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Use of Insurance Claims Data in Measuring Quality of Care

Published online by Cambridge University Press:  10 March 2009

Kathleen N. Lohr
Kathleen N. Lohr
Affiliation:
Institute of Medicine
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Abstract

This article discusses data that might be used for measuring quality of care, for health care administrative purposes, and for tracking the use of technologies. The advantages and limitations of administrative data banks for research purposes and some process-of-care and outcome analysis are noted. Three important obstacles to their use—reliability of diagnosis and service information, unique patient identifiers, and provider identifiers—are discussed briefly.

Type
Special Section: Measuring Health Care Effectiveness: Use of Large Data Bases for Technology and Quality Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 6 , Issue 2 , January 1990 , pp. 263 - 271
Copyright
Copyright © Cambridge University Press 1990

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References

REFERENCES

1Anderson, G. F., & Steinberg, E. P.Predicting hospital readmissions in the Medicare population. Inquiry, 1985, 22, 251–58.Google ScholarPubMed
2Bell, N. R., & Krikke, E. H.Letter to the editor. The use of claims data to evaluate health care. Journal of the American Medical Association, 1987, 257, 3226.Google Scholar
3Bergner, M.Measurement of health status. Medical Care, 1985, 23, 696–704.CrossRefGoogle ScholarPubMed
4Bowen, O. R., & Roper, W. L.Medicare hospital mortality information, 1986. I-ICFA publication no. 01–002. Baltimore, MD: Health Care Financing Administration, U.S. Department of Health and Human Services, 1987.Google Scholar
5Brook, R. H., & Lohr, K. N.Monitoring quality of care in the Medicare program. Journal of the American Medical Association, 1987, 258, 3138–41.CrossRefGoogle ScholarPubMed
6Chassin, M. R., Park, R. E., Lohn, K. N. et al. , Differences among hospitals in Medicare patient mortality. Health Services Research, 1989, 24, 1–31.Google ScholarPubMed
7Donabedian, A.Evaluating the quality of medical care. Milbank Memorial Fund Quarterly, 1966, 07 (Part 2) 44, 166–203.CrossRefGoogle ScholarPubMed
8Donabedian, A.The definition of quality and approaches to its management. Volumes I–III. Ann Arbor, Michigan: Health Administration Press, 1980, 1982, 1984.Google Scholar
9Donabedian, A.The assessment of technology and quality. International Journal of Technology Assessment in Health Care, 1988, 4, 487–96.CrossRefGoogle ScholarPubMed
10Dubois, R. W., Brook, R. H., & Rogers, W. H.Adjusted hospital death rates: A potential screen for quality of medical care. American Journal of Public Health, 1987, 77, 1162–66.CrossRefGoogle ScholarPubMed
11Dubois, R. W., Rogers, W. H., Moxley, J. et al. , Hospital inpatient mortality: Is it a prediction of quality? New England Journal of Medicine, 1987, 317, 1674–78.CrossRefGoogle ScholarPubMed
12Elinson, J., quoting himself in: Donabedian, A. et al. , Advances in health assessment conference discussion panel. Journal of Chronic Diseases, 1987,40 (Supplement 1), 183S–91S.Google Scholar
13Ellwood, P.Outcomes management. A technology of patient experience. New England Journal of Medicine, 1988, 318, 1549–56.CrossRefGoogle ScholarPubMed
14General Accounting Office. Medicare: Improving quality of care assessment and assurance. GAO/PEMD-88–10. Washington, DC: General Accounting Office, 1988.Google Scholar
15General Accounting Office. Medicare: Improved patient outcomes analyses could enhance quality assessments. GAO/PEMD-88–23. Washington, DC: General Accounting Office, 1988.Google Scholar
16Goldberg, G. A., & Tracey, L. V. Exploring health claims data as a quality monitoring tool: A first step, 1986–1987. Paper presented at 1988 American Public Health Association annual meeting, Committee on Health Services Research Session “Computer Applications for Quality Assessment and Assurance.”Google Scholar
17Greenfield, S., Aronow, H. U., Elashoff, R. M. et al. , Flaws in mortality data. The hazards of ignoring comorbid disease. Journal of the American Medical Association, 1988, 260, 2253–55.CrossRefGoogle ScholarPubMed
18Hsia, D. C., Krushat, W. M., Fagan, A. B. et al. , Accuracy of diagnostic coding for Medicare patients under the prospective-payment system. New England Journal of Medicine, 1988, 318, 352–55.CrossRefGoogle ScholarPubMed
19Iezzoni, L. I., & Moskowitz, M. A.A clinical assessment of MedisGroups. Journal of the American Medical Association, 1988, 260, 3159–63.CrossRefGoogle ScholarPubMed
20Jencks, S. F., Daley, J., Draper, D. et al. , Interpreting hospital mortality data. The role of clinical risk adjustment. Journal of the American MedicalAssociation, 1988, 260 3611–16.CrossRefGoogle ScholarPubMed
21Jencks, S. F., Williams, D. K., & Kay, T. L.Assessing hospital associated deaths from discharge data. The role of length of stay and comorbidities. Journal of the American Medical Association, 1988, 260 2240–46.CrossRefGoogle ScholarPubMed
22Jencks, S. F., Brook, R. H., Iezzoni, L. I. et al. , Symposium: Case-mix measurement and assessing quality of hospital care. Health Care Financing Review Annual Supplement, 1987, 12, 39–48.Google Scholar
23Kane, R. A., & Kane, R. L.Long-term care: Variations on a quality assurance theme. Inquiry, 1988, 25, 132–46.Google ScholarPubMed
24Katz, S., guest editor. The Portugal conference: Measuring quality of life and functional status in clinical and epidemiological research. Journal of Chronic Diseases, 1987, 40, 459–650.CrossRefGoogle Scholar
25Lohr, K. N.Quality of care in episodes of common respiratory infections in a disadvantaged population. P-6570. Santa Monica, CA: The RAND Corporation, 1981.Google Scholar
26Lohr, K. N.Outcome measurement: Concepts and questions. Inquiry, 1988, 25, 37–50.Google ScholarPubMed
27Lohn, K. N., guest editor. Advances in health status assessment: Conference proceedings. Medical Care, 1989, 27 (March Supplement), S1–S294.Google Scholar
28Lohr, K. N., & Ware, J. E. Jr, guest editors. Proceedings of the advances in health assessment conference. Journal of Chronic Diseases, 1987, 40 (Supplement 1), 1S–193S.CrossRefGoogle Scholar
29Lohr, K. N., Brook, R. E., & Kaufman, M. A.Quality of care in the New Mexico Medicaid program. The effect of the New Mexico Experimental Medical Care Review Organization on the use of antibiotics for common infectious diseases. Medical Care, 1980, 18 (01 Supplement), 1–129.Google ScholarPubMed
30Moskowitz, M. A. Using computerized clinical data for quality review in hospitals. Paper presented at 1988 American Public Health Association annual meeting, Committee on Health Services Research Session “Computer Applications for Quality Assessment and Assurance.”Google Scholar
31Mossey, J. M., & Roos, L. L. JrUsing insurance claims to measure health status: The Illness Scale. Journal of Chronic Diseases, 1987, 40 (Supplement 1), 41S–50S.CrossRefGoogle ScholarPubMed
32National Association of Health Data Organizations. Briefing papers for “Fostering Uniformity and Priorities for Health Care Assessment Data Gathering,” a NAHDO project funded by a John A. Hartford Foundation Grant (No 86375–2H). Washington, DC: NAHDO, various dates.Google Scholar
33Office of Technology Assessment. The quality of medical care: Information for consumers. OTA-H-386. Washington, DC: Congress of the United States, Office of Technology Assessment, 1988.Google Scholar
34Ray, W. A., Federspiel, C. F., & Schaffner, W.Prescribing of chioramphenicol in ambulatory practice. Annals of Internal Medicine, 1976, 84, 266–70.CrossRefGoogle Scholar
35Ray, W. A., Federspiel, C. F., & Schaffner, W.The mal-prescribing of liquid tetracycline preparations. American Journal of Public Health, 1977, 67, 762–63.CrossRefGoogle ScholarPubMed
36Ray, W. A., Federspiel, C. F., & Schaffner, W.Prescribing of tetracycline to children less than 8 years old. Journal of the American Medical Association, 1977, 237, 2069–74.CrossRefGoogle Scholar
37Roos, L. L., & Sharp, S. M.Becoming more efficient at outcomes research. International Journal of Technology Assessment, 1988, 4, 555–71.CrossRefGoogle ScholarPubMed
38Roos, L. L., Cageorge, S. M., Austen, E. et al. , Using computers to identify complications after surgery. American Journal of Public Health, 1985, 75, 1288–95.CrossRefGoogle ScholarPubMed
39Roos, L. L., Nicol, J. P., Johnson, C. F. et al. , Using administrative data banks for research and evaluation. Evaluation Quarterly, 1979, 3, 236–55.CrossRefGoogle Scholar
40Roos, L. L., Roos, N. P., Fisher, E. et al. , Strengths and Weaknesses of Health Insurance Data Systems for Assessing Outcomes.Paper prepared for the Study to Design a Strategy for Quality Review and Assurance in Medicare, Institute of Medicine, National Academy of Sciences, 05, 1989.Google Scholar
41Roos, L. L., Roos, N. P., & Sharp, S. M. Monitoring adverse outcomes of surgery using administrative data. Health Care Financing Review Annual Supplement, HCFA Publication No. 03258, 1987, 12, 5–16.Google Scholar
42Roos, N. P., & Ramsey, E. W.A population-based study of prostatectomy: Outcomes associated with differing surgical approaches. Journal of Urology, 1987, 137, 1184–88.CrossRefGoogle ScholarPubMed
43Roos, N. P., Roos, L. L., Mossey, J. et al. , Using administrative data to predict important health outcomes. Entry to hospital, nursing home, and death. Medical Care 1988, 26, 221–39.CrossRefGoogle ScholarPubMed
44Roper, W. L., & Hackbarth, G. M.HCFA's agenda for promoting high-quality care. Health Affairs, 1988, 7 (Spring), 91–98.CrossRefGoogle ScholarPubMed
45Schaffner, W., Ray, W. A., & Federspiel, C. F.Surveillance of antibiotic prescribing in office practice. Annals of Internal Medicine, 1979, 89, 796–99.CrossRefGoogle Scholar
46Stewart, A. L., Greenfield, S., Hays, R. D. et al. , Functional status and well-being of patients with chronic conditions: Results from the Medical Outcomes Study. Journal of the American Medical Association, 1989, 262, 907–13.CrossRefGoogle ScholarPubMed
47Tarlov, A. R., Ware, J. E., Greenfield, S. et al. , The Medical Outcomes Study. Journal of the American Medical Association, 1989, 262, 925–30.CrossRefGoogle ScholarPubMed
48Wells, K. B., Stewart, A., Hays, R. D. et al. , The functioning and well-being of depressed patients: Results from the Medical Outcomes Study. Journal of the American MedicalAssociation, 1989, 262, 914–19.CrossRefGoogle ScholarPubMed
49Wennberg, J. E.Commentary: Using claims to measure health status. Journal of Chronic Diseases, 1987, 40 (Supplement 1), 51S–54S.CrossRefGoogle Scholar
50Wennberg, J. E., Roos, N. P., Sola, L. et al. , Use of claims data systems to evaluate health care outcomes: Mortality and reoperation following prostatectomy. Journal of the A merican Medical Association, 1987, 257, 933–36.CrossRefGoogle ScholarPubMed