Validation of comorbid conditions on the end-stage renal disease medical evidence report: The CHOICE study

Since 1995, the Medical Evidence Report for endstage renal disease (Form 27 28) has been used nationally to collect information on comorbid conditions. To date, these data have not been validated. A national cross-sectional st udy of 1005 incident dialysis patients (734 hemodialysis and 271 peritoneal dialysis) enrolled between October 1995 and June 1998 was conducted using clinical data to validate 17 comorbid conditions on Form 2728. Sensitivity and specificity were calculated for each condition. The relationship betwee n patient characteristics and sensitivity was assessed in multivariate anal ysis. Sensitivity was fairly high (0.67 to 0.83) for HIV disease, diabetes, and hypertension; intermediate (0.40 to 0.52) for peripheral vascular dise ase, neoplasm, myocardial infarction, cerebrovascular disease, coronary art ery disease, cardiac arrest, and congestive heart failure; and poor (<0.36) for dysrhythmia, ambulation status, pericarditis, chronic obstructive pulm onary disease, and smoking. Sensitivity did not change significantly over c alendar time. The sensitivity of Form 2728 averaged across all 17 condition s was 0.59 (95% confidence interval, 0.43 to 0.75). The average sensitivity was 0.10 greater in peritoneal dialysis than hemodialysis patients, 0.11 g reater in diabetic patients than nondiabetic patients, and 0.04 less with e ach added comorbid condition. The specificity was very good for hypertensio n (0.91) and excellent (>0.95) for the other 16 conditions. Comorbid condit ions are significantly underreported on Form 2728, but diagnoses are not fa lsely attributed to patients. Scientific research, quality of care comparis ons, and payment policies that use Form 2728 data should take into account these limitations. Considerable effort should be expended to improve Form 2 728 coding if it is to provide accurate estimates of total disease burden i n end-stage renal disease patients.