Effectiveness and Outcomes in Health Care Proceedings of an Invitational Conference (1990) / Chapter Skim
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Pages 71-79
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PART IV Methoclological Issues and Work in Progress
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He discusses the uses and limitations of claims data for out comes research.
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Usually, it refers to administrative records, or insurance claims data, regarding patients receiving various treatments. The nice thing about using claims for research purposes is that someone else actually collects the data, namely, providers filling out the claims forms.
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USES OF LARGE DATA BASES Probably the most common use of claims data for effectiveness research is to follow patients with a specific diagnosis or patients receiving a specific therapy. Diagnoses are available on institutional claims; procedures are documented on all physician bills.
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Using claims data to examine outcomes associated with ambulatory episodes of care is more problematic because of the absence of diagnostic information on the Part B claims. Thus it is not possible to determine the reason for a given office visit or to trace referral patterns accurately.
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The researcher cannot tell this from the claims data, however, and it will appear as if twice the number of pacemakers were inserted in that area. One carrier has dealt with the team approach by having one physician bill for the insertion, while the other physician bills for pacemaker repair.
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Because state Medicaid programs do cover these services, however, Medicaid claims can be used to fill some important gaps. Similarly, because Medicaid pays for most prescription drugs, these claims can be used to evaluate alternative treatments or to identify a sample of patients undergoing a given treatment regimen: for example, all AIDS patients receiving AZT.
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Repeal of the Act in late 1989 deprived researchers of the opportunity to broaden the questions that could be addressed using Medicare claims data and thus expand effectiveness and outcomes research.
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