Electronic health records in community health centers provide a better picture of care than insurance claims data
Research Activities, March 2012, No. 379
In community health centers (CHCs), insurance claims data documenting the receipt of preventive health services can be incomplete. In fact, relying solely on Medicaid claims data is likely to substantially underestimate the quality of care, concludes a new study. It found that electronic health record (EHR) data provided a more complete picture than did data from Medicaid claims for preventive diabetes care received at 50 CHCs.
The combined EHR and Medicaid claims data provided the most complete picture, according to a team of Oregon-based researchers led by Jennifer E. DeVoe, M.D. For example, EHR records documented the following services not found in the Medicaid claims data: 49.3 percent of cholesterol screenings, 50.4 percent of influenza vaccinations, 50.1 percent of nephropathy screenings, and 48.4 percent of HbA1c tests of blood-glucose level. By contrast, Medicaid claims data documented much smaller percentages of those services not found in the EHR: 11.6 percent of cholesterol screenings, 7.0 percent of influenza vaccinations, 10.5 percent of nephropathy screenings, and 8.8 percent of HbA1c tests. Those who were more likely to have services documented in the EHR but not in the Medicaid claims data included patients who were Spanish-speaking, above the Federal poverty level, or who had noncontinuous insurance.
An important part of most health care quality assessment efforts is measuring rates of receipt of recommended services. However, insurance claims data can be incomplete since not all services received are billed. Also, patients change insurers, and they may not have continuous health insurance. Since CHCs provide services to uninsured populations, their medical records include information about receipt of care that would not be captured in claims data. The findings were based on analysis of receipt of preventive services in 50 Oregon CHCs among established diabetes patients who had ever been enrolled in Medicaid. This study was supported in part by the Agency for Healthcare Research and Quality (HS16181).
See "Electronic health records vs. Medicaid claims: Completeness of diabetes preventive care data in community health centers," by Dr. DeVoe, Rachel Gold, Ph.D., Patti McIntire, B.A., and others in the July/August 2011 Annals of Family Medicine 9(4), pp. 351-358.