Developing a quality improvement database using health insurance data: a guided tour with application to Medicare's National Claims History file.

S. T. Parente, Jonathan Weiner, D. W. Garnick, T. M. Richards, J. Fowles, A. G. Lawthers, P. Chandler, R. H. Palmer

Research output: Contribution to journalArticle

Abstract

Health policy researchers are increasingly turning to insurance claims to provide timely information on cost, utilization, and quality trends in health care markets. This research offers an in-depth description of how to systematically transform raw inpatient and ambulatory claims data into useful information for health care management and research using the Health Care Financing Administration's National Claims History file as an example. The topics covered include: (a) understanding the contents and architecture of claims data, (b) creating analytic files from raw claims, (c) technical innovations for health policy studies, (d) assessing data accuracy, (d) the costs of using claims data, and (e) ensuring confidentiality. In summary, claims data are found to have great potential for quality of care analysis. As in any analysis, careful development of a database is required for scientific research. The methods outlined in this study offer health data novices as well as experienced analysts a series of strategies to maximize the value of claims data for health policy analysis.

Original languageEnglish (US)
Pages (from-to)162-176
Number of pages15
JournalAmerican Journal of Medical Quality
Volume10
Issue number4
StatePublished - Dec 1995

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Health Insurance
Medicare
Health Policy
Quality Improvement
History
Databases
Costs and Cost Analysis
Centers for Medicare and Medicaid Services (U.S.)
Health Care Sector
Quality of Health Care
Policy Making
Health Services Research
Confidentiality
Insurance
Research
Inpatients
Research Personnel
Health

ASJC Scopus subject areas

  • Health Policy
  • Nursing(all)

Cite this

Developing a quality improvement database using health insurance data : a guided tour with application to Medicare's National Claims History file. / Parente, S. T.; Weiner, Jonathan; Garnick, D. W.; Richards, T. M.; Fowles, J.; Lawthers, A. G.; Chandler, P.; Palmer, R. H.

In: American Journal of Medical Quality, Vol. 10, No. 4, 12.1995, p. 162-176.

Research output: Contribution to journalArticle

Parente, ST, Weiner, J, Garnick, DW, Richards, TM, Fowles, J, Lawthers, AG, Chandler, P & Palmer, RH 1995, 'Developing a quality improvement database using health insurance data: a guided tour with application to Medicare's National Claims History file.', American Journal of Medical Quality, vol. 10, no. 4, pp. 162-176.
Parente, S. T. ; Weiner, Jonathan ; Garnick, D. W. ; Richards, T. M. ; Fowles, J. ; Lawthers, A. G. ; Chandler, P. ; Palmer, R. H. / Developing a quality improvement database using health insurance data : a guided tour with application to Medicare's National Claims History file. In: American Journal of Medical Quality. 1995 ; Vol. 10, No. 4. pp. 162-176.
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