Abstract P201: Use of Medicare Claims Data for the Identification of Myocardial Infarction. The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Lisandro D Colantonio ◽  
Emily B Levitan ◽  
Huifeng Yun ◽  
Meredith L Kilgore ◽  
George Howard ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Data Collection ◽  
Racial Differences ◽  
Primary Diagnosis ◽  
Self Report ◽  
Primary Data ◽  
Administrative Claims ◽  
Primary Position ◽  
Medicare Claims ◽  
Regards Study

Background: Administrative claims are used to conduct epidemiology research. However, few studies have compared results using administrative claims versus primary data collection. Objective: To compare myocardial infarction (MI) rates using primary data collection and Medicare claims in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Methods: We included 9,951 REGARDS study participants ≥65 years of age with Medicare Part A (inpatient) fee-for-service coverage at baseline in 2003-2007. Participants were asked every 6 months to report heart-related hospitalizations which were subsequently adjudicated to detect definite or probable MIs (MI Definition 1, see Table footnotes). Events detected through surveillance in REGARDS were supplemented with adjudicated definite or probable MIs detected through Medicare inpatient claims with a diagnosis code for MI (i.e., ICD-9 code 410.x0 or 410.x1) in any position (Definition 2) and in the primary position (Definition 3). MIs were also defined by a Medicare inpatient claim with a code for MI in any position (Definition 4) and in the primary position (Definition 5), without further adjudication. MIs were ascertained through December 2012. Results: REGARDS study procedures detected and adjudicated 669 definite or probable MIs over a mean follow-up of 6.3 years, representing 10.7 MIs per 1,000 person-years (Definition 1, Table ). Supplementing adjudicated MIs with Medicare inpatient claims resulted in a 12% (any diagnosis position, Definition 2) and 6% (primary diagnosis position, Definition 3) higher rate for MI. Using only Medicare claims without adjudication underestimated the rate for MI by 8% (any diagnosis position, Definition 4) and 32% (primary diagnosis position, Definition 5), compared with REGARDS study procedures. Conclusion: Supplementing MIs detected through participant self-report with those identified in claims could improve event detection. Using only Medicare claims to identify events may underestimate MI rates.

Abstract P109: Consistency of Self-reported Prior Diagnosis of Atrial Fibrillation and Medicare Claims Diagnoses: The Reasons for Geographic and Racial Differences in Stroke

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Oluseun O Akinyele ◽  
Elsayed Z Soliman ◽  
Ligong Chen ◽  
Hooman Kamel ◽  
Emily B Levitan
Keyword(s):  
Atrial Fibrillation ◽  
Health Professional ◽  
Racial Differences ◽  
High Specificity ◽  
Cognitive Status ◽  
Self Report ◽  
Fee For Service ◽  
Medicare Claims ◽  
Regards Study ◽  
Low Sensitivity

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Although self-reported prior diagnosis is a widely used method for ascertainment of AF in population studies, recall bias may impact the accuracy of this method. Objective: To examine the consistency of self-reported AF as compared to diagnoses recorded in Medicare claims. Methods: Among 30,239 black and white adults aged 45 years and older who enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, 8,588 participants aged 65 years and older with a minimum of 6 months of Medicare fee-for-service coverage at the time of enrollment were included in this analysis. Using AF diagnosis codes from Medicare claims as the “gold standard”, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predicted value (NPV) of self-reported prior diagnosis of AF by a physician or other health professional. Results: The average age of the study population was 73.4 years, 50.5% were women, 31.6% were black, and 10.1% reported a prior diagnosis of AF. The prevalence of Medicare claims diagnoses for AF ranged from 28.6% to 32.5% depending on definition ( Table ). Compared to Medicare claims, self-reported prior diagnosis of AF had 22.4-24.5% sensitivity, 95.6-95.7% specificity, 68.8-71.5% PPV, and 71.9-76.0% NPV. Results were consistent across strata defined by age, gender, race, and cognitive status. Conclusion: Compared to Medicare claims, self-reported prior diagnosis by a physician or other health professional had low sensitivity but high specificity to detect AF. This suggests that an approach utilizing only self-report to detect AF would not be ideal. However, most participants who reported a prior diagnosis of AF had Medicare claims supporting this diagnosis.

scholarly journals Measuring Neighborhood Order and Disorder: a Rapid Literature Review

2019 ◽  
Vol 6 (4) ◽  
pp. 316-326
Author(s):  
Steeve Ndjila ◽  
Gina S. Lovasi ◽  
Dustin Fry ◽  
Amélia A. Friche
Keyword(s):  
Data Collection ◽  
Literature Review ◽  
Self Report ◽  
Primary Data ◽  
Neighborhood Disorder ◽  
Perceived Safety ◽  
The Past ◽  
Order And Disorder ◽  
Urban Contexts ◽  
Collection Methods

Abstract Purpose of Review Neighborhood disorder has received attention as a determinant of health in urban contexts, through pathways that include psychosocial stress, perceived safety, and physical activity. This review provides a summary of data collection methods, descriptive terms, and specific items employed to assess neighborhood disorder/order. Recent Findings The proliferation of methods and terminology employed in measuring neighborhood disorder (or neighborhood order) noted over the past two decades has made related studies increasingly difficult to compare. Following a search of peer-reviewed articles published from January 1998 to May 2018, this rapid literature review identified 18 studies that described neighborhood environments, yielding 23 broad terms related to neighborhood disorder/order, and a total of 74 distinct measurable items. Summary A majority of neighborhood disorder/order measurements were assessed using primary data collection, often relying on resident self-report or investigatory observations conducted in person or using stored images for virtual audits. Items were balanced across signs of order or disorder, and further classification was proposed based on whether items were physically observable and relatively stable over time.

scholarly journals Validation Study of Medicare Claims to Identify Older US Adults With CKD Using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

2015 ◽  
Vol 65 (2) ◽  
pp. 249-258 ◽  
Author(s):  
Paul Muntner ◽  
Orlando M. Gutiérrez ◽  
Hong Zhao ◽  
Caroline S. Fox ◽  
Nicole C. Wright ◽  
...  
Keyword(s):  
Racial Differences ◽  
Validation Study ◽  
Medicare Claims ◽  
Regards Study

scholarly journals Self-Report of Stroke, Transient Ischemic Attack, or Stroke Symptoms and Risk of Future Stroke in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Stroke ◽  
2013 ◽  
Vol 44 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Suzanne E. Judd ◽  
Dawn O. Kleindorfer ◽  
Leslie A. McClure ◽  
J. David Rhodes ◽  
George Howard ◽  
...  
Keyword(s):  
Racial Differences ◽  
Transient Ischemic Attack ◽  
Self Report ◽  
Regards Study ◽  
Ischemic Attack

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 P321: Assembly and Validation of a Heart Failure Free Cohort From the Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Lauren Balkan ◽  
Matthew Mefford ◽  
Ligong Chen ◽  
Madeline R Sterling ◽  
Raegan W Durant ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Negative Predictive Value ◽  
Racial Differences ◽  
Predictive Value ◽  
Enzyme Inhibitor ◽  
Gender Diversity ◽  
Medicare Claims ◽  
Regards Study ◽  
And Gender

Introduction: Studies of incident heart failure (HF) have provided insights into key risk factors for the disease but have been limited to select populations that often lack geographic, racial, and gender diversity. There is a need to assemble a HF-free cohort using a contemporary, geographically diverse sample. Aim: To develop and validate a strategy for assembling a HF-free cohort from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Methods: To assemble a HF-free cohort, we identified and excluded REGARDS participants who were taking HF-specific medications at baseline including: digoxin without atrial fibrillation, angiotensin converting enzyme inhibitor/angiotensin receptor blocker plus beta-blocker in the absence of hypertension, carvedilol, spironolactone, loop diuretic or a combination of hydralazine and nitrates. We then examined the subgroup of REGARDS participants with at least 6 months of Medicare claims at the time of the baseline assessment; we evaluated diagnostic performance (negative predictive value, positive predictive value, sensitivity and specificity) using three Medicare claims-based definitions of HF as the referent standard: Hospitalization for HF, Principal Diagnosis of HF, and Any Diagnosis of HF. Results: Among 28,884 eligible participants, 3,125 used HF-specific medications at baseline, leaving 25,759 (89%) participants in the proposed HF-free cohort. Participants in the HF-free cohort had a lower prevalence of coronary disease, atrial fibrillation, and diabetes compared to excluded participants. Depending on the Medicare definition used as the referent, the percent of the HF-free cohort without evidence of HF based on Medicare claims (the negative predictive value) ranged from 95.0-99.2% (Table 1). Negative predictive value was stable across age, sex, and race strata. Conclusions: This medication-based strategy to assembling a HF-free cohort in REGARDS can serve as a basis for future studies to examine incident HF in REGARDS and similar studies.

scholarly journals Linkage of a Population-Based Cohort With Primary Data Collection to Medicare Claims

2016 ◽  
Vol 184 (7) ◽  
pp. 532-544 ◽  
Author(s):  
Fenglong Xie ◽  
Lisandro D. Colantonio ◽  
Jeffrey R. Curtis ◽  
Monika M. Safford ◽  
Emily B. Levitan ◽  
...  
Keyword(s):  
Data Collection ◽  
Population Based ◽  
Primary Data ◽  
Medicare Claims
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