Physician-billing claims databases can be used to determine the incidence of fractures in the community. This study tested three algorithms designed to accurately and reliably identify fractures from a physician-billing claims database and concluded that they were useful for identifying all types of fractures, except vertebral, sacral, and coccyx fractures.
To develop and validate algorithms that identify fracture events from a physician-billing claims database (PCDs).
Three algorithms were developed using physician's specialty, diagnostic, and medical service codes used in a PCD from the province of Quebec. Algorithm validity was assessed via calculation of positive predictive values (PPV; via verification of a sample of algorithm-identified cases with hospitalization files) and sensitivities (via cross-referencing respective algorithm-identified fracture cases with a well-characterized fracture cohort).
PPV and sensitivity varied across fracture sites. For most fracture sites, the PPV with algorithm 3 was higher than with algorithms 1 or 2. Except for knee fracture, the PPVs ranged from 0.81 to 0.96. Sensitivities were low at the vertebral, sacral, and coccyx sites (0.40-0.50), but high at all other fracture sites. For 95% of fractures, the fracture site identified by algorithm agreed with the fracture site from patients' medical records. Fracture dates identified by algorithm were within 2 days of the actual fracture date in 88% of fracture cases. Among cases identified by algorithm 3 to have had an open reduction (N?=?461), 95% underwent surgery according to their respective medical charts.
Algorithms using PCDs are accurate and reliable for identifying incident fractures associated with osteoporosis-related fracture sites. The identification of these fractures in the community is important for helping to estimate the burden associated with osteoporosis and the utility of programs designed to reduce the rates of fragility fracture.
The absence of ongoing surveillance for childhood asthma in Montreal, Quebec, prompted the present investigation to assess the validity and practicality of administrative databases as a foundation for surveillance.
To explore the consistency between cases of asthma identified through physician billings compared with hospital discharge summaries.
Rates of service use for asthma in 1998 among Montreal children aged one, four and eight years were estimated. Correspondence between the two databases (physician billing claims versus medical billing claims) were explored during three different time periods: the first day of hospitalization, during the entire hospital stay, and during the hospital stay plus a one-day margin before admission and after discharge ('hospital stay +/- 1 day').
During 1998, 7.6% of Montreal children consulted a physician for asthma at least once and 0.6% were hospitalized with a principal diagnosis of asthma. There were no contemporaneous physician billings for asthma 'in hospital' during hospital stay +/- 1 day for 22% of hospitalizations in which asthma was the primary diagnosis recorded at discharge. Conversely, among children with a physician billing for asthma 'in hospital', 66% were found to have a contemporaneous in-hospital record of a stay for 'asthma'.
Both databases of hospital and medical billing claims are useful for estimating rates of hospitalization for asthma in children. The potential for diagnostic imprecision is of concern, especially if capturing the exact number of uses is more important than establishing patterns of use.
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Several studies have found a relation between economic incentives and physicians' clinical decisions. The bulk of these studies deals with data from private organisations providing medical care. The purpose of the present study is to explore whether a similar relationship is valid in a system where hospital care is provided by salaried physicians in the public sector. A distinction is made between medical and economic prioritysetting. If the relative fees influence the proportion of outpatient surgery or the compositions of treatments, economic prioritysetting is said to take place. Data were collected from a sample of Norwegian hospitals. The main findings of the empirical section can be summarised in two points: (i) Economic prioritysetting seems to be applied in the choice between inpatient and outpatient surgical treatment for patients with an identical diagnosis. (ii) Medical priority setting seems to be applied in the priority among patients with different diagnoses.
There is mutual agreement that health care should be delivered according to need. In this article, although we employ different specifications for need, we conclude that there is inequity in the delivery of health care in Sweden. Higher income groups visit doctors more often than lower income groups in relation to need, but lower income groups remain in hospital longer once they have been admitted. These findings may be interpreted to mean that lower income groups, for various reasons, wait too long before visiting a doctor for a specific disease, the consequence being that the disease is so serious by the time the doctor is contacted that inpatient care and a longer time in hospital are necessary. The policy implication of this situation is that lower patient fees and/or higher incomes may help to reduce the inequities in health care.
To determine the effect of obesity and sleep apnea on health care expenditure in women over 10 years.
Retrospective observational study
Tertiary university-based medical center
Three groups of age-matched women: 223 obese women with OSAS (body mass index: 39.3 +/- 0.6 kg/m2), and from the general population, 223 obese controls (BMI 36.3 +/- 0.4) and 223 normal weight controls (BMI 23.9 +/- 0.4).
We examined health care utilization in the 3 matched groups for the 10 years leading up to the documentation of OSAS. The mean physician fees and the number of physician visits were significantly higher in obese controls than in normal weight controls during the observed period. Physician fees and physician visits progressively increased in the 10 years before diagnosis in the OSAS cases and were significantly higher than in the matched obese controls. Physician fees, in Canadian dollars, one year before diagnosis in the OSAS cases were higher than in obese controls: $547.49 +/- 34.79 vs $246.85 +/- 20.88 (P
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Cites: Health Rep. 2000 Oct;12(1):21-39 (Eng); 23-44 (Fre)11565112
To examine what role demographic factors and increases in physician fees and utilization played in the rise in costs of physician services provided for elderly people in Quebec between 1982 and 1992, and to investigate changes in patterns of care (type and amount of services) related to utilization.
Retrospective study of population-based data.
Province of Quebec.
Elderly people (65 years of age and over) in Quebec in 1982 (n = 589,800) and in 1992 (n = 803,600).
Proportion of the increase in physician care costs attributable to (a) aging (defined as a shift in the age distribution) of the elderly population, (b) the increase in the size of the elderly population, (c) the increase in physician fees and (d) the increase in utilization of physician services; proportion of care provided by general practitioners (GPs) and by specialists; proportion of minor and complete examinations provided by GPs; and rates of hospital admissions and surgery.
Aging was responsible for 0.5% of the increase in physician care costs between 1982 and 1992, population growth for 27.0% and the increase in physician fees for 25.5%. The increased utilization accounted for 47.0% of the total cost increase. Analyses of the utilization data revealed a shift toward more costly services, more visits to specialists and higher rates of hospital admissions and surgery in 1992 than in 1982.
Aging and population growth had minor effects on the increase in physician care costs between 1982 and 1992. Increased utilization was the most important factor. The appropriateness of this trend needs to be verified.
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Recent years have witnessed important public investments in physicians' compensation across Canada. The current paper uses data from Quebec to assess the impact of those investments on the volumes of services provided to the population. While total physician compensation costs, average physician compensation and average unit cost per service all rose extremely fast, the total number of services, number of services per capita and average number of services per physician either stagnated or declined. This pattern is compatible with the economic target income hypothesis and raises important policy questions.