TY - JOUR
T1 - Electronic health records vs medicaid claims
T2 - Completeness of diabetes preventive care data in community health centers
AU - Devoe, Jennifer E.
AU - Gold, Rachel
AU - Mcintire, Patti
AU - Puro, Jon
AU - Chauvie, Susan
AU - Gallia, Charles A.
N1 - Funding Information:
Funding support: This study was supported by grant number UB2HA20235 from the Health Resources and Services Administration (HRSA) , grant number 1RC4LM010852 from the National Library of Medicine, National Institutes of Health (NIH), and a small pilot grant from the Oregon Clinical and Translational Research Institute (OCTRI) , grant number UL1 RR024140 01 from the National Center for Research Resources (NCRR), a component of the NIH, and NIH Roadmap for Medical Research (Gold and Mclntire), and received support from the OHSU Department of Family Medicine Research Division (DeVoe) . Dr DeVoe's time on this project was also supported by grant number 1K08HS16181 from the Agency for Healthcare Research and Quality (AHRQ) . These funding agencies had no involvement in the design and conduct of the study; analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Ms Chauvie and Mr Puro's time was donated by OCHIN. Dr Gallia's time was donated by the Oregon Division of Medical Assistance Programs.
PY - 2011
Y1 - 2011
N2 - PURPOSE 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 infl uenza vaccinations, 10.5% of nephropathy screenings, and 8.8% of tests for glycated hemoglobin (HbA1c). In contrast, the following services were documented in the EHR but not in Medicaid claims: 49.3% of cholesterol screenings, 50.4% of infl uenza vaccinations, 50.1% of nephropathy screenings, and 48.4% of HbA1c 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.
AB - PURPOSE 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 infl uenza vaccinations, 10.5% of nephropathy screenings, and 8.8% of tests for glycated hemoglobin (HbA1c). In contrast, the following services were documented in the EHR but not in Medicaid claims: 49.3% of cholesterol screenings, 50.4% of infl uenza vaccinations, 50.1% of nephropathy screenings, and 48.4% of HbA1c 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.
KW - Access to health care
KW - Community health centers
KW - Diabetes mellitus
KW - Electronic health records
KW - Medicaid
KW - Medically uninsured
KW - Preventive health services
KW - Primary health care
UR - http://www.scopus.com/inward/record.url?scp=79960442666&partnerID=8YFLogxK
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U2 - 10.1370/afm.1279
DO - 10.1370/afm.1279
M3 - Article
C2 - 21747107
AN - SCOPUS:79960442666
SN - 1544-1709
VL - 9
SP - 351
EP - 358
JO - Annals of family medicine
JF - Annals of family medicine
IS - 4
ER -