Agreement of Medicaid claims and electronic health records for assessing preventive care quality among adults

Abstract

To compare the agreement of electronic health record (EHR) data versus Medicaid claims data in documenting adult preventive care. Insurance claims are commonly used to measure care quality. EHR data could serve this purpose, but little information exists about how this source compares in service documentation. For 13 101 Medicaid-insured adult patients attending 43 Oregon community health centers, we compared documentation of 11 preventive services, based on EHR versus Medicaid claims data. Documentation was comparable for most services. Agreement was highest for influenza vaccination (κ = 0.77; 95% CI 0.75 to 0.79), cholesterol screening (κ = 0.80; 95% CI 0.79 to 0.81), and cervical cancer screening (κ = 0.71; 95% CI 0.70 to 0.73), and lowest on services commonly referred out of primary care clinics and those that usually do not generate claims. EHRs show promise for use in quality reporting. Strategies to maximize data capture in EHRs are needed to optimize the use of EHR data for service documentation.

Keywords: Claims Data; Electronic Health Records; Medical Care Delivery; Preventive Services; Quality of Care.

Figure 1

Decreasing κ statistic for agreement between electronic health record and Medicaid claims potentially related to location of service provision. Flexible sigmoidoscopy, body mass index, and tobacco assessment were not included because of low overall numbers.