Validity of claims-based stroke algorithms in contemporary Medicare data: reasons for geographic and racial differences in stroke (REGARDS) study linked with medicare claims. Academic Article Article uri icon

Overview

MeSH

  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Reproducibility of Results
  • Retrospective Studies
  • United States

MeSH Major

  • Algorithms
  • Continental Population Groups
  • Fee-for-Service Plans
  • Insurance Claim Review
  • Medical Records
  • Medicare
  • Stroke

abstract

  • The accuracy of stroke diagnosis in administrative claims for a contemporary population of Medicare enrollees has not been studied. We assessed the validity of diagnostic coding algorithms for identifying stroke in the Medicare population by linking data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study to Medicare claims. The REGARDS Study enrolled 30 239 participants ≥45 years in the United States between 2003 and 2007. Stroke experts adjudicated suspected strokes, using retrieved medical records. We linked data for participants enrolled in fee-for-service Medicare to claims files from 2003 through 2009. Using adjudicated strokes as the gold standard, we calculated accuracy measures for algorithms to identify incident and recurrent strokes. We linked data for 15 089 participants, among whom 422 participants had adjudicated strokes during follow-up. An algorithm using primary discharge diagnosis codes for acute ischemic or hemorrhagic stroke (International Classification of Diseases, Ninth Revision, Clinical Modification codes: 430, 431, 433.x1, 434.x1, 436) had a positive predictive value of 92.6% (95% confidence interval, 88.8%-96.4%), a specificity of 99.8% (99.6%-99.9%), and a sensitivity of 59.5% (53.8%-65.1%). An algorithm using only acute ischemic stroke codes (433.x1, 434.x1, 436) had a positive predictive value of 91.1% (95% confidence interval, 86.6%-95.5%), a specificity of 99.8% (99.7%-99.9%), and a sensitivity of 58.6% (52.4%-64.7%). Claims-based algorithms to identify stroke in a contemporary Medicare cohort had high positive predictive value and specificity, supporting their use as outcomes for etiologic and comparative effectiveness studies in similar populations. These inpatient algorithms are unsuitable for estimating stroke incidence because of low sensitivity. © 2014 American Heart Association, Inc.

publication date

  • July 2014

has subject area

  • Aged
  • Algorithms
  • Continental Population Groups
  • Fee-for-Service Plans
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Insurance Claim Review
  • Male
  • Medical Records
  • Medicare
  • Reproducibility of Results
  • Retrospective Studies
  • Stroke
  • United States

Research

keywords

  • Journal Article
  • Multicenter Study

Identity

Language

  • eng

PubMed Central ID

  • PMC4109622

Digital Object Identifier (DOI)

  • 10.1161/CIRCOUTCOMES.113.000743

PubMed ID

  • 24963021

Additional Document Info

start page

  • 611

end page

  • 619

volume

  • 7

number

  • 4