以台灣健保申報資料，進行糖尿病相關研究個案定義作法之差異

Variations in case definition algorithms in diabetes-related studies using Taiwan National Health Insurance claims data

"目標：本描述性研究探討以台灣健保申報資料進行糖尿病相關研究個案定義作法之差異。方法：搜尋文獻資料庫找出2001至2020年發表的相關論文，整理出每一篇研究使用的個案定義作法。個案定義作法的組成包括：1)診斷編碼，2)使用資料（譬如門診，住院或藥物處方紀錄），3)診斷碼最少就診次數，4)是否有時間間隔要求。本研究參考已發表準確度研究的陽性預測值高低將不同作法進行分類。結果：本研究找出611篇相關研究，整理出8類30種不同個案定義作法。陽性預測值第1類最低，第8類最高。數目最多的作法依序是第8類「診斷碼且有藥物處方」194篇（32%），第1類「1次門診診斷碼」119篇（20%）與第3類「2次以上門診診斷碼」111篇（18%）。第7,8類「有使用藥物處方為個案定義條件」的研究論文篇數顯著增加，由2001-2011年的18篇增加到2018-2020年的89篇，而且86篇是用較嚴格的「有診斷碼且有藥物處方」。反之，第1,2類「1次門診或住院診斷碼」的比例由2001-2011年的31%，下降到2018- 2020年的14%。結論：近二十年來，越來越多研究使用較嚴格（高陽性預測值）的個案定義作法。未來應該有研究進一步產出台灣不同個案定義作法的準確度指標數據，提供後續研究者引用，以符合國際學術期刊對於使用例行收集行政資料研究的報告規範要求。（台灣衛誌2021；40(6)：725-733）"

"Objectives: This descriptive study examined the variations in case definition algorithms in diabetes-related studies using Taiwan National Health Insurance claims data. Methods: We searched the PubMed database to retrieve relevant papers published between 2001 and 2020. The components of a case definition algorithm included 1) diagnostic codes, 2) data used, 3) minimum number of visits with diagnostic codes, and 4) time intervals required. We grouped the algorithms according to their positive predictive value (PPV) derived from a published validity study. Results: We identified 611 studies with 30 distinct case definition algorithms and classified them into 8 groups. The PPV was lowest in Group 1 and highest in Group 8. The three most frequently used algorithm appeared in Group 8, (“diagnostic code AND antidiabetic drugs prescribed,”194 papers, 32%), followed by Group 1 (“at least one outpatient diagnostic code,”119 papers, 20%) and Group 3, (“at least two outpatient diagnostic codes,”111 papers, 18%). The number of papers in Groups 7 and 8 that used antidiabetic drugs as a condition for case definition increased prominently, from 18 between 2001 and 2011 to 89 between 2018 and 2020. Furthermore, 86 papers used the more rigorous definition“diagnostic codes AND medications.”However, the proportion of papers in Groups 1 and 2 decreased from 31% between 2001 and 2011 to 14% between 2018 and 2020. Conclusions: The number of diabetes-related studies using more rigorous (higher PPV) case definition algorithms increased between 2001 and 2020. Additional studies, which are requested through the reporting of studies conducted using observational routinely collected health data (RECORD), on the validity of these algorithms are required. (Taiwan J Public Health. 2021;40(6):725-733)"