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101. Implementation Guide for the CANDOR Process: Appendix B | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/candor/impguide/apb.html
     August 01, 2022 - investigation and analysis process for the organization Risk management staff, nurse manager, legal, claims … developing, educating, and implementing the resolution process for the organization Risk management staff, claims … designee Risk Management Champion Reinforces goals of the CANDOR process; educates risk, legal, claims … process; serves as liaison to promote and support CANDOR process implementation with the risk, legal, and claims

102. Executive Summary | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/candor/demo-program/grants/summary.html
     August 01, 2022 - preventing harm through the use of best practices, and (3) exploring alternative methods of settling claims … Exploring alternative methods of settling claims. … One demonstration project (NY) sought to expedite the movement of malpractice cases through the claims … "Incurred" amounts (loss payments on closed claims and reserves set aside to pay pending claims) were … The grantee had access to more years of claims data due to its participation in Phase I of this study

103. Executive Summary | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/prospectscare/prospsum.html
     July 01, 2018 - systems such as electronic health records (EHR), health information exchanges (HIE), and all-payer claims … EHR audit files Use claims data to confirm follow-up care occurred within expected time frame … APCDs, HIE * (if includes claims data) or payer files Use claims data to examine instances of … redundant testing APCDs, HIE * (if includes claims data) or payer files Would be enhanced by … addition of clinical data from EHR or HIE * APCD—all-payer claims database; CCD—continuity

104. Appropriate Antibiotic Prophylaxis for Children With Sickle Cell Disease (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-0138-fullreport.pdf
     April 01, 2018 - This measure is part of the Q-METRIC Sickle Cell Disease Administrative Claims set. 3. … Administrative data (e.g., claims data). … This measure is based on administrative claims data. … This measure is implemented with administrative claims data. … This measure is implemented with Medicaid administrative claims data.

105. Measure: Pediatric All-Condition Readmission Measure (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra_14-p008-1-ef.pdf
     October 01, 2014 - Administrative data (e.g., claims data). … Measure Testing This measure used four large, administrative claims datasets to develop and evaluate … the measure:13 ● 2008 Medicaid Analytic eXtract (MAX) data for 26 States, which include Medicaid claims … ● 2005-2009 AHRQ Revisit data for New York and Nebraska, which include claims for all payers from … National Association of Children's Hospitals and Related Institutions case-mix data, which include claims

106. Measure: Pediatric Lower Respiratory Infection (LRI) Readmission Measure (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra_1415-p008-2-ef.pdf
     January 01, 2015 - Administrative data (e.g., claims data). … 30-day readmissions measures. 3 Measure Testing This measure used four large, administrative claims … non-children’s hospitals ● 2005–2009 AHRQ revisit data for New York and Nebraska, which include claims … National Association of Children’s Hospitals and Related Institutions case-mix data, which include claims … ● Claims data are limited as billing codes do not reflect certain information such as disease severity

107. Measure Inventory | Agency for Healthcare Research and Quality
     www.ahrq.gov/data/apcd/backgroundrpt/measure.html
     April 01, 2017 - Inventory and Prioritization of Measures To Support the Growing Effort in Transparency Using 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 … Data Evaluation of All-Payer Claims Databases Discussion Conclusion and Future Directions References … distinguished from other widely available datasets (e.g., hospital discharge data) by the inclusion of claims

108. Measure: Attention Deficit Hyperactivity Disorder (ADHD) - Measure of Chronic Care Followup (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra-1416-p005-3-ef.pdf
     October 01, 2015 - ● Data for this measure are reliably available in administrative claims data. … Measure ● Measure reliability was assessed by implementing the measure in a large, administrative claims … database that included administrative claims data from both Medicaid and commercial payment model … Caveats ● The measure uses administrative claims data and is therefore subject to all issues related … to administrative claims-based measures, including long continuous coverage requirements, lack of

109. Evaluation Issues | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/capacity/candor/demo-program/grants/issues.html
     May 01, 2016 - their demonstration project, two Principal Investigators answered “time to resolution of [malpractice] claims … Among the threshold challenges identified was the problem of the malpractice “claims tail” (i.e., that … malpractice claims frequently take years from the occurrence of an adverse event to surface and/or resolve … across projects made it difficult for many of the PSML projects to document direct patient safety or claims-based … need to be funded for longer grant periods (6–10 years), allowing for the maturation of the “tail” of claims

110. Issues Regarding Identification of Urinary Catheter Use From Medical Records | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/hai/patient-safety-resources/advances-in-hai/hai-article18.html
     August 01, 2018 - Administrative Discharge Abstract (Claims Data) After completion of all medical record abstractions … , claims data were requested. … Comorbidity variables 21 were generated from the claims data using comorbidity software (version 3.4 … Claims data indicators of UC use Overall, claims data codes identified 25 (8%) hospitalizations … Urinary Catheter Use Documented in Administrative Discharge Abstract (Claims Data) Claims data contained

111. CHIPRA 194: Section 6, Tables 13-14 (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-194-section-6-tables-13-14.pdf
     April 17, 2019 - Contingency Table for Presence of Signs or Symptoms of Increased Intracranial Pressure in Administrative Claims … Total 18 137 155 Table 14: Contingency Table for Presence of Lumbar Puncture in Administrative Claims

112. Final Progress Report: Demonstration of Quality Improvement of Medication Therapy Management Services (pdf file)
     www.ahrq.gov/sites/default/files/2024-12/doucette-report.pdf
     January 01, 2024 - Using drug claims and MTM claims, a set of medication use variables was calculated and used in repeated … service claims provided by Outcomes. … a significantly lower level of MTM Targeted Intervention claims compared to the Control Group. … No interactions were significant for MTM claims. … For example, we used drug claims data in 6-month periods to measure medication use.

113. Materials VI-B (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-164-materials-vi-b.pdf
     March 09, 2017 - 9.285 8.281 10.411 6.134 6.077 6.191 5.156 5.101 5.211 9.676 9.458 9.898 8.513 8.348 Dental Prophy Claims … Service) Well Child Visit 0.0486 <.0001 Dental Prophy‐At least one claim 0.4146 <.0001 Dental Prophy Claims … 0.4729 <.0001 3+ 0.99 <.0001 Fluoride Treatment‐At least one claim 0.4047 <.0001 Fluoride Treatment Claims … <.0001 Fluoride Treatment Medical Provider‐At least one claim ‐0.0134 0.0368 Fluoride Treatment Claims … 0.0472 0.4973 Fluoride Treatment Dental Provider‐At least one claim 0.3632 <.0001 Fluoride Treatment Claims

114. Measure 1, Section 2, Attachment 6 (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-88-measure-1-section-2-attachment-6.pdf
     January 17, 2017 - Form Measure 1: Accurate ADHD Diagnosis Section 2: Detailed Measure Specifications Attachment 6: Claims … DATA SOURCE Administrative Claims Data 1. Inpatient 2. Outpatient D. … Form Measure 1: Accurate ADHD Diagnosis Section 2: Detailed Measure Specifications Attachment 6: Claims … Disclaimer: This is only an example of how a specification could be constructed from administrative claims

115. Appendix C. Glossary and Abbreviations | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/prospectscare/prospectsapc.html
     April 01, 2020 - tied to achieving health care quality goals and outcomes that result in cost savings. 1 All-Payer Claims … Database (APCD) —Also known as an All-Payer, All-Claims Database. … Large-scale databases that systematically collect health care claims data from a variety of payer sources … that include claims from most health care providers. … , pharmacy claims, eligibility files, provider (physician and facility) files, and dental claims from

116. Overuse of Imaging for the Evaluation of Children with Post-Traumatic Headache (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-195-fullreport.pdf
     December 17, 2019 - This measure uses administrative claims data to identify the eligible population for medical record … Administrative claims data; paper and electronic clinical data; paper and electronic health record ( … Using administrative claims, identify the population eligible for the denominator. … Using administrative claims, exclude individuals with ICD-9-CM codes associated with child abuse and … Many denominator and numerator exclusions were not adequately captured in administrative claims.

117. Lessons from the Field: Identifying Measurement Challenges and Successes (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/lessons/lessons-challenges-successes.pdf
     January 01, 2019 - While the majority of data used to measure quality come from health care claims submitted by providers … A state medical director noted her state’s success in linking claims and vital statistics records, … •Q-METRIC: measure uses claims data, and is reported and assessed only annually (at state and health … • While there is a lag in claims data availability at the state level, the Q-METRIC team found … plan-level claims data for calculating more timely performance scores

118. Project Context | Agency for Healthcare Research and Quality
     www.ahrq.gov/data/apcd/envscan/context.html
     June 01, 2017 - All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices … and Evidence Project Context Previous Page Next Page Table of Contents All-Payer Claims … These are large-scale databases that systematically collect medical claims, facility claims, pharmacy … claims, and dental claims (typically, but not always), as well as eligibility and provider files from … For example, Medicare and Medicaid claims cover important populations but leave out a large portion of

119. Ratio of Magnetic Resonance Imaging Scans to Computed Tomography Scans for the Evaluation of Children with Atraumatic Headache (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-196-fullreport.pdf
     January 01, 2020 - Ratio of MRI to CT Using Administrative Claims Data After applying claims-based exclusions to cases … This measure is specified using administrative claims. … This measure requires administrative claims. … This measure requires administrative claims data. … This measure is specified using administrative claims.

120. Ratio of Magnetic Resonance Imaging Scans to Computed Tomography Scans for the Evaluation of Children with Atraumatic Seizure: Report (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0197-fullreport.pdf
     November 01, 2019 - Ratio of MRI to CT Using Administrative Claims Data After applying claims-based exclusions to cases … This measure is specified using administrative claims. … This measure requires administrative claims data. … This measure requires administrative claims data. … This measure is specified using administrative claims.