The full content of Annals is available to subscribers

Subscribe/Learn More  >
Medicine and Public Policy |

Discordance of Databases Designed for Claims Payment versus Clinical Information Systems: Implications for Outcomes Research

James G. Jollis, MD; Marek Ancukiewicz, PhD; Elizabeth R. DeLong, PhD; David B. Pryor, MD; Lawrence H. Muhlbaier, PhD; and Daniel B. Mark, MD, MPH
[+] Article, Author, and Disclosure Information

From Duke University Medical Center, Durham, North Carolina. Requests for Reprints: James G. Jollis, MD, Box 3254, Duke University Medical Center, Durham, NC 27710. Grant Support: By grants HS-06503 and HS-05635 from the Agency for Health Care Policy and Research; grant HL-17670 from the National Heart, Lung, and Blood Institute; and a grant from the Robert Wood Johnson Foundation. Dr. Jollis was an American College of Cardiology Merck Research Fellow during the course of this research. Acknowledgments: The authors thank Patrick S. Romano, MD, MPH, and Leslie L. Roos, PhD, who designed the ICD-9-CM mapping system used in the Patient Outcomes Research Team for ischemic heart disease; the other members of the Patient Outcomes Research Team for ischemic heart disease for their comments on earlier versions of this work; and Lloyd Hedgpeth and his staff in the Duke Medical Center Information System for providing the insurance claims data for this study.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(8):844-850. doi:10.7326/0003-4819-119-8-199310150-00011
Text Size: A A A

Objective: To determine the suitability of insurance claims information for use in clinical outcomes research in ischemic heart disease.

Design: Concordance study of two databases.

Setting: Tertiary care referral center.

Patients: A total of 12 937 consecutive patients hospitalized for cardiac catheterization for suspected ischemic heart disease between July 1985 and May 1990.

Interventions: Two-by-two tables were used to compute overall and measures of agreement comparing clinical versus claims data for 12 important predictors of prognosis in patients with ischemic heart disease.

Measurements: Kappa statistics (agreement adjusted for chance agreement) were used to quantify agreement rates.

Results: Agreement rates between the clinical and claims databases ranged from 0.83 for the diagnosis of diabetes to 0.09 for the diagnosis of unstable angina ( values). Claims data failed to identify more than one half of the patients with prognostically important conditions, including mitral insufficiency, congestive heart failure, peripheral vascular disease, old myocardial infarction, hyperlipidemia, cerebrovascular disease, tobacco use, angina, and unstable angina, when compared with the clinical information system.

Conclusions: Our results suggest that insurance claims data lack important diagnostic and prognostic information when compared with concurrently collected clinical data in the study of ischemic heart disease. Thus, insurance claims data are not as useful as clinical data for identifying clinically relevant patient groups and for adjusting for risk in outcome studies, such as analyses of hospital mortality.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.