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21. References | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/data/apcd/envscan/references.html
    November 01, 2020 - The basics of all-payer claims databases: a primer for states. … The value of all-payer claims databases to states. N C Med J 2014;75(3):211-3. … All-payer claims databases: an overview for policymakers. … Making use of all-payer claims databases for health care reform evaluation. … Overview of the Massachusetts all payer claims database.

22. Appendix A. Grantee Profiles | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/patient-safety/reports/candor-demo-program/plan-grants/appa.html
    August 01, 2022 - First, an actuarial review of claims concluded that the use of an ACEx2 system might stabilize claims … inflation and reduce costs through an accelerated claims process. … The RMCM was modeled after the University of Michigan Claims Management Model. … During this time period, 41 claims had sufficient data for analysis. … Claims were categorized by six unique claim types that ranged from grievances to formal claims against

23. Asthma 1 Measure Calculation Steps (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/flow-diagrams.pdf
    March 11, 2021 - Asthma 1 Measure Calculation Steps Medicaid/APCD claims data Eligibility Table (summary of continuous … (all medical claims during time frame) Pharmacy Claims Data HEDIS ASM-C/MMA-A NDC Lists2 … Import into SAS data format Medical Claims Data (long format medical claims during time frame with … Data Medical Claims Data (long format medical claims during time frame) Asthma_Meds: Evaluation … DEC_IDENT_CE 10 4 Comorbidity Claims (all medical claims during time frame) PMCA v3 Algorithm

24. Physician and Physician Practice Research Database Feasibility Report (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/data/3P-RD-Feasibility-Report.pdf
    February 01, 2024 - Claims files derived from CMS sources as well as state all-payer claims database (APCD) data, where … We then identified APCD or CMS claims (claims) data elements as sources to enhance the core 3P-RD data … files, although access to claims data can be challenging. … Claims data (APCD data And additional claims data [e.g., Medicare FFS, T-MSIS]) • Claims data … information and claims information to be more closely aligned

25. Appendix A. Detailed Literature Search Methodology | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/data/apcd/envscan/app-a.html
    June 01, 2017 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … The search included articles since January 2008, when the first all-payer claims databases (APCDs) were … They decided to include in the set of first search terms “claims data” without restricting it to “all … data” OR “claims data.” … data (e.g., survey data or clinical data not available in the claims database).

26. Findings | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/patient-safety/reports/candor-demo-program/plan-grants/findings.html
    August 01, 2022 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Of the 230 claims examined, 13 (5.7%) were determined to involve a potential transition of care event … was instituted in 2008 based on the successful University of Michigan Claims Management Model. … In the first part of the study, researchers surveyed patients and medical staff involved in 41 claims … In the second part of the study, researchers compared the same 41 claims closed under the new system

27. United States Health Information Knowledgebase | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/data/ushik.html
    July 01, 2022 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … The All-Payer Claims Databases portal contained APCD File Submission Specifications from 14 states. … APCDs are large-scale databases that systematically collect healthcare claims data from a variety of … , pharmacy claims, eligibility files, provider (physician and facility) files, and dental claims from … leveraging data from within the insurance claims and reimbursement system.

28. Tables 1-7 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-195-tables%201-7.pdf
    December 18, 2019 - Contingency Table for Presence of Seizure in Administrative Claims and Charts Seizure in Claims … Contingency Table for Presence of Indicators of Increased Intracranial Pressure in Administrative Claims … and Charts Indicators of Increased Intracranial Pressure in Claims Based on ICD-9-CM Codes … Sensitivity Analysis with Variation in Claims-Based Exclusion Criteria among Children with Neuroimaging … Overuse Percentage within the Chart Review Sample using Claims or Chart Review Criteria Chart Review

29. Overuse of Computed Tomography Scans for the Evaluation of Children with a First Generalized Afebrile, Atraumatic Seizure: Tables 14-17 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0198-tables14-17.pdf
    October 16, 2019 - 522)** 0.5 (1.4) 5.5 (8.8) 8.5 (13.2) 0.1 (0.5) 78.2 (17.8) 2.8 (2.0) 4.3 (6.6) Subset following claims … (7.0) 7.9 (12.1) 0.1 (0.3) 80.6 (15.7) 2.6 (1.5) 4.0 (5.8) Subset following claims … missing or unmatched ZIP code, yielding n=522 (98.1%). *** Among the subset of children following claims … missing or unmatched ZIP code, yielding n=293 (99.0%). **** Among the subset of children following claims … denominator exclusions (n=293)*** 10.5 (14.5) Subset following claims numerator exclusions (n=243)*

30. CHIPRA 194: Section 7, Tables 15-18 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-194-section-7-tables-15-18.pdf
    April 17, 2019 - (8.1) 7.6 (12.2) 0.1 (0.2) 80.6 (16.7) 2.5 (1.4) 3.7 (6.0) Subset following claims … (8.0) 7.7 (12.1) 0.1 (0.2) 81.1 (16.4) 2.5 (1.4) 3.4 (5.6) Subset following claims … missing or unmatched ZIP code, yielding n=4,312 (98.2%). *** Among the subset of children following claims … missing or unmatched ZIP code, yielding n=2,626 (98.2%). **** Among the subset of children following claims … denominator exclusions (n=2,626)*** 9.1 (12.7) Subset following claims numerator exclusions (n=2,156

31. Tables 11-14 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-196-section-7.pdf
    December 18, 2019 - 1,585)*** 0.4 (0.7) 5.7 (8.6) 6.9 (10.5) 0.1 (0.2) 80.4 (16.0) 2.6 (1.4) 3.9 (6.1) Subset following claims … (7.2) 8.4 (13.1) 0.1 (0.2) 81.5 (16.6) 2.4 (1.4) 3.0 (4.9) Subset following claims … missing or unmatched ZIP code, yielding n=1,585 (98.3%). **** Among the subset of children following claims … a CT scan (n=2,977)** 9.4 (13.3) Subset who had an MRI (n=1,585)*** 10.2 (13.2) Subset following claims … CT exclusions (n=1,781)**** 8.2 (11.8) Subset following claims MRI exclusions (n=1,363)***** 10.0 (

32. Conclusion and Future Directions | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/data/apcd/backgroundrpt/conclusion.html
    April 01, 2017 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Us Español FAQs Home Data & Analytics All-Payer Claims … Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Databases Introduction Reviewing the Landscape of All-Payer Claims Databases Measure Inventory … This will require building a dataset by removing potential duplicates or claims that have been replaced

33. Appendix A: Technical Expert Panel and Learning Network Members | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/data/apcd/backgroundrpt/app-a.html
    April 01, 2017 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Us Español FAQs Home Data & Analytics All-Payer Claims … Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Inventory and Prioritization of Measures To Support the Growing Effort in Transparency Using All-Payer Claims … Databases Introduction Reviewing the Landscape of All-Payer Claims Databases Measure Inventory

34. Introduction | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/data/apcd/backgroundrpt/intro.html
    April 01, 2017 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Us Español FAQs Home Data & Analytics All-Payer Claims … Databases Introduction Reviewing the Landscape of All-Payer Claims Databases Measure Inventory … All-payer claims databases (APCDs) incorporate utilization and cost across the health care system and … APCDs are large datasets that aggregate medical, facility, pharmacy, and sometimes dental claims, as

35. Asthma 1: Emergency Room Visits for Children between 3 and 21 with identifiable asthma (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/sas-code.pdf
    October 31, 2018 - Claims will be filtered by time, diagnosis code, and age at service but can be pre-filtered to cut … Table: All (unfiltered) medical claims for at least the patients in the measure cohort. … These claims are in wide form and have 1 record per claim. … The Process: 1) 'Claims' dataset: claims are read in. 2) The program identifies whether … with that body system indicated (sum across claims). */ *indicator y/n; *sum across claims; if

36. Section 6, Tables 2 and 3 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/section-6-table-2-3.pdf
    June 28, 2017 - Other ≥ 1 claim per body system for 2 different body systems during the measurement period* ≥ 2 claims … claim for a single body system not flagged as progressive during the measurement period* ≥ 2 claims … specificity for PMCA in Seattle Children’s Hospital (SCH) discharge and Washington State (WA) Medicaid claims

37. Materials X (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-164-materials-x.pdf
    March 09, 2017 - A: Dental Prophy -­‐ 2 claims PREV_A_3 Prev. Grp. A: Dental Prophy -­‐ 3+ claims PREV_A_CLM Prev. … B: Fluoride  Tx -­‐ 2 claims PREV_B_3 Prev. Grp. B: Fluoride  Tx -­‐ 3 claims PREV_B_4 Prev. … B: Fluoride  Tx -­‐ 4+ claims PREV_B_CLM Prev. Grp. … B: Fluoride  Tx -­‐ Count of claims PREV_B_DENT Prev. Grp. … B: Fluoride Tx -­‐ (Med Prov) 2 claims PREV_B_MED_3 Prev. Grp.

38. Exhibit 7.4. Core measures for asthma, diabetes, and congestive heart failure | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/exh7-4.html
    October 01, 2014 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Percentage of members who followed up with a physician after an ER visit or hospital admission Claims … (AQA and HEDIS Measure) Percentage of members with diabetes with most recent LDL-C <130 mg/dl Claims … ) Percentage of members who received at least one LDL-C screening during the measurement year Claims … <130mg/dl)(AQA Measure) Percentage of members with diabetes with most recent LDL-C <130 mg/dl Claims

39. Exploring Learning Health Systems’ Needs | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/learning-health-systems/exploring-needs.html
    September 01, 2022 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Multiple claims-based frailty indexes (CFIs) have been developed and validated over the past few years … ; however, healthcare providers often do not have access to the insurance claims records of their entire … This project focused on validating an established CFI using linked claims-EHR databases of multiple large … Developing and Assessing the Validity of Claims-based Indicators of Frailty & Functional Disabilities

40. Ratio of Magnetic Resonance Imaging Scans to Computed Tomography Scans for the Evaluation of Children with Atraumatic Seizure: Tables 13 & 14 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0197-tables13-14.pdf
    October 17, 2019 - Min 25th Percentile Median 75th Percentile Max Subset following claims … $66,899 $29,432 $24,260 $44,612 59,082 $82,679 $191,200 Subset following claims … ZIP code or missing census data, yielding n=546 (98.0%). **** Among the subset of children following claims … code or missing census data, yielding n=426 (98.2%). ***** Among the subset of children following claims … 94.1 100 100 Subset who had an MRI (n=546)*** 77.6 33.2 0 68.5 95.4 100 100 Subset following claims