Validity of Race and Ethnicity Codes in Medicare Administrative Data Compared With Gold-standard Self-reported Race Collected During Routine Home Health Care Visits
Validity of Race and Ethnicity Codes in Medicare Administrative Data Compared With Gold-standard Self-reported Race Collected During Routine Home Health Care Visits
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DOI：
10.1097/mlr.0000000000001216
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发表时间：
2020-01-01
期刊：
影响因子：
3
通讯作者：
Lin, Haiqun
中科院分区：
文献类型：
--
作者：
Jarrin, Olga F.;Nyandege, Abner N.;Lin, Haiqun
背景：行政数据来源中对医疗保险受益人的种族/民族的错误分类经常被忽视，这是健康差异研究的一个限制。目的：比较在联邦医疗保险管理数据[登记数据库(EDB)和研究三角研究所(RTI)RACE]中发现的2个种族/民族变量与联邦医疗保险数据仓库中也可用的黄金标准来源：家庭健康结果和评估信息集(OASIS)上自我报告的种族/民族变量的有效性。研究对象：2015年接受家庭保健的18岁以上的医疗保险受益人(N=4,243,090人)。测量：符合率、敏感度、特异度、阳性预测值和Cohen kappa系数。结果：EDB和RTI种族变量对黑人具有较高的效度，对美洲印第安人/阿拉斯加原住民的效度较低。尽管RTI种族变量对其他种族的效度高于EDB种族变量，但Kappa值表明，在白人(0.90)、西班牙裔(0.87)、亚洲/太平洋岛民(0.77)和美洲印第安人/阿拉斯加原住民(0.44)的分类方面，未来仍有改进的空间。讨论：通过使用医疗保险数据仓库中提供的自我报告的种族/族裔数据，可以改善使用联邦医疗保险管理数据中包含的“足够好的政府”种族/族裔变量进行少数族裔健康差距研究的现状。卫生服务和政策研究人员应严格审查少数群体健康和健康差距研究中使用的种族/族裔变量的来源。为提高医疗保险受益人种族/族裔数据的准确性，今后的工作应纳入并增强评估和调查数据中包含的自我报告的种族/族裔数据，这些数据可在医疗保险数据仓库内获得。
Background: Misclassification of Medicare beneficiaries' race/ethnicity in administrative data sources is frequently overlooked and a limitation in health disparities research. Objective: To compare the validity of 2 race/ethnicity variables found in Medicare administrative data [enrollment database (EDB) and Research Triangle Institute (RTI) race] against a gold-standard source also available in the Medicare data warehouse: the self-reported race/ethnicity variable on the home health Outcome and Assessment Information Set (OASIS). Subjects: Medicare beneficiaries over the age of 18 who received home health care in 2015 (N=4,243,090). Measures: Percent agreement, sensitivity, specificity, positive predictive value, and Cohen kappa coefficient. Results: The EDB and RTI race variable have high validity for black race and low validity for American Indian/Alaskan Native race. Although the RTI race variable has better validity than the EDB race variable for other races, kappa values suggest room for future improvements in classification of whites (0.90), Hispanics (0.87), Asian/Pacific Islanders (0.77), and American Indian/Alaskan Natives (0.44). Discussion: The status quo of using "good-enough for government" race/ethnicity variables contained in Medicare administrative data for minority health disparities research can be improved through the use of self-reported race/ethnicity data, available in the Medicare data warehouse. Health services and policy researchers should critically examine the source of race/ethnicity variables used in minority health and health disparities research. Future work to improve the accuracy of Medicare beneficiaries' race/ethnicity data should incorporate and augment the self-reported race/ethnicity data contained in assessment and survey data, available within the Medicare data warehouse.