Assessing Healthcare Utilization and Cost of Care Among Rheumatoid Arthritis Patients: A Comparison of Electronic Medical Records and Claims Data

Jing Hao, Ph.D., Daniel D. Maeng, Ph.D., Xiaowei Yan, Ph.D., Walter F. Stewart, Ph.D., MPH, Joseph A. Boscarino


Electronic medical records (EMR) and health insurance claims data offer two potential data sources for researchers to examine healthcare utilization patterns and the cost of care. In particular, combining the clinical and epidemiological variables typically available in EMR with cost information available in the claims data is not only intuitively sensible, but also increasingly more feasible with growing standardization of EMR across healthcare delivery systems. In this study, we compare EMR and claims data within a cohort of rheumatoid arthritis patients who received care from Geisinger Health System (GHS) and also had concurrent Geisinger Health Plan (GHP) coverage. We also develop a cost “imputation” method to obtain GHP claims-based cost estimates within EMR, even for those who did not have GHP coverage. The findings confirm that there is significant disagreement between EMR and claims data and suggest that each represent a different set of clinical phenomena. This study also illustrates different factors to consider for researchers in choosing one data source over the other in conducting clinical research. 

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