Can cardiovascular clinical characteristics be identified and outcome models be developed from an in-patient claims database?

The objective of this study was to assess whether administrative (claims) d atabases can be used to assess clinical variables and predict outcome. Alth ough administrative databases ore useful for assessing resource utilization , their utility for assessing clinical information is less certain. Prospec tively gathered clinical databases, however, are expensive and not widely a vailable. The UB92 formulation of the hospital bill was used as an administ rative source of data and compared with the clinical cardiovascular databas e at Emory University. The claims database was compared with the clinical d atabase for 11 variables. Outcome models were developed with multivariate m ethods. A total of 11,883 patients who underwent catheterization (5,255 und erwent percutaneous transluminal coronary angioplasty [PTCA] and 3,794 unde rwent coronary artery bypass surgery [CABG]) between 1991 and 1995 were inc luded. For some variables, the claims database correlated well (diabetes, s ensitivity 87%, specificity 99%), whereas for others the claims database wa s less accurate (peripheral vascular disease, sensitivity 20%, specificity 99%). Uncertain coding in the claims database, which can result in the same code being used for co-morbid states and severity of disease, as well as c omplications, limited the ability of claims to predict outcome. Clinical da tabases may also be limited by lack of objectivity and missing data. The ut ility of claims databases to assess severity of disease and co-morbid state s is limited, and outcome modeling and risk assessment from claims database s may be inappropriate and spurious. Developing better data standards and l ess expensive methods for acquisition of clinical data is necessary for imp roved outcome assessment. (C) 1999 by Excerpta Medica, Inc.