Dataset Information

Creating Unidimensional Global Measures of Physician Practice Quality Based on Health Insurance Claims Data.

ABSTRACT:

Objective

To explore the extent to which commonly used claims-based process quality indicators can be used to create an internally valid global composite measure of physician practice quality.

Data sources

Health insurance claims data (October 2007-May 2010) from 134 physician practices in Seattle, WA.

Study design

We use confirmatory and exploratory factor analysis to develop theory- and empirically driven internally valid composite measures based on 19 quality indicators.

Data collection methods

Health insurance claims data from nine insurance companies and self-funded employers were collected and aggregated by third-party organization.

Principal findings

Our results did not support a single global measure using the entire set of quality indicators. We did identify an acceptable multidimensional model (RMSEA = 0.059; CFI = 0.934; TLI = 0.910). The four dimensions in our data were diabetes, depression, preventive care, and generic drug prescribing.

Conclusions

Our study demonstrates that commonly used process indicators can be used to create a small set of useful composite measures. However, the lack of an internally valid single unidimensional global measure has important implications for policy approaches meant to improve quality by rewarding "high-quality physicians."

SUBMITTER: Martsolf GR

PROVIDER: S-EPMC5441486 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Publications

Creating Unidimensional Global Measures of Physician Practice Quality Based on Health Insurance Claims Data.

Martsolf Grant R GR Carle Adam C AC Scanlon Dennis P DP

Health services research 20160724 3

<h4>Objective</h4>To explore the extent to which commonly used claims-based process quality indicators can be used to create an internally valid global composite measure of physician practice quality.<h4>Data sources</h4>Health insurance claims data (October 2007-May 2010) from 134 physician practices in Seattle, WA.<h4>Study design</h4>We use confirmatory and exploratory factor analysis to develop theory- and empirically driven internally valid composite measures based on 19 quality indicators. ...[more]

PMID: 27452191

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Project description:PurposeThe purpose of the study is to develop an algorithm to identify pregnancies in administrative databases and apply it to assess pregnancy rates and outcomes in women prescribed isotretinoin or tretinoin.MethodsUsing the 2011 to 2015 Truven Health MarketScan Database, we identified pregnancies, including losses and terminations. In a cohort design, nonpregnant women filling a prescription for isotretinoin or tretinoin were matched to five women without either prescription. Women were followed for 365 days or until conception, medication discontinuation, or enrollment discontinuation ("prescription episode"). Rates of pregnancy, risks of pregnancy losses, and prevalence of infant malformations at birth were assessed by exposure.ResultsWe identified 2 179 192 livebirths, 8434 stillbirths, 2521 mixed births, 415 110 spontaneous abortions, 124 556 elective terminations, and 8974 unspecified abortions. There were 86 834 isotretinoin and 973 587 tretinoin episodes, matched to 5 302 105 unexposed women. Pregnancy rates were 3 (isotretinoin), 19 (tretinoin), and 34 (unexposed) per 1000 person-years. Risk of spontaneous pregnancy losses were similar; however, terminations were more common in the isotretinoin-exposed (28% [95% CI: 21%-36%]) than the tretinoin-exposed (10% [95% CI: 9%-11%]) or unexposed pregnancies (6%). Malformations occurred in 4.5% (95% CI: 3.5%-5.6%) of the tretinoin-exposed pregnancies and 4.2% of the unexposed pregnancies (adjusted odds ratio: 1.16 [95% CI: 0.85-1.58]); isotretinoin-exposed births were too few to assess malformations.ConclusionsAdministrative databases can complement risk evaluation and mitigation strategies (REMS) for known teratogens and contribute to safety surveillance for other medications. Here, isotretinoin-exposed pregnancy rates were low, but existent, and many pregnancies were terminated. Tretinoin exposure was not associated with a meaningfully elevated risk of losses or malformations as compared with unexposed pregnancies.

Dataset Information

Creating Unidimensional Global Measures of Physician Practice Quality Based on Health Insurance Claims Data.

Objective

Data sources

Study design

Data collection methods

Principal findings

Conclusions

Publications

Creating Unidimensional Global Measures of Physician Practice Quality Based on Health Insurance Claims Data.

Similar Datasets

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