TY - JOUR
T1 - Pharmacy and medical claims data identified migraine sufferers with high specificity but modest sensitivity
AU - Kolodner, Ken
AU - Lipton, Richard B.
AU - Lafata, Jennifer Elston
AU - Leotta, Carol
AU - Liberman, Joshua N.
AU - Chee, Elsbeth
AU - Moon, Christina
N1 - Funding Information:
This work was supported, in part, by AstraZeneca Pharmaceuticals.
PY - 2004/9
Y1 - 2004/9
N2 - Objective Claims data are often used to identify and monitor individuals with particular conditions, but many health conditions are not easily recognizable from claims data alone. Patient characteristics routinely available in claims data were used to develop model-based claims signatures to identify migraineurs. Study design and setting A validated telephone interview was administered to 23,299 continuously enrolled managed care members aged 18-55 to identify 1,265 migraineurs and 1,178 controls. Responses were linked to medical and prescription claims. Claims variables were evaluated for sensitivity, specificity, and positive and negative predictive value in predicting migraine status. Regression models for predicting migraine status were developed. Results Regression-based claims signature models were successful in case-finding, as indicated by fairly sizable odds ratios (OR). In the full model (including demographic, medical, pharmacy, and comorbidity claims variables), a claim for a migraine drug, gender, and a claims-based headache diagnosis were strongly associated with migraine case status (OR=3.9, 3.2, and 3.0, respectively). Conclusion Using either medical or pharmacy claims provided highly specific and moderately sensitive case-findings. Strategies that combined medical and pharmacy information improved sensitivity and may increase the usefulness of claims for identifying migraine and improving the quality of migraine care.
AB - Objective Claims data are often used to identify and monitor individuals with particular conditions, but many health conditions are not easily recognizable from claims data alone. Patient characteristics routinely available in claims data were used to develop model-based claims signatures to identify migraineurs. Study design and setting A validated telephone interview was administered to 23,299 continuously enrolled managed care members aged 18-55 to identify 1,265 migraineurs and 1,178 controls. Responses were linked to medical and prescription claims. Claims variables were evaluated for sensitivity, specificity, and positive and negative predictive value in predicting migraine status. Regression models for predicting migraine status were developed. Results Regression-based claims signature models were successful in case-finding, as indicated by fairly sizable odds ratios (OR). In the full model (including demographic, medical, pharmacy, and comorbidity claims variables), a claim for a migraine drug, gender, and a claims-based headache diagnosis were strongly associated with migraine case status (OR=3.9, 3.2, and 3.0, respectively). Conclusion Using either medical or pharmacy claims provided highly specific and moderately sensitive case-findings. Strategies that combined medical and pharmacy information improved sensitivity and may increase the usefulness of claims for identifying migraine and improving the quality of migraine care.
KW - Insurance claim review
KW - Migraine
KW - Sensitivity and specificity
KW - Utilization
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U2 - 10.1016/j.jclinepi.2004.01.014
DO - 10.1016/j.jclinepi.2004.01.014
M3 - Article
C2 - 15504639
AN - SCOPUS:7044229449
SN - 0895-4356
VL - 57
SP - 962
EP - 972
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 9
ER -