title: Administrative data on diagnosis and mineralocorticoid receptor antagonist prescription identified patients with primary aldosteronism in Taiwan.
abstract: OBJECTIVE
  To develop algorithms of locating patients with primary aldosteronism (PA) using insurance reimbursement data and to validate the algorithms using medical charts.
  
  
  METHODS
  We extracted National Health Insurance (NHI) reimbursement data and medical charts in seven enrolled hospitals and analyzed diagnosis-related information for 1999-2010. The NHI codes PA as 255.1x, using the International Classification of Diseases, Ninth Revision, Clinical Modification. Confirmation of PA was based on suppression tests.
  
  
  RESULTS
  We reviewed medical charts for 1,094 cases with at least one PA diagnosis. PA was confirmed for 563 cases. Compared with patients with essential hypertension, PA patients had higher systolic blood pressure, higher aldosterone, lower renin activity, and lower potassium level (all P-values <0.05). An algorithm based on PA diagnosis reported in at least one hospital stay or three outpatient visits had modest performance (sensitivity = 0.94 and specificity = 0.20). The best additional condition for the algorithm was use of mineralocorticoid receptor antagonist (MRA; sensitivity = 0.89 and specificity = 0.88).
  
  
  CONCLUSIONS
  Using information on PA diagnosis and MRA prescription reported in insurance claims data can precisely locate PA patients in high-risk groups. This algorithm can construct a reliable PA sample for conducting research in various fields, including epidemiology and clinical practice.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.affiliation: Division of Endocrinology, Taipei Tzu Chi General Hospital, 289 Jianguo Road, Xindian, Taiwan.
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Hu
authors.affiliation: Division of Nephrology, Taipei Tzu Chi General Hospital, 289 Jianguo Road, Xindian, Taiwan.
authors.forename: Che-Hsiung
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, 250 Wu-Hsing Street, Taipei, Taiwan.
authors.forename: Chih-Chin
authors.initials: CC
authors.lastname: Kao
authors.affiliation: Department of Internal Medicine and Medical Research Center, Cardinal Tien Hospital, 362 Zhongzheng Road, Xindian, Taiwan.
authors.forename: Cheng-Yi
authors.initials: CY
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, 25 Jingguo Road, Hsinchu, Taiwan.
authors.forename: Wei-Shen
authors.initials: WS
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Taipei City Hospital, Zhongxing Branch, 145 Zhengzhou Road, Taipei, Taiwan.
authors.forename: Hsiu-Hao
authors.initials: HH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Postal Hospital, 14 Fu-Chuo Street, Taipei, Taiwan.
authors.forename: Yuan-Shian
authors.initials: YS
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
authors.forename: Yen-Hung
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Department of Urology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan. Electronic address: likwang@nhri.org.tw.
authors.forename: Shuo-Meng
authors.initials: SM
authors.lastname: Wang
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Taiwan. Electronic address: dturo62@yahoo.com.tw.
authors.forename: Likwang
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000188:drug therapy*; D007349:Insurance, Health, Reimbursement; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D015203:Reproducibility of Results; D013624:Taiwan
chemical_list: D000451:Mineralocorticoid Receptor Antagonists
keywords: Adjudication; Administrative data; Medical chart review; Mineralocorticoid receptor antagonist; Primary aldosteronism; Validation