COMPARABILITY OF OPEN AND CLOSED CLAIMS DATA FOR HEALTHCARE RESOURCE UTILIZATION ASSESSMENT IN ACUTE ISCHEMIC STROKE
Author(s)
Michael V. Murphy, BA1, Beni A. Turner, BS2, Jessica Duchen, MPH3;
1Magnolia Market Access, Director, RWE & HEOR Strategy, Lowell, MA, USA, 2Magnolia Market Access, Director, Real World Clinical Insights, Madison, WI, USA, 3Magnolia Market Access, VP, RWE & HEOR Strategy, Hamden, CT, USA
1Magnolia Market Access, Director, RWE & HEOR Strategy, Lowell, MA, USA, 2Magnolia Market Access, Director, Real World Clinical Insights, Madison, WI, USA, 3Magnolia Market Access, VP, RWE & HEOR Strategy, Hamden, CT, USA
OBJECTIVES: To compare patient cohorts with acute ischemic stroke (AIS) identified using open versus closed U.S. claims data and to assess whether open claims data can be used to characterize healthcare resource utilization (HCRU).
METHODS: Patients with ≥1 inpatient admission for AIS (ICD-10-CM I63.x or I64.x) between January 1, 2017 and December 31, 2023 were identified in open and closed claims databases. In closed claims, patients were required to have continuous enrollment for ≥6 months pre-index and ≥12 months post-discharge, unless death occurred. In open claims, enrollment was proxied by evidence of ≥1 claim during the corresponding baseline and follow-up periods. Baseline characteristics included demographics, comorbidities, payer type, hospitalization characteristics, and 12-month post-discharge HCRU. Analyses were descriptive; continuous variables were summarized using means, standard deviations, medians, and percentiles, and categorical variables using counts and percentages.
RESULTS: In closed claims, 11,324 AIS patients were identified (median age: 67 years; 50% Medicare Advantage [MA]). Comorbidity burden was high, with hypertension (90%), diabetes (50%), and coronary artery disease (32%) most prevalent. Mean length of stay (LOS) was 8 days, and 42% required intensive care unit (ICU) admission. Within 12 months post-discharge, 51% utilized outpatient physical or occupational therapy (PT/OT), and 13% experienced a fracture. In open claims, 249,970 AIS patients were identified (median age: 70 years; 31% MA). Comorbidity prevalence was similar (hypertension 90%, diabetes 51%, coronary artery disease 32%). Mean LOS was 9 days, and 28% required ICU care. During the 12 month follow-up, 38% utilized PT/OT and 11% experienced a fracture.
CONCLUSIONS: Proxy enrollment criteria applied to open claims data yielded patient demographic and clinical characteristics comparable to those observed in closed claims. However, differences in measured post-discharge HCRU suggest that open claims data may be less reliable for longitudinal utilization assessment, particularly for services requiring consistent capture over time.
METHODS: Patients with ≥1 inpatient admission for AIS (ICD-10-CM I63.x or I64.x) between January 1, 2017 and December 31, 2023 were identified in open and closed claims databases. In closed claims, patients were required to have continuous enrollment for ≥6 months pre-index and ≥12 months post-discharge, unless death occurred. In open claims, enrollment was proxied by evidence of ≥1 claim during the corresponding baseline and follow-up periods. Baseline characteristics included demographics, comorbidities, payer type, hospitalization characteristics, and 12-month post-discharge HCRU. Analyses were descriptive; continuous variables were summarized using means, standard deviations, medians, and percentiles, and categorical variables using counts and percentages.
RESULTS: In closed claims, 11,324 AIS patients were identified (median age: 67 years; 50% Medicare Advantage [MA]). Comorbidity burden was high, with hypertension (90%), diabetes (50%), and coronary artery disease (32%) most prevalent. Mean length of stay (LOS) was 8 days, and 42% required intensive care unit (ICU) admission. Within 12 months post-discharge, 51% utilized outpatient physical or occupational therapy (PT/OT), and 13% experienced a fracture. In open claims, 249,970 AIS patients were identified (median age: 70 years; 31% MA). Comorbidity prevalence was similar (hypertension 90%, diabetes 51%, coronary artery disease 32%). Mean LOS was 9 days, and 28% required ICU care. During the 12 month follow-up, 38% utilized PT/OT and 11% experienced a fracture.
CONCLUSIONS: Proxy enrollment criteria applied to open claims data yielded patient demographic and clinical characteristics comparable to those observed in closed claims. However, differences in measured post-discharge HCRU suggest that open claims data may be less reliable for longitudinal utilization assessment, particularly for services requiring consistent capture over time.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
SA25
Topic
Study Approaches
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Neurological Disorders