The use of Medicaid claims as a supplementary source of information on quality of asthma care.
This study examines the correspondence between medical records and Medicaid claims to determine whether claims are a valid source of data for monitoring quality of asthma care. A total of 460 claims for care encounters were matched to medical records of the encounters. While most of the diagnoses and procedures recorded on the claims were documented in medical records, claims failed to identify 29% of encounters with asthma diagnoses and 45% of nebulization procedures administered during encounters. About 30% of documented asthma prescriptions were not associated with filed claims, and about 30% of filed claims for asthma medication were not documented in medical records.
Bronstein
J M
JM
School of Public Health, University of Alabama at Birmingham, USA. jbronste@uab.edu
Santer
L
L
Johnson
V
V
D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004282:Documentation / Q000592:standards; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007344:Insurance Claim Reporting / Q000592:standards*; D008484:Medicaid / Q000706:statistics & numerical data; D008499:Medical Records / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*