title: Electronic health records vs Medicaid claims: completeness of diabetes preventive care data in community health centers.
abstract: OBJECTIVE
  Electronic Health Record (EHR) databases in community health centers (CHCs) present new opportunities for quality improvement, comparative effectiveness, and health policy research. We aimed (1) to create individual-level linkages between EHR data from a network of CHCs and Medicaid claims from 2005 through 2007; (2) to examine congruence between these data sources; and (3) to identify sociodemographic characteristics associated with documentation of services in one data set vs the other.
  
  
  METHODS
  We studied receipt of preventive services among established diabetic patients in 50 Oregon CHCs who had ever been enrolled in Medicaid (N = 2,103). We determined which services were documented in EHR data vs in Medicaid claims data, and we described the sociodemographic characteristics associated with these documentation patterns.
  
  
  RESULTS
  In 2007, the following services were documented in Medicaid claims but not the EHR: 11.6% of total cholesterol screenings received, 7.0% of total influenza vaccinations, 10.5% of nephropathy screenings, and 8.8% of tests for glycated hemoglobin (HbA(1c)). In contrast, the following services were documented in the EHR but not in Medicaid claims: 49.3% of cholesterol screenings, 50.4% of influenza vaccinations, 50.1% of nephropathy screenings, and 48.4% of HbA(1c) tests. Patients who were older, male, Spanish-speaking, above the federal poverty level, or who had discontinuous insurance were more likely to have services documented in the EHR but not in the Medicaid claims data.
  
  
  CONCLUSIONS
  Networked EHRs provide new opportunities for obtaining more comprehensive data regarding health services received, especially among populations who are discontinuously insured. Relying solely on Medicaid claims data is likely to substantially underestimate the quality of care.
authors: Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA. devoej@ohsu.edu
authors: Jennifer E
authors: JE
authors: Devoe
authors: Rachel
authors: R
authors: Gold
authors: Patti
authors: P
authors: McIntire
authors: Jon
authors: J
authors: Puro
authors: Susan
authors: S
authors: Chauvie
authors: Charles A
authors: CA
authors: Gallia
mesh_terms: D000328:Adult; D000368:Aged; D003151:Community Health Centers / Q000592:standards*; D003920:Diabetes Mellitus / Q000517:prevention & control; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting / Q000592:standards*; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009922:Oregon; D014481:United States; D055815:Young Adult