根据ICD-10-CM编码定义测量并发症的差异,使用Medicare优势遭遇数据和服务费索赔
Emilie D Duchesneau1, Allison Musty1, Elyse Miller1,2
1Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.
Medical care
|January 20, 2026
概括
医疗保险优势 (MA) 遭遇数据显示,与费用服务 (FFS) 索赔相比,共发病率在很大程度上一致. 这支持MA数据的可靠性用于衰老研究,尽管一些编码变异需要进一步研究.
科学领域:
- 老年学是指老年学的学科.
- 医疗保健服务研究 医疗服务研究
- 生物统计学 生物统计学
背景情况:
- 自2019年以来可获得的Medicare Advantage (MA) 遭遇数据为研究提供了机会.
- 对于MA遭遇数据的质量和一致性仍然存在担忧.
- 了解MA的并发症编码与传统的费用服务 (FFS) 对准确的健康研究至关重要.
研究的目的:
- 为了评估国际疾病分类第10版临床修改 (ICD-10-CM) 协同疾病编码在医疗保险优势 (MA) 和服务费用 (FFS) 数据之间的一致性.
- 通过将其与FFS索赔数据进行比较,评估MA遭遇数据的可靠性.
主要方法:
- 利用了来自国家健康和衰老趋势研究 (NHATS) 的数据,与医疗保险入学,MA遭遇和FFS索赔 (2016-2017) 相联系.
- 包括在研究前一年连续注册MA或FFS的参与者.
- 使用ICD-10-CM代码识别的并发症和人口统计和临床共变量标准化后估计的流行差异 (PDs).
主要成果:
- 在标准化后,MA和FFS受益者之间的并发症患病率在很大程度上是相似的.
- 周围血管疾病和功能衰竭在MA受益者中更为普遍.
- 流体/电解质障碍和缺血性贫血在FFS受益者中患病率较高,其他差异较小.
结论:
- 在MA遭遇和FFS索赔之间,并发病率在很大程度上是一致的,这支持了MA数据对衰老研究的可靠性.
- 观察到的差异可能源于真正的差异或编码实践的变化,受供应商激励和文档的影响.
- 建议进行进一步的验证研究,以解决剩余的编码差异.
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