Lanata Mariana M, Kilgore Jacob T, Holthaus Brandi, Willis Jonathan M, Anderson Tess, Samples Borden, Sparks Jennifer, Evans Joseph E, Wattles Bethany A, Smith Michael J
Department of Pediatrics, Division of Pediatric Infectious Diseases, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA.
Hoops Family Children's Hospital, Huntington, WV, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Jun 30;5(1):e141. doi: 10.1017/ash.2025.10042. eCollection 2025.
This study evaluated Medicaid claims (MC) data as a valid source for outpatient antimicrobial stewardship programs (ASPs) by comparing it to electronic medical record (EMR) data from a single academic center.
This retrospective study compared pediatric patients' MC data with EMR data from the Marshall Health Network (MHN). Claims were matched to EMR records based on patient Medicaid ID, service date, and provider NPI number. Demographics, antibiotic choice, diagnosis appropriateness, and guideline concordance were assessed across both data sources.
The study was conducted within the MHN, involving multiple pediatric and family medicine outpatient practices in West Virginia, USA.
Pediatric patients receiving care within MHN with Medicaid coverage.
MC and EMR data showed >90% agreement in antibiotic choice, gender, and date of service. Discrepancies were observed in diagnoses, especially for visits with multiple infectious diagnoses. MC data demonstrated similar accuracy to EMR data in identifying inappropriate prescriptions and assessing guideline concordance. Additionally, MC data provided timely information, enhancing the feasibility of impactful outpatient ASP interventions.
MC data is a valid and timely resource for outpatient ASP interventions. Insurance providers should be leveraged as key partners to support large-scale outpatient stewardship efforts.
本研究通过将医疗补助计划索赔（MC）数据与来自单一学术中心的电子病历（EMR）数据进行比较，评估其作为门诊抗菌药物管理计划（ASP）有效数据来源的可行性。
这项回顾性研究将儿科患者的MC数据与马歇尔健康网络（MHN）的EMR数据进行了比较。根据患者医疗补助ID、服务日期和医疗服务提供者全国提供者识别码（NPI）对索赔与EMR记录进行匹配。在两个数据源中评估了人口统计学、抗生素选择、诊断合理性和指南一致性。
该研究在MHN内部进行，涉及美国西弗吉尼亚州的多个儿科和家庭医学门诊机构。
在MHN接受医疗补助覆盖的儿科患者。
MC和EMR数据在抗生素选择、性别和服务日期方面显示出>90%的一致性。在诊断方面存在差异，尤其是对于有多种感染性诊断的就诊。在识别不适当处方和评估指南一致性方面，MC数据显示出与EMR数据相似的准确性。此外，MC数据提供了及时的信息，提高了有影响力的门诊ASP干预措施的可行性。
MC数据是门诊ASP干预措施的有效且及时的资源。应利用保险提供者作为关键合作伙伴来支持大规模门诊管理工作。
