量化美国初级保健工作人员：一项有和没有不完全测量参照标准的验证研究。

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology Pub Date : 2025-06-23 DOI:10.1016/j.annepidem.2025.06.011

Nicole Rafalko , Scott Siegel , Paul Yerkes , Jan M. Eberth , Igor Burstyn , Neal D. Goldstein

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引用次数: 0

摘要

目的：验证国家提供者标识符（NPI），这是卫生服务研究中常用的数据源，用于识别初级保健医生、医师助理（PAs）和执业护士（NPs）。方法：验证研究，计算医生、PAs和NPs的敏感性、特异性和相关的95%置信区间。对于医生来说，医疗保险索赔数据被用作不完全测量的参考标准。对于PAs和NPs，我们使用基于模拟的方法来估计精度参数，假设NPI和医疗保险索赔同样被错误分类。结果：使用医疗保险索赔作为医生的参考标准，其敏感性和特异性分别为0.95 （95% CI: 0.88, 0.98）和0.76 （95% CI: 0.73, 0.79）。使用基于模拟的方法，PAs的敏感性和特异性分别为0.57 （95% CrI: 0.11, 0.97）和0.56 (95% CrI: 0.10, 0.96)， NPs的敏感性和特异性分别为0.58 （95% CrI: 0.13, 0.97）和0.61 （95% CrI: 0.14, 0.97）。结论：我们的验证结果因提供者角色而异。医生的准确性最高，进一步强调了仅根据NPI量化pa和NPs的挑战。未能考虑NPI中潜在的错误分类可能导致有偏见的研究结果。

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Quantifying the primary care workforce in the U.S.: A validation study with and without an imperfectly measured referent standard

Purpose

To validate the National Provider Identifier (NPI), a commonly used data source in health services research, for identifying primary care physicians, physician assistants (PAs), and nurse practitioners (NPs).

Methods

Validation studies to calculate the sensitivity, specificity, and associated 95 % confidence intervals for physicians, PAs, and NPs. For physicians, Medicare claims data were used as an imperfectly measured referent standard. For PAs and NPs, we used a simulation-based method to estimate accuracy parameters that assumed the NPI and Medicare claims were equally misclassified.

Results

Using the Medicare claims as the referent standard for physicians yielded a sensitivity and specificity of 0.95 (95 % CI: 0.88, 0.98) and 0.76 (95 % CI: 0.73, 0.79), respectively. Using the simulation-based method yielded a sensitivity and specificity of 0.57 (95 % CrI: 0.11, 0.97) and 0.56 (95 % CrI: 0.10, 0.96), respectively for PAs and 0.58 (95 % CrI: 0.13, 0.97) and 0.61 (95 % CrI: 0.14, 0.97), respectively for NPs.

Conclusions

Our validation results varied by provider role. Accuracy was highest for physicians further highlighting the challenges in quantifying PAs and NPs based on their NPI alone. Failure to consider potential misclassification in the NPI may result in biased research findings.

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来源期刊

Annals of Epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.40

自引率

1.80%

发文量

207

审稿时长

59 days

期刊介绍： The journal emphasizes the application of epidemiologic methods to issues that affect the distribution and determinants of human illness in diverse contexts. Its primary focus is on chronic and acute conditions of diverse etiologies and of major importance to clinical medicine, public health, and health care delivery.