Breast cancer incidence using administrative data: correction with sensitivity and specificity.

OBJECTIVE: To estimate breast cancer incidence in the general population using a method that corrects for lack of sensitivity and specificity in the identification of incident breast cancer in inpatient claims data. STUDY DESIGN AND SETTINGS: Two-phase study: phase 1 to identify incident cases in claims data, and phase 2 to estimate sensitivity and specificity in a subset of the population. Two algorithms (1: principal diagnosis; 2: principal diagnosis+specific surgery procedures) were used to identify incident cases in claims of women aged 20 years or older, living in a French district covered by a cancer registry. Sensitivity and specificity were estimated in one district and used to correct incident cases identified. RESULTS: The sensitivity and specificity for algorithms 1 and 2 were 69.0% and 99.89%, and 64.4% and 99.93%, respectively. In contrast to specificity, the sensitivity for both algorithms was lower for women younger than 40 years and older than 65 years. Cases reported by cancer registries were closer to cases identified with algorithm 2 (-3.2% to +20.1%) and to corrected numbers with algorithm 1 (-1% to +15%). CONCLUSION: To obtain reliable estimates of breast cancer incidence in the general population, sensitivity and specificity, which reflect medical and coding practice variations, are necessary.

[Management of acute community-acquired pneumonia in a health centre. Assessment of 101 cases using the retrospective clinical audit method]. / Prise en charge des pneumonies aiguës communautaires en établissement de santé. Evaluation de 101 cas par la méthode d'audit clinicque rétrospectif.

OBJECTIVE: To assess the conformity of practitioners' practices in the management of community acquired pneumonia with the French Agence Nationale d'Accréditation et d'Evaluation en Santé (Anaes) guidelines. METHODS: We retrospectively reviewed a random sample of 210 medical records which included a principal or associated diagnosis of pneumonia in a French university hospital. RESULTS: A hundred and one medical records were assessable. Sixty-two patients were high risk (Pneumonia Severity Index class IV or V of the prediction rule of Fine et al.), and 10 patients were admitted into an intensive care unit. The overall in-hospital mortality was 14 patients [8-22]. The level of care was appropriate according to the guidelines in 40 cases ([30-50)]. Seven patients did not require hospitalisation, 31 patients required admission into a medical department, 56 patients into an intensive care unit and 7 patients were managed in non specified conditions. Eighteen patients ([11-27]) had appropriate microbiologic investigations. Forty-three patients (([33-53]) received antibiotics within 8 hours of arrival. Empirical antibiotic treatment (dosage and molecule) was appropriate in 38 patients ([28-48]). There was no significant relationship between compliance with the guidelines and in-hospital mortality. CONCLUSION: The rate of conformity of practitioners' practices with the Anaes guidelines for management of community-acquired pneumonia is low in our hospital. It could be improved by active implementation of these guidelines.