Research use of insurance claims data presents unique challenges and requires a series of value judgments that are intended to improve the data quality. In this study, medical insurance claims from 2 large companies were combined to assess utilization of complementary and alternative medicine. Challenges included assessing and improving the quality of data, combining data from 2 different companies with dissimilar coding systems, and determining the most appropriate ways to describe utilization. This article addresses 4 methodologic challenges in creating the analytic files: (1) conversion of claims into unique visits, (2) identification of incomplete claims data, (3) categorization of providers and locations of service, and (4) selecting the most useful measures of utilization and expenditures.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1533763PMC
http://dx.doi.org/10.1177/1062860606288774DOI Listing

Publication Analysis

Top Keywords

insurance claims
12
claims data
12
medical insurance
8
data
6
claims
5
challenges
4
challenges medical
4
utilization
4
data utilization
4
utilization analysis
4

Similar Publications

To date, there are limited studies describing the use of glucose-lowering medications (GLMs) in adult kidney transplant recipients (KTRs), and the uptake of sodium glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1RAs). Thus, we aimed to evaluate the use of GLMs, including SGLT2i and GLP1RA, among adult KTRs with type 2 diabetes (T2D). This is an ecologic study of adult KTR with T2D.

View Article and Find Full Text PDF

Impact of Uterine Leiomyomas on Cardiovascular Disease Risk in Young Reproductive-Aged Women: A Nationwide Population-Based Cohort Study.

J Clin Med

January 2025

Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.

Uterine leiomyomas are the most common benign gynecological tumors in women of reproductive age and are often associated with localized symptoms. However, emerging evidence suggests a link between uterine leiomyomas and systemic conditions such as cardiovascular disease (CVD), particularly myocardial infarction (MI) and ischemic stroke (IS). This study aimed to investigate the relationship between uterine leiomyomas and the risk of CVD events in young women aged 20-39 years using a large, nationwide, population-based cohort.

View Article and Find Full Text PDF

Surgical Scheduling Errors During Manual Data Transfer.

Qual Manag Health Care

January 2025

Author Affiliations: Source Healthcare, Santa Monica, California.

Background And Objectives: Retrospective studies examining errors within a surgical scheduling setting do not fully represent the effects of human error involved in transcribing critical patient health information (PHI). These errors can negatively impact patient care and reduce workplace efficiency due to insurance claim denials and potential sentinel events. Previous reports underscore the burden physicians face with prior authorizations which may lead to serious adverse events or the abandonment of treatment due to these delays.

View Article and Find Full Text PDF

This study quantifies the impact of COVID-19 vaccination on hospitalization for COVID-19 infection in a South African private health insurance population. This retrospective cohort study is based on the analysis of demographic and claims records for 550,332 individuals belonging to two health insurance funds between 1 March 2020 and 31 December 2022. A Cox Proportional Hazards model was used to estimate the impact of vaccination (non-vaccinated, partly vaccinated, fully vaccinated) on COVID-19 hospitalization risk; and zero-inflated negative binomial models were used to estimate the impact of vaccination on hospital utilization and hospital expenditure for COVID-19 infection, with adjustments for age, sex, comorbidities and province of residence.

View Article and Find Full Text PDF

A new model-based approach for estimating rural hospital markets.

J Rural Health

January 2025

North Carolina Rural Health Research Program, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Purpose: To provide a new approach for defining rural hospital markets.

Methods: First, we estimated models of hospital choice. We defined hospitals in the choice set using nationwide hospital data from the Healthcare Cost Report Information System (HCRIS).

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!