Identification Of Dementia In Recent Medicare Claims Data, Compared To Rigorous Clinical Assessments

2021 ◽  
Author(s):  
Francine Grodstein ◽  
Chiang-Hua Chang ◽  
Ana W Capuano ◽  
Melinda C Power ◽  
David X Marquez ◽  
...  
Keyword(s):  
Predictive Value ◽  
Claims Data ◽  
False Negative ◽  
Health Indicators ◽  
Fee For Service ◽  
Medicare Claims ◽  
Diagnosis Of Dementia ◽  
Dementia Research ◽  
Wrong Diagnosis ◽  
Memory Concerns

Abstract BACKGROUND Medicare fee-for-service (FFS) claims data are increasingly leveraged for dementia research. Few studies address the validity of recent claims data to identify dementia, or carefully evaluate characteristics of those assigned the wrong diagnosis in claims. METHODS We used claims data from 2014-2018, linked to participants administered rigorous, annual dementia evaluations in five cohorts at the Rush Alzheimer’s Disease Center. We compared prevalent dementia diagnosed through the 2016 cohort evaluation versus claims identification of dementia, applying the Bynum-standard algorithm. RESULTS Of 1,054 participants with Medicare Parts A and B FFS in a 3-year window surrounding their 2016 index date, 136 had prevalent dementia diagnosed during cohort evaluations; the claims algorithm yielded 217. Sensitivity of claims diagnosis was 79%, specificity 88%, positive predictive value 50%, negative predictive value 97%, and overall accuracy 87%. White participants were disproportionately represented among detected dementia cases (true-positive) versus cases missed (false-negative) by claims (90% versus 75%, respectively, p=0.04). Dementia appeared more severe in detected than missed cases in claims (mean MMSE=15.4 versus 22.0, respectively, p<0.001; 28% with no limitations in activities of daily living versus 45%, p=0.046). By contrast, those with “over-diagnosis” of dementia in claims (false-positive) had several worse health indicators than true negatives (eg, self-reported memory concerns=51% versus 29%, respectively, p<0.001; mild cognitive impairment in cohort evaluation=72% versus 44%, p<0.001; mean comorbidities=7 versus 4, p<0.001). CONCLUSIONS Recent Medicare claims perform reasonably well in identifying dementia; however, there are consistent differences in cases of dementia identified through claims than in rigorous cohort evaluations.

scholarly journals Comparability of Event Adjudication Versus Administrative Billing Claims for Outcome Ascertainment in the DAPT Study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Kamil F. Faridi ◽  
Hector Tamez ◽  
Neel M. Butala ◽  
Yang Song ◽  
Changyu Shen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Claims Data ◽  
High Specificity ◽  
Kappa Statistics ◽  
Administrative Claims ◽  
Medicare Claims

Background: Data from administrative claims may provide an efficient alternative for end point ascertainment in clinical trials. However, it is uncertain how well claims data compare to adjudication by a clinical events committee in trials of patients with cardiovascular disease. Methods: We matched 1336 patients ≥65 years old who received percutaneous coronary intervention in the DAPT (Dual Antiplatelet Therapy) Study with the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims as part of the EXTEND (Extending Trial-Based Evaluations of Medical Therapies Using Novel Sources of Data) Study. Adjudicated trial end points were compared with Medicare claims data with International Classification of Diseases, Ninth Revision codes from inpatient hospitalizations using time-to-event analyses, sensitivity, specificity, positive predictive value, negative predictive value, and kappa statistics. Results: At 21-month follow-up, the cumulative incidence of major adverse cardiovascular and cerebrovascular events (combined mortality, myocardial infarction, and stroke) was similar between trial-adjudicated events and claims data (7.9% versus 7.2%, respectively; P =0.50). Bleeding rates were lower using adjudicated events compared with claims (5.0% versus 8.6%, respectively; P <0.001). The sensitivity and positive predictive value of comprehensive billing codes for identifying adjudicated events were 65.6% and 85.7% for myocardial infarction, 61.5% and 47.1% for stroke, and 76.8% and 39.3% for bleeding, respectively. Specificity and negative predictive value for all outcomes ranged from 93.7% to 99.5%. All 39 adjudicated deaths were identified using Medicare data. Kappa statistics assessing agreement between events for myocardial infarction, stroke, and bleeding were 0.73, 0.52, and 0.49, respectively. Conclusions: Claims data had moderate agreement with adjudication for myocardial infarction and poor agreement but high specificity for bleeding and stroke in the DAPT Study. Deaths were identified equivalently. Using claims data in clinical trials could be an efficient way to assess mortality among Medicare patients and may help detect other outcomes, although additional monitoring is likely needed to ensure accurate assessment of events.

Abstract 15791: Evaluation of Medicare Claims for Heart Failure Diagnostic Development: A Multisense-linkage Feasibility Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ramesh Wariar ◽  
Gezheng Wen ◽  
Caroline Jacobsen ◽  
Stephen B Ruble ◽  
John Boehmer
Keyword(s):  
Heart Failure ◽  
Disease Burden ◽  
Diagnostic Performance ◽  
Claims Data ◽  
False Positive Rate ◽  
Fee For Service ◽  
Medicare Claims ◽  
Diagnosis Codes ◽  
Positive Rate ◽  
Contrast Matching

Introduction: The validity of utilizing claims data for the development of worsening heart failure (HF) diagnostics has not been previously reported. Therefore, we linked data from the MultiSENSE study, in which the HeartLogic diagnostic was first reported, with claims data in order to validate claims HF events and compare diagnostic performance. Methods: Identifiers from 791 United States study patients were directly linked with Medicare claims to produce 320 patients with continuous Medicare Part A/B fee-for-service (FFS) coverage during study participation. Claims HF events were defined using primary HF diagnosis codes (DRG and ICD-9-CM) and included inpatient events as well as outpatient events with intravenous decongestive therapy. We matched events by patient and date, calculated agreement between events (Cohen’s kappa coefficient κ), and evaluated HeartLogic diagnostic performance using sensitivity and false positive rate (FPR). Results: The linked cohort was older than the remaining patients and had greater disease burden. Study deaths (N=14) matched exactly with claims. In contrast, matching of 207 study hospitalizations with 197 acute inpatient events resulted in a total of 239 events of which 193 matched with claims (81%), 32 (13%) were claims-unique, and 14 (6%) were study-unique. Claims HF events had substantial agreement with study adjudicated hospitalizations (observed = 93.3%, κ = 0.823). The HeartLogic algorithm detected claims-derived events with a sensitivity of 75.6% and an FPR of 1.539 alerts/pt-year, which was not different from performance derived using study events (sensitivity = 77.6% and FPR = 1.528, P = 0.82 and 0.92). HeartLogic detected events contributed to 91% of HF event costs used for performance evaluation ($605,000 out of $663,000). Conclusions: The agreement between claims and study events, and equivalence of HeartLogic diagnostic performance suggest that claims data may have utility for future diagnostic development/enhancement. Additional data are needed to demonstrate safety, efficacy, and cost-effectiveness of HeartLogic-directed interventions.

scholarly journals Identifying a Population Living With Alzheimer’s: Concordance Between Medicare Claims and Survey Reports

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 173-173
Author(s):  
Ayse Akincigil ◽  
Camille McKenzie
Keyword(s):  
Health Planning ◽  
False Negative ◽  
International Classification Of Diseases ◽  
Care Quality ◽  
Self Report ◽  
Fee For Service ◽  
Care Needs ◽  
Medicare Claims ◽  
Case Ascertainment ◽  
Icd 10

Abstract Community-level estimates of Alzheimer’s disease and related dementias (ADRD) are necessary to assess health care needs and supports (to patients and family members), determine the burden of disease, conduct public health planning, improve access and care quality improvement, and to build a workforce with the necessary skills. Data from Medicare claims can provide efficient and timely estimates. However, earlier studies suggest that identifying ADRD populations solely from Medicare claims fails to capture many individuals that live with ADRD, with false-negative cases as high as 60%. We examined nationally representative data from the 2015-2017 Medicare Current Beneficiary Survey (MCBS) to assess the claims-based case ascertainment method, covering the transition to the International Classification of Diseases, Tenth Revision (ICD-10). The study population included community dwellers aged 65 or older, enrolled in traditional fee-for-service (n=12,409). Claims based method identified 1,325 cases (10.7% prevalence). However, there were 196 (1.6%) additional cases that self/proxy reported ADRD, but there was no ADRD diagnosis in any of their Medicare claims (hereafter referred to as self-report only). On average, the self-report only group reported higher numbers of limitations in activities, or instrumental activities of daily living, worse overall health, and more difficulty in concentrating or remembering, suggesting they are likely to be false negatives under claims-based case ascertainment method. In conclusion, claims based case ascertainment methods failed to capture some individuals with ADRD, but the magnitude of false-negative cases declined substantially in the era of ICD-10.

scholarly journals Predictive value of Medicare claims data for identifying revision of index hip replacement was modest

2011 ◽  
Vol 64 (5) ◽  
pp. 543-546 ◽  
Author(s):  
Jeffrey N. Katz ◽  
Elizabeth A. Wright ◽  
John A. Baron ◽  
Kelly L. Corbett ◽  
Akosua A. Nti ◽  
...  
Keyword(s):  
Predictive Value ◽  
Hip Replacement ◽  
Claims Data ◽  
Medicare Claims ◽  
Medicare Claims Data

scholarly journals NESTROFT—A Cost-Effective Mass Screening Tool for the Detection of β-Thalassemia Carrier Status in Anemic Pregnant Women: A Step Toward Reducing the National Disease Burden

2021 ◽  
Author(s):  
Manasi Gosavi ◽  
Ramesh Chavan ◽  
M. B. Bellad
Keyword(s):  
Pregnant Women ◽  
Effective Mass ◽  
Mass Screening ◽  
Predictive Value ◽  
Screening Tool ◽  
Hematological Parameters ◽  
False Negative ◽  
Cost Effective ◽  
Mean Corpuscular Hemoglobin ◽  
Carrier Status

Abstract Introduction β-Thalassemias are inherited hemoglobinopathies commonly encountered in practice. With chances of a promising cure being rare, the prevention of births with this disorder should assume priority, especially in low-resource countries. This can be achieved by the implementation of a mass screening program that is reliable and, at the same time, cost-effective. Objectives This study focuses on the utility of Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) as a mass screening tool to detect thalassemia carriers. Hematological parameters that may predict carrier status were also evaluated. Materials and Methods Hemoglobin estimation was performed on all consented pregnant women. If the patient was found to have hemoglobin < 11 g/dL, the blood sample was subjected to other routine hematological tests along with peripheral smear examination. NESTROFT was performed using 0.36% saline solution. Confirmation was done using high-performance liquid chromatography (HPLC). Statistical Analysis Data obtained were tabulated using version 21 of the Statistical Package for Social Sciences. Means, standard deviations, and percentages were used to describe the sample. Chi-square test and Students’ “t” test were used to identify differences between the groups. Results Of 441 pregnant women enrolled, 206 were found to be anemic. Nineteen (9.2%) of the anemic pregnant women were detected to be carriers of hemoglobinopathies. Among the hematological parameters, mean red blood cell count and reticulocyte count were higher, while mean corpuscular hemoglobin concentration was lower in carriers. Also, carriers were more likely to present with microcytic hypochromic anemia. NESTROFT showed a sensitivity of 84.21%, specificity of 96.25%, a positive predictive value of 69.56%, and a negative predictive value of 98.36%. A false-positive result was seen in 3.74% of the tests, while a false negative result was seen in 15.78% of the tests. Conclusions NESTROFT (0.36%) can be used as a simple and cost-effective mass screening tool for the detection of carrier status. This should be followed by confirmation using HPLC or hemoglobin electrophoresis.

Exercise induced reduction in myocardial work predicts significant coronary artery disease in patients with false negative stress echocardiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.L Chilingaryan ◽  
L.G Tunyan ◽  
K.G Adamyan ◽  
P.H Zelveyan ◽  
L.R Tumasyan ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Predictive Value ◽  
Stress Echocardiography ◽  
False Negative ◽  
Funding Source ◽  
Concentric Hypertrophy ◽  
Constructive Work ◽  
Artery Disease ◽  
Isovolumic Relaxation

Abstract   Stress echocardiography (SE) is a reliable technique for the diagnosis of coronary artery disease (CAD) with high sensitivity and specificity. However in patients with small left ventricular (LV) cavity caused by marked concentric hypertrophy the sensitivity of SE is low. We assumed that in patients with false negative SE evaluation of global myocardial work (GW) might detect significant CAD. Methods 238 patents with chest pain (98 female, mean age 61±5 years) without history of CAD were referred to SE for CAD confirmation. 94 (39.5%) patients had negative SE and were enrolled in our study for re-examination. Age and gender matched 50 healthy subjects served as controls. GW index (GWI) was obtained from pressure-strain loops composed from speckle tracking analysis indexed to brachial systolic blood pressure. Global constructive work (GCW) as the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation, global wasted work (GWW) as energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation, and GW efficiency (GWE) as the percentage ratio of constructive work to the sum of constructive work and wasted work were measured after submaximal treadmill SE at the heart rate of 100–110 beats per minute (109±11 s after SE) using EchoPac software by blinded experienced echocardiographer. All patients were referred to coronary angiography after re-examination. Results 42 (44.7%) patients had lower GWI values than the lowest limit of GWI value in controls. These patients had significant reduction in GWI, compared with remaining 52 patients in whom GWI did not differ from those of controls (GWI 1897±112 mmHg% vs 2518±243 mmHg%, p&lt;0.01). GCW, GWE and GWW were comparable between patients with or without reduced GWI (GCW 2283±107mmHg% vs 2321±110 mmHg%, p=NS; GWE 96.9±1.1% vs 97.4±1.2%, p=NS; GWW 57±3 mmHg% vs 53±4 mmHg%, p=NS). 28 (66.7%) of 42 patients with GWI reduction and 8 (15.0%) of 52 patients without GWI reduction had at least one vessel significant CAD. GWI had sensitivity, specificity, and accuracy in detection of CAD 78%, 76%, 77% respectively with 67% positive predictive value, and 85% negative predictive value. 29 (80.5%) patients out of 36 with significant CAD had concentric increase in LVMi compared with true negative SE patients (83±6 g/m2 vs 71±4 g/m2, p&lt;0.01). GWI was the predictor of significant CAD (area under the curve 0.793). Conclusion GWI extends diagnostic power of conventional SE in detection of CAD, especially in patients with smaller LV cavity due to concentric hypertrophy when sensitivity of conventional SE is low. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Committee of Sience at Ministry of Education of Republic of Armenia

Validity of ultrasound arterial wall vascularization for assessment of vascular inflammation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Sato ◽  
Y Kobayashi ◽  
M Otaka ◽  
M Unuma ◽  
T Yamanaka ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Predictive Value ◽  
Arterial Wall ◽  
Carotid Arteries ◽  
Vascular Inflammation ◽  
False Negative ◽  
Intraplaque Hemorrhage ◽  
Funding Source ◽  
Negative Finding ◽  
18F Fdg

Abstract Background Vascular inflammation plays a fundamental role in most vascular diseases including atherosclerosis and vasculitis syndrome, in which arterial wall vascularization (AWV) frequently develops. Visualization of AWV is informative in detecting the vascular inflammation but is challenging. A new ultrasound technique (superb micro-vascular imaging [SMI]) allows the detection of extremely low-velocity flows. We examined an availability of SMI for assessment of the instability of atherosclerotic plaques and the activity of Takayasu arteritis (TA). Methods and results The study consists of two independent and consecutive parts A and B, examined in carotid stenosis (A) and TA (B), respectively. In part A, 12 patients with symptomatic severe carotid stenosis (CS group) scheduled for carotid endarterectomy were enrolled. In six of 12 patients, preoperative ultrasonography with SMI showed intraplaque neovascularization at the plaque shoulder. Postoperatively, histopathology confirmed the neovessels at the corresponding sites of visualized AWV. SMI had a sensitivity of 67%, specificity of 90% for detection of AWV in CS group. In SMI analysis, false positive findings were caused by motion artifact and arterial wall calcification, and a false negative finding is attributed by intraplaque hemorrhage. In part B, 10 patients with TA were enrolled. All patients underwent 18F-FDG-PET/CT, and its vascular uptake were compared with AWV detected by SMI. Bilateral common carotid arteries (CCA), internal carotid arteries and common iliac arteries were examined by SMI. Active vascular 18F-FDG uptake (max SUV &gt;2.1) were found at five sites in three patients, which were not significantly correlated with the prevalence of macaroni sign, increase in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Of note, SMI revealed AWV at five sites corresponding to uptake of 18F-FDG, with a sensitivity/specificity of 100% and 98%, positive predictive value 71%, and a negative predictive value 100%. Conclusion SMI enables visualization of AWV at vulnerable plaque in CS patients and at 18F-FDG positive sites in TA patients. SMI has potential as a modality to detect the vascular inflammation. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research, Japan

Positive predictive value between medical-chart body-mass-index category and obesity versus codes in a claims-data warehouse

2017 ◽  
Vol 34 (1) ◽  
pp. 117-121 ◽  
Author(s):  
Eleanor O. Caplan ◽  
Pravin S. Kamble ◽  
Raymond A. Harvey ◽  
B. Gabriel Smolarz ◽  
Andrew Renda ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Positive Predictive Value ◽  
Data Warehouse ◽  
Body Mass ◽  
Predictive Value ◽  
Claims Data ◽  
Body Mass Index Category ◽  
Medical Chart

scholarly journals Evaluation of the Carba NP Test for Rapid Detection of Carbapenemase-Producing Enterobacteriaceae and Pseudomonas aeruginosa

2013 ◽  
Vol 57 (9) ◽  
pp. 4578-4580 ◽  
Author(s):  
Nathalie Tijet ◽  
David Boyd ◽  
Samir N. Patel ◽  
Michael R. Mulvey ◽  
Roberto G. Melano
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Rapid Detection ◽  
False Negative ◽  
Bacterial Extract ◽  
Content Type ◽  
Negative Results ◽  
False Negative Results

ABSTRACTThe Carba NP test was evaluated against a panel of 244 carbapenemase- and non-carbapenemase-producingEnterobacteriaceaeandPseudomonas aeruginosaisolates. We confirmed the 100% specificity and positive predictive value of the test, but the sensitivity and negative predictive value were 72.5% and 69.2%, respectively, and increased to 80% and 77.3%, respectively, using a more concentrated bacterial extract. False-negative results were associated with mucoid strains or linked to enzymes with low carbapenemase activity, particularly OXA-48-like, which has emerged globally in enterobacteria.

Sign in / Sign up

Export Citation Format

Share Document