Paul Komenda1, Nancy Yu2, Stella Leung2, Keevin Bernstein3, James Blanchard4, Manish Sood5, Claudio Rigatto1, Navdeep Tangri6. 1. Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Man. ; Seven Oaks General Hospital, Winnipeg, Man. 2. Department of Community Health Sciences, University of Manitoba, Winnipeg, Man. 3. Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Man. ; Health Sciences Centre, Winnipeg, Man. 4. Seven Oaks General Hospital, Winnipeg, Man. 5. Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Man. ; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont. 6. Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Man. ; Seven Oaks General Hospital, Winnipeg, Man. ; Department of Community Health Sciences, University of Manitoba, Winnipeg, Man.
Abstract
INTRODUCTION: End-stage renal disease (ESRD) is a major public health problem with increasing prevalence and costs. An understanding of the long-term trends in dialysis rates and outcomes can help inform health policy. We determined the optimal case definition for the diagnosis of ESRD using administrative claims data in the province of Manitoba over a 7-year period. METHODS: We determined the sensitivity, specificity, predictive value and overall accuracy of 4 administrative case definitions for the diagnosis of ESRD requiring chronic dialysis over different time horizons from Jan. 1, 2004, to Mar. 31, 2011. The Manitoba Renal Program Database served as the gold standard for confirming dialysis status. RESULTS: During the study period, 2562 patients were registered as recipients of chronic dialysis in the Manitoba Renal Program Database. Over a 1-year period (2010), the optimal case definition was any 2 claims for outpatient dialysis, and it was 74.6% sensitive (95% confidence interval [CI] 72.3%-76.9%) and 94.4% specific (95% CI 93.6%-95.2%) for the diagnosis of ESRD. In contrast, a case definition of at least 2 claims for dialysis treatment more than 90 days apart was 64.8% sensitive (95% CI 62.2%-67.3%) and 97.1% specific (95% CI 96.5%-97.7%). Extending the period to 5 years greatly improved sensitivity for all case definitions, with minimal change to specificity; for example, for the optimal case definition of any 2 claims for dialysis treatment, sensitivity increased to 86.0% (95% CI 84.7%-87.4%) at 5 years. CONCLUSION: Accurate case definitions for the diagnosis of ESRD requiring dialysis can be derived from administrative claims data. The optimal definition required any 2 claims for outpatient dialysis. Extending the claims period to 5 years greatly improved sensitivity with minimal effects on specificity for all case definitions.
INTRODUCTION:End-stage renal disease (ESRD) is a major public health problem with increasing prevalence and costs. An understanding of the long-term trends in dialysis rates and outcomes can help inform health policy. We determined the optimal case definition for the diagnosis of ESRD using administrative claims data in the province of Manitoba over a 7-year period. METHODS: We determined the sensitivity, specificity, predictive value and overall accuracy of 4 administrative case definitions for the diagnosis of ESRD requiring chronic dialysis over different time horizons from Jan. 1, 2004, to Mar. 31, 2011. The Manitoba Renal Program Database served as the gold standard for confirming dialysis status. RESULTS: During the study period, 2562 patients were registered as recipients of chronic dialysis in the Manitoba Renal Program Database. Over a 1-year period (2010), the optimal case definition was any 2 claims for outpatient dialysis, and it was 74.6% sensitive (95% confidence interval [CI] 72.3%-76.9%) and 94.4% specific (95% CI 93.6%-95.2%) for the diagnosis of ESRD. In contrast, a case definition of at least 2 claims for dialysis treatment more than 90 days apart was 64.8% sensitive (95% CI 62.2%-67.3%) and 97.1% specific (95% CI 96.5%-97.7%). Extending the period to 5 years greatly improved sensitivity for all case definitions, with minimal change to specificity; for example, for the optimal case definition of any 2 claims for dialysis treatment, sensitivity increased to 86.0% (95% CI 84.7%-87.4%) at 5 years. CONCLUSION: Accurate case definitions for the diagnosis of ESRD requiring dialysis can be derived from administrative claims data. The optimal definition required any 2 claims for outpatient dialysis. Extending the claims period to 5 years greatly improved sensitivity with minimal effects on specificity for all case definitions.
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