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21. Appendix A: Technical Expert Panel and Learning Network Members | Agency for Healthcare Research and Quality
    www.qualitymeasures.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

22. Introduction | Agency for Healthcare Research and Quality
    www.qualitymeasures.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

23. Asthma 1: Emergency Room Visits for Children between 3 and 21 with identifiable asthma (pdf file)
    www.qualitymeasures.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

24. Section 6, Tables 2 and 3 (pdf file)
    www.qualitymeasures.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

25. Materials X (pdf file)
    www.qualitymeasures.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.

26. Exhibit 7.4. Core measures for asthma, diabetes, and congestive heart failure | Agency for Healthcare Research and Quality
    www.qualitymeasures.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

27. Measure Inventory | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/data/apcd/backgroundrpt/measure.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

28. Exploring Learning Health Systems’ Needs | Agency for Healthcare Research and Quality
    www.qualitymeasures.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

29. Ratio of Magnetic Resonance Imaging Scans to Computed Tomography Scans for the Evaluation of Children with Atraumatic Seizure: Tables 13 & 14 (pdf file)
    www.qualitymeasures.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

30. Ratio of Magnetic Resonance Imaging Scans to Computed Tomography Scans for the Evaluation of Children with Atraumatic Seizure: Tables 11 & 12 (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0197-tables11-12.pdf
    October 17, 2019 - 546)*** 0.4 (0.4) 5.6 (8.6) 8.0 (11.8) 0.1 (0.2) 79.7 (16.8) 2.6 (1.5) 3.7 (6.1) Subset following claims … (8.2) 8.1 (12.3) 0.1 (0.5) 79.3 (16.9) 2.7 (2.1) 4.1 (6.2) Subset following claims … missing or unmatched ZIP code, yielding n=546 (98.0%). **** Among the subset of children following claims … missing or unmatched ZIP code, yielding n=426 (98.2%). ***** Among the subset of children following claims … CT exclusions (n=426)**** 10.8 (14.9) Subset following claims MRI exclusions (n=489)***** 9.6 (13.4

31. 1b.4_Input_File_Specifications_508 (xls file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/input-file-specifications.xlsx
    January 01, 2014 - Medical Claims Reference Name Concept Description Variable Type Note claim_header_id Claim level … unique identifier text or numeric Can be derived, just need a way to uniquely identify claims. … unique identifier text or numeric Can be derived, just need a way to uniquely identify claims. … Note: Comorbidity source table is in wide form, unlike the medical claims source table DX2 The ICD9 … End of Table Pharmacy Claims Pharmacy Claims Reference Name Concept Description Required Variable

32. Transcranial Doppler (TCD) Ultrasonography Screening for Children with SCD; and Appropriate Antibiotic Prophylaxis (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra-1416-p007-2-ef.pdf
    November 01, 2015 - Claims data. … Claims data. … (MAX) administrative claims data from six States with a moderate to high prevalence of SCD … ● This measure was also tested using administrative claims acquired directly from the respective … Caveats These measures are based on administrative claims; incomplete reporting of claims or SCD diagnosis

33. CHIPRA 235: Section 6, Table 5. Reasons for Variance (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-235-section-6-table-5.pdf
    January 01, 2013 - code was added/updated after Analyst 1 data extraction 1 Data update: Specialty-related visit claims … code was added/updated after Analyst 1 data extraction 2 Data update: Specialty-related visit claims … code was added/updated after Analyst 1 data extraction 2 Data update: Specialty-related visit claims … code was added/updated after Analyst 1 data extraction 1 Data update: Specialty-related visit claims … taxonomy record was added after Analyst 1 data extraction 1 Data update: Specialty-related visit claims

34. Chipra-141-Section-2-Tech-Specs (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-141-section-2-tech-specs.pdf
    December 01, 2012 - Algorithm to identify children with complex and non-complex chronic conditions using Medicaid claims … file that includes all claims (inpatient, outpatient, managed care encounter data) and has at … The Process: 1) 'Claims' dataset: claims are read in and the decimals are stripped from the … ICD-9 codes with or without decimals are thus accommodated. 2) Claims are sorted by person … <---- 1) SET LOCATION OF CLAIMS DATA TO BE USED; %let icdnum=25;

35. Section 8.A, Data Availability (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/duration/chipra-153-section-8a.pdf
    January 01, 2011 - Some states do not report enrollment data, and none reports claims for their state funded (S-CHIP) … Additionally, while some states usually provide managed care claims, others do not (Byrd and Verdier … Testing managed care claims data quality in each state Managed care claims data is sometimes absent … States highlighted in Gray did not meet criteria to be utilized for studying appendectomy claims. … All claims data in these states is reported via FFS or PCCM, wherein claims are billed as FFS.

36. Tables 7-10 (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-196-section-6.pdf
    January 01, 2006 - after the date of evaluation for atraumatic headache, was calculated using 5 consecutive years of claims … data drawn from Medicaid Analytic eXtract (MAX) administrative claims data provided by the Centers … range) 0.99 (0.90-1.00) Table 9: Contingency Table for Presence of Exclusions in Administrative Claims … Measurement Year Exclusion Documented in Charts Present Absent Total Exclusion present based on claims … 62 Total 18 48 66 Table 10: Contingency Table for Presence of Exclusions in Administrative Claims

37. Ratio of Magnetic Resonance Imaging Scans to Computed Tomography Scans for the Evaluation of Children with Atraumatic Seizure: Table 7 - 10 (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0197-tables7-10.pdf
    January 01, 2006 - days after the date of evaluation for atraumatic seizure, was calculated using 5 consecutive years of claims … data drawn from Medicaid Analytic eXtract (MAX) administrative claims data provided by the Centers … range) 0.98 (0.81-0.99) Table 9: Contingency Table for Presence of Exclusions in Administrative Claims … Measurement Year Exclusion Documented in Charts Present Absent Total Exclusion present based on claims … 97 Total 13 91 104 Table 10: Contingency Table for Presence of Exclusions in Administrative Claims

38. Overuse of Imaging for the Evaluation of Children with Simple Febrile Seizure: Tables 12 - 15 (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0192-tables12-15.pdf
    October 16, 2019 - 7.2 (10.2) 8.5 (12.5) 0.2 (0.6) 75.1 (18.7) 3.2 (2.2) 5.4 (7) Subset following claims … missing or unmatched ZIP code, yielding n=458 (97.4%). ** Among the subset of children following claims … ‡ Mean (SD) Eligible children who had a febrile seizure (n=458)* 13.7 (15.8) Subset following claims … missing or unmatched ZIP code, yielding n=458 (97.4%). ** Among the subset of children following claims … missing or unmatched ZIP code, yielding n=457 (97.2%). ** Among the subset of children following claims

39. Section 6.A, Figures 1 to 4 and Table 5 (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-0138-section-6a.pdf
    December 01, 2013 - tested using a sample drawn from 5 consecutive years of Medicaid Analytic eXtract (MAX) administrative claims … tested using a sample drawn from 5 consecutive years of Medicaid Analytic eXtract (MAX) administrative claims …                                                       Figure 3: Michigan Medicaid Claims … CHAMPS) compared with a corresponding sample drawn from Medicaid Analytic eXtract (MAX) administrative claims … Figure 4: Michigan Medicaid Claims Results Compared with MAX data for 350‐Day Rate 0% 5% 10%

40. Tables 8-11 (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-195-tables%208-11.pdf
    December 18, 2019 - 2,918)** 0.5 (1.0) 4.9 (7.9) 8.0 (12.6) 0.1 (0.2) 80.2 (16.8) 2.6 (1.4) 3.7 (6.1) Subset following claims … )*** 0.5 (1.0) 4.8 (7.8) 8.2 (12.7) 0.1 (0.2) 80.3 (16.8) 2.6 (1.4) 3.6 (6.0) Subset following claims … headache (n=5,807)* 9.7 (13.5) Subset who had a CT or MRI (n=2,918)** 9.8 (13.6) Subset following claims … denominator exclusions (n=2,386)*** 9.5 (13.3) Subset following claims numerator exclusions (n=1,985 … CT or MRI (n=2,917)** $69,540 $29,624 $16,036 $47,028 $63,542 $85,462 $219,688 Subset following claims