确定居住在辅助生活环境中的国家医疗保险受益者队列:一种更新的方法
Kali S Thomas1, Lindsey Smith2, Gauri Gadkari2
1Brown University School of Public Health, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA.
概括
准确识别在辅助生活 (AL) 环境中的医疗保险受益人至关重要. 这项研究改进了使用许可容量和索赔数据的识别方法,以提高医疗保险行政数据的准确性.
科学领域:
- 老年学是一门学科.
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
背景情况:
- 在获得许可的辅助生活 (AL) 设置中准确识别医疗保险受益人是一项挑战.
- 现有的方法可能会过度或过少计算这个人群,影响卫生服务研究和政策.
- 了解AL居民的特点对于资源分配和护理规划至关重要.
研究的目的:
- 提出一种更新的,更准确的方法来识别居住在美国各地授权的辅助生活 (AL) 设施中的医疗保险受益人.
- 在医疗保险行政数据中提高AL居民识别的准确性.
- 区分真正的AL居民与居住在AL设施附近的受益者.
主要方法:
- 一项回顾性队列研究利用了医疗保险入学,索赔和评估数据,结合了获得许可的AL设置和美国邮政服务 (USPS) 数据的国家清单.
- 受益人使用与AL地址相关的ZIP+4代码进行识别,不包括在养老院或医院的受益人.
- 精细的识别涉及使用USPS数据的地址密度,AL许可容量和索赔/评估数据来将居民分类为"绝对"或"非常可能"的AL居民.
主要成果:
- 精细的识别过程排除了一组受益者 (标记为"可能的邻居"),他们通常比最终确定为AL居民的人年轻,身体更健康.
- 通过添加索赔和评估数据识别的受益人表现出相似的人口统计数据,但与其他纳入的队列相比,他们的健康状况较差.
- 该研究表明,结合许可容量和索赔/评估数据可以提高对识别AL居民的信心.
结论:
- 利用许可容量信息,并补充索赔和评估数据,可显著提高使用医疗保险行政数据识别辅助生活居民的准确性.
- 这种更新的方法为AL居民识别的准确性提供了更大的信心.
- 这些发现对未来的研究和政策产生了影响,这些研究和政策与医疗保险中的受助生活人口有关.
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