Sensitivity of billing claims for cardiovascular disease events among kidney transplant recipients.

Full Abstract

BACKGROUND AND OBJECTIVES: Billing claims are increasingly examined beyond administrative functions as outcomes measures in observational research. Few studies have described the performance of billing claims as surrogate measures of clinical events among kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We investigated the sensitivity of Medicare billing claims for clinically verified cardiovascular diagnoses (five categories) and procedures (four categories) in a novel database linking Medicare claims to electronic medical records of one transplant program. Cardiovascular events identified in medical records for 571 Medicare-insured transplant recipients in 1991 through 2002 served as reference measures. RESULTS: Within a claims-ascertainment period spanning +/-30 d of clinically recorded dates, aggregate sensitivity of single claims was higher for case definitions incorporating Medicare Parts A and B for diagnoses and procedures (90.9%) compared with either Part A (82.3%) or Part B (84.6%) alone. Perfect capture of the four procedures was possible within +/-30 d or with short claims window expansion, but sensitivity for the diagnoses trended lower with all study algorithms (91.2% with window up to +/-90 d). Requirement for additional confirmatory diagnosis claims did not appreciably reduce sensitivity. Sensitivity patterns were similar in the early compared with late periods of the study. CONCLUSIONS: Combined use of Medicare Parts A and B billing claims composes a sensitive measure of cardiovascular events after kidney transplant. Further research is needed to define algorithms that maximize specificity as well as sensitivity of claims from Medicare and other insurers as research measures in this population.

Author information

Author/s: Lentine, Krista L (KL); Schnitzler, Mark A (MA); Abbott, Kevin C (KC); Bramesfeld, Kosha (K); Buchanan, Paula M (PM); Brennan, Daniel C (DC);

Affiliation: Center for Outcomes Research and Division of Nephrology, School of Medicine, Saint Louis University, St. Louis, MO 63104, USA. lentine.krista(-atsign-)stanfordalumni.org

Grants: K08DK073036 (Agency:NIDDK NIH HHS) ; P30DK079333 (Agency:NIDDK NIH HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural

Journal: Clinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol), published in United States. (Language: eng)

Reference: 2009-Jul; vol 4 (issue 7) : pp 1213-21

Dates: Created 2009/07/07; Completed 2009/09/23;

PMID: 19541817, status: MEDLINE (last retrieval date: 9/23/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Clin J Am Soc Nephrol. 2009 Jul;4(7):1156-8. (PMID: 19541811)

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