Applying insurance claims data to assess quality of care: a compilation of potential indicators

QRB Qual Rev Bull. 1990 Dec;16(12):424-38. doi: 10.1016/s0097-5990(16)30404-3.

Abstract

Insurance claims records, which document many aspects of the process and outcome of medical care, are a practical and unobtrusive source of data for monitoring the quality of care provided to enrollees--a purpose for which they are rarely used. Data for these potential indicators could be drawn from claims or other administrative data systems. The authors established categories of care that could be used to develop claims-based indicators and compiled an annotated list of broad indicators for assessing the quality of care. The compilation of indicators is preceded by a discussion of some of the issues and challenges facing those who use and interpret claims-based indicators of quality.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Data Collection
  • Databases, Factual / standards*
  • Forecasting
  • Humans
  • Insurance Claim Reporting / standards*
  • Insurance, Health / statistics & numerical data*
  • Methods
  • Outcome and Process Assessment, Health Care / methods*
  • Quality Assurance, Health Care / standards*
  • United States