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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.
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W. W. Stead, R. A. Miller, M. A. Musen, and W. R. Hersh Integration and Beyond: Linking Information from Disparate Sources andinto Workflow J. Am. Med. Inform. Assoc., March 1, 2000; 7(2): 135 - 145. [Abstract] [Full Text] [PDF]
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J. C. LONGENECKER, J. CORESH, M. J. KLAG, A. S. LEVEY, A. A. MARTIN, N. E. FINK, and N. R. POWE Validation of Comorbid Conditions on the End-Stage Renal Disease Medical Evidence Report: The CHOICE Study J. Am. Soc. Nephrol., March 1, 2000; 11(3): 520 - 529. [Abstract] [Full Text] [PDF]
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H. D. Stein, P. Nadkarni, J. Erdos, and P. L. Miller Exploring the Degree of Concordance of Coded and Textual Data in Answering Clinical Queries from a Clinical Data Repository J. Am. Med. Inform. Assoc., January 1, 2000; 7(1): 42 - 54. [Abstract] [Full Text] [PDF]
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J.Z. Ayanian Using administrative data to assess health care outcomes Eur. Heart J., December 1, 1999; 20(23): 1689 - 1691. [PDF]
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 R. S. Mangus, N. C. Mann, W. Worrall, and R. J. Mullins Statewide Variation in the Treatment of Patients Hospitalized With Spleen Injury Arch Surg, December 1, 1999; 134(12): 1378 - 1384. [Abstract] [Full Text] [PDF]
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E. C. Schneider, V. Riehl, S. Courte-Wienecke, D. M. Eddy, and C. Sennett Enhancing Performance Measurement: NCQA's Road Map for a Health Information Framework JAMA, September 22, 1999; 282(12): 1184 - 1190. [Abstract] [Full Text] [PDF]
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G. D. RUBENFELD, D. C. ANGUS, M. R. PINSKY, J. R. CURTIS, A. F. CONNORS Jr., G. R. BERNARD, and The Members of the Outcomes Re Outcomes Research in Critical Care . Results of the American Thoracic Society Critical Care Assembly Workshop on Outcomes Research Am. J. Respir. Crit. Care Med., July 1, 1999; 160(1): 358 - 367. [Full Text]
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H. M. Krumholz, J. Chen, Y. Wang, M. J. Radford, Y.-T. Chen, and T. A. Marciniak Comparing AMI Mortality Among Hospitals in Patients 65 Years of Age and Older : Evaluating Methods of Risk Adjustment Circulation, June 15, 1999; 99(23): 2986 - 2992. [Abstract] [Full Text] [PDF]
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N. R. Every, P. D. Frederick, M. Robinson, J. Sugarman, L. Bowlby, and H. V. Barron A comparison of the National Registry of Myocardial Infarction 2 with the Cooperative Cardiovascular Project J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1886 - 1894. [Abstract] [Full Text] [PDF]
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G. T. O'Connor, H. B. Quinton, N. D. Traven, L. D. Ramunno, T. A. Dodds, T. A. Marciniak, and J. E. Wennberg Geographic Variation in the Treatment of Acute Myocardial Infarction: The Cooperative Cardiovascular Project JAMA, February 17, 1999; 281(7): 627 - 633. [Abstract] [Full Text] [PDF]
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E. D. Peterson, E. R. DeLong, J. G. Jollis, L. H. Muhlbaier, and D. B. Mark The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly J. Am. Coll. Cardiol., October 1, 1998; 32(4): 993 - 999. [Abstract] [Full Text] [PDF]
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C. A. Herzog, J. Z. Ma, and A. J. Collins Poor Long-Term Survival after Acute Myocardial Infarction among Patients on Long-Term Dialysis N. Engl. J. Med., September 17, 1998; 339(12): 799 - 805. [Abstract] [Full Text] [PDF]
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 J. M. Gill and A. G. Mainous III The Role of Provider Continuity in Preventing Hospitalizations Arch Fam Med, July 1, 1998; 7(4): 352 - 357. [Abstract] [Full Text] [PDF]
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R. J. Mullins, N. C. Mann, J. R. Hedges, W. Worrall, M. Helfand, A. D. Zechnich, and G. J. Jurkovich Adequacy of Hospital Discharge Status as a Measure of Outcome Among Injured Patients JAMA, June 3, 1998; 279(21): 1727 - 1731. [Abstract] [Full Text] [PDF]
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 S. M. Wright, L. A. Petersen, and J. Daley Availability of Cardiac Technology: Trends in Procedure Use and Outcomes for Patients with Acute Myocardial Infarction Med Care Res Rev, June 1, 1998; 55(2): 239 - 254. [Abstract] [PDF]
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R. A. Nordyke and C. A. Kulikowski An Informatics-based Chronic Disease Practice: Case Study of a 35-year Computer-based Longitudinal Record System J. Am. Med. Inform. Assoc., January 1, 1998; 5(1): 88 - 103. [Abstract] [Full Text]
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 P. W. Yoon, R. S. Olney, M. J. Khoury, W. M. Sappenfield, G. F. Chavez, and D. Taylor Contribution of Birth Defects and Genetic Diseases to Pediatric Hospitalizations: A Population-Based Study Arch Pediatr Adolesc Med, November 1, 1997; 151(11): 1096 - 1103. [Abstract] [PDF]
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 T. FACISZEWSKI, S. K. BROSTE, and D. FARDON Quality of Data Regarding Diagnoses of Spinal Disorders in Administrative Databases. A Multicenter Study J. Bone Joint Surg. Am., October 1, 1997; 79(10): 1481 - 8. [Abstract] [Full Text]
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N. P. Wray, J. C. Hollingsworth, N. J. Petersen, and C. M. Ashton Case-Mix Adjustment Using Administrative Databases: A Paradigm to Guide Future Research Med Care Res Rev, September 1, 1997; 54(3): 326 - 356. [Abstract] [PDF]
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J. G. Jollis, E. D. Peterson, C. L. Nelson, J. A. Stafford, E. R. DeLong, L. H. Muhlbaier, and D. B. Mark Relationship Between Physician and Hospital Coronary Angioplasty Volume and Outcome in Elderly Patients Circulation, June 3, 1997; 95(11): 2485 - 2491. [Abstract] [Full Text]
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R. O. Cummins, D. Chamberlain, M. F. Hazinski, V. Nadkarni, W. Kloeck, E. Kramer, L. Becker, C. Robertson, R. Koster, A. Zaritsky, et al. Recommended Guidelines for Reviewing, Reporting, and Conducting Research on In-Hospital Resuscitation: The In-Hospital `Utstein Style' : A Statement for Healthcare Professionals From the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa Circulation, April 15, 1997; 95(8): 2213 - 2239. [Full Text]
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