Measuring quality in diabetes care: an expert-based statistical approach
1 Sloan School of Management, Massachusetts Institute of Technology, E40-147, Cambridge, MA, 02139, USA
2 Department of Marketing and Decision Sciences, San Jose State University, San Jose, CA, 95192-0069, USA
3 MIT Medical, Building E23, 77 Massachusetts Avenue, Cambridge, MA, 02139-4307, USA
SpringerPlus 2013, 2:226 doi:10.1186/2193-1801-2-226Published: 16 May 2013
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.