Harvard Pilgrim Health Careharvard Vanguard Medical Associates

The Harvard Pilgrim Health Care (HPHC) is a non-profit HMO in New England, the northeastern corner of the United States. It is the largest HMO in New England, with approximately 1.1

million members. The median age of the members is 31 years, with more than a quarter of the membership aged 17 or younger, and 7% aged 65 or older (Chan and Platt, 2000). HPHC includes Medicare and Medicaid populations, as well as members from private corporations, state employees, and individual memberships.

The dis-enrollment rate is approximately 14% a year among all members, but, as with the other databases described, is much lower for members who have been enrolled for longer than three years (Chan and Platt, 2000). The attrition rate is also lower among those with chronic conditions, such as asthma or hypertension.

Approximately 90% of HPHC members have prescription drug benefits, which offer a copay-ment of up to $10 a prescription for a 30-day supply at member pharmacies. For each prescription dispensed, the following data are recorded: unique patient identifying number, gender, date of birth, dispensing date, prescriber identifier, generic drug name, dosage strength, amount dispensed, route, American Hospital Formulary Service (AHFS) code, NDC code, member's contract number, and dependency code (noting the relationship between family members and contract holders).

The basic membership file includes demographic and health plan coverage information for each member, including date of birth, gender, dates of membership (including all starts, stops and changes in coverage or benefit status during each membership interval), and most recent residential zip code. Also recorded, though less reliably, are race, marital status, education, and occupation. Family membership information is noted, as well as the organization through which membership was obtained (Medicare, Medicaid, private employer, etc.).

Ambulatory visits generate claims with diagnosis and procedure codes, as well as provider identifier and dates of visits. Emergency Department visits and hospitalizations also generate claims, with hospital name, dates, discharge diagnoses and procedures performed. The largest single inpatient facility is Brigham and Women's Hospital, where detailed automated patient records are available. Automated searches can also be made of long-term care and home care provided by physicians, nurses, or other private vendors.

A subset of the HPHC membership is composed of a multi-specialty group, Harvard Vanguard Medical Associates (HVMA), with a membership of 300 000 (Chan and Platt, 2000). For these members, fully automated medical records are available, which include results of most laboratory tests, diagnostic imaging procedures and other tests performed within and outside HVMA facilities, providers' notes and dictations, patients' vital signs, and an unlimited number of diagnoses per encounter (including telephone calls). Hard copy records must be used for electrocardiogram results and information from prior health care providers. Paper text is also reviewed to confirm coded information and to obtain details on the outcomes of interest and on potential confounders and effect modifiers. Routine record reviews have been performed for research and quality assurance purposes.

The data required for research projects are stored in diverse computer systems. These data must be converted into usable databases for each research project. The pharmacy dispensing and claims data have supported a number of studies using a variety of study designs, including cohort and nested case-control studies.

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