Identifying Medicare beneficiaries with dementia.
Medicare claims
dementia
dementia prevalence
electronic health record
validation
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
revised:
02
04
2021
received:
22
02
2021
accepted:
03
04
2021
pubmed:
27
4
2021
medline:
14
4
2022
entrez:
26
4
2021
Statut:
ppublish
Résumé
No data exist regarding the validity of International Classification of Disease (ICD)-10 dementia diagnoses against a clinician-adjudicated reference standard within Medicare claims data. We examined the accuracy of claims-based diagnoses with respect to expert clinician adjudication using a novel database with individual-level linkages between electronic health record (EHR) and claims. In this retrospective observational study, two neurologists and two psychiatrists performed a standardized review of patients' medical records from January 2016 to December 2018 and adjudicated dementia status. We measured the accuracy of three claims-based definitions of dementia against the reference standard. Mass-General-Brigham Healthcare (MGB), Massachusetts, USA. From an eligible population of 40,690 fee-for-service (FFS) Medicare beneficiaries, aged 65 years and older, within the MGB Accountable Care Organization (ACO), we generated a random sample of 1002 patients, stratified by the pretest likelihood of dementia using administrative surrogates. None. We evaluated the accuracy (area under receiver operating curve [AUROC]) and calibration (calibration-in-the-large [CITL] and calibration slope) of three ICD-10 claims-based definitions of dementia against clinician-adjudicated standards. We applied inverse probability weighting to reconstruct the eligible population and reported the mean and 95% confidence interval (95% CI) for all performance characteristics, using 10-fold cross-validation (CV). Beneficiaries had an average age of 75.3 years and were predominately female (59%) and non-Hispanic whites (93%). The adjudicated prevalence of dementia in the eligible population was 7%. The best-performing definition demonstrated excellent accuracy (CV-AUC 0.94; 95% CI 0.92-0.96) and was well-calibrated to the reference standard of clinician-adjudicated dementia (CV-CITL <0.001, CV-slope 0.97). This study is the first to validate ICD-10 diagnostic codes against a robust and replicable approach to dementia ascertainment, using a real-world clinical reference standard. The best performing definition includes diagnostic codes with strong face validity and outperforms an updated version of a previously validated ICD-9 definition of dementia.
Sections du résumé
BACKGROUND/OBJECTIVES
No data exist regarding the validity of International Classification of Disease (ICD)-10 dementia diagnoses against a clinician-adjudicated reference standard within Medicare claims data. We examined the accuracy of claims-based diagnoses with respect to expert clinician adjudication using a novel database with individual-level linkages between electronic health record (EHR) and claims.
DESIGN
In this retrospective observational study, two neurologists and two psychiatrists performed a standardized review of patients' medical records from January 2016 to December 2018 and adjudicated dementia status. We measured the accuracy of three claims-based definitions of dementia against the reference standard.
SETTING
Mass-General-Brigham Healthcare (MGB), Massachusetts, USA.
PARTICIPANTS
From an eligible population of 40,690 fee-for-service (FFS) Medicare beneficiaries, aged 65 years and older, within the MGB Accountable Care Organization (ACO), we generated a random sample of 1002 patients, stratified by the pretest likelihood of dementia using administrative surrogates.
INTERVENTION
None.
MEASUREMENTS
We evaluated the accuracy (area under receiver operating curve [AUROC]) and calibration (calibration-in-the-large [CITL] and calibration slope) of three ICD-10 claims-based definitions of dementia against clinician-adjudicated standards. We applied inverse probability weighting to reconstruct the eligible population and reported the mean and 95% confidence interval (95% CI) for all performance characteristics, using 10-fold cross-validation (CV).
RESULTS
Beneficiaries had an average age of 75.3 years and were predominately female (59%) and non-Hispanic whites (93%). The adjudicated prevalence of dementia in the eligible population was 7%. The best-performing definition demonstrated excellent accuracy (CV-AUC 0.94; 95% CI 0.92-0.96) and was well-calibrated to the reference standard of clinician-adjudicated dementia (CV-CITL <0.001, CV-slope 0.97).
CONCLUSION
This study is the first to validate ICD-10 diagnostic codes against a robust and replicable approach to dementia ascertainment, using a real-world clinical reference standard. The best performing definition includes diagnostic codes with strong face validity and outperforms an updated version of a previously validated ICD-9 definition of dementia.
Identifiants
pubmed: 33901296
doi: 10.1111/jgs.17183
pmc: PMC8373730
mid: NIHMS1704529
doi:
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2240-2251Subventions
Organisme : NIA NIH HHS
ID : NIH-NIA 5K08AG053380-02
Pays : United States
Organisme : NINDS NIH HHS
ID : NIH-NINDS K23NS114201
Pays : United States
Organisme : NIA NIH HHS
ID : P01 AG032952
Pays : United States
Organisme : NLM NIH HHS
ID : NLM T15 LM007092
Pays : United States
Organisme : NIA NIH HHS
ID : NIH-NIA 2P01AG032952-11
Pays : United States
Organisme : NIA NIH HHS
ID : U01 AG076478
Pays : United States
Organisme : NIA NIH HHS
ID : K08 AG053380
Pays : United States
Organisme : NIA NIH HHS
ID : NIH-NIA 5R01AG062282-02
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG062282
Pays : United States
Informations de copyright
© 2021 The American Geriatrics Society.
Références
Alzheimers Dement. 2020 Mar;16(3):531-540
pubmed: 31859230
Epidemiology. 2019 Mar;30(2):291-302
pubmed: 30461528
Biochem Med (Zagreb). 2012;22(3):276-82
pubmed: 23092060
JAMA Netw Open. 2020 Mar 2;3(3):e201809
pubmed: 32227181
N Engl J Med. 2018 Jun 7;378(23):2153-2155
pubmed: 29874539
Alzheimers Dement. 2011 May;7(3):270-9
pubmed: 21514249
Alzheimers Dement (N Y). 2019 Jun 06;5:197-207
pubmed: 31198838
N Engl J Med. 2013 Apr 4;368(14):1326-34
pubmed: 23550670
J Popul Ageing. 2015 Mar;8(1-2):101-112
pubmed: 25926904
Health Serv Res. 2008 Feb;43(1 Pt 1):313-26
pubmed: 18211532
J Clin Epidemiol. 2002 Sep;55(9):929-37
pubmed: 12393082
J Neurol Neurosurg Psychiatry. 2002 Oct;73(4):385-9
pubmed: 12235304
Med Care. 2019 Apr;57(4):318-324
pubmed: 30762723
J Alzheimers Dis. 2009;17(4):807-15
pubmed: 19542620
Neurology. 2009 Nov 24;73(21):1738-45
pubmed: 19933974
Neurology. 2014 Jan 28;82(4):317-25
pubmed: 24353333
Health Aff (Millwood). 2014 Apr;33(4):683-90
pubmed: 24711331
BMC Med Inform Decis Mak. 2017 Jul 19;17(1):110
pubmed: 28724366
J Gerontol B Psychol Sci Soc Sci. 1997 May;52 Spec No:37-48
pubmed: 9215356
Acta Psychiatr Scand. 2009 Apr;119(4):252-65
pubmed: 19236314
Alzheimers Dement. 2011 May;7(3):263-9
pubmed: 21514250
Alzheimers Dement. 2020 Oct 8;:
pubmed: 33090695
Alzheimers Dement. 2011 Jan;7(1):94-109
pubmed: 21255747