Abstract
BACKGROUND: This paper describes a collaborative Medicare claims data linkage and sharing effort between the Baylor Health Care System (BHCS) and Texas Medical Foundation (TMF, the Texas Quality Improvement Organization) designed to assess the effect of three quality improvement interventions on care delivered to elderly patients with diabetes. The randomized controlled trial is being conducted among a network of primary care physician practices owned by BHCS and focuses on measures of care process and outcome. METHODS: Cohort definition and baseline measurement took place between January 1 and December 31, 2000. BHCS administrative data and TMF-supplied Medicare enrollment data were used to define the January 1, 2001 prevalence cohort of Medicare diabetic beneficiaries meeting study inclusion criteria. A total of 22 practices (with 92 physicians and 2,158 patients) were randomized to one of three interventions, each of which involved performance measurement feedback on three claims-based measures of care process. Physician profiles, generated by TMF using Medicare utilization files, were reported to study physicians via academic detailing sessions with a BHCS physician educator. RESULTS: The January 1 - December 31, 2000 baseline Medicare claims for the January 1, 2001 prevalence cohort were provided to HTPN by TMF in October 2001, representing a ten-month lag in the ability of Quality Improvement Organizations to provide Part B data relative to a specific episode of care time frame. Overall baseline rates for the claims-based process measures were: annual HbA1c testing (86.1%), annual eye examination (60.8%), and annual lipid profile (72.5%). As anticipated, medical-record based rates of annual eye examination were significantly underrepresented. Agreement between claims-based and medical record-based measures was very close for annual HbA1c and annual lipid profile. CONCLUSIONS: The use of Medicare claims data, through collaboration with a QIO, can help health care providers overcome a significant barrier associated with quality improvement initiatives. Limitations associated with the use of Medicare claims can impact implementation of intervention strategies, but do not prevent them from being a practical tool for improving care.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aubert R. E., Herman W. H., Waters J., Moore W., Sutton D., Peterson B. L., Bailey C. M., Koplan J. P. Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization. A randomized, controlled trial. Ann Intern Med. 1998 Oct 15;129(8):605–612. doi: 10.7326/0003-4819-129-8-199810150-00004. [DOI] [PubMed] [Google Scholar]
- Deichmann R. E., Castello E., Horswell R., Friday K. E. Improvements in diabetic care as measured by HbA1c after a physician education project. Diabetes Care. 1999 Oct;22(10):1612–1616. doi: 10.2337/diacare.22.10.1612. [DOI] [PubMed] [Google Scholar]
- Fleming B. B., Greenfield S., Engelgau M. M., Pogach L. M., Clauser S. B., Parrott M. A. The Diabetes Quality Improvement Project: moving science into health policy to gain an edge on the diabetes epidemic. Diabetes Care. 2001 Oct;24(10):1815–1820. doi: 10.2337/diacare.24.10.1815. [DOI] [PubMed] [Google Scholar]
- Hebert P. L., Geiss L. S., Tierney E. F., Engelgau M. M., Yawn B. P., McBean A. M. Identifying persons with diabetes using Medicare claims data. Am J Med Qual. 1999 Nov-Dec;14(6):270–277. doi: 10.1177/106286069901400607. [DOI] [PubMed] [Google Scholar]
- Jencks S. F., Cuerdon T., Burwen D. R., Fleming B., Houck P. M., Kussmaul A. E., Nilasena D. S., Ordin D. L., Arday D. R. Quality of medical care delivered to Medicare beneficiaries: A profile at state and national levels. JAMA. 2000 Oct 4;284(13):1670–1676. doi: 10.1001/jama.284.13.1670. [DOI] [PubMed] [Google Scholar]
- Sutherland J. E., Hoehns J. D., O'Donnell B., Wiblin R. T. Diabetes management quality improvement in a family practice residency program. J Am Board Fam Pract. 2001 Jul-Aug;14(4):243–251. [PubMed] [Google Scholar]
- Weiner J. P., Parente S. T., Garnick D. W., Fowles J., Lawthers A. G., Palmer R. H. Variation in office-based quality. A claims-based profile of care provided to Medicare patients with diabetes. JAMA. 1995 May 17;273(19):1503–1508. doi: 10.1001/jama.273.19.1503. [DOI] [PubMed] [Google Scholar]