Identifying diabetics in Medicare claims and survey data: implications for health services research.

TitleIdentifying diabetics in Medicare claims and survey data: implications for health services research.
Publication TypeJournal Article
Year of Publication2014
AuthorsSakshaug, JW, Weir, DR, Nicholas, LHersch
JournalBMC Health Serv Res
Date Published2014 Apr 03
ISSN Number1472-6963
KeywordsAged, Aged, 80 and over, Algorithms, Diabetes Mellitus, Female, Glycated Hemoglobin, Health Services Research, Humans, Insurance Claim Review, Male, Medicare, Prevalence, United States

BACKGROUND: Diabetes health services research often utilizes secondary data sources, including survey self-report and Medicare claims, to identify and study the diabetic population, but disagreement exists between these two data sources. We assessed agreement between the Chronic Condition Warehouse diabetes algorithm for Medicare claims and self-report measures of diabetes. Differences in healthcare utilization outcomes under each diabetes definition were also explored.

METHODS: Claims data from the Medicare Beneficiary Annual Summary File were linked to survey and blood data collected from the 2006 Health and Retirement Study. A Hemoglobin A1c reading, collected on 2,028 respondents, was used to reconcile discrepancies between the self-report and Medicare claims measures of diabetes. T-tests were used to assess differences in healthcare utilization outcomes for each diabetes measure.

RESULTS: The Chronic Condition Warehouse (CCW) algorithm yielded a higher rate of diabetes than respondent self-reports (27.3 vs. 21.2, p < 0.05). A1c levels of discordant claims-based diabetics suggest that these patients are not diabetic, however, they have high rates of healthcare spending and utilization similar to diabetics.

CONCLUSIONS: Concordance between A1c and self-reports was higher than for A1c and the CCW algorithm. Accuracy of self-reports was superior to the CCW algorithm. False positives in the claims data have similar utilization profiles to diabetics, suggesting minimal bias in some types of claims-based analyses, though researchers should consider sensitivity analysis across definitions for health services research.


Export Date: 21 April 2014 Source: Scopus Article in Press

User Guide Notes

Endnote Keywords

Diabetes/Survey data/Medicare claims/Chronic condition warehouse

Endnote ID


Alternate JournalBMC Health Serv Res
Citation Key8056
PubMed ID24693862
PubMed Central IDPMC3975984
Grant ListU01 AG009740 / AG / NIA NIH HHS / United States
UL1RR024986 / RR / NCRR NIH HHS / United States
U01AG09740 / AG / NIA NIH HHS / United States
K01 AG041763 / AG / NIA NIH HHS / United States
101AG041763 / AG / NIA NIH HHS / United States