Commercial Health Insurance Claims Data. for Studying HIV/AIDS Care. Senior Scientist, Innovus Epidemiology. David D.

Transcription

1 Commercial Health Insurance Claims Data for Studying HIV/AIDS Care David D. Dore, PharmD, PhD Senior Scientist, Innovus Epidemiology Adjunct Assistant Professor, Alpert Medical School, Brown University 28 April 2011

2 Who We Are Leadership in technology-driven efficiencies Touching more than 73 million lives Interacting with 650,000 physicians and 5,000 health care institutions Specialists serving: - Employers - Individuals - Governments - Payers - Providers - Pharmaceutical and biotech - Medical device and diagnostics One of the best performing and most financially stable companies in the world Galaxy

3 Data Elements in the Ingenix Normative Health Information Database NHI Member Identifier Plan Gender Age Dates of Eligibility Member identifier Prescribing physician Drug dispensed (NDC) Quantity and date dispensed Drug strength Days supply Dollar amounts Member identifier Physician or Facility identifier Procedures (CPT-4, revenue codes, ICD-9) Diagnosis (ICD-9-CM, DRG) Admission and discharge dates Date and place of service Dollar amounts Member identifier Lab Test Name Result Member identifier Income Net Worth Education Race & Ethnicity Life Stage Life Style Indicators Administrative Data Pharmacy Claims Physician and Facility Claims Lab Test Results Data Data Data Consumer Elements Unique Dataset Per-Project Data Chart Reviews Surveys Hospital Inpatient Clinical Measures Fact and Date of Death

4 NHI Size 16,000,000 14,000,000 12,000,000 10,000,000 8,000,000 6,000,000 4,000,000 2,000,000 0 Number of Enrollees Year Covered Lives Continuously Enrolled Midyear Enrollment

5 Enrollment Duration M30 Mean Median M onths % Random Sample, June 2005 to December 2007 Age Total (%) N=1,602,627 At Least 9 Months Continuous Enrollment g Distribution Age Total (%) and Older Age N=44,867

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7 Abstraction Timelines Screen of Claims Data Initial automated screen of claims data Use diagnosis, procedure codes Create inclusive list of potential events Month 1 Profile Review Review of chronologic listing of claims data Select provider/facility for abstraction Generate/send letters to providers requesting charts Month 2 Chart Abstraction Abstraction of selected medical records Seek alternate providers for charts not obtained Months 3,4,5 Blind PHI, exposure / Make photocopies of relevant documents Send copies to Adjudication Committee Clinical Chart Review Clinical review of medical charts and claims prof iles Case adjudication and determination of case date Consensus adjudication Month 6 Analysis Merge adjudication results with analytic file Verif y enrollment Calculate person-time and rates Month 7

8 Age and Sex Distributions versus US Census 8 Ingenix US Database Census (2004) (2000) Age, y Total (%) Total (%)

9 9 Geographical Distribution versus US Census Population Ingenix Database (2004) I i US US Census (2000) Region (2004) (2000) Northeast 4% 21% Southeast 37% 22% Midwest 45% 25% West 14% 32%

10 10 Some Counts from NHI ( ) Patients with at least one diagnosis of HIV/AIDS (ICD xx)

11 11 Demographic Characteristics

12 12 Laboratory Results

13 13 Laboratory Results

14 Likely Availability and Quality of HIV/AIDS Data Elements in Commercial Health Insurance Claims Data Research Repositories* Available Available in De-identified Claims Available in Supplemented, De-identified Claims through Claim Linkage Requiring Use of PHI** Data Element 1. HIV testing and linkage to care a. Date of HIV diagnosis +/- +/- ++(i) b. CD4 count at diagnosis/at first treatment - ++(i) ++(i) c. Referral to provider for HIV care d. Other 2. Clinical a. CD4 count - ++(i) ++(i) b. Viral load - ++(i) ++(i) c. HCV co-infection d. STIs e. Other opportunistic infections f. Screening for mental health or substance abuse +/- +/- +(i) g. Screening for/monitoring other comorbidities (e.g., diabetes, hyperlipidemia, etc.) +/-(i) +/-(i) +(i) h. PAP, gynecological care i. Date of death

15 3. Access to care a. Insurance status b. Access to providers with HIV care experience +/- +/- +/- c. Ability to obtain HIV-related medications d. Number of visits per year e. Patient ED/inpatient utilization f. Access to dental care +/- +/- + g. Social work/case management h. Other 4. Treatment and adherence a. Medications prescribed b. Number/frequency of refills for medications c. Toxicities d. Other 5. Financial security a. Employment status +/-(i) +/-(i) +(i) b. Income +/- +/- - c. Housing stability - - +/-(i) d. Other 6. Demographics a. Age b. Sex c. Sexual orientation - -(i) +/-(i) d. Race/ethnicity - +/-(i) +(i) e. Education - +/- + f. Living arrangement (e.g., live alone, with family, non-family) - - +/- g. Metropolitan statistical area size or locality of residence - + +/- 15

16 7. Risk behavior assessment a. Sexual risk behaviors - - +/-(i) b. HIV status of current partners - - +/- c. Substance use +/-(i) +/-(i) +(i) d. Other 8. Patient experience with care a. Patient satisfaction with care practice/provider - - +/-(i) b. Discrimination - - +/-(i) c. Other PHI, protected health information Legend: ++, available and highly accurate; +, available, fairly accurate; +/-, available with questionable accuracy; -, unavailable; (i) potentially incomplete *Values based on the opinion and experience of the presenter only. No guarantee regarding the correctness of this table should be inferred. **Linkage to external data sources using PHI not feasible through some commercial health insurance databases. Further, some data owners with this capability will not allow researchers to use PHI for HIV/AIDS populations (e.g., UnitedHealth Care) 16

17 Thank You