Cargando…

Identification of volume overload hospitalizations among hemodialysis patients using administrative claims: a validation study

BACKGROUND: High rates of volume overload hospitalizations may indicate inadequate dialysis facility fluid management. Administrative claims databases are often used to study such outcomes, but these data are generated for billing purposes and may not capture clinical nuance. It is unknown if volume...

Descripción completa

Detalles Bibliográficos
Autores principales: Assimon, Magdalene M., Nguyen, Thuy, Katsanos, Suzanne L., Brunelli, Steven M., Flythe, Jennifer E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5105303/
https://www.ncbi.nlm.nih.gov/pubmed/27835958
http://dx.doi.org/10.1186/s12882-016-0384-6
_version_ 1782466877938728960
author Assimon, Magdalene M.
Nguyen, Thuy
Katsanos, Suzanne L.
Brunelli, Steven M.
Flythe, Jennifer E.
author_facet Assimon, Magdalene M.
Nguyen, Thuy
Katsanos, Suzanne L.
Brunelli, Steven M.
Flythe, Jennifer E.
author_sort Assimon, Magdalene M.
collection PubMed
description BACKGROUND: High rates of volume overload hospitalizations may indicate inadequate dialysis facility fluid management. Administrative claims databases are often used to study such outcomes, but these data are generated for billing purposes and may not capture clinical nuance. It is unknown if volume overload admissions can be correctly identified in administrative data and if a single claims-based definition for volume overload can be used across epidemiologic surveillance studies, observational studies of exposure-outcome associations and quality assessments. We conducted a validation study to assess the accuracy of claims-based definitions for volume overload hospitalizations among hemodialysis patients. METHODS: Data were taken from a random sample of 315 adult hemodialysis patients admitted to University of North Carolina Hospitals from January 2010 through June 2013. Standardized chart reviews were conducted to clinically adjudicate the presence or absence of volume overload at hospital admission. Claims-based definitions were constructed from varying combinations of fluid-related ICD-9 discharge diagnosis codes including fluid overload, pulmonary edema, pleural effusion, and heart failure. Using clinically adjudicated volume overload hospitalizations as the reference standard, validity metrics and their 95 % confidence intervals (CIs) were estimated for each definition. RESULTS: Of the 315 hospital admissions, 77 (24.4 %) were clinically adjudicated as volume overload hospitalizations. The prevalence of claims-identified volume overload admissions varied across definitions, ranging from 1.6 to 37.1 %. When definitions were constructed with discharge diagnosis codes present in any billing position, volume overload hospitalizations defined by fluid overload, pleural effusion or heart failure diagnosis codes had the highest sensitivity, 81.8 % (95 % CI: 71.4 %, 89.7 %). Volume overload hospitalizations defined by pulmonary edema diagnosis codes had the highest specificity, 98.3 % (95 % CI: 95.8 %, 99.5 %). Definitions constructed with discharge diagnosis codes present in any billing position (versus the primary position) captured more false positive events. CONCLUSIONS: Prevalence and validity estimates of volume overload hospitalizations vary across claims-based definitions. A universal claims-based definition for volume overload hospitalizations may not apply to all clinical and research scenarios. Investigators and regulators need to consider the implications of misclassifying events when evaluating and monitoring hemodialysis patient volume overload admissions with administrative data. Claims-based definitions should be selected accordingly. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0384-6) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-5105303
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-51053032016-11-14 Identification of volume overload hospitalizations among hemodialysis patients using administrative claims: a validation study Assimon, Magdalene M. Nguyen, Thuy Katsanos, Suzanne L. Brunelli, Steven M. Flythe, Jennifer E. BMC Nephrol Research Article BACKGROUND: High rates of volume overload hospitalizations may indicate inadequate dialysis facility fluid management. Administrative claims databases are often used to study such outcomes, but these data are generated for billing purposes and may not capture clinical nuance. It is unknown if volume overload admissions can be correctly identified in administrative data and if a single claims-based definition for volume overload can be used across epidemiologic surveillance studies, observational studies of exposure-outcome associations and quality assessments. We conducted a validation study to assess the accuracy of claims-based definitions for volume overload hospitalizations among hemodialysis patients. METHODS: Data were taken from a random sample of 315 adult hemodialysis patients admitted to University of North Carolina Hospitals from January 2010 through June 2013. Standardized chart reviews were conducted to clinically adjudicate the presence or absence of volume overload at hospital admission. Claims-based definitions were constructed from varying combinations of fluid-related ICD-9 discharge diagnosis codes including fluid overload, pulmonary edema, pleural effusion, and heart failure. Using clinically adjudicated volume overload hospitalizations as the reference standard, validity metrics and their 95 % confidence intervals (CIs) were estimated for each definition. RESULTS: Of the 315 hospital admissions, 77 (24.4 %) were clinically adjudicated as volume overload hospitalizations. The prevalence of claims-identified volume overload admissions varied across definitions, ranging from 1.6 to 37.1 %. When definitions were constructed with discharge diagnosis codes present in any billing position, volume overload hospitalizations defined by fluid overload, pleural effusion or heart failure diagnosis codes had the highest sensitivity, 81.8 % (95 % CI: 71.4 %, 89.7 %). Volume overload hospitalizations defined by pulmonary edema diagnosis codes had the highest specificity, 98.3 % (95 % CI: 95.8 %, 99.5 %). Definitions constructed with discharge diagnosis codes present in any billing position (versus the primary position) captured more false positive events. CONCLUSIONS: Prevalence and validity estimates of volume overload hospitalizations vary across claims-based definitions. A universal claims-based definition for volume overload hospitalizations may not apply to all clinical and research scenarios. Investigators and regulators need to consider the implications of misclassifying events when evaluating and monitoring hemodialysis patient volume overload admissions with administrative data. Claims-based definitions should be selected accordingly. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0384-6) contains supplementary material, which is available to authorized users. BioMed Central 2016-11-11 /pmc/articles/PMC5105303/ /pubmed/27835958 http://dx.doi.org/10.1186/s12882-016-0384-6 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Assimon, Magdalene M.
Nguyen, Thuy
Katsanos, Suzanne L.
Brunelli, Steven M.
Flythe, Jennifer E.
Identification of volume overload hospitalizations among hemodialysis patients using administrative claims: a validation study
title Identification of volume overload hospitalizations among hemodialysis patients using administrative claims: a validation study
title_full Identification of volume overload hospitalizations among hemodialysis patients using administrative claims: a validation study
title_fullStr Identification of volume overload hospitalizations among hemodialysis patients using administrative claims: a validation study
title_full_unstemmed Identification of volume overload hospitalizations among hemodialysis patients using administrative claims: a validation study
title_short Identification of volume overload hospitalizations among hemodialysis patients using administrative claims: a validation study
title_sort identification of volume overload hospitalizations among hemodialysis patients using administrative claims: a validation study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5105303/
https://www.ncbi.nlm.nih.gov/pubmed/27835958
http://dx.doi.org/10.1186/s12882-016-0384-6
work_keys_str_mv AT assimonmagdalenem identificationofvolumeoverloadhospitalizationsamonghemodialysispatientsusingadministrativeclaimsavalidationstudy
AT nguyenthuy identificationofvolumeoverloadhospitalizationsamonghemodialysispatientsusingadministrativeclaimsavalidationstudy
AT katsanossuzannel identificationofvolumeoverloadhospitalizationsamonghemodialysispatientsusingadministrativeclaimsavalidationstudy
AT brunellistevenm identificationofvolumeoverloadhospitalizationsamonghemodialysispatientsusingadministrativeclaimsavalidationstudy
AT flythejennifere identificationofvolumeoverloadhospitalizationsamonghemodialysispatientsusingadministrativeclaimsavalidationstudy