Assessing insurance claims as a measure for outpatient antimicrobial stewardship

Area of Science:

• Health Services Research
• Infectious Diseases
• Pharmacy Practice

Background:

• Antimicrobial stewardship programs (ASPs) are crucial for combating antimicrobial resistance.
• Outpatient settings present unique challenges for ASP implementation due to data accessibility.
• Validating alternative data sources is essential for expanding stewardship efforts.

Purpose of the Study:

• To evaluate the utility of Medicaid claims (MC) data as a source for outpatient antimicrobial stewardship programs (ASPs).
• To compare the accuracy of MC data against electronic medical record (EMR) data for key stewardship metrics.

Main Methods:

• A retrospective study comparing pediatric MC data with EMR data from Marshall Health Network (MHN).
• Data matching was performed using patient Medicaid ID, service date, and provider NPI.
• Assessed demographics, antibiotic choice, diagnosis appropriateness, and guideline concordance.

Main Results:

• MC and EMR data demonstrated over 90% agreement in antibiotic choice, gender, and service date.
• Discrepancies in diagnosis coding were noted, particularly with multiple infectious diagnoses.
• MC data showed comparable accuracy to EMR in identifying inappropriate prescriptions and assessing guideline concordance.

Conclusions:

• Medicaid claims data is a valid and timely resource for outpatient ASP interventions.
• Leveraging insurance providers as partners can enhance large-scale outpatient stewardship initiatives.