Development of an algorithm to identify preoperative medical consultations using administrative data.
Med Care
; 47(12): 1258-64, 2009 Dec.
Article
em En
| MEDLINE
| ID: mdl-19890221
ABSTRACT
BACKGROUND:
Preoperative consultation by internal medicine specialists may help improve the care of patients undergoing major surgery. Population-based administrative data are an efficient approach for studying these consultations at a population-level. However, administrative data in many jurisdictions lack specific codes to identify preoperative medical consultations, as opposed to consultations for nonoperative indications.OBJECTIVE:
To develop an accurate claims-based algorithm for identifying preoperative medical consultations before major elective noncardiac surgery. RESEARCHDESIGN:
We conducted a multicenter cross-sectional study in Ontario, Canada. Preoperative medical consultations identified by medical record abstraction were compared with those identified by linked administrative data (physician service claims, hospital discharge abstracts).SUBJECTS:
We randomly selected 606 individuals, aged older than 40 years, who underwent elective intermediate-to-high-risk noncardiac surgery at 8 randomly selected hospitals between April 1, 2002 and March 31, 2004.RESULTS:
Medical record abstraction identified preoperative medical consultations in 317 patients (52%). The optimal claims-based algorithm for identifying these consultations was a physician service claim for a consultation by a cardiologist, general internist, endocrinologist, geriatrician, or nephrologist within 4 months before the index surgical procedure. This algorithm had a sensitivity of 90% (95% confidence interval [CI] 86-93), specificity of 92% (95% CI 88-95), positive predictive value of 93% (95% CI 89-95), and negative predictive value of 90% (95% CI 86-93).CONCLUSIONS:
A simple claims-based algorithm can accurately identify preoperative medical consultations before major elective noncardiac surgery. This algorithm may help enhance population-based evaluations of preoperative care, provided that the requisite linked administrative healthcare data are present.
Texto completo:
1
Temas:
ECOS
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Aspectos_gerais
Bases de dados:
MEDLINE
Assunto principal:
Encaminhamento e Consulta
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Revisão da Utilização de Seguros
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Algoritmos
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Período Pré-Operatório
Tipo de estudo:
Clinical_trials
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Observational_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
Idioma:
En
Revista:
Med Care
Ano de publicação:
2009
Tipo de documento:
Article
País de afiliação:
Canadá