Concordance between patient self-reports and claims data on clinical diagnoses, medication use, and health system utilization in Taiwan

PLoS One. 2014 Dec 2;9(12):e112257. doi: 10.1371/journal.pone.0112257. eCollection 2014.

Abstract

Purpose: The aim of this study was to evaluate the concordance between claims records in the National Health Insurance Research Database and patient self-reports on clinical diagnoses, medication use, and health system utilization.

Methods: In this study, we used the data of 15,574 participants collected from the 2005 Taiwan National Health Interview Survey. We assessed positive agreement, negative agreement, and Cohen's kappa statistics to examine the concordance between claims records and patient self-reports.

Results: Kappa values were 0.43, 0.64, and 0.61 for clinical diagnoses, medication use, and health system utilization, respectively. Using a strict algorithm to identify the clinical diagnoses recorded in claims records could improve the negative agreement; however, the effect on positive agreement and kappa was diverse across various conditions.

Conclusion: We found that the overall concordance between claims records in the National Health Insurance Research Database and patient self-reports in the Taiwan National Health Interview Survey was moderate for clinical diagnosis and substantial for both medication use and health system utilization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Algorithms
  • Automation
  • Child
  • Cross-Sectional Studies
  • Drug Therapy / statistics & numerical data*
  • Female
  • Health Services Research
  • Hospitalization
  • Humans
  • Insurance Claim Review
  • Insurance, Health / statistics & numerical data*
  • Male
  • Middle Aged
  • Models, Statistical
  • National Health Programs
  • Reproducibility of Results
  • Self Report*
  • Surveys and Questionnaires
  • Taiwan
  • Young Adult

Grants and funding

No potential financial conflicts of interest relevant to this study were reported. Dr. Wu is supported in part by a grant from National Science Council, Taiwan (PI: Wu, NSC 102-2314-B-418 -002). Dr. Tsai is supported in part by grants from the National Health Research Institutes, Taiwan (PI: Tsai, PH-100-PP-14, PH-102-PP-14, PH-101-SP-14, PH-102-SP-5). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.