Abstract
To investigate the reliability of Medicaid claims data for use in research, clinical decision-making, and policy, medical records were abstracted of 105 inpatient stays on the psychiatric service of a large general hospital. Primary and secondary diagnoses and outpatient specialty mental health services after hospitalization were compared between Medicaid claims data and medical record information. Primary and secondary diagnoses were reliable, but claims data failed to capture several types of outpatient services. This suggests strategies to use claims files more appropriately.
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REFERENCES
Boyer, C.A., & Mechanic, D.(1994).Psychiatric reimbursement reform in New York State:Lessons in implementing change.The Milbank Quarterly,72, 621–651.
Center for Research on the Organization and Financing of Care for the Severely Mentally III.(1994). Evaluation of the consolidated inpatient and outpatient psychiatric rate methodology:Analyses of linkage rates.New Brunswick, NJ: Institute for Health, Health Care Policy and Aging Research.
Dickey, B., & Azeni, H.(1996).Persons with dual diagnoses of substance abuse and major mental illness:Their excess costs of psychiatric care.American Journal of Public Health,86, 973–977.
Edouard, L., & Rawson, N.(1996).Reliability of the recording of hysterectomy in the Saskatchewan health care system.British Journal of Obstetrics and Gynaecology,103, 891–897.
Federspiel, C.F., Ray, W.A., & Schaffner, W.(1976).Medicaid records as a valid data source:The Tennessee experience.Medical Care,14, 166–182.
Fisher, E., Whaley, F., Krushat, M., Malenka, D., Fleming, C., Baron, J., & Hsia, D.(1992).The accuracy of Medicare's hospital claims data:Progress has been made, but problems remain.American Journal of Public Health,82, 243–248.
Fowles, J.B., Lawthers, A.G., Weiner, J.P., Garnick, D.W., Petrie, D.S., & Palmer, R.H.(1995).Agreement between physicians'office records and Medicare Part B claims data.Health Care Financing Review,16, 189–199.
Green, J.(1988).Frequent rehospitalization and noncompliance with treatment.Hospital E Community Psychiatry,39, 963–966.
Green, J., Wintfeld, N., Sharkey, P., & Passman, L.J.(1990).The importance of severity of illness in assessing hospital mortality.Journal of the American Medical Association, 263, 241–246.
Hillman, B., Joseph, C., Mabry, M., Sunshine, J., Kennedy, S., & Noether, M.(1991).Frequency and costs of diagnostic imaging in office practice:A comparison of self-referring and radiologist-referring physicians.New England Journal of Medicine,323, 1604–1608.
Horner, R., Paris, J., Purvis, J., & Lawler, F.(1991).Accuracy of patient encounter and billing information in ambulatory care.Journal of Family Practice,33, 593–598.
Iezzoni, L.I., Foley, S.M., Daley, J., Hughes, J., Fisher, E.S., & Heeren, T.(1992).Comorbidities, complications, and coding bias:Does the number of diagnosis codes matter in predicting in-hospital mortality? Journal of the American Medical Association,267, 2197–2203.
Jencks, S.F., Williams, D.K., & Kay, T.L.(1988).Assessing hospital-associated deaths from discharge data.Journal of the American Medical Association,260, 2240–2245.
Kashner, T.(1998).Agreement between administrative files and written medical records:A case of the Department of Veterans Affairs.Medical Care,36, 1324–1336.
Kendall, D.B., & Levine, S.R.(1998).Pursuing the promise of an information-age health care system. Health Affairs,17, 41–43.
Kleinke, J.D.(1998).Release 0.0:Clinical information technology in the real world.Health Affairs,17, 23–38.
Kosecoff, J., Chassin, M., Fink, A., Flynn, M., McCloskey, L., Genovese, B., Oken, C., Solomon, D., & Brook, R.(1987).Obtaining clinical data on the appropriateness of medical care in community practice.Journal of the American Medical Association,258, 2538–2542.
Krakauer, H., Bailey, R., Skellan, K., Stewart, J., Hartz, A., Kuhn, E., & Rimm, A.(1992).Evaluation of the HCFA model for the analysis of mortality following hospitalization.Health Services Research,27, 317–335.
Lohr, K.N.(1990).Use of insurance claims data in measuring quality of care.International Journal of Technology Assessment,6, 263–281.
Lurie, N., Popkin, M., Dysken, M., Moscovice, I., & Finch, M.(1992).Accuracy of diagnoses of schizophre-nia in Medicaid claims.Hospital E Community Psychiatry,43, 69–71.
Olfson, M., Mechanic, D., Hansell, S., Boyer, C.A., Walkup, J., & Weiden, P.J.(1998).Predicting medication noncompliance in schizophrenia following hospital discharge.Unpublished paper.Rutgers University, Institute for Health, Health Care Policy and Aging Research.
Quam, L., Ellis, L.B.M., Venus, P., Clouse, J., Taylor, C.G., & Leatherman, S.(1993).Using claims data for epidemiologic research:The concordance of claims-based criteria with the medical record and patient survey for identifying a hypertensive population.Medical Care, 31, 498–507.
Rawson, N., & Malcolm, E.(1995).Validity of the recording of ischaemic heart disease and chronic obstructive disease in the Saskatchewan health care datafiles.Statistics in Medicine,14, 2627–2643.
Rawson, N., Malcolm, E., & D'Arcy, C.(1997).Reliability of the recording of schizophrenia and depressive disorder in the Saskatchewan health care datafiles.Social Psychiatry and Psychiatric Epidemiology,32, 191–199.
Ray, W., & Griffin, M.(1989).Use of Medicaid data for pharmacoepidemiology.American Journal of Epidemiology,129, 837–849.
Ries, R., Mullen, M., & Cox, G.(1994).Symptom severity and utilization of treatment resources among dually diagnosed inpatients.Hospital &Community Psychiatry,45, 562–567.
Roos, L.L., Jr., Sharp, S.M., Cohen, M.M., & Wajda, A.(1989).Risk adjustment in claims-based research: The search for efficient approaches.Journal of Clinical Epidemiology,42, 1193–1206.
Roos, N.P., Wennberg, J.E., Malenka, D.J., Fisher, E.S., McPherson, K., Andersen, T.F., Cohen, M.M., & Ramsey, E.(1989).Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia.New England Journal of Medicine,320, 1120–1126.
Rosenfield, S., Caton, C., Nachumi, G., & Robbins, E.(1986).Closing the gaps:The effectiveness of linking programs connecting chronic mental patients from the hospital to the community.Journal of Applied Behavioral Science,22, 411–423.
Schwartz, A., Perlman, B., Paris, M., Schmidt, K., & Thornton, J.C.(1980).Psychiatric diagnoses as reported to Medicaid and as recorded in patient charts.American Journal of Public Health,70, 406–408.
Soloman, P., Gordon, B., & Davis, J.(1986).Reconceptualizing assumptions about community mental health.Hospital &Community Psychiatry,37, 708–712.
Tessler, R., & Mason, J.(1979).Continuity of care in the delivery of mental health services.American Journal of Psychiatry,136, 1297–1301.
Thomas, J.W., Holloway, J.J., & Guire, K.E.(1993).Validating risk-adjusted mortality as an indicator for quality of care.Inquiry,30, 6–22.
Weiner, J., Powell, N., Steinwachs, D., & Dent, G.(1990).Applying insurance claims data to assess quality of care:A compilation of potential indicators.Quality Review Bulletin,16, 424–438.
Whittle, J., Steinberg, E.P., Anderson, G.F., & Herbert, R.(1991).Use of Medicare claims data to evaluate the outcomes of elderly patients undergoing lung resection for lung cancer.Chest, 100, 729–734.
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Walkup, J.T., Boyer, C.A. & Kellermann, S.L. Reliability of Medicaid Claims Files for Use in Psychiatric Diagnoses and Service Delivery. Adm Policy Ment Health 27, 129–139 (2000). https://doi.org/10.1023/A:1021308007343
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DOI: https://doi.org/10.1023/A:1021308007343