Biomedical subjects

Miriam Maney

Publications and source records attributed to Miriam Maney.

4 recordsLinked to original sources

PubMed2006

Failure of ICD-9-CM codes to identify patients with comorbid chronic kidney disease in diabetes.

OBJECTIVE: To determine prevalence of chronic kidney disease (CKD) in patients with diabetes, and accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify such patients. DATA SOURCES/STUDY SETTING: Secondary data from 1999 to 2000. We linked all inpatient and outpatient administrative and clinical records of U.S. veterans with diabetes dually enrolled in Medicare and the Veterans Administration (VA) health care systems. STUDY DESIGN: We used a cross-sectional, observational design to determine the sensitivity and specificity of renal-related ICD-9-CM diagnosis codes in identifying individuals with chronic kidney disease. DATA COLLECTION/EXTRACTION METHODS: We estimated glomerular filtration rate (eGFR) from serum creatinine and defined CKD as Stage 3, 4, or 5 CKD by eGFR criterion according to the Kidney Disease Outcomes Quality Initiative guidelines. Renal-related ICD-9-CM codes were grouped by algorithm. PRINCIPAL FINDINGS: Prevalence of CKD was 31.6 percent in the veteran sample with diabetes. Depending on the detail of the algorithm, only 20.2 to 42.4 percent of individuals with CKD received a renal-related diagnosis code in either VA or Medicare records over 1 year. Specificity of renal codes for CKD ranged from 93.2 to 99.4 percent. Patients hospitalized in VA facilities were slightly more likely to be correctly coded for CKD than patients hospitalized in facilities reimbursed by Medicare (OR 5.4 versus 4.1, p=.0330) CONCLUSIONS: CKD is a common comorbidity for patients with diabetes in the VA system. Diagnosis codes in administrative records from Medicare and VA systems are insensitive, but specific markers for patients with CKD.

Adult↗

PubMed2005

Diabetes healthcare quality report cards: how accurate are the grades?

OBJECTIVE: To evaluate the accuracy and precision of random sampling in identifying healthcare system outliers in diabetes performance measures. STUDY DESIGN: Cross-sectional analysis of 79 Veterans Health Administration facilities serving 250 317 patients with diabetes mellitus between October 1, 1999, and September 30, 2000. METHODS: Primary outcome measures were poor glycosylated hemoglobin (A1C) control and good low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) control. Facility performance for each measure was calculated using 150 separate random samples and was compared with results using the bootstrap method as the criterion standard for determining outlier status (defined as a >/=5% difference from the mean, within the 10th or 90th percentile, or >/=2 SDs from the mean). RESULTS: The study population was largely male (97.4%), with 54.0% of subjects being 65 years or older. The facility-level mean performances were 22.8% for poor A1C control, 53.1% for good LDL-C control, and 55.3% for good BP control. Comparing the random sampling method with the bootstrap method, the sensitivity ranged between 0.64 and 0.83 for the 3 outcome measures, positive predictive values ranged between 0.55 and 0.88, and specificity and negative predictive values ranged between 0.88 and 0.99. CONCLUSIONS: The specificity and negative predictive value of the random sampling method in identifying nonoutliers in performance were generally high, while its sensitivity and positive predictive value were moderate. The use of random sampling to determine performance for individual outcome measures may be most appropriate for internal quality improvement rather than for public reporting.

Aged↗

PubMed2004

Measures of postural stability.

Dynamic posturography has become an important tool for understanding standing balance in clinical settings. A key test in the NeuroCom International (Clackamas, Oregon) dynamic posturography system, the Sensory Organization Test (SOT), provides information about the integration of multiple components of balance. The SOT test leads to an outcome measure called the "equilibrium score" (ES), which reflects the overall coordination of the visual, proprioceptive, and vestibular systems for maintaining standing posture. Researchers, therapists, and physicians often use the ES from the SOT as a clinically relevant measure of standing balance. We discuss here the formula used for evaluating the ES and propose an additional measure of postural stability, called the Postural Stability Index (PSI), that accounts for shear force and individual anthropomorphic measures. We propose that this new measure provides a clinically important adjunct to the current SOT and can be calculated from data already collected by the NeuroCom forceplate during the SOT.

Adult↗

PubMedDate not supplied

Postural stability index is a more valid measure of stability than equilibrium score.

Researchers, therapists, and physicians often use equilibrium score (ES) from the Sensory Organization Test, a key test in the NeuroCom EquiTest System (a dynamic posturography system) to assess stability. ES reflects the overall coordination of the visual, proprioceptive, and vestibular systems for maintaining standing posture. In our earlier article, we proposed a new measure of anterior-posterior (A-P) postural stability called the Postural Stability Index (PSI), which accounts for more biomechanical aspects than ES. This article showed that PSI provides a clinically important adjunct to ES. In the present article, we show that PSI can provide an acceptable index even if a person falls during the trial, whereas ES assigns a zero score for any fall. We also show that PSI decreases as ankle stiffness increases, which is intuitive, while ES exhibits the opposite behavior. Ankle stiffness is generally recognized as an indicator of postural stability. These results suggest that PSI is a more valid measure of A-P stability than ES.

Adult↗