Identifying types of nursing facility stays using medicare claims data: an algorithm and validation
Identifying types of nursing facility stays using medicare claims data: an algorithm and validation
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DOI：
10.1007/s10742-010-0060-4
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发表时间：
2010-06-01
影响因子：
1.5
通讯作者：
Locher, Julie L.
中科院分区：
文献类型：
--
作者：
Yun, Huifeng;Kilgore, Meredith L.;Locher, Julie L.
护理机构为短期住院的病人提供熟练的护理和康复护理，为长期住院的病人提供监护护理。在保健服务研究中，护理机构住院的类型（短期或长期）是一个潜在的重要风险因素和健康结果，并且从医疗和财政角度提供信息。本研究的目的是开发和验证一种算法，以识别护理机构服务的使用，并利用医疗保险索赔数据区分短期和长期护理。我们使用5%的医疗保险受益人样本的索赔数据来开发一种算法，以检测护理机构服务的使用情况，并区分短期和长期住院。我们使用双重合格受益人的医疗补助长期护理索赔中的居住状态和医疗保险当前受益人调查（MCBS）中的居住状态来测试该算法。在纳入基线队列的1,694,051名受益人中，25.6%的人有一定的护理机构居住迹象。使用我们的算法，使用任何护理机构护理的受益人中有59.8%被归类为长期居民。针对医疗补助长期护理索赔和MCBS的算法验证产生了高灵敏度和特异性。据我们所知，这是第一篇论文，提出了一种有效的算法，用于识别医疗保险受益人使用护理设施服务，区分短期和长期护理住院状态。
Nursing facilities provide skilled nursing and rehabilitative care to patients for short stays and custodial care to patients for long stays. The type of nursing facility stay (short-or long-term) is a potentially important risk factor and health outcome in health services research and is informative from both medical and fiscal perspectives. The purpose of this study was to develop and validate an algorithm to identify the use of nursing facility services and differentiate short-from long-term care using Medicare claims data. We used claims data for a 5% sample of Medicare beneficiaries to develop an algorithm to detect the use of nursing facility services and to distinguish between short-and long-term stays. We tested this algorithm using residency status from Medicaid long-term care claims for dually eligible beneficiaries and using residency status from the Medicare Current Beneficiary Survey (MCBS). Among 1,694,051 beneficiaries included in the baseline cohort, 25.6% had some indication of nursing facility residency. Using our algorithm, 59.8% of beneficiaries using any nursing facility care were classified as long-term residents. Validation of the algorithm against Medicaid long-term care claims and MCBS yielded high sensitivity and specificity. To our knowledge, this is the first paper to present a validated algorithm for identification of use of nursing facility services among Medicare beneficiaries that differentiates between short-and long-term care residency status.