the quality of reporting on race ethnicity in medicare data assessing the effect of improved coding l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
The Quality of Reporting on Race & Ethnicity in Medicare Data: Assessing the Effect of Improved Coding PowerPoint Presentation
Download Presentation
The Quality of Reporting on Race & Ethnicity in Medicare Data: Assessing the Effect of Improved Coding

Loading in 2 Seconds...

play fullscreen
1 / 15

The Quality of Reporting on Race & Ethnicity in Medicare Data: Assessing the Effect of Improved Coding - PowerPoint PPT Presentation


  • 115 Views
  • Uploaded on

The Quality of Reporting on Race & Ethnicity in Medicare Data: Assessing the Effect of Improved Coding. Ernest Moy, Linda G. Greenberg Center for Quality Improvement and Patient Safety.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'The Quality of Reporting on Race & Ethnicity in Medicare Data: Assessing the Effect of Improved Coding' - kioshi


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
the quality of reporting on race ethnicity in medicare data assessing the effect of improved coding

The Quality of Reporting on Race & Ethnicity in Medicare Data: Assessing the Effect of Improved Coding

Ernest Moy, Linda G. Greenberg

Center for Quality Improvement and Patient Safety

The analytic database was created by the Research Triangle Institute (RTI) for CMS and AHRQ under CMS Contract Number: 500-00-0024, Task No. 8 (2005) and an AHRQ/CMS Interagency Agreement CMS Contract Number 500-00-0024 Task No. 21 (2006).

background
Background
  • Assessing health care disparities is often hindered by
    • Small samples
    • Lack of detailed geographic information
    • Inaccurate racial identification
    • Lack of socioeconomic information
  • Medicare administrative data can address 1 & 2 but need enrichment to address 3 & 4
project goals
Project Goals
  • Builds on project to enrich Medicare data & allow better disparities assessments
    • Enrich identification of Hispanics & Asians
    • Add information on socioeconomic status
  • Quantifies impact of improved coding compared with standard Medicare enrollment database (EDB) coding
methods for improving data
Methods for Improving Data
  • Identification of Hispanics & Asians
    • Enriched racial coding of enrollment database using combination of surname, first name, and State of residence
    • Validated against self-reported race data (Medicare Current Beneficiary Survey)
      • Sensitivity improved dramatically
        • Hispanics from 30% to 77%
        • Asians from 55% to 80%
      • Specificity unchanged
methods for improving data5
Methods for Improving Data
  • Added area SES info at block group level
    • % labor force unemployed
    • % people living below poverty level
    • Median household income
    • Median value of dwellings
    • % adults w/ < high school education
    • % adults w/ 4+ years of college
    • % households w/ >1 person per room
  • Created SES index
  • Sorted people by index into quartiles
enriched database
Enriched Database
  • Significant population shifts
    • Hispanics +2.0 million
    • Asians +260,000
    • Whites -1.7 million
    • Other/Unknown -460,000
  • Stratified sample of Medicare fee-for-service beneficiaries to allow estimates of all racial groups
measures of health care
Measures of Health Care
  • Datasource: 2002 CMS inpatient, outpatient, physican, & DME claims
  • Cancer screening
    • Colorectal cancer screening (FOBT or lower endoscopy)
    • Mammography
    • Prostate specific antigen
  • Diabetes care
    • Diabetic testing (HbA1c, lipids, urine)
    • Eye examination
    • Instruction in self-care
analysis
Analysis
  • Compared measures of health care by
    • Standard Medicare race coding (EDB race)
    • Enriched race coding (enriched race)
  • Compared magnitude of racial differences compared with Non-Hispanic whites for EDB vs. enriched race
  • Compared racial differences stratified by SES for EDB vs. enriched race
summary of effects
Summary of Effects
  • Overall, almost all disparities underestimated
  • Asians: 4/6 measures, direction of disparity changed
  • Blacks: 3/6 measures, disparity underestimated >100%
  • Hispanics: 4/6 measures, disparity underestimated >100%
  • For cancer screening, racial disparity among low SES underestimated the most
conclusions
Conclusions
  • Standard Medicare coding of race/ethnicity is unreliable
  • Medicare coding can be enriched
  • Enrichment is important to correct
    • Wrong direction of disparity among Asians
    • Large underestimates of disparities among Blacks, Hispanics, AI/AN
      • Especially those of low SES
  • CMS does use enriched coding for some analyses, but does not do so routinely