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1. Use of Electronic Medical Records and Administrative Claims Data for Assessing Type 2 Diabetes Care | Effective Health Care (EHC) Program
   effectivehealthcare.ahrq.gov/products/diabetes-claims-data/

2. Use of Electronic Medical Records and Administrative Claims Data for Assessing Type 2 Diabetes Care | Effective Health Care (EHC) Program
   effectivehealthcare.ahrq.gov/products/diabetes-claims-data/research
   April 07, 2010 - Use of Electronic Medical Records and Administrative Claims Data for Assessing Type 2 Diabetes Care … Evaluating the adequacy of diabetic care requires access to clinical data not available from administrative claims … lipid, or hypertension control in the Medicaid population due to a lack of clinical information in the claims … condition such as DMT2 is difficult when using any electronic database, whether EMRs or administrative claims … may be validated using full-text information from the same EMR, whereas validation of administrative claims

3. Data Development for Patient Safety — A Pilot Study using Medicare Part B Drug Data | Effective Health Care (EHC) Program
   effectivehealthcare.ahrq.gov/products/patient-safety-drug-data/abstract
   January 01, 2005 - Part B Drug Data Abstract January 1, 2005 Topic Abstract Medicare administrative claims … Medicare claims provide a broad picture of the health services received by individuals, with considerable … of frameworks to organize claims data into structures that link relevant interventions, outcomes and … The analysis will exploit information available in Part B claims on drugs, to produce a framework that … can be readily adapted to incorporate Part D claims when they come on line next year.

4. Research and Surveillance Methods for Improving Medication Safety Using Administrative Claims Databases | Effective Health Care (EHC) Program
   effectivehealthcare.ahrq.gov/products/medicine-safety-databases/abstract
   January 01, 2005 - Research and Surveillance Methods for Improving Medication Safety Using Administrative Claims Databases … process measures such as misuse, over- and under-use of prescription medications based on dispensing claims … evaluate based on the typical structure of Medicare, Medicaid, SCHIP, and managed care administrative claims … We will test the process measures using data from state Medicaid claims files.

5. Icd-Categories-Prevalence-Reimbursement Research (pdf file)
   effectivehealthcare.ahrq.gov/sites/default/files/pdf/icd-categories-prevalence-reimbursement_research.pdf
   January 01, 2011 - In 2009, nearly 14.7 million inpatient claims were submit- ted to Medicare. … claims (as identified via the Carrier file) were submitted. … Medicare Part C claims were not considered. … DEFINITIONS AND METHODS Determination of Counts of Beneficiaries and Claims For each study year, claims … Claims were further stratified by the setting from which they arose.

6. Adaptation of Data Mining Algorithms Assessing the Comparative Effectiveness and Safety of NSAIDs | Effective Health Care (EHC) Program
   effectivehealthcare.ahrq.gov/products/nsaids-safety-data-mining/research
   December 02, 2009 - Adaptation of Bayesian Data Mining Algorithms to Longitudinal Claims Data: Coxib Safety as an Example … Their adaptation for use with longitudinal data such as administrative claims has not been previously … empirical Bayes Multi-item Gamma Poisson Shrinkage (MGPS) algorithm to longitudinal administrative claims … Further work will be needed to extend these findings to different types of drug exposures and to other claims

7. S58 (pdf file)
   effectivehealthcare.ahrq.gov/sites/default/files/s58.pdf
   October 01, 2007 - Although claims files in some states include “pseudo- claims” for services to capitated beneficiaries … An algorithm using nonpharmacy claims produced 88% sensitivity; adding phar- macy claims produced 95% … Challenges and Best Practices in Working With Medicaid Claims Data Challenges Best Practices Claims … and Medicaid claims for non-Medicare-covered services. … Accuracy of diagnoses of schizophrenia in Medicaid claims.

8. Primary-Healthcare-Spending-Draft-Tech-Brief-Appendix-H (xls file)
   effectivehealthcare.ahrq.gov/sites/default/files/related_files/primary-healthcare-spending-draft-tech-brief-appendix-h.xlsx
   January 01, 2011 - Evidence Table H-1 Estimate Number of annual estimates (years) Claims data Non-claims data Other data … Using NPI on claims, determined taxonomy (NUCC) based on NPPES database No CPT, HCPCS Long term care, … and reported non claims and supplemental payments. … , carve outs, prescription spending Full claims of medical spending, denied claims were excluded Oregone … Claims- and Non-Claims-Based Estimates Evidence Table H-2 First Author/Organization # of estimates

9. Research and Surveillance Methods for Improving Medication Safety Using Administrative Claims Databases | Effective Health Care Program
   effectivehealthcare.ahrq.gov/products/medicine-safety-databases
   January 01, 2005 - Research and Surveillance Methods for Improving Medication Safety Using Administrative Claims Databases … Research and Surveillance Methods for Improving Medication Safety Using Administrative Claims

10. Radiotherapy-Proton-Beam Research (pdf file)
    effectivehealthcare.ahrq.gov/sites/default/files/pdf/radiotherapy-proton-beam_research.pdf
    May 01, 2012 - Denied claims were excluded from the analysis. … **Reimbursement is calculated for all claims in each year. … analysis of denied claims proved difficult. … Most commonly, claims were denied for being submitted multiple times. … Denied claims accounted for 5 percent of the claims submitted in each year.

11. Treatment of Dementia Among Community-Dwelling and Institutionalized Medicare Beneficiaries | Effective Health Care (EHC) Program
    effectivehealthcare.ahrq.gov/products/dementia-databases-methods/research
    May 22, 2008 - Measurements: ADRD was identified by ICD-9 codes in Medicare claims and self/proxy reports. … This information is augmented with data from Medicare administrative files and paid claims for Part A … Medicare claims included both Part A and B claims, and any diagnosis (not just primary) of ADRD was counted … In LTC facilities claims miss 19% while medical record/MDS reports miss 27% of ADRD cases. … The accuracy of medicare claims data in identifying Alzheimer's disease.

12. Diabetes-Drugs-Utilization Research (pdf file)
    effectivehealthcare.ahrq.gov/sites/default/files/pdf/diabetes-drugs-utilization_research.pdf
    March 01, 2011 - rosiglitazone.11 A recent study showed up to a 54 percent decrease in rosiglit- azone prescription claims … Beneficiaries with prescription claims for sulfonylureas also frequently had prescription claims for … A pronounced reduction in claims occurred from 2007 to 2009, likely driven by highly publicized concerns … Claims for meglitinides decreased from 2006-2009 (3 percent to 2 percent). … Similarly, claims for alpha-gluco- sidase inhibitors decreased from 0.6 percent to 0.4 percent.

13. Distributed Ambulatory Research in Therapeutics Network (DARTNet): Informing Practice and Improving Depression Care | Effective Health Care (EHC) Program
    effectivehealthcare.ahrq.gov/products/depression-care-distributed-networks/abstract
    May 08, 2009 - Access additional data including medication fulfillment data, diagnostic data, claims and point-of-care … This will be conducted in three phases: Phase 1: Claims Database Study Utilization - Conduct population-based … cohort studies of new episodes of major depression using commercially available national claims data … Depression – Compare the responsiveness and remission rates for major depression treatments, beginning with claims-based … Phase 2: DARTNet EHR Database Study The second phase will compare the findings of the claims database

14. Medicare Prescription Drug Data Development: Methods for Improving Patient Safety and Pharmacovigilance Using Observational Data | Effective Health Care (EHC) Program
    effectivehealthcare.ahrq.gov/products/patient-safety-databases-prescriptions/research
    August 26, 2008 - databases through linking prescription drug claims with medical claims. … We separated medical claims into four tables, which included professional-based claims and facility-based … claims. … Data available from Medicaid claims, employer claims, and (eventually) Medicare claims can now be used … Pharmacy Claims File; 3. Medical Claims; and 4. Death records.

15. Diabetes-Foot-Ulcer-Amputation-Economics Research (pdf file)
    effectivehealthcare.ahrq.gov/sites/default/files/pdf/diabetes-foot-ulcer-amputation-economics_research.pdf
    January 01, 2011 - In this population, all Part D claims in the given year with a National Drug Code (NDC) corresponding … antidiabetic (results online only), anti-infective (results online only), or all medication drug claims … the ingredient cost, dispensing fee, sales tax, and vaccine administration fee across all Part D claims … pay, other true out-of-pocket amount, and low-income cost-sharing subsidy amount across all Part D claims … For selected services on skilled nursing facility (SNF) claims, the total claim reimbursement was simply

16. Treatment of Dementia Among Community-Dwelling and Institutionalized Medicare Beneficiaries (pdf file)
    effectivehealthcare.ahrq.gov/sites/default/files/pdf/dementia-databases-methods_research.pdf
    May 01, 2008 - Measurements: ADRD was identified by ICD-9 codes in Medicare claims and self/proxy reports. … This information is augmented with data from Medicare administrative files and paid claims for Part … Medicare claims included both Part A and B claims, and any diagnosis (not just primary) of ADRD was … In LTC facilities claims miss 19% while medical record/MDS reports miss 27% of ADRD cases. … The accuracy of medicare claims data in identifying Alzheimer's disease.

17. Cancer-Drugs-Utilization-Cost Research (pdf file)
    effectivehealthcare.ahrq.gov/sites/default/files/pdf/cancer-drugs-utilization-cost_research.pdf
    January 01, 2011 - Counts of beneficiaries with anticancer biologic claims, by active ingredient, can be found online ( … Expenditures related to biologics billed for in other Medi- care claims files (such as the Inpatient … The Common Working File (CWF) was used to identify claims for biologics billed under Medicare Parts … Biologics were identified in Medicare Part D claims via National Drug Codes (NDCs) (codes available … Therefore, claims for panitu- mumab prior to January 1, 2007, were excluded from these analyses.

18. S9 (pdf file)
    effectivehealthcare.ahrq.gov/sites/default/files/s9.pdf
    October 01, 2007 - the Health Plan Management System), beneficiary enrollment files, and prescription drug event (PDE) claims-type … PDE data are claims-like records of beneficiary-specific records submitted by the Part D plans (both … Normally, these claims-like data would not be an output of a program reimbursed under a capitation-based … PDE data, in particular, theoretically provide beneficiary claims-level data that could be linked to … †According to experts, there has historically been a 5.5% decrease in prescription drug claims volume

19. Ch 8-User-Guide-To-Ocer 130129 (pdf file)
    effectivehealthcare.ahrq.gov/sites/default/files/ch_8-user-guide-to-ocer_130129.pdf
    October 01, 2013 - For outpatient encounters, the CPT is used for submitting claims for services. … Claims submitted to the insurance company use the NDC as the identifier of the product. … Prescription claims can be available for research in as little as one week. … Data validity issues in using claims data. … Development of a claims-based risk score to identify obese individuals.

20. Evaluating the Effects of Drug-Eluting and Bare Metal Stents in Patient Subgroups and Comparing Diagnostic Tools in Predicting Outcomes Following Stenting Procedures | Effective Health Care (EHC) Program
    effectivehealthcare.ahrq.gov/products/coronary-stents-effects/abstract
    December 15, 2009 - stents in older persons with chronic kidney disease: a report from the Linked CathPCI Registry–CMS Claims … Linking the National Cardiovascular Data Registry CathPCI Registry with Medicare claims data: validation