Medical insurance claims as a source of data for research: accuracy of diagnostic coding.
Validation of diagnostic codes in a sample of Hawaii medical insurance claims in 1986 to 1987 revealed 96% accuracy in hospital claims, high enough to supply data for research purposes. In physician claims the accuracy was only 62%. Initiation of two feedback loops to physicians from the insurer in 1989 resulted in a marked improvement of diagnostic coding accuracy by 1992 to 1994.
Worth
R M
RM
Hawaii MEDTEP Research Center, Pacific Health Research Institute, Honolulu 96813, USA.
Mytinger
R E
RE
D003141:Communicable Diseases / Q000175:diagnosis; D003933:Diagnosis; D005246:Feedback; D005568:Forms and Records Control; D006254:Hawaii; D006753:Hospital Records; D006801:Humans; D007256:Information Systems; D007348:Insurance, Health; D010820:Physicians; D015203:Reproducibility of Results; D012106:Research