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Claims database enhances health care research

Rhode Island researchers utilize All-Payer Claims Database, provide training

After securing access to Rhode Island’s All-Payer Claims Database through a partnership between Brown-based Advance Clinical and Translational Research and the Rhode Island Department of Health, five researchers now have the resources to ask questions about the state’s health care utilization in a more comprehensive way.

The researchers are affiliated with the University of Rhode Island, Lifespan and Brown. They study health care costs and Rhode Island’s insured population’s health care utilization, according to Ira Wilson, co-leader of the partnership and professor and chair of Health Services, Policy and Practice at the School of Public Health and professor of Medicine at the Alpert Medical School. The All-Payer Claims Database is unique because it contains claims data from commercial insurers, Medicare and Medicaid, he added.

“A claims data set is a very valuable resource for any clinical researcher because it tells you what happened and how much it cost,” said Neil Sarkar, co-leader of the partnership, director of the Brown Center for Biomedical Informatics, associate professor of medical science and associate professor of Health Services, Policy and Practice. “That gives the researcher the opportunity to … build a research hypothesis around that particular problem.”

An important benefit of having access to APCD data, as opposed to claims data from one insurance provider, is that patients may change their insurance provider each year or lose employer-sponsored insurance, making it challenging to track one person’s health care usage over long periods of time, Sarkar said.

The Advance-CTR initiative works to create opportunities and infrastructure for translational research, Wilson said. This kind of research involves turning basic science research into programs and policies that improve the health of Rhode Islanders, he added.

In addition to working as co-leaders of the partnership, Wilson and Sarkar each lead teams that use the APCD data for other projects. Wilson investigates trends in the cost of health care to keep track of its growth and help prevent excessive increases.

Sarkar and his team look at what conditions can be effectively modeled by claims data like the APCD. Claims data only reflects billed interactions, which health care providers send to insurance providers for payment, Sarkar said. This type of data can sometimes be sufficient to build clinical models but can also lack detail, such as the reason why a health service was administered, he added. One of the goals of his project is to develop clinical decision support tools that use these models to help clinicians provide better care, he said.

Along with Wilson and Sarkar, three other researchers have received access to and are using the data set through Advance-CTR.

Orestis Panagiotou, assistant professor of Health Services, Policy and Practice, leads a project comparing “the use of low-value services between Medicaid and commercial insurance in the state,” he said. Low-value services are ones that clinicians have agreed do not benefit patients, he added.

Brett Owens, chief of sports medicine at Miriam Hospital and professor of orthopedic surgery, uses APCD data to study shoulder instability. The data shows injuries, treatment trends and reinjury rates, Owens wrote in an email to The Herald. “We’re looking to see how socioeconomic status and insurance status affect the management and reoccurrence of shoulder instability injuries,” he wrote. One benefit to having access to APCD data is the ability to “see the long-term outcomes for orthopedic injuries … and better understand the state of care in RI,” he wrote.

Steven Cohen, an assistant professor at the University of Rhode Island, leads another team that is funded by Advance-CTR and uses the APCD data to ask questions about health care in the state, according to the University press release.

Along with the Center for Biomedical Informatics and Brown Computing and Information Services, Advance-CTR provides secure access to de-identified data, Wilson said. The data is maintained in a digital environment where users with special certifications have strict limitations on how they can view and use the data, Sarkar explained. For example, users can analyze the data but cannot export it without permission or access the internet at the same time, he said.

Although in theory the data set contains no way to link people to their health information, “re-identifiability can be a concern, and we need to make sure we put every possible safeguard in place to prevent this risk,” Sarkar said. In some instances, researchers may be required to pass their protocols by an Institutional Review Board and agree not to make any attempt to use the data to identify individuals, he added.

Another central focus of the partnership is training new scientists and students of all levels in using the data, Wilson said.

An exciting aspect of the partnership is that by learning how to use APCD data and leveraging this opportunity, students can develop and provide documentation for how to use APCD data sets.

This partnership between Advance-CTR and the Rhode Island Department of Health is just one example of how the state is trying to be innovative with health care, Wilson said. He added that it’s a remarkable way of leveraging federal money at the state level through a partnership between a public university and a private university.

“We’re so fortunate at Brown to be able to be in an environment where you’re not only doing really interesting science … but we’re impacting the community,” Sarkar said. “We’re not just a University up on a hill, we’re a University that also wants to make a direct impact on the community in which we reside.”


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