title: Combining state administrative databases and provider records to assess the quality of care for children enrolled in Medicaid.
abstract: Our objective was to assess the capability of state administrative health care databases to evaluate the quality of immunization rates for a Medicaid managed care population. Data on 5599 2 year olds were obtained from a Medicaid claims database, a health department database, and the records of the children's assigned providers. The study was conducted on 1 managed care program in 1 state. Test performance ratio analyses were used to assess the relative accuracy and contribution of each source of administrative data. We found that of the 67,188 doses needed, 45,511 (68%) were documented as administered per at least 1 of the data sources. Medicaid claims data alone accounted for 18% of immunized children, while health department data used by itself accounted for 12%. Together, these 2 sources identified 34% of immunized children. Large administrative databases, such as Medicaid claims and data from a health department, while valuable sources of information on quality, may underestimate outcomes such as immunization rates. Assessments of the quality of health care should rely on a combination of administrative data and providers' records as sources of information.
authors.affiliation: Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0306, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Cotter
authors.forename: W R
authors.initials: WR
authors.lastname: Smith
authors.forename: L F
authors.initials: LF
authors.lastname: Rossiter
authors.forename: C B
authors.initials: CB
authors.lastname: Pugh
authors.forename: J D
authors.initials: JD
authors.lastname: Bramble
mesh_terms: D002662:Child Health Services / Q000592:standards*; D019992:Databases as Topic / Q000592:standards; D005260:Female; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D007345:Insurance Claim Review; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008484:Medicaid / Q000706:statistics & numerical data*; D008498:Medical Record Linkage; D011635:Public Health Administration; D011785:Quality Assurance, Health Care / Q000379:methods*; D014481:United States