Table 2.
Accuracy of disease detection through drugs prescription among hospitalized patients (N = 108,915)
| Morbidity group | Diagnosed condition | Screened by drug | Sensitivity | Specificity | K c a | K 0 a | K 1 a | Use b |
|---|---|---|---|---|---|---|---|---|
|
With KC > 0.4 |
|
|
|
|
|
|
|
|
| Transplant |
467 |
601 |
0.82 |
1.00 |
0.71 |
(0.63) |
(0.82) |
M, C, R |
| Diabetes mellitus |
8,171 |
8,114 |
0.71 |
0.98 |
0.70 |
(0.70) |
(0.69) |
M, C, R |
| HIV disease |
413 |
372 |
0.60 |
1.00 |
0.63 |
(0.67) |
(0.60) |
M, C, R |
| Hypertensive disease |
22,307 |
34,680 |
0.77 |
0.80 |
0.49 |
(0.37) |
(0.67) |
|
|
Alternative refinement: |
|
|
|
|
|
|
|
|
| Hypertension and heart failure |
23,886 |
35,954 |
0.78 |
0.80 |
0.51 |
(0.39) |
(0.68) |
M, C, R |
| Thyroid disorders |
3,179 |
2,993 |
0.40 |
0.98 |
0.40 |
(0.41) |
(0.38) |
M, C, R |
|
With K
0
>0.4 and alternatives to pharmacological treatment |
|
|
|
|
||||
| Multiple sclerosis |
444 |
115 |
0.20 |
1.00 |
(0.32) |
0.78 |
(0.20) |
C, R |
| Abuse of alcohol |
4,584 |
619 |
0.09 |
1.00 |
(0.16) |
0.68 |
(0.09) |
C, R |
| Ischemic heart disease |
10,691 |
4,537 |
0.26 |
0.98 |
(0.33) |
0.56 |
(0.23) |
C, R |
| Conduction disorders and cardiac arrhythmias |
8,297 |
2,512 |
0.18 |
0.99 |
(0.26) |
0.56 |
(0.16) |
C, R |
| Malignant neoplasms |
7,528 |
3,757 |
0.29 |
0.98 |
(0.36) |
0.54 |
(0.26) |
C, R |
| Abuse of opioid |
1,131 |
45 |
0.02 |
1.00 |
(0.04) |
0.51 |
(0.02) |
C, R |
| Hepatitis B or C |
885 |
90 |
0.05 |
1.00 |
(0.09) |
0.50 |
(0.05) |
C, R |
| Non-nutritional anaemia |
6,114 |
642 |
0.05 |
1.00 |
(0.08) |
0.41 |
(0.04) |
|
|
Including those of end stage renal disease and due to chemotherapy |
8,868 |
642 |
0.05 |
1.00 |
(0.08) |
0.63 |
(0.04) |
C, R |
|
With K1 > 0.4 |
|
|
|
|
||||
|
Obvious under-coded diagnoses |
|
|
|
|
||||
| Glaucoma |
431 |
4167 |
0.70 |
0.96 |
(0.13) |
(0.07) |
0.69 |
M, C, R |
| Hyperlipidemia |
8,052 |
18,050 |
0.71 |
0.88 |
(0.38) |
(0.26) |
0.65 |
M, C, R |
| Functional digestive disorders |
1,275 |
27,846 |
0.63 |
0.75 |
(0.04) |
(0.02) |
0.50 |
c |
| Hyperplasia of prostate |
2,793 |
7,816 |
0.52 |
0.94 |
(0.26) |
(0.17) |
0.49 |
M, C, R |
| Osteoporosis |
2,443 |
4,765 |
0.49 |
0.97 |
(0.31) |
(0.23) |
0.46 |
M, C, R |
|
Signs of under-coded diagnoses |
|
|
|
|
||||
| Mood disorders |
6,649 |
19,624 |
0.68 |
0.85 |
(0.29) |
(0.18) |
0.61 |
M, C, R |
| Reactive airway disease |
6,045 |
11,960 |
0.58 |
0.92 |
(0.36) |
(0.25) |
0.53 |
M, C, R |
| Alzheimer’s disease |
844 |
1,307 |
0.48 |
0.99 |
(0.37) |
(0.31) |
0.48 |
M, C, R |
| Crohn’s disease and ulcerative colitis |
433 |
824 |
0.48 |
0.99 |
(0.33) |
(0.25) |
0.48 |
M, C, R |
|
Multiple diagnoses indication of tracer drugs |
|
|||||||
| Parkinson’s disease |
914 |
2,219 |
0.67 |
0.99 |
(0.38) |
(0.27) |
0.66 |
|
|
Alternative refinement |
|
|
|
|
|
|
|
|
| w/o anti-psychotic |
914 |
1,739 |
0.65 |
0.99 |
0.44 |
(0.37) |
0.64 |
M, C, R |
| Schizophrenia and other disorders |
1,911 |
6,439 |
0.67 |
0.95 |
(0.29) |
(0.18) |
0.64 |
|
|
Alternative refinement |
|
|
|
|
|
|
|
|
| w/o anti-cholinesterasic |
1,911 |
5,985 |
0.66 |
0.96 |
(0.30) |
(0.20) |
0.64 |
C, R |
| Epilepsy |
1,656 |
5,727 |
0.54 |
0.96 |
(0.23) |
(0.14) |
0.52 |
|
|
Alternative refinement |
|
|
|
|
|
|
|
|
| w/o chronic pain drugs |
1,656 |
4,260 |
0.52 |
0.97 |
(0.28) |
(0.19) |
0.50 |
C, R |
|
Prophylactic treatment |
|
|
|
|
|
|
|
|
| Thrombo-embolic risk or disease |
6,122 |
29,427 |
0.72 |
0.76 |
(0.18) |
(0.10) |
0.61 |
|
|
if including thrombogenic cardiac diseases |
17,804 |
29,427 |
0.73 |
0.82 |
0.45 |
(0.33) |
0.63 |
M, C, R |
| Diseases of esophagus, peptic ulcer |
3,805 |
31,331 |
0.72 |
0.73 |
(0.11) |
(0.05) |
0.60 |
c |
|
With all K values < 0.4 |
|
|
|
|||||
|
Acute diseases with time limited treatment, minor or rare conditions as inpatients |
|
|||||||
| Migraine |
601 |
1,771 |
0.29 |
0.99 |
(0.14) |
(0.09) |
0.28 |
C |
| Vertigo |
623 |
2,084 |
0.29 |
0.98 |
(0.13) |
(0.08) |
0.28 |
c |
| Bacterial infection or septicemia |
10,433 |
41,704 |
0.58 |
0.64 |
(0.13) |
(0.05) |
0.32 |
c |
| Eye inflammation |
467 |
6,827 |
0.33 |
0.94 |
(0.04) |
(0.02) |
0.29 |
C |
| Dermatitis |
1,091 |
14,461 |
0.33 |
0.87 |
(0.03) |
(0.02) |
0.23 |
C , R |
| Mycosis |
988 |
16,971 |
0.36 |
0.85 |
(0.03) |
(0.01) |
0.25 |
C |
| Other diseases of upper respiratory tract – allergy |
466 |
9,917 |
0.31 |
0.91 |
(0.02) |
(0.01) |
0.24 |
C |
| Disorders of external ear |
71 |
2,070 |
0.27 |
0.98 |
(0.02) |
(0.01) |
0.25 |
C |
| Parasitosis |
61 |
1,984 |
0.26 |
0.98 |
(0.01) |
(0.01) |
0.25 |
C |
| Other acute upper respiratory infections |
856 |
32,259 |
0.50 |
0.71 |
(0.01) |
(0.01) |
0.28 |
c |
| Acne |
72 |
2,774 |
0.25 |
0.97 |
(0.01) |
(0.01) |
0.23 |
C , R |
| Psoriasis |
466 |
1,188 |
0.35 |
0.99 |
(0.19) |
(0.13) |
0.34 |
C , R |
| Gout |
659 |
2,126 |
0.39 |
0.98 |
(0.18) |
(0.12) |
0.38 |
C , R |
| Female inflammatory diseases |
864 |
6,331 |
0.25 |
0.94 |
(0.05) |
(0.03) |
0.20 |
|
| Conjonctivitis |
114 |
6,458 |
0.24 |
0.94 |
(0.01) |
(0.00) |
0.19 |
|
| Hemorrhoids |
1,188 |
3,048 |
0.19 |
0.97 |
(0.10) |
(0.06) |
0.16 |
|
| Skin or subcutaneous infections |
695 |
9,565 |
0.21 |
0.91 |
(0.02) |
(0.01) |
0.14 |
|
| Paludism 28 444 0.14 1.00 0.02 0.01 0.14 |
28 |
444 |
0.14 |
1.00 |
(0.02) |
(0.01) |
0.14 |
|
| Intestinal infectious diseases |
1,608 |
7,131 |
0.19 |
0.94 |
(0.06) |
(0.03) |
0.13 |
|
| Viral diseases |
1,261 |
1,801 |
0.15 |
0.98 |
(0.11) |
(0.09) |
0.13 |
|
| Influenza |
177 |
74 |
0.00 |
0.00 |
(0.00) |
|
|
|
|
Multiple diagnoses indication of tracer drugs |
|
|
||||||
| Inflammatory polyarthritis and connective tissue disorders |
1,321 |
6,526 |
0.39 |
0.94 |
(0.12) |
(0.07) |
0.35 |
c |
| Anaemias – nutritional |
3,122 |
11,845 |
0.31 |
0.90 |
(0.10) |
(0.06) |
0.23 |
c |
| Other mental and behavioral disorders |
7,852 |
28,126 |
0.54 |
0.76 |
(0.16) |
(0.08) |
0.37 |
c |
| Pain |
12,341 |
66,022 |
0.73 |
0.41 |
(0.07) |
(0.02) |
0.31 |
c |
|
Severe pain
d
|
12,341 |
7,429 |
0.16 |
0.92 |
(0.13) |
(0.13) |
0.07 |
|
|
Prophylaxis treatment |
|
|
|
|||||
| Tuberculosis |
216 |
226 |
0.31 |
1.00 |
(0.30) |
(0.29) |
0.30 |
|
|
Active tuberculosis |
216 |
82 |
0.25 |
1.00 |
(0.36) |
(0.66) |
0.25 |
C, R |
|
Alternatives to pharmacological treatment |
|
|
||||||
| Neutropenia |
468 |
369 |
0.18 |
1.00 |
(0.21) |
0.26 |
(0.17) |
|
|
Extended to prophylaxis of myelosuppressive chemotherapy |
1,452 |
369 |
0.16 |
1.00 |
(0.25) |
0.63 |
(0.16) |
C, R |
| Obesity |
6,106 |
639 |
0.03 |
1.00 |
(0.05) |
0.23 |
(0.02) |
c |
| Other endocrine nutritional and metabolic diseases |
8,393 |
160 |
0.00 |
1.00 |
(0.01) |
0.19 |
(0.00) |
|
| Hemorrhagic risk or disease |
1,434 |
756 |
0.05 |
0.99 |
(0.07) |
0.09 |
(0.05) |
|
| Poisonings |
1,061 |
309 |
0.00 |
1.00 |
(0.00) |
0.00 |
(0.00) |
|
| Heart failure |
3,166 |
94 |
0.00 |
1.00 |
(0.00) |
0.02 |
(0.00) |
|
|
Alternative refinement: see hypertension/heart failure above |
|
|
|
|||||
| Abuse of tobacco | 7,062 | 14 | 0.00 | 1.00 | (0.00) | 0.08 | (0.00) | |
aKappa values, not used as judgment criteria are in parenthesis.
bContext of use: morbidity indicator (M), ambulatory costs control (C), insurers’ risk adjustment (R) only for chronic conditions.
cAppropriateness of pharmacologic treatment uncertain, prone to practice variations.
dStrong opioids.