, Ellis SG, Frommer PL, Carmichael DB, Hammermeister KE, Effros MN, Bost JE, Bodycombe...
- Society of Thoracic Surgeons web site....
Evaluating the yield of medical tests
JAMA
Regression modelling strategies for improved prognostic prediction
Statist Med
Accuracy of diagnostic coding for Medicare patients under the prospective-payment system
New Engl J Med
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This study was funded by a grant from Merck U.S. Human Health, West Point, Pennsylvania.