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Identifying Medicare beneficiaries with dementia
Moura LMVR, Festa N, Price M, Volya M, Benson NM, Zafar S, Weiss M, Blacker D et al.. Journal of the American Geriatrics Society, 2021-04-26
Topic: Risk, prevention and care in population studies
Background/objectives No data exist regarding the validity of International Classification of Disease (ICD)-10 dementia diagnoses against a clinician-adjudicated reference standard within Medicare claims data. We examined the accuracy of claims-based diagnoses with respect to expert clinician adjudication using a novel database with individual-level linkages between electronic health record (EHR) and claims. Design In this retrospective observational study, two neurologists and two psychiatrists performed a standardized review of patients' medical records from January 2016 to December 2018 and adjudicated dementia status. We measured the accuracy of three claims-based definitions of dementia against the reference standard. Setting Mass-General-Brigham Healthcare (MGB), Massachusetts, USA. Participants From an eligible population of 40,690 fee-for-service (FFS) Medicare beneficiaries, aged 65 years and older, within the MGB Accountable Care Organization (ACO), we generated a random sample of 1002 patients, stratified by the pretest likelihood of dementia using administrative surrogates. Intervention None. Measurements We evaluated the accuracy (area under receiver operating curve [AUROC]) and calibration (calibration-in-the-large [CITL] and calibration slope) of three ICD-10 claims-based definitions of dementia against clinician-adjudicated standards. We applied inverse probability weighting to reconstruct the eligible population and reported the mean and 95% confidence interval (95% CI) for all performance characteristics, using 10-fold cross-validation (CV). Results Beneficiaries had an average age of 75.3 years and were predominately female (59%) and non-Hispanic whites (93%). The adjudicated prevalence of dementia in the eligible population was 7%. The best-performing definition demonstrated excellent accuracy (CV-AUC 0.94; 95% CI 0.92-0.96) and was well-calibrated to the reference standard of clinician-adjudicated dementia (CV-CITL Conclusion This study is the first to validate ICD-10 diagnostic codes against a robust and replicable approach to dementia ascertainment, using a real-world clinical reference standard. The best performing definition includes diagnostic codes with strong face validity and outperforms an updated version of a previously validated ICD-9 definition of dementia.
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APA 7th
Moura, L. M. V. R., Festa, N., Price, M., Volya, M., Benson, N. M., Zafar, S., et al. (2021). Identifying Medicare beneficiaries with dementia. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.17183
Vancouver
Moura LMVR, Festa N, Price M, Volya M, Benson NM, Zafar S, et al. Identifying Medicare beneficiaries with dementia. Journal of the American Geriatrics Society. 2021. doi:10.1111/jgs.17183. PMID: 33901296.
BibTeX
@article{moura2021-33901296,
author = {Moura, L. M. V. R. and Festa, N. and Price, M. and Volya, M. and Benson, N. M. and Zafar, S. and Weiss, M. and Blacker, D. and others},
title = {{Identifying Medicare beneficiaries with dementia}},
journal = {Journal of the American Geriatrics Society},
year = {2021},
doi = {10.1111/jgs.17183},
pmid = {33901296},
url = {https://doi.org/10.1111/jgs.17183}
}
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Key findings
- Results Beneficiaries had an average age of 75.3 years and were predominately female (59%) and non-Hispanic whites (93%).
- The best-performing definition demonstrated excellent accuracy (CV-AUC 0.94; 95% CI 0.92-0.96) and was well-calibrated to the reference standard of clinician-adjudicated dementia (CV-CITL <0.001, CV-slope 0.97).
Why it matters
This study validated ICD-10 claims-based definitions of dementia against clinician adjudication, with the best-performing definition showing excellent accuracy. This improves how dementia can be identified in Medicare data for research and planning, but it does not treat, cure, or prevent the disease.
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Study details
- Participants1,002
- Effect sizeAUC 0.94
- Evidence strengthLow
How this study scored 60/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | 3 / 4 | Journal of the American Geriatrics Society: journal h-index 344 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,002 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 100 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 14.3 citations a year over 7 year(s) since 2021 |
| Impact for its field and year | 4 / 6 | Cited 10.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 13 other studies in this library |
| Still being cited | 3 / 4 | Cited 77 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author John Hsu: h-index 45 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Harvard University: institution h-index 3,235 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 33901296) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 60 / 100 | — |
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