The validity of Medicaid pharmacy claims for estimating drug use among elderly nursing home residents: The Oregon experience

Darlene A. McKenzie, Joyce Semradek, Bentson H. McFarland, John P. Mullooly, Lynn E. McCamant

Research output: Contribution to journalArticle

58 Scopus citations

Abstract

This study compared computerized Medicaid pharmacy claims data for nursing home residents with chart data to establish how well the claims data identified those receiving drugs within three different psychoactive drug classes (yes/no for each class) and how well the claims estimated total within-class average daily dose. Percent agreement, positive predictive value (PPV), and negative predictive value (NPV) for drug exposure were over 85% for each class. Kappas were excellent for antipsychotics and antidepressants, and good for anxiolytics. Correspondence was lower for average daily dose. Using an algorithm that credits some but not all doses associated with overlapping claims, correlations ranged from 0.97 to 0.66. Agreement on therapeutic dose was excellent for antipsychotics (κ = 0.81) and fair to good for antidepressants and anxiolytics (κ = 0.63, and κ = 0.52, respectively). The findings suggest that Medicaid pharmacy claims data are reasonably accurate for quality assurance and accreditation purposes.

Original languageEnglish (US)
Pages (from-to)1248-1257
Number of pages10
JournalJournal of Clinical Epidemiology
Volume53
Issue number12
DOIs
StatePublished - Dec 1 2000

Keywords

  • Claims
  • Drug utilization review
  • Health services research methods
  • Medicaid
  • Pharmacoepidemiology
  • Quality indicators

ASJC Scopus subject areas

  • Epidemiology

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