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Open Access Research article

Validation of a case definition to define chronic dialysis using outpatient administrative data

Fiona M Clement13, Matthew T James1234, Rick Chin13, Scott W Klarenbach5, Braden J Manns1234, Robert R Quinn1, Pietro Ravani1, Marcello Tonelli5, Brenda R Hemmelgarn1234* and the Alberta Kidney Disease Network

Author Affiliations

1 Department of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, T2N 1N4, Canada

2 Department of Community Health Sciences, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, T2N 1N4, Canada

3 Libin Cardiovascular Institute, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, T2N 1N4, Canada

4 Calgary Population and Public Health Institute, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, T2N 1N4, Canada

5 Department of Medicine, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton, Alberta, T6G 2R7, Canada

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BMC Medical Research Methodology 2011, 11:25  doi:10.1186/1471-2288-11-25

Published: 1 March 2011

Abstract

Background

Administrative health care databases offer an efficient and accessible, though as-yet unvalidated, approach to studying outcomes of patients with chronic kidney disease and end-stage renal disease (ESRD). The objective of this study is to determine the validity of outpatient physician billing derived algorithms for defining chronic dialysis compared to a reference standard ESRD registry.

Methods

A cohort of incident dialysis patients (Jan. 1 - Dec. 31, 2008) and prevalent chronic dialysis patients (Jan 1, 2008) was selected from a geographically inclusive ESRD registry and administrative database. Four administrative data definitions were considered: at least 1 outpatient claim, at least 2 outpatient claims, at least 2 outpatient claims at least 90 days apart, and continuous outpatient claims at least 90 days apart with no gap in claims greater than 21 days. Measures of agreement of the four administrative data definitions were compared to a reference standard (ESRD registry). Basic patient characteristics are compared between all 5 patient groups.

Results

1,118,097 individuals formed the overall population and 2,227 chronic dialysis patients were included in the ESRD registry. The three definitions requiring at least 2 outpatient claims resulted in kappa statistics between 0.60-0.80 indicating "substantial" agreement. "At least 1 outpatient claim" resulted in "excellent" agreement with a kappa statistic of 0.81.

Conclusions

Of the four definitions, the simplest (at least 1 outpatient claim) performed comparatively to other definitions. The limitations of this work are the billing codes used are developed in Canada, however, other countries use similar billing practices and thus the codes could easily be mapped to other systems. Our reference standard ESRD registry may not capture all dialysis patients resulting in some misclassification. The registry is linked to on-going care so this is likely to be minimal. The definition utilized will vary with the research objective.