학술논문
Using Claims Data to Predict Pre-Operative BMI Among Bariatric Surgery Patients: Development of the BMI Before Bariatric Surgery Scoring System (B3S3)
Document Type
Academic Journal
Author
Source
Pragmatic and Observational Research. March 31, 2024, Vol. 15, p65, 14 p.
Subject
Language
English
ISSN
1179-7266
Abstract
Background: Lack of body mass index (BMI) measurements limits the utility of claims data for bariatric surgery research, but preoperative BMI may be imputed due to existence of weight-related diagnosis codes and BMI-related reimbursement requirements. We used a machine learning pipeline to create a claims-based scoring system to predict pre-operative BMI, as documented in the electronic health record (EHR), among patients undergoing a new bariatric surgery. Methods: Using the Optum Labs Data Warehouse, containing linked de-identified claims and EHR data for commercial or Medicare Advantage enrollees, we identified adults undergoing a new bariatric surgery between January 2011 and June 2018 with a BMI measurement in linked EHR data [less than or equal to]30 days before the index surgery (n=3226). We constructed predictors from claims data and applied a machine learning pipeline to create a scoring system for pre-operative BMI, the B3S3. We evaluated the B3S3 and a simple linear regression model (benchmark) in test patients whose index surgery occurred concurrent (2011-2017) or prospective (2018) to the training data. Results: The machine learning pipeline yielded a final scoring system that included weight-related diagnosis codes, age, and number of days hospitalized and distinct drugs dispensed in the past 6 months. In concurrent test data, the B3S3 had excellent performance ([R.sup.2] 0.862, 95% confidence interval [CI] 0.815-0.898) and calibration. The benchmark algorithm had good performance ([R.sup.2] 0.750, 95% CI 0.686-0.799) and calibration but both aspects were inferior to the B3S3. Findings in prospective test data were similar. Conclusion: The B3S3 is an accessible tool that researchers can use with claims data to obtain granular and accurate predicted values of pre-operative BMI, which may enhance confounding control and investigation of effect modification by baseline obesity levels in bariatric surgery studies utilizing claims data. Plain Language Summary: * Pre-operative BMI is an important potential confounder in comparative effectiveness studies of bariatric surgeries. * Claims data lack clinical measurements, but insurance reimbursement requirements for bariatric surgery often result in pre-operative BMI being coded in claims data. * We used a machine learning pipeline to create a model, the B3S3, to predict pre-operative BMI, as documented in the EHR, among bariatric surgery patients based on the presence of certain weight-related diagnosis codes and other patient characteristics derived from claims data. * Researchers can easily use the B3S3 with claims data to obtain granular and accurate predicted values of pre-operative BMI among bariatric surgery patients. Keywords: bariatric surgery, body mass index, confounding variable, comparative effectiveness research, administrative claims, supervised machine learning
Background With a steady rise in the prevalence of severe obesity, defined as a body mass index (BMI) of 40 kg/[m.sup.2] or greater, among US adults over the past two [...]
Background With a steady rise in the prevalence of severe obesity, defined as a body mass index (BMI) of 40 kg/[m.sup.2] or greater, among US adults over the past two [...]