Abstract
Backgroundthere is no established method to identify care-home residents in routine healthcare datasets. Methods matching patient’s addresses to known care-home addresses have been proposed in the UK, but few have been formally evaluated.Study designprospective diagnostic test accuracy study.Methodsfour independent samples of 5,000 addresses from Community Health Index (CHI) population registers were sampled for two NHS Scotland Health Boards on 1 April 2017, with one sample of adults aged ≥65 years and one of all residents. To derive the reference standard, all 20,000 addresses were manually adjudicated as ‘care-home address’ or not. The performance of five methods (NHS Scotland assigned CHI Institution Flag, exact address matching, postcode matching, Phonics and Markov) was evaluated compared to the reference standard.Resultsthe CHI Institution Flag had a high PPV 97–99% in all four test sets, but poorer sensitivity 55–89%. Exact address matching failed in every case. Postcode matching had higher sensitivity than the CHI flag 78–90%, but worse PPV 77–85%. Area under the receiver operating curve values for Phonics and Markov scores were 0.86–0.95 and 0.93–0.98, respectively. Phonics score with cut-off ≥13 had PPV 92–97% with sensitivity 72–87%. Markov PPVs were 90–95% with sensitivity 69–90% with cut-off ≥29.6.Conclusionsmore complex address matching methods greatly improve identification compared to the existing NHS Scotland flag or postcode matching, although no method achieved both sensitivity and positive predictive value > 95%. Choice of method and cut-offs will be determined by the specific needs of researchers and practitioners.
Highlights
Research which analyses routinely-collected healthcare data for whole populations has major advantages [1], but relies on being able to accurately classify individuals’ personal characteristics
The proportion of care-home addresses varied across the four samples from 4.3 to 11.1%, primarily because of expected higher prevalence in the ≥65-year-olds versus the whole population sample (Table 1)
The existing National Health Service (NHS) Scotland Community Health Index (CHI) Institution Flag has a very high positive predictive value (PPV) but less good sensitivity. Put another way, where it identifies an address as being a care-home it is almost always correct, but it fails to identify 11–45% of care-home resident addresses depending on the sample
Summary
Research which analyses routinely-collected healthcare data for whole populations has major advantages [1], but relies on being able to accurately classify individuals’ personal characteristics. If we were able to reliably identify the care-home population using routine data, this would allow greater insights into their health and care needs and resource use. Methods used include postcode matching (sometimes with exclusion of postcodes that include more than one care-home) which inevitably includes residents of nearby houses, other forms of address matching, and large manual validation exercises [5, 6]. These can be time-consuming and complex, and are usually unsuitable for routine use beyond a specific project, by researchers who lack access to identifiable information to verify their findings
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