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소장정보 검색

국회도서관 홈으로 정보검색 소장정보 검색
결과 내 검색 동의어 포함
결과 내 검색 동의어 포함

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Title page

Contents

Summary 6

Key findings from the validation of algorithms for diabetes case definition 6

Key findings from case definitions for diabetes type ascertainment 7

Conclusion 7

1. Introduction 9

Aim of the project 10

Structure of the report 10

2. Data source and methods 11

MedicineInsight 11

Conditions 12

Study population 12

Study period 12

Markers of diabetes status 15

Prescriptions 15

HbA1c tests from pathology results 16

Medicare Benefits Schedule service items 16

Measures of validity and reference standard 17

Reference standard 17

Performance characteristics 18

Limitations 20

3. Diabetes case identification using markers of diabetes status 22

Diabetes case definitions 22

Methods 23

Findings from validation of the algorithms for diabetes case definition 25

Single diabetes marker approach 25

Combined data approaches for diabetes case identification 29

Potential algorithms for diabetes case definition 33

4. Diabetes type ascertainment 35

Type 1 and type 2 diabetes case definitions 35

Methods 36

Findings from validation of the algorithms for type 2 diabetes case definition 37

Single diabetes marker approach 37

Combined data approaches 40

Potential algorithms for type 2 diabetes case definition 43

Findings from validation of the algorithms for type 1 diabetes case definition 45

Single diabetes marker approach 45

Combined data approaches 46

Potential algorithms for type 1 diabetes case definition 48

5. Recording of diabetes markers before and after diagnosis of diabetes 50

Methods 50

Findings 50

People with diabetes markers recorded pre- and post-diagnosis 51

Pre- and post-diagnosis records for diabetes markers 53

Conclusion 55

Recommendations 56

Appendix A: Definitions 57

Appendix B: Sociodemographic characteristics of study populations 59

Acknowledgements 62

Abbreviations 63

Symbols 65

Glossary 66

References 68

Tables

Table 3.1. Misclassification risk and predictive power of diabetes status based on number of prescriptions for individual diabetes medicine class 26

Table 3.2. Predictive power of diabetes status based on number of prescriptions for any diabetes medicine 27

Table 3.3. Predictive power of diabetes status based on number of prescriptions for any diabetes medicines (excluding people with only metformin prescriptions) 27

Table 3.4. Predictive power of diabetes status based on number of HbA1c tests recorded 28

Table 3.5. Predictive power of diabetes status based on number of HbA1c tests each with 6 months gap of another HbA1c test 28

Table 3.6. Misclassification risk and predictive power of diabetes status based on number of diabetes-related MBS items (excluding MBS items for HbA1c) for... 29

Table 3.7. Predictive power of diabetes status based on number of diabetes-related MBS items (excluding MBS items for HbA1c) 29

Table 3.8. Sensitivity and PPV based on number of prescriptions for any diabetes medicine and HbA1c tests 30

Table 3.9. Predictive power of diabetes status based on combination of prescriptions for any diabetes medicine or HbA1c tests 31

Table 3.10. Predictive power of diabetes status based on combination of diabetes-related prescriptions or MBS items (excluding MBS items for HbA1c) 32

Table 3.11. Predictive power of diabetes status based on number of prescriptions for diabetes medicines or HbA1c tests or diabetes-related MBS items (excluding... 33

Table 3.12. Validation of diabetes case definition algorithms against people identified with diabetes using MedicineInsight standard definition; all study population... 34

Table 4.1. Misclassification risk and predictive power of type 2 diabetes status based on number of prescriptions for individual diabetes medicines 38

Table 4.2. Predictive power of type 2 diabetes status based on number of prescriptions for any diabetes medicines 38

Table 4.3. Predictive power of type 2 diabetes status based on number of prescriptions for any diabetes medicines (excluding insulin) 39

Table 4.4. Predictive power of type 2 diabetes status based on number of HbA1c tests 39

Table 4.5. Predictive power of type 2 diabetes status based on number of diabetes-related MBS items (excluding MBS items specific for HbA1c tests) 40

Table 4.6. Sensitivity and PPV based on number of prescriptions for diabetes medicine (excluding people with only insulin prescriptions) and HbA1c tests 41

Table 4.7. Predictive power of type 2 diabetes status based on number of prescriptions for diabetes medicines or HbA1c tests 42

Table 4.8. Predictive power of type 2 diabetes status based on number of prescriptions for diabetes medicines or diabetes-related MBS items (excluding MBS... 42

Table 4.9. Predictive power of type 2 diabetes status based on number of prescriptions for diabetes medicines or diabetes-related MBS items or HbA1c tests 43

Table 4.10. Validation of type 2 diabetes definition algorithms against people identified with type 2 diabetes using MedicineInsight standard definition; all study... 44

Table 4.11. Predictive power of type 1 diabetes status based on number of prescriptions for individual diabetes medicines 45

Table 4.12. Sensitivity and PPV based on number of prescriptions for insulin (with/without other diabetes medicines) and HbA1c tests 47

Table 4.13. Predictive power of type 1 diabetes status based on number of insulin prescriptions or diabetes-related MBS items (excluding MBS items for HbA1c) 47

Table 4.14. Predictive power of type 1 diabetes status based on number of prescriptions for insulin only (without other diabetes medicines) or diabetes-related... 48

Table 4.15. Validation of type 1 diabetes definition algorithms against people identified with type 1 diabetes using MedicineInsight standard definition; study population... 49

Table 5.1. Proportion of the diabetes incident cohort who had a minimum of one diabetes marker and proportion of those with at least one HbA1c test, diabetes-related... 52

Table 5.2. Proportion of all records for each diabetes marker for the diabetes incident cohort recorded pre- or post-diagnosis period 53

Figures

Figure 2.1. Study period for the cohorts and the markers of diabetes status in MedicineInsight 14

Figure 2.2. Number of diabetes-related prescriptions (excluding repeats) 16

Figure 2.3. Number of diabetes-related Medicare services recorded 17

Figure 2.4. Reference standard/standard definition for diabetes, type 1 and type 2 diabetes 18

Boxes

Box 2.1. Calculating measures of validity 19

Box 3.1. Examples of published methods in literature which have been used to identify diabetes cases using electronic medical records or administrative data sources 23

Box 3.2. Assessment approach and records thresholds 24

Box 3.3. Approaches used to identify diabetes case definitions 25

Box 4.1. Examples of published methods in literature which have been used to identify type 1 or type 2 diabetes cases using electronic medical records or administrative... 36

Appendix Tables

Table A1. Diabetes definition 57

Table A2. ATC codes used to identify diabetes medicines 57

Table A3. Diabetes-related Medicare Benefits Schedule item numbers included in the study 58

Table B1. Sociodemographic characteristics of study populations 60

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