Document Type
Article
Publication Date
January 2013
Publication Title
SpringerPlus
Volume
2
Issue Number
1
DOI
10.1186/2193-1801-2-226
Keywords
Quality of care, Claims data, Logistic regression, Diabetes
Disciplines
Business | Business Administration, Management, and Operations | Insurance | Other Business
Abstract
We present a methodology for using health insurance claims data to monitor quality of care. The method uses a statistical model trained on the quality ratings of a medical expert. In a pilot study, the expert rated the quality of care received over the course of two years by 101 diabetes patients. A logistic regression model accurately identified the quality of care for 86% of the patients. Because the model uses data derived from patients’ health insurance claims it can be used to monitor the care being received by a large patient population. One important use of the model is to identify potential candidates for case management, especially patients with complicated medical histories.
Recommended Citation
Dimitris Bertsimas, David Czerwinski, and Michael Kane. "Measuring quality in diabetes care: an expert-based statistical approach" SpringerPlus (2013). https://doi.org/10.1186/2193-1801-2-226
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Included in
Business Administration, Management, and Operations Commons, Insurance Commons, Other Business Commons
Comments
This article was published in SpringerPlus, volume 2, 2013, and is also available online at this link.
© 2013 Bertsimas et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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