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.
Dimitris Bertsimas, David Czerwinski, and Michael Kane. "Measuring quality in diabetes care: an expert-based statistical approach" SpringerPlus (2013). doi:10.1186/2193-1801-2-226
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