Bynum 1-Year Standard Method for identifying Alzheimer’s Disease and Related Dementias (ADRD) in Medicare Claims data

Principal Investigator(s):  View help for Principal Investigator(s) Julie Bynum, Institute for Healthcare Policy and Innovation, University of Michigan

Version:  View help for Version V3

Version Title:  View help for Version Title Updated restrictions in 1_ADRD_HOF_Claims file

Name File Type Size Last Modified
  SAS-Script 06/22/2023 02:49:PM
  Stata-Script 06/22/2023 02:49:PM
README.pdf application/pdf 221.8 KB 06/22/2023 11:19:AM

Project Citation: 

Bynum, Julie. Bynum 1-Year Standard Method for identifying Alzheimer’s Disease and Related Dementias (ADRD) in Medicare Claims data. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2023-06-22. https://doi.org/10.3886/E183523V3

Project Description

Summary:  View help for Summary Here, you will find resources to use the Bynum-Standard 1-Year Algorithm including a README file that accompanies SAS and Stata scripts for the 1-Year Standard Method for identifying Alzheimer’s Disease and Related Dementias (ADRD) in Medicare Claims data. 
 
There are seven script files (plus a parameters file for SAS [parm.sas]) for both SAS and Stata. The files are numbered in the order in which they should be run; the five “1” files may be run in any order.

The full algorithm requires access to a single year of Medicare Claims data for (1) MedPAR, (2) Home Health Agency (HHA) Claims File, (3) Hospice Claims File, (4) Carrier Claims and Line Files, and (5) Hospital Outpatient File (HOF) Claims and Revenue Files. All Medicare Claims files are expected to be in SAS format (.sas7bdat).
For each data source, the script will output three files*:

  1. Diagnosis-level file: Lists individual ADRD diagnoses for each beneficiary for a given visit. This file allows researchers to identify which ICD-9-CM or ICD-10-CM codes are used in the claims data.
  2. Service Date-level file: Aggregated from the Diagnosis-level file, this file includes all beneficiaries with an ADRD diagnosis by Service Date (date of a claim with at least one ADRD diagnosis).
  3. Beneficiary-level file: Aggregated from the Service Date-level file, this file includes all beneficiaries with at least one* ADRD diagnosis at any point in the year within a specific file

* The algorithm combines the Carrier and HOF files at the Service Date-level. The final combined Carrier and HOF Beneficiary-level file includes those with at least two (2) claims that are seven (7) or more days apart.
​
A final combined file is created by merging all Beneficiary-level files. This file is used to identify beneficiaries with ADRD and can be merged onto other files by the Beneficiary ID (BENE_ID).


With appreciation & acknowledgement to colleagues from a grant funded by the NIA for their involvement in development & validation of the Bynum-Standard 1-Year Algorithm
Funding Sources:  View help for Funding Sources United States Department of Health and Human Services. National Institutes of Health. National Institute on Aging (AG066582)

Scope of Project

Subject Terms:  View help for Subject Terms ADRD; Dementia; Alzheimer's Disease; Alzheimer's; Medicare; CMS; Medicare Claims
Geographic Coverage:  View help for Geographic Coverage USA
Universe:  View help for Universe Medicare Population, age 65+ in the U.S.A.
Data Type(s):  View help for Data Type(s) program source code

Methodology

Response Rate:  View help for Response Rate NA
Sampling:  View help for Sampling Medicare beneficiaries with Traditional Medicare/FFS (continuous enrollment in parts A and B for one (1) calendar year)

The following restrictions are applied to the files:
  • HHA Claims are restricted to claims with Claim Query Code equal to “3” to capture only final bills
  • Hospice Claims are restricted to claims with Claim Query Code equal to “3” to capture only final bills
  • Carrier Claims are restricted such that claims with Line Processing Indicator Code equal to “I”, “M”, or “R” OR claims with Line Allowed Charge Amount <= $0 are removed to capture only final bills
  • HOF Claims are restricted to the following three settings: Rural Health Centers (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals—option 2 (CAH Opt2)
  • MedPAR claims are not restricted
In V3 of the upload, the HOF claims file ("1_ADRD_HOF_Claims") was updated with new definitions for RHCs, FQHCs, and CAH Opt2 as it was found that the previous definitions were overly restrictive. The updated definitions resulted in an overall increase in the prevalence of an ADRD diagnosis of 0.1% among Traditional FFS beneficiaries in years 2018 and 2019.
Data Source:  View help for Data Source Centers for Medicare and Medicaid Services (CMS). Users can request access to data at https://www.cms.gov
Scales:  View help for Scales NA
Weights:  View help for Weights NA
Unit(s) of Observation:  View help for Unit(s) of Observation ICD-9 and/or ICD-10 Diagnosis Code, Service Date/Date of Diagnosis, Person
Geographic Unit:  View help for Geographic Unit NA

Related Publications

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Published Versions

V3 [2023-06-22]

V2 [2022-12-15]

V1 [2022-12-13]

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