商业医疗保健索赔数据的基准评价
Alex Dahlen1,2, Yaowei Deng2,3, Vivek Charu2,4
1Department of Biostatistics, School of Global Public Health, New York University, New York, NY.
medRxiv : the preprint server for health sciences
|September 4, 2024
概括
商业医疗保健索赔数据显示了显著的偏差,低估了美国一般人口的手术率的23.1%. 这种偏见与社会经济因素有关,当专注于商业保险人员时,这种偏见会减少.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 生物统计学 生物统计学
- 卫生经济学 卫生经济学
背景情况:
- 商业医疗保健索赔数据集被广泛用于医疗服务研究,但由于社会经济和人口偏见,可能无法准确地代表整个美国人口.
- 现有的研究缺乏严格的比较来量化索赔数据中的偏差,并了解其驱动因素.
研究的目的:
- 量化不同目标人群的商业医疗保健索赔数据中的偏差.
- 评估社会经济和人口因素对这种偏差程度的影响.
主要方法:
- 以 Merative MarketScan 商业数据库和州住院患者数据库 (SID) 为参考的回顾性观察研究.
- 从2019年开始,对五个州的18-64岁患者的住院出院记录进行分析.
- 估计和比较250个最常见的住院手术的病例率,对三个目标人群的索赔数据和参考数据进行比较.
主要成果:
- 索赔数据低估了美国一般人口 (18-64岁) 的住院出院率的23.1%.
- 在不同程序中观察到偏差的显著变化,22.8%的偏差被低估了超过两倍的因素.
- 偏见与社区层面的社会经济因素有显著的关联,特别是在弱势地区更常见的程序中 (R2=51.6%,p<0.001).
- 将目标人群限制在商业保险的个人中,大大减少了偏见 (3.2%的程序偏见>2x),尽管仍存在一些变化.
结论:
- 对商业医疗保健索赔数据的天真使用来估计美国人口率可能会导致严重的低估.
- 邻里社会经济因素部分解释了索赔数据中观察到的偏差.
- 虽然对商业保险人群的偏见有所减少,但仍然需要仔细考虑数据限制.
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