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Identification of Heart Failure Events in Medicare Claims: The Atherosclerosis Risk in Communities (ARIC) Study.

TitleIdentification of Heart Failure Events in Medicare Claims: The Atherosclerosis Risk in Communities (ARIC) Study.
Publication TypeJournal Article
Year of Publication2016
AuthorsKucharska-Newton AMaria, Heiss G, Ni H, Stearns SC, Puccinelli-Ortega N, Wruck LM
Secondary AuthorsChambless L
JournalJ Card Fail
Date Published2016 Jan
KeywordsAcute Disease, Administrative Claims, Healthcare, Aged, Atherosclerosis, Chronic Disease, Clinical Coding, Female, Heart Failure, Humans, Longitudinal Studies, Male, Medicare, Middle Aged, Patient Discharge, Prospective Studies, Residence Characteristics, United States

BACKGROUND: We examined the accuracy of Medicare heart failure (HF) diagnostic codes in the identification of acute decompensated (ADHF and chronic stable (CSHF) HF.

METHODS AND RESULTS: Hospitalizations were identified from medical discharge records for Atherosclerosis Risk in Communities (ARIC) study participants with linked Medicare Provider Analysis and Review (MedPAR) files for the years 2005-2009. The ARIC study classification of ADHF and CSHF, based on adjudicated review of medical records, was considered to be the criterion standard. A total 8,239 ARIC medical records and MedPAR records meeting fee-for-service (FFS) criteria matched on unique participant ID and date of discharge (68.5% match). Agreement between HF diagnostic codes from the 2 data sources found in the matched records for codes in any position (κ > 0.9) was attenuated for primary diagnostic codes (κ

CONCLUSION: Matching of hospitalizations from Medicare claims with those obtained from abstracted medical records is incomplete, even for hospitalizations meeting FFS criteria. Within matched records, HF diagnostic codes from Medicare show excellent agreement with HF diagnostic codes obtained from medical record abstraction. The Medicare data may, however, overestimate the occurrence of hospitalized ADHF or CSHF.

Alternate JournalJ Card Fail
PubMed ID26211720
PubMed Central IDPMC4706484
Grant ListHHSN268201100009 C / / PHS HHS / United States
HHSN268201100010 C / / PHS HHS / United States
N01 HC055018 / HC / NHLBI NIH HHS / United States
HHSN268201100006 C / / PHS HHS / United States
HHSN268201100011 C / / PHS HHS / United States
HHSN268201100007 C / / PHS HHS / United States
HHSN268201100008 C / / PHS HHS / United States
HHSN268201100005 C / / PHS HHS / United States
HHSN268201100012 C / / PHS HHS / United States