从医疗保险记录中估计诊断率:依赖索赔号和潜在的临床特征
Beth Hogans1, Bernadette Siaton2, John Sorkin3
1Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United States; Department of Neurology, Johns Hopkins School of Medicine, Meyer 6-113, Baltimore, MD 21205, United States.
Journal of biomedical informatics
|July 30, 2023
概括
医疗保险索赔数据显示,更高的索赔数量与老年人诊断代码利用率的增加有关. 这影响了如何使用国际疾病分类第10版 (ICD-10) 代码来评估医疗保健过程.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
- 老年学是一门学科.
背景情况:
- 医疗保健数据分析主要依赖于国际疾病分类第10版 (ICD-10) 代码.
- 医疗保险索赔对于人口研究和医疗保健过程评估至关重要.
- 受益人索赔变异性对诊断决定的影响尚未得到充分理解.
研究的目的:
- 评估医疗保险索赔的分布性质.
- 检查索赔率如何影响ICD-10代码的使用和索赔率的决定.
主要方法:
- 从2017年起对医疗保险受益者 (75-79.99岁) 数据的分析.
- 包括医疗保险B部分覆盖全年的受益人.
- 将受益人划分为索赔号码队列的特征.
主要成果:
- 超过221,000名受益者产生了超过760万份索赔.
- 大多数受益者 (96.4%) 有1-120个索赔,中位数为24 (男性) 和25 (女性).
- 诊断率估计 (DREs) 总体上随着索赔人数的增加而增加,特别是对于像胸痛这样的疾病,而一些良性疾病则停滞不前.
结论:
- 75-80岁的医疗保险受益人表现出各种各样的索赔活动.
- 诊断率估计 (DREs) 是高于中位数的索赔号码的受益人更高.
- 索赔号和ICD-10代码使用之间的关系因病情而异.
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