DOI: 10.2105/ajph.82.2.243. The accuracy of Medicare's hospital claims data: progress has been made, but problems remain.

The accuracy of Medicare's hospital claims data: progress has been made, but problems remain.

10.2105/ajph.82.2.243

Crossref journal-article

American Public Health Association

American Journal of Public Health (844)

Abstract

BACKGROUND. Health care databases provide a widely used source of data for health care research, but their accuracy remains uncertain. We analyzed data from the 1985 National DRG Validation Study, which carefully reabstracted and reassigned ICD-9-CM diagnosis and procedure codes from a national sample of 7050 medical records, to determine whether coding accuracy had improved since the Institute of Medicine studies of the 1970s and to assess the current coding accuracy of specific diagnoses and procedures. METHODS. We defined agreement as the proportion of all reabstracted records that had the same principal diagnosis or procedure coded on both the original (hospital) record and on the reabstracted record. We also evaluated coding accuracy in 1985 using the concepts of diagnostic test evaluation. RESULTS. Overall, the percentage of agreement between the principal diagnosis on the reabstracted record and the original hospital record, when analyzed at the third digit, improved from 73.2% in 1977 to 78.2% in 1985. However, analysis of the 1985 data demonstrated that the accuracy of diagnosis and procedure coding varies substantially across conditions. CONCLUSIONS. Although some diagnoses and all major surgical procedures that we examined were accurately coded, the variability in the accuracy of diagnosis coding poses a problem that must be overcome if claims-based research is to achieve its full potential.

Bibliography

Fisher, E. S., Whaley, F. S., Krushat, W. M., Malenka, D. J., Fleming, C., Baron, J. A., & Hsia, D. C. (1992). The accuracy of Medicareâs hospital claims data: progress has been made, but problems remain. American Journal of Public Health, 82(2), 243â248.

Authors 7

E S Fisher (first)
F S Whaley (additional)
W M Krushat (additional)
D J Malenka (additional)
C Fleming (additional)
J A Baron (additional)
D C Hsia (additional)

References 32 Referenced 547

Farmer ME, White LR, Brody JA. Race and sex differences in hip fracture incidence.AmJPublic Health. 1984;74:1374-1380. (10.2105/AJPH.74.12.1374)
Kellie SE, Brody JA. Sex-specific and race-specific hip fracture rates. AmJPublic Health. 1990;80:326-328. (10.2105/AJPH.80.3.326)
Fisher ES, Baron JA, Malenka DJ, etal. Hip fracture incidence and mortality in New England. EpidemioL 1991;2:116-122. (10.1097/00001648-199103000-00005)
Ray WA, Griffin MR, Schaffner W, Baugh DK, Melton JL. Psychotropic drug use and the risk of hip fracture. N Engi J MedL 1987;316:363-369. (10.1056/NEJM198702123160702)
10.1056/NEJM198211183072104
10.1126/science.182.4117.1102
Health Care Financing Administration. Medicare Hospital Mortality Infonnation: 1986. Washington, DC: US Dept of Health and Human Services; 1988.
10.1056/NEJM198811033191805
10.1056/NEJM198904273201705
10.1001/jama.1987.03390070053022
Institute of Medicine. Reliability ofHospitalDischargeAbstracts. Washington, DC: National Academy of Sciences; 1977.
Institute of Medicine. Reliability of Medicare Hospital Dischaige Records. Washington, DC: National Academy of Sciences; 1977.
Institute of Medicine. Reliabiity of National Hospital Discharge Swvey Data. Washington, DC: National Academy of Sciences; 1980.
10.7326/0003-4819-109-9-745
10.1001/jama.1988.03410150088036
10.1001/jama.1988.03410150101039
Hsia DC, Krushat M, Fagan AB, Tebbutt JA, Kusserow RP. Accuracy of diagnostic coding for medicare patients under the prospective-payment system. N EnglJ MeL 1988;318:352-355. (10.1056/NEJM198802113180604)
10.1001/jama.1986.03370070081030
Delaney AM, Hsia DC. National DRG Validation Study: Final Report. Waltham, Mass: Baxter Health Data Institute; 1987.
10.7326/0003-4819-104-1-60
Conover ,WJ. Practical Nonparametric Statistics. 2nd ed. New York, NY: John Wiley & Sons Inc; 1986.
Carter GM, Newhouse JP, Relles DA. How much change in the case-mix index is DRG creep? Santa Monica, Calif: The RAND/UCLA/Harvard Center for Health Care Financing Policy Research; 1990. Publication R-3826-HCFA. (10.1016/0167-6296(90)90003-L)
{'key': 'p_23', 'first-page': '58', 'author': 'American Hospital Association', 'year': '1979', 'journal-title': 'IL.'} / IL. by American Hospital Association (1979)
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Cohen BE, Pokras R, Meads MS, Krushat WM. Howwill diagnosis related groups affect epidemiologic research? Am J EpidemioL 1987;126:1-9. (10.1093/oxfordjournals.aje.a114639)

Dates

Type	When
Created	16 years, 9 months ago (Nov. 29, 2008, 8:17 a.m.)
Deposited	3 years, 3 months ago (May 9, 2022, 2:45 p.m.)
Indexed	21 hours, 3 minutes ago (Sept. 4, 2025, 9:35 a.m.)
Issued	33 years, 7 months ago (Feb. 1, 1992)
Published	33 years, 7 months ago (Feb. 1, 1992)
Published Print	33 years, 7 months ago (Feb. 1, 1992)

Funders 0

None

BibTeX

@article{Fisher_1992, title={The accuracy of Medicare’s hospital claims data: progress has been made, but problems remain.}, volume={82}, ISSN={1541-0048}, url={http://dx.doi.org/10.2105/ajph.82.2.243}, DOI={10.2105/ajph.82.2.243}, number={2}, journal={American Journal of Public Health}, publisher={American Public Health Association}, author={Fisher, E S and Whaley, F S and Krushat, W M and Malenka, D J and Fleming, C and Baron, J A and Hsia, D C}, year={1992}, month=feb, pages={243–248} }

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