Clinical investigationsAccuracy of medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records☆
Section snippets
Study population
Medicare beneficiaries in Pennsylvania who were also enrolled in that state's Pharmaceutical Assistance Contract for the Elderly in 1999, 2000, or both formed the available source population. The Pharmaceutical Assistance Contract for the Elderly is a state-run pharmacy benefits program that pays for medications for low-income elderly residents (annual gross income ≤$14,000 if single or $17,200 if married). The target population for this study were all hospitalization episodes during 1999 or
Results
Of the 2200 records for hospital episodes requested, 2022 (91.9%) were retrieved and reviewed. Of the 2022 reviewed, 1874 hospitalization episodes met the primary claims-based definition of AMI aforementioned. We excluded 23 hospitalization episodes that had missing data for >2 of 3 reference standard criteria, leaving 1851 hospitalization episodes in the final study sample.
Baseline characteristics of subjects included in the sample of hospital records (n = 2022) and subjects whose hospital
Discussion
We examined the positive predictive value of discharge diagnosis codes for AMI in a sample of Medicare beneficiaries from Pennsylvania. The positive predictive value for the primary claims-based definition we tested was 94.1%. All alternative claims-based definitions tested had similarly high positive predictive values when tested in the population overall. Secondary analyses found that the positive predictive value was lower among subjects with a history of MI in the year before the index
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Supported by a research grant from Merck. Dr Solomon also receives grant support from National Institutes of Health (grants K23-AR48616 and R55-AR48264). Dr Cannuscio is an employee of Merck.