Quality of care in surgical/interventional vascular medicine: what can routinely collected data from the insurance companies achieve?

Peters, Frederik; Kreutzburg, Thea; Kuchenbecker, J; Marschall, Ursula; Remmel, Marko; Dankhoff, Mark; Trute, Hans-Heinrich; Repgen, Tilman; Debus, Eike Sebastian; Behrendt, Christian‐Alexander

doi:10.1007/s00772-020-00679-4

Cited by 14 publications

(6 citation statements)

References 59 publications

(57 reference statements)

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“…Indeed, health insurance claims are primarily collected for the reimbursement and administration of medical care. However, they are universally used to monitor healthcare services and quality improvement [16]. There is growing data of their good internal and external validity, especially regarding outcomes with major health impacts [42].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, comprehensive information on pharmacological treatments is available in the same database. The BARMER cohort includes nationally generalizable data with comparable sex and age distributions to the entire German population and has been widely used for cardiovascular research [16]. The database contains longitudinal information for each person, including date of birth, start and end of insurance episodes, and date of death, through to 31 December 2019.…”

Section: Barmer Cohortmentioning

confidence: 99%

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Sex Disparities in Long-Term Mortality after Paclitaxel Exposure in Patients with Peripheral Artery Disease: A Nationwide Claims-Based Cohort Study

Behrendt

Sedrakyan

Κατσάνος

et al. 2021

JCM

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Background: Randomized controlled trials have reported excess mortality in patients treated with paclitaxel-coated devices versus uncoated devices, while observational studies have reported the opposite. This study aims to determine the underlying factors and cohort differences that may explain these opposite results, with specific focus on sex differences in treatment and outcomes. Methods: Multicenter health insurance claims data from a large insurance fund, BARMER, were studied. A homogeneous sample of patients with an index of endovascular revascularization for symptomatic peripheral arterial occlusive disease between 2013 and 2017 was included. Adjusted logistic regression and Cox regression models were used to determine the factors predicting allocation to paclitaxel-coated devices and sex-specific 5-year all-cause mortality, respectively. Results: In total, 13,204 patients (54% females, mean age 74 ± 11 years) were followed for a median of 3.5 years. Females were older (77 vs. 71 years), and had less frequent coronary artery disease (23% vs. 33%), dyslipidemia (44% vs. 50%), and diabetes (29% vs. 41%), as well as being less likely to have a history of smoking (10% vs. 15%) compared with males. Mortality differences were mostly attributable to the female subgroup who were revascularized above the knee (hazard ratio, HR 0.78, 95% CI: 0.64–0.95), while no statistically significant differences were observed in males. Conclusions: This study found that females treated above the knee benefited from paclitaxel-coated devices, while no differences were found in males. Ongoing and future registries and trials should take sex disparities into account.

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Section: Discussionmentioning

confidence: 99%

Section: Barmer Cohortmentioning

confidence: 99%

Sex Disparities in Long-Term Mortality after Paclitaxel Exposure in Patients with Peripheral Artery Disease: A Nationwide Claims-Based Cohort Study

Behrendt

Sedrakyan

Κατσάνος

et al. 2021

JCM

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“…Information about the German healthcare system and the validity of the database have been described elsewhere. 16,17 Variables were identified according to the German version of the World Health Organisation (WHO) International Classification of Diseases (ICD-10-GM), the Operations and Procedures Codes (OPS), and the international Anatomical Therapeutic Chemical (ATC) Classification (for details see Supplementary Table S2).…”

Section: Methodsmentioning

confidence: 99%

The OAC3-PAD Risk Score Predicts Major Bleeding Events one Year after Hospitalisation for Peripheral Artery Disease

Behrendt

Kreutzburg

Nordanstig

et al. 2022

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS While available risk prediction scores for major bleeding events were developed primarily for patients treated for cardiac disease, there is a paucity of evidence concerning the mid term bleeding risk after treatment of patients with peripheral artery disease. Taking advantage of unselected data from the second largest insurance fund in Germany, a total of 81 930 patients were included in the current retrospective analysis. For the first time, a pragmatic risk score was developed to predict the individual bleeding risk classifying a fifth of the cohort as high risk patients. In total 2.2% of all patients had a major bleeding event after one year.Objective: There is a paucity of evidence concerning the risk of bleeding after hospitalisation for symptomatic peripheral artery disease (PAD) in everyday clinical practice, as randomised clinical trials commonly exclude patients with heightened risk. The current study aimed to develop a pragmatic risk score that enables prediction of major bleeding during the first year after index discharge. Methods: Unselected retrospective data from the second largest insurance fund in Germany, BARMER, were used to identify patients with a first hospitalisation for PAD registered between 1 January 2010 and 31 December 2018. Within a separate training cohort, final predictors were selected using penalised Cox regression (least absolute shrinkage and selection operator with ten fold cross validation) with one year major bleeding requiring hospitalisation as outcome. The risk score was internally validated. Four different risk groups were constructed. Results: A total of 81 930 patients (47.2% female, 72.3 years) underwent hospitalisation for symptomatic PAD. After one year, 1 831 (2.2%) of the patients had a major bleeding event. Independent predictors were previous oral anticoagulation, age over 80, chronic limb threatening ischaemia, congestive heart failure, severe chronic kidney disease, previous bleeding event, anaemia, and dementia. The OAC 3 -PAD risk score exhibited adequate calibration and discrimination between four risk groups (c ¼ 0.69, 95% confidence interval 0.67 e 0.71) from low risk (1.3%) to high risk (6.4%). Conclusion: A pragmatic risk score was developed to predict the individual major bleeding risk classifying a fifth of the cohort as high risk patients. Individual prediction scores such as the one proposed here may help to inform the risk and benefit of intensified antithrombotic strategies.

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“…Validation via medical record review was not performed in the SNR or GePaRD for this study. However, clinical data from the SNR and GePaRD have been previously validated and determined to be of good quality [ 9 – 12 ]. The characteristics of these three databases (CPRD GOLD, THIN, and ISD Scotland) have been reported previously [ 3 ].…”

Section: Methodsmentioning

confidence: 99%

Identification and Validation of Major Cardiovascular Events in the United Kingdom Data Sources Included in a Multi-database Post-authorization Safety Study of Prucalopride

Ruigómez

Plana²,

Gilsenan

et al. 2021

Drug Saf

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Introduction A multinational post-authorization safety study assessed cardiovascular safety in initiators of prucalopride for chronic constipation compared with a matched cohort of polyethylene glycol 3350 initiators. The primary safety outcome was major adverse cardiovascular events (MACE), a composite of hospitalization for acute myocardial infarction, stroke, or in-hospital cardiovascular death. We report the validation process for MACE endpoints in United Kingdom (UK) data sources: Clinical Practice Research Datalink (CPRD GOLD), The Health Improvement Network (THIN), and the Information Services Division (ISD) Scotland. Methods Modified electronic algorithms from prior research identified potential MACE cases. Validation followed a common protocol, adapted for each database, with all information anonymized: (1) direct confirmation via linkage to hospital records (CPRD GOLD); (2) requests for additional clinical information through questionnaires (CPRD GOLD), free-text (THIN), or abstraction of hospital records (ISD); (3) manual review of electronic records of potential events retrieved by the algorithm (CPRD GOLD/THIN); and (4) event adjudication by three clinicians, blinded to exposure, for all remaining events. Results Electronic algorithms identified 260 potential MACE cases: 38 confirmed via linkage to hospital records (CPRD GOLD), 56 ruled out as non-cardiovascular death cases (THIN), and three unavailable for review (ISD), leaving 163 potential cases. After manual review with additional information (steps 2 and 3), 45 were considered noncases (CPRD GOLD/THIN). Upon final adjudication (step 4), remaining potential events were adjudicated as definite ( n = 62), probable ( n = 10), possible ( n = 13), or noncases ( n = 33). Conclusions Given the limitations of relying solely on computer algorithms to identify cardiovascular outcomes, validation with clinical review is essential to guide interpretation. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01044-4.

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Quality of care in surgical/interventional vascular medicine: what can routinely collected data from the insurance companies achieve?

Cited by 14 publications

References 59 publications

Sex Disparities in Long-Term Mortality after Paclitaxel Exposure in Patients with Peripheral Artery Disease: A Nationwide Claims-Based Cohort Study

Sex Disparities in Long-Term Mortality after Paclitaxel Exposure in Patients with Peripheral Artery Disease: A Nationwide Claims-Based Cohort Study

The OAC3-PAD Risk Score Predicts Major Bleeding Events one Year after Hospitalisation for Peripheral Artery Disease

Identification and Validation of Major Cardiovascular Events in the United Kingdom Data Sources Included in a Multi-database Post-authorization Safety Study of Prucalopride

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