Association between claims-based setting of diagnosis and treatment initiation among Medicare patients with hepatitis...

Area of Science:

• Health Services Research
• Epidemiology
• Health Informatics

Background:

• Determining the initial diagnosis setting for diseases like Hepatitis C Virus (HCV) is crucial for understanding care pathways.
• Claims data offers a valuable resource for retrospective analysis of healthcare delivery.

Purpose of the Study:

• To develop and validate a claims-based algorithm for identifying the specific healthcare setting where a Hepatitis C Virus (HCV) diagnosis is first recorded.
• To assess the relationship between the diagnostic setting and subsequent treatment initiation for HCV.

Main Methods:

• A claims-based algorithm was developed using facility indicators, revenue center codes, and place of service codes to pinpoint HCV diagnosis settings.
• Medicare enrollment and claims data (2014-2019) for continuously enrolled patients were analyzed.
• The algorithm's validity was assessed by examining the association between identified diagnostic settings and subsequent HCV treatment initiation.

Main Results:

• The algorithm successfully identified the setting of HCV diagnosis for the majority of patients.
• A significant proportion of diagnoses occurred in outpatient settings (70.1% for ages 18-64, 69% for ages ≥65).
• Logistic regression indicated lower odds of treatment initiation when HCV was diagnosed in emergency departments, urgent cares, hospitals, laboratories, or unclassified settings compared to outpatient visits.

Conclusions:

• The developed claims-based algorithm effectively determines the setting of HCV diagnosis.
• The identified diagnostic setting is significantly associated with the likelihood of treatment initiation.
• This algorithm provides a adaptable approach for future claims-based research on disease diagnosis settings.