This paper reviews the utility of administrative data for assessing patient care.

Medicare databases include: (1) the Health Insurance Skeletonized Eligibility Write-off (HISKEW) file of all enrolled patients (data includes age, gender, race, residence, reason for and length of entitlement under Medicare parts A and B, HMO enrolled, and occurrence and time of death); (2) the Medicare Provider Analysis and Review (MEDPAR) file of all hospitalized enrollees (data includes reason for admission and other diagnoses and procedures done in the hospital); (3) the Part B Medicare Annual Data (BMAD) of 5% of the Medicare population (data includes physician care information); and (4) the National Claims History (NCH) of the entire Medicare population (data includes all procedures use). Other databases include the Shared Medical Systems (SMS) of patients from contracting hospitals (data on use of drugs and other services, full diagnostic and procedural profiles, and demographic and insurance).

The authors review the kinds of information necessary to make use of administrative files, which include clinical information about the patient, processes of care for the patient, and patient status over time. The quality (accuracy, completeness, and timeliness) of the data must also be considered.

The usefulness of these types of data include measuring processes of care and contrasting different population (demographic) groups, including comparisons over time and across cohorts.

As a demonstration of the use of claims data, an assessment of cardiac procedure use and patient outcomes after an AMI for the 1987 Medicare cohort is presented.