Garbage in, Garbage out? Validity of Coded Diagnoses from GP Claims Records

被引:55
作者
Erler, A. [1 ,2 ]
Beyer, M. [1 ]
Muth, C. [1 ]
Gerlach, F. M. [1 ]
Brennecke, R. [2 ]
机构
[1] Goethe Univ Frankfurt, Inst Allgemeinmed, D-60590 Frankfurt, Germany
[2] Charite Univ Med Berlin, Zentrum Human & Gesundheitswissensch, Inst Gesundheitssyst Forsch, Berlin, Germany
关键词
risk adjustment; validity; administrative diagnoses; sensitivity; positive predictive value; family practice; PRIMARY-CARE; SENSITIVITY; INFORMATION; PREVALENCE; ACCURACY;
D O I
10.1055/s-0029-1214399
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Context: ICD-10-coded diagnoses from claims records are frequently used as morbidity indicators for research as well as for risk adjustment purposes in quality management and remuneration. A requirement for this application is the high validity of the diagnoses. In GP practices in particular, it is questionable whether claims-based diagnoses realistically reflect the health problems of patients treated over a one year period. Methods: In a retrospective cross-sectional study of a random sample of 250 patients from 10 GP practices we examined whether, on the basis of the patients' medical records, health problems treated in the year 2003 matched claims-based diagnoses within the same time period. Results: In spite of a high mean of 6.1 claims-based diagnoses per patient, health problems treated within the study period were under-reported in 30% of the cases, mainly relating to non-severe diagnoses frequently encountered in GP practice, chronic conditions not requiring medication, and diagnoses justifying a screening test. An over-reporting for diseases not treated within the study period was observed in 19% of the cases, most often in the case of permanent chronic conditions. In 11% of cases the ICD-10 codes of claims-based diagnoses and the diagnoses in the medical records did not match ("erroneous codes"). For six of the diagnoses most common in GP practice (hypertension, diabetes, hyperlipoproteinemia, cardiovascular disease, back pain, and acute respiratory tract infections) correctness at 71-93% was higher than completeness (56-86%). Conclusion: The low validity of ICD-10-coded diagnoses from GP claims records calls their usefulness as morbidity indicators into question.
引用
收藏
页码:823 / 831
页数:9
相关论文
共 33 条
  • [1] [Anonymous], BIOMETRICS
  • [2] The sensitivity of medicare claims data for case ascertainment of six common cancers
    Cooper, GS
    Yuan, Z
    Stange, KC
    Dennis, LK
    Amini, SB
    Rimm, AA
    [J]. MEDICAL CARE, 1999, 37 (05) : 436 - 444
  • [3] *DIMDI, 2006, ICD 10 GM VERS 2006
  • [4] THE ACCURACY OF MEDICARES HOSPITAL CLAIMS DATA - PROGRESS HAS BEEN MADE, BUT PROBLEMS REMAIN
    FISHER, ES
    WHALEY, FS
    KRUSHAT, WM
    MALENKA, DJ
    FLEMING, C
    BARON, JA
    HSIA, DC
    [J]. AMERICAN JOURNAL OF PUBLIC HEALTH, 1992, 82 (02) : 243 - 248
  • [5] Fowles J B, 1995, Health Care Financ Rev, V16, P189
  • [6] Fowles J B, 1998, J Ambul Care Manage, V21, P24
  • [7] Gerste B, 2006, GESUNDHEITS SOZIALPO, P29
  • [8] HORNER RD, 1991, J FAM PRACTICE, V33, P593
  • [9] Medical care research based on family doctor routine data - Are interface-communicated treatment data feasible?
    Hummers-Pradier, E
    Simmenroth-Nayda, A
    Scheidt-Navel, C
    Scheer, N
    Fischer, T
    Niebling, W
    Kochen, MM
    [J]. GESUNDHEITSWESEN, 2003, 65 (02) : 109 - 114
  • [10] Sensitivity and positive predictive value of Medicare Part B physician claims for rheumatologic diagnoses and procedures
    Katz, JN
    Barrett, J
    Liang, MH
    Bacon, AM
    Kaplan, H
    Kieval, RI
    Lindsey, SM
    Roberts, WN
    Sheff, DM
    Spencer, RT
    Weaver, AL
    Baron, JA
    [J]. ARTHRITIS AND RHEUMATISM, 1997, 40 (09): : 1594 - 1600