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Article
June 19, 1987

The Use of Claims Data to Evaluate Health Care-Reply

Author Affiliations

Dartmouth Medical School Hanover, NH
University of Manitoba Winnipeg

Dartmouth Medical School Hanover, NH
University of Manitoba Winnipeg

JAMA. 1987;257(23):3226-3227. doi:10.1001/jama.1987.03390230062014
Abstract

In Reply.—  Drs Bell and Krikke suggest that investigators using claims data for evaluating health care outcomes should be careful to recognize the limitations of their data. We agree. In the case of outcomes for prostatectomy, we found the claims data were quite useful for measuring mortality and readmissions to the hospital as well as untoward outcomes defined by specific events such as death or reoperation, the development of postoperative urethral strictures requiring treatment, and subsequent diagnostic interventions. Claims data are not useful for measuring symptoms and events, such as impotence and incontinence, that are not necessarily associated with specific interventions. We recommend direct patient interviews as the best way of obtaining information on these outcomes.1The reason for keeping detailed records of procedures such as a prostatectomy, a cystoscopic examination, or a urethral dilatation is so that physicians and hospitals can be paid for what they do. Fraudulent

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