Hammill Bradley G, Curtis Lesley H, Qualls Laura G, Hastings Susan N, Wang Virginia, Maciejewski Matthew L
*Duke Clinical Research Institute †Department of Medicine ‡Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC §Center for Health Services Research in Primary Care ∥Geriatrics Research, Education and Clinical Center ¶Ambulatory Care Service, Durham Veterans Affairs Medical Center, Durham, NC.
Med Care. 2015 Nov;53(11):974-9. doi: 10.1097/MLR.0000000000000420.
Medicare is the single largest purchaser of laboratory testing in the United States, yet test results associated with Medicare laboratory claims have historically not been available.
The purpose of this study was to describe both the linkage of laboratory results data to Medicare claims and the completeness of these results data. In a subgroup of beneficiaries initiating angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, we also demonstrate the generalizability of Medicare beneficiaries with laboratory values compared with those without laboratory values. We end with a discussion of the limitations and potential uses of these linked data.
We obtained information about laboratory orders and results for all Medicare fee-for-service beneficiaries in 10 eastern states who had outpatient laboratory tests conducted by a large national laboratory services vendor in 2011. Using a combination of direct identifiers and patient demographic characteristics, we linked patients in these laboratory data to Medicare beneficiaries, enabling us to associate test results with existing claims.
Nearly all patients in the laboratory data were able to be linked to Medicare beneficiaries. There were over 2 million distinct beneficiaries with nearly 125 million specific test results in the laboratory data. For specific tests ordered in an outpatient or office setting in these 10 states, between 5% and 15% of them had linked laboratory data. Medicare beneficiaries initiating angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers who had laboratory results data had similar patient characteristics to those without results data.
This novel linkage of laboratory results data to Medicare claims creates unprecedented opportunities for conducting comparative effectiveness research related to patient safety and quality.
医疗保险是美国实验室检测的最大单一购买方，但历史上与医疗保险实验室索赔相关的检测结果一直无法获取。
本研究的目的是描述实验室结果数据与医疗保险索赔的关联以及这些结果数据的完整性。在开始使用血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂的受益人群中，我们还展示了有实验室检测值的医疗保险受益人与没有实验室检测值的受益人相比的普遍性。最后，我们讨论了这些关联数据的局限性和潜在用途。
我们获取了2011年在10个东部州由一家大型全国性实验室服务供应商进行门诊实验室检测的所有医疗保险按服务收费受益人的实验室订单和结果信息。通过直接标识符和患者人口统计学特征相结合的方式，我们将这些实验室数据中的患者与医疗保险受益人进行关联，从而使我们能够将检测结果与现有索赔相关联。
实验室数据中的几乎所有患者都能够与医疗保险受益人关联起来。实验室数据中有超过200万不同的受益人，有近1.25亿条具体检测结果。在这10个州的门诊或办公室环境中所开具的特定检测中，其中5%至15%有与之关联的实验室数据。开始使用血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂且有实验室结果数据的医疗保险受益人，其患者特征与没有结果数据的受益人相似。
这种将实验室结果数据与医疗保险索赔的新颖关联为开展与患者安全和质量相关的比较效果研究创造了前所未有的机会。
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