title: Agreement between insurance claim and self-reported hospital and emergency room utilization data among persons with diabetes.
abstract: As part of a retrospective evaluation of a diabetes management program, the agreement between self-reported and insurance claim data on hospitalization and emergency room utilization was examined. Data agreement on hospitalization or emergency room visits between the two collection modes was evaluated through the use of simple agreement proportions and the kappa agreement statistic. A total of 1,230 participant responses were studied. The proportions of patients with hospitalization or emergency room visits were indistinguishable between the self-reported and medical claims data, and kappa statistics also indicated good-to-excellent agreement between data sets. The percentages of participants whose self-reported hospitalization and emergency room utilization exactly matched data derived from insurance claims were high (89.1% and 87.2%, respectively). Furthermore, the kappa statistics of agreement for the number of hospitalizations (0.6366) and emergency room visits (0.5390) indicate good agreement between self-reported and insurance claim data. The results of this study suggest either self-reported or insurance claims data can be used to evaluate the impact of health care interventions on hospital or emergency room utilization.
authors.affiliation: Department of Analytics and Outcomes Research, Caremark Rx, Inc., 2211 Sanders Road NBT3, Northbrook, IL 60062, USA. andrea.marks@caremark.com
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Marks
authors.forename: David W
authors.initials: DW
authors.lastname: Lee
authors.forename: Julie
authors.initials: J
authors.lastname: Slezak
authors.forename: Jan
authors.initials: J
authors.lastname: Berger
authors.forename: Hitesh
authors.initials: H
authors.lastname: Patel
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Johnson
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data*; D007350:Insurance, Hospitalization; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies