title: The use of administrative health care databases to identify patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To validate and compare the decision rules to identify rheumatoid arthritis (RA) in administrative databases.
  
  
  METHODS
  A study was performed using administrative health care data from a population of 1 million people who had access to universal health care. Information was available on hospital discharge abstracts and physician billings. RA cases in health administrative databases were matched 1:4 by age and sex to randomly selected controls without inflammatory arthritis. Seven case definitions were applied to identify RA cases in the health administrative data, and their performance was compared with the diagnosis by a rheumatologist. The validation study was conducted on a sample of individuals with administrative data who received a rheumatologist consultation at the Arthritis Center of Nova Scotia.
  
  
  RESULTS
  We identified 535 RA cases and 2,140 non-RA, noninflammatory arthritis controls. Using the rheumatologist's diagnosis as the gold standard, the overall accuracy of the case definitions for RA cases varied between 68.9% and 82.9% with a kappa statistic between 0.26 and 0.53. The sensitivity and specificity varied from 20.7% to 94.8% and 62.5% to 98.5%, respectively. In a reference population of 1 million, the estimated annual number of incident cases of RA was between 176 and 1,610 and the annual number of prevalent cases was between 1,384 and 5,722.
  
  
  CONCLUSIONS
  The accuracy of case definitions for the identification of RA cases from rheumatology clinics using administrative health care databases is variable when compared to a rheumatologist's assessment. This should be considered when comparing results across studies. This variability may also be used as an advantage in different study designs, depending on the relative importance of sensitivity and specificity for identifying the population of interest to the research question.
authors: Division of Rheumatology, Department of Medicine; Department of Pathology.
authors: John G
authors: JG
authors: Hanly
authors: Department of Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University.
authors: Kara
authors: K
authors: Thompson
authors: Atlantic Clinical Cancer Research Unit, Capital Health, Halifax, Nova Scotia, Canada.
authors: Chris
authors: C
authors: Skedgel
keywords: case definitions; incidence; inflammatory arthritis; population health; prevalence