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Most disease surveillance in Texas is conducted through passive means, relying on laboratories, medical providers and the public to report suspected cases of disease. To supplement the passive surveillance system, the Texas Department of State Health Services Emerging and Acute Infectious Disease Branch (EAIDB) investigated whether Medicaid inpatient administrative claims could be used as a supplemental source of reports of notifiable conditions.
METHODS:
Data files of all Medicaid inpatient administrative claims made January-June, 2012 to Texas Medicaid were electronically shared with EAIDB. Using ICD-9 codes, all claims for salmonellosis, tetanus, pertussis, and varicella were selected. Varicella claims were further restricted to patients less than one year of age at date of service.
Patients identified in the Medicaid data were matched by name, date of birth and condition for records in the notifiable conditions database that EAIDB maintains. This database includes electronic laboratory results as well as all patients reported to the CDC for the four diseases listed above. Medical records were requested for all patients in the Medicaid dataset not identified in the notifiable conditions database. Medical records were reviewed to determine whether the patient met the surveillance case definition.
RESULTS:
Medicaid claims data identified 83 pertussis claims, 8 tetanus claims, 83 salmonellosis claims, and 28 varicella claims in children under 1. None of the varicella or tetanus patients had been reported, however, 38 (45.8%) of the pertussis patients and 51 (61.4%) of the salmonellosis patients had been reported.
After reviewing medical records, 1 (2.6%) pertussis patient, 1 (14.3%) tetanus patient, 6 (21.4%) salmonellosis patients, and 23 (92%) varicella patients met the surveillance case definitions. The addition of the tetanus case doubled the number of tetanus cases reported by Texas to the CDC in 2012. The addition of 23 varicella cases increased the number of cases reported to CDC for that time frame and age group by 23.2%. The effect on salmonellosis and pertussis case reports to the CDC was negligible at less than 1% for each condition.
CONCLUSIONS:
Medicaid administrative claims data may be a useful source of data for surveillance for some notifiable conditions. EAIDB plans to repeat this process for additional conditions (and age groups for varicella) to pinpoint where the Medicaid data is most useful.