Abstract 173: A Comparison of Administrative Claims Discharge Diagnosis with Electronic Medical Record Problem List in the Diagnosis of Acute Myocardial Infarction

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Michael D McCulloch ◽  
Tim Sobol ◽  
Joy Yuhas ◽  
Bill Ahern ◽  
Eric D Hixson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Medical Record ◽  
Chart Review ◽  
Claims Data ◽  
Administrative Claims ◽  
Problem List ◽  
Principal Diagnosis ◽  
Administrative Claims Data ◽  
Patient Admissions

Background: Administrative claims data are commonly used for measurement of mortality and readmissions in Acute Myocardial Infarction (AMI). With advent of the Electronic Medical Record (EMR), the electronic problem list offers new ways to capture diagnosis data. However, no data comparing the accuracy of administrative claims data and the EMR problem list exists. Methods: Two years of admissions at a single, quaternary medical center were analyzed to compare the presence of AMI diagnosis in administrative claims and EMR problem list data using a 2x2 matrix. To gain insights into this novel method, 25 patient admissions were randomly selected from each group to undergo physician chart review to adjudicate a clinical diagnosis of myocardial infarction based on the universal definition. Results: A total of 105,929 admissions from January 1, 2010 to December 31, 2011 were included. Where EMR problem list and administrative claims data were in agreement for or against AMI diagnosis they were highly accurate. Where administrative claims data, but not EMR problem list, reported AMI the most common explanation was true AMI with missing EMR problem list diagnoses (60%). Less common reasons for discordance in this category include: (1) administrative coding error (20%), (2) computer algorithm error (8%), (3) patient death before EMR problem list created (4%), (4) EMR problem list not used (4%) and (5) AMI diagnosis was removed from EMR problem list (4%). Where EMR problem list, but not administrative claims data, reported AMI the most common explanation was no AMI with historical diagnosis of AMI from a previous admission (60%). Less common reasons for discordance in this category include: (1) AMI present but not the principal diagnosis (32%), (2) administrative coding error (4%) and (3) erroneous EMR problem list entry (4%). Conclusion: Compared to administrative and chart review diagnoses, we found that using the EMR problem list to identify patient admissions with a principal diagnosis of AMI will overlook a subset of patients primarily due to inadequate clinical documentation. Additionally, the EMR problem list does not discriminate the admission principal diagnosis from the secondary diagnoses.

Abstract 20172: Identifying Hospital Cardiac Services for Acute Myocardial Infarction Using Individual Patient Claims Data

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tiffany E Chang ◽  
Shu-Xia Li ◽  
Isuru Ranasinghe ◽  
Harlan Krumholz
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Claims Data ◽  
Administrative Claims ◽  
Hospital Data ◽  
American Hospital ◽  
American Hospital Association ◽  
Surgical Services ◽  
Chest X Ray ◽  
Using Data

Background: Hospital data on cardiac services provided is restricted to a limited number of services collected by the American Hospital Association (AHA) Survey. We developed an alternative method to identify hospital services using individual patient administrative claims data for acute myocardial infarction (AMI) in the Premier Database. Methods: We first determined inpatient cardiac services relevant for AMI care from guidelines. Then, we identified these services from patient claims using ICD-9, CPT, Medicare Revenue and provider specialty codes. Additionally, Premier Chargemaster and Physician Specialty Codes were used. A hospital was classified as providing a service if they had >5 AMI patient claims for the service in the Premier database from 2009-2011. To measure the accuracy of the claims based method, we compared the percentage of hospitals that were shown to provide a service identified through the AHA survey for a subset of services identifiable from both sources. Results: We identified 32 services relevant for AMI care that could be defined using data with inpatient claims among 476 hospitals in the Premier database (Figure). The availability of these services ranged from 100% (for services such as chest x-ray) to 1% for heart transplant service. When compared to the subset of 12 services also collected in the AHA survey, a high percentage of agreement (≥80%) was noted for 10/16 (63%) services (such as a dedicated ED, general CT, coronary angiography, PCI, ICU, pharmacist and physio/OT services). Moderate agreement was seen for one service (coronary care unit), and 5/16 (31%) services showed low agreement (≤50%) (EP testing, inpatient cardiac surgical services, inpatient cardiac rehabilitation, transplant unit, and social worker). Conclusion: It is feasible to use claims data to determine in-hospital AMI services, but the accuracy of the method needs to be investigated further for certain services that have a low degree of agreement in our analysis.

scholarly journals Disparities by sex in P2Y12 inhibitor therapy duration, or differences in the balance of ischaemic-benefit and bleeding-risk clinical outcomes in older women versus comparable men following acute myocardial infarction? A P2Y12 inhibitor new user retrospective cohort analysis of US Medicare claims data

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050236
Author(s):  
Ryan P Hickson ◽  
Anna M Kucharska-Newton ◽  
Jo E Rodgers ◽  
Betsy L Sleath ◽  
Gang Fang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Older Women ◽  
Retrospective Cohort ◽  
Claims Data ◽  
Cohort Analysis ◽  
Inhibitor Therapy ◽  
Secondary Outcome ◽  
Administrative Claims ◽  
P2y12 Inhibitor

ObjectivesTo determine if comparable older women and men received different durations of P2Y12 inhibitor therapy following acute myocardial infarction (AMI) and if therapy duration differences were justified by differences in ischaemic benefits and/or bleeding risks.DesignRetrospective cohort.Setting20% sample of 2007–2015 US Medicare fee-for-service administrative claims data.Participants≥66-year-old P2Y12 inhibitor new users following 2008–2013 AMI hospitalisation (N=30 613). Older women compared to older men with similar predicted risks of study outcomes.Primary and secondary outcome measuresPrimary outcome: P2Y12 inhibitor duration (modelled as risk of therapy discontinuation). Secondary outcomes: clinical events while on P2Y12 inhibitor therapy, including (1) death/hospice admission, (2) composite of ischaemic events (AMI/stroke/revascularisation) and (3) hospitalised bleeds. Cause-specific risks and relative risks (RRs) estimated using Aalen-Johansen cumulative incidence curves and bootstrapped 95% CIs.Results10 486 women matched to 10 486 men with comparable predicted risks of all 4 study outcomes. No difference in treatment discontinuation was observed at 12 months (women 31.2% risk; men 30.9% risk; RR 1.01; 95% CI 0.97 to 1.05), but women were more likely than men to discontinue therapy at 24 months (54.4% and 52.9% risk, respectively; RR 1.03; 95% CI 1.00 to 1.05). Among patients who did not discontinue P2Y12 inhibitor therapy, women had lower 24-month risks of ischaemic outcomes than men (13.1% and 14.7%, respectively; RR 0.90; 95% CI 0.84 to 0.96), potentially lower 24-month risks of death/hospice admission (5.0% and 5.5%, respectively; RR 0.91; 95% CI 0.82 to 1.02), but women and men both had 2.5% 24-month bleeding risks (RR 0.98; 95% CI 0.82 to 1.14).ConclusionsRisks for death/hospice and ischaemic events were lower among women still taking a P2Y12 inhibitor than comparable men, with no difference in bleeding risks. Shorter P2Y12 inhibitor durations in older women than comparable men observed between 12 and 24 months post-AMI may reflect a disparity that is not justified by differences in clinical need.

scholarly journals Characterization of bariatric surgery and outcomes using administrative claims data in the research network of a nationwide commercial health plan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qinli Ma ◽  
Michael Mack ◽  
Sonali Shambhu ◽  
Kathleen McTigue ◽  
Kevin Haynes
Keyword(s):  
Bariatric Surgery ◽  
Health Systems ◽  
Comparative Effectiveness ◽  
Claims Data ◽  
Research Network ◽  
Hospital Death ◽  
Administrative Claims ◽  
Administrative Claims Data ◽  
Abdominal Operations

Abstract Background The supplementation of electronic health records data with administrative claims data may be used to capture outcome events more comprehensively in longitudinal observational studies. This study investigated the utility of administrative claims data to identify outcomes across health systems using a comparative effectiveness study of different types of bariatric surgery as a model. Methods This observational cohort study identified patients who had bariatric surgery between 2007 and 2015 within the HealthCore Anthem Research Network (HCARN) database in the National Patient-Centered Clinical Research Network (PCORnet) common data model. Patients whose procedures were performed in a member facility affiliated with PCORnet Clinical Research Networks (CRNs) were selected. The outcomes included a 30-day composite adverse event (including venous thromboembolism, percutaneous/operative intervention, failure to discharge and death), and all-cause hospitalization, abdominal operation or intervention, and in-hospital death up to 5 years after the procedure. Outcomes were classified as occurring within or outside PCORnet CRN health systems using facility identifiers. Results We identified 4899 patients who had bariatric surgery in one of the PCORnet CRN health systems. For 30-day composite adverse event, the inclusion of HCARN multi-site claims data marginally increased the incidence rate based only on HCARN single-site claims data for PCORnet CRNs from 3.9 to 4.2%. During the 5-year follow-up period, 56.8% of all-cause hospitalizations, 31.2% abdominal operations or interventions, and 32.3% of in-hospital deaths occurred outside PCORnet CRNs. Incidence rates (events per 100 patient-years) were significantly lower when based on claims from a single PCORnet CRN only compared to using claims from all health systems in the HCARN: all-cause hospitalization, 11.0 (95% Confidence Internal [CI]: 10.4, 11.6) to 25.3 (95% CI: 24.4, 26.3); abdominal operations or interventions, 4.2 (95% CI: 3.9, 4.6) to 6.1 (95% CI: 5.7, 6.6); in-hospital death, 0.2 (95% CI: 0.11, 0.27) to 0.3 (95% CI: 0.19, 0.38). Conclusions Short-term inclusion of multi-site claims data only marginally increased the incidence rate computed from single-site claims data alone. Longer-term follow up captured a notable number of events outside of PCORnet CRNs. The findings suggest that supplementing claims data improves the outcome ascertainment in longitudinal observational comparative effectiveness studies.

scholarly journals Attribution of Adverse Events Following Coronary Stent Placement Identified Using Administrative Claims Data

2020 ◽  
Vol 9 (4) ◽  
Author(s):  
Sanket S. Dhruva ◽  
Craig S. Parzynski ◽  
Ginger M. Gamble ◽  
Jeptha P. Curtis ◽  
Nihar R. Desai ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stent Placement ◽  
Claims Data ◽  
Coronary Stent ◽  
Administrative Claims ◽  
Administrative Claims Data

Validation of diabetes case definitions using administrative claims data

2011 ◽  
Vol 28 (4) ◽  
pp. 424-427 ◽  
Author(s):  
S. Amed ◽  
S. E. Vanderloo ◽  
D. Metzger ◽  
J.-P. Collet ◽  
K. Reimer ◽  
...  
Keyword(s):  
Claims Data ◽  
Administrative Claims ◽  
Case Definitions ◽  
Administrative Claims Data ◽  
Diabetes Case

Abstract MP74: It's Not Too Late to Improve Adherence: Association Between All-Cause Mortality and Statin Adherence Change After Acute Myocardial Infarction

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Ryan P Hickson ◽  
Jennifer G Robinson ◽  
Izabela E Annis ◽  
Ley A Killeya-Jones ◽  
Gang Fang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Proportional Hazards Model ◽  
Reference Group ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Administrative Claims ◽  
Post Discharge ◽  
All Cause Mortality ◽  
Statin Adherence

Introduction: Hospitalization for acute myocardial infarction (AMI) affects medication adherence in prevalent statin users. Our objective was to estimate the association between changes in statin adherence and all-cause mortality after AMI discharge. Hypothesis: Patients who are adherent both pre- and post-AMI have the lowest risk of all-cause mortality. Methods: Medicare administrative claims were used to identify AMI hospitalizations in 2008-2010. Patients were ≥66 years old, continuously enrolled ≥360 days pre-AMI with a statin prescription claim, discharged to home/self-care, and survived ≥180 days post-AMI with continuous enrollment. Statin adherence was measured in the 180 days pre- and post-AMI hospitalization using proportion of days covered and categorized as severely nonadherent, moderately nonadherent, and adherent. The exposure was categorical change in statin adherence from pre- to post-AMI (9 categories, see Figure); adherent/adherent was the reference group. Patients were followed for all-cause mortality from 180 days post-discharge for up to 18 months. A multivariable Cox proportional hazards model estimated hazard ratios (HRs). Results: Of 101,011 eligible patients, 15% decreased, 20% increased, and 64% did not change statin adherence categories. Compared to patients who were adherent pre- and post-AMI, the adjusted HR (95% confidence intervals [CIs]) for patients who increased from severely nonadherent to adherent was 0.93 (95% CI: 0.85-1.02); other increases in adherence had similar HRs (see Figure). Compared to patients who were adherent pre- and post-AMI, the adjusted HR for patients who decreased from adherent to severely nonadherent was 1.22 (95% CI: 1.13-1.33); other decreases in adherence had similar HRs. Conclusions: Although patients with decreased statin adherence had the worst mortality outcomes, those with increased adherence had similar or better outcomes than continuously adherent patients, showing that, even after an AMI, it is not too late to improve statin adherence.

scholarly journals A risk-model for hospital mortality among patients with severe sepsis or septic shock based on German national administrative claims data

PLoS ONE ◽  
2018 ◽  
Vol 13 (3) ◽  
pp. e0194371 ◽  
Author(s):  
Daniel Schwarzkopf ◽  
Carolin Fleischmann-Struzek ◽  
Hendrik Rüddel ◽  
Konrad Reinhart ◽  
Daniel O. Thomas-Rüddel
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Claims Data ◽  
Risk Model ◽  
Administrative Claims ◽  
Administrative Claims Data
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