Comparison of provider claims data versus medical records review for assessing provision of adult preventive services

J Ambul Care Manage. Apr-Jun 2008;31(2):178-86. doi: 10.1097/01.JAC.0000314708.65289.3b.

Abstract

Administrative claims data are often used to assess the delivery of preventive services, yet there are important limitations. This study assessed the use of claims data to measure quality for pay-for-performance and as a preventive services screening tool compared with medical records review. Accuracy and bias in relying on claims data from a provider perspective were investigated, including a comparison of practice types. Claims data consistently underestimated the rate of preventive services, but the type of practice influenced accuracy. Claims data should be used cautiously, if at all, for pay for performance or to trigger reminders for preventive services completion.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Aged
  • Female
  • Humans
  • Insurance Claim Review / statistics & numerical data*
  • Male
  • Medical Audit / statistics & numerical data*
  • Middle Aged
  • Minnesota
  • Preventive Medicine* / statistics & numerical data
  • Quality Assurance, Health Care / economics