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Objective: To evaluate the performance of different approaches for identifying live births using Transformed Medicaid Statistical Information System Analytic Files (TAF). Data Sources: The primary data source for this study were TAF inpatient (IP), other services (OT), and demographic and eligibility files. These data contain administrative claims for Medicaid enrollees in all 50 states and the District of Columbia from January 1, 2018 to December 31, 2018. Study Design: We compared five approaches for identifying live birth counts obtained from the TAF IP and OT data with the Centers for Disease Control and Prevention (CDC) Natality data--the gold standard for birth counts at the state level. Data Collection/Extraction Methods: The five approaches used varying combinations of diagnosis and procedure, revenue, and place of service codes to identify live births. Approaches 1 and 2 follow guidance developed by the Centers for Medicare and Medicaid Services (CMS). Approaches 3 and 4 build on the approaches developed by CMS by including all inpatient hospital claims in the OT file and excluding codes related to delivery services for infants, respectively. Approach 5 applied Approach 4 to only the IP file. Principal Findings: Approach 4, which included all inpatient hospital claims in the OT file and excluded codes related to infants to identify deliveries, achieved the best match of birth counts relative to CDC birth record data, identifying 1,656,794 live births--a national overcount of 3.6%. Approaches 1 and 3 resulted in larger overcounts of births (20.5% and 4.5%), while Approaches 2 and 5 resulted in undercounts of births (-3.4% and -6.8%). Conclusions: Including claims from both the IP and OT files, and excluding codes unrelated to the delivery episode and those specific to services rendered to infants improves accuracy of live birth identification in the TAF data. KEYWORDS administrative data uses, maternal and perinatal care and outcomes, Medicaid, obstetrics/gynecology What is known on this topic * No research has evaluated approaches for identifying live births using the newly-available Transformed Medicaid Statistical Information System Analytic Files (TAF), which contain claims from all Medicaid enrollees * Approaches to identify live births in the Medicaid Analytic extract, the prior version of TAF, rely on variables that are not reported or have been re-structured in the TAF * Accurately approximating the date of delivery is critical to measuring maternal health outcomes, which often begin or center around this date What this study adds * Using claims data from both the inpatient and other services TAF files produced the best state-year match to Natality data from the Centers for Disease Control and Prevention * This comparison of different approaches to identify live births using the TAF can help researchers interested in using these data to answer questions related to maternal health decide which approach best fits their needs * The approach used by researchers to identify live births may depend on the states of interest, as performance of each approach varies across states, 1 | INTRODUCTION Improving maternal outcomes has been a long-standing priority in the United States where maternal mortality rates far outpace those identified in peer nations. (1) Further, higher risk [...]

Objective: To investigate the relationship between community care (CC) treatment and a postoperative surgical complication in elective hernia surgery among Veterans using multiple approaches to control for potential selection bias. Data Sources and Study Setting: Veterans Health Administration (VHA) data sources included Corporate Data Warehouse (VHA encounters and patient data), the Program Integrity Tool and Fee tables (CC encounters), the Planning Systems Support Group (geographic information), and the Paid file (VHA primary care providers). Study Design: Prior works suggest patient outcomes are better in VHA than in CC settings; however, these studies may not have appropriately accounted for the selection of higher-risk cases into CC. We estimated (1) a naive logistic regression model to calculate the effect of CC setting on the probability of a complication, controlling for facility fixed effects and patient and procedure characteristics, and (2) a 2-stage model using the hernia patient's primary care provider's 1-year prior CC referral rate as the instrument. Data Collection: We identified patients residing [less than or equal to]40 miles from a VHA surgical facility with elective VHA or CC hernia surgery from 2018 to 2019. Principal Findings: Of 7991 hernia surgeries, 772 (9.7%) were in CC. The overall complication rate was 4.2%; 286/7219 (4.0%) among VHA surgeries versus 51/5772 (6.6%, p < 0.05) in CC. We observed a 2.8 percentage point increase in the probability of postoperative complication given CC surgery (95% confidence interval: 0.7, 4.8) in the naive model. After accounting for the VHA provider's historical rate of CC referral, we no longer observed a relationship between surgery setting and risk of postoperative complication. Conclusions: After accounting for the selection of higher-risk patients to CC settings, we found no difference in hernia surgery postoperative complications between CC and VHA. Future VHA and non-VHA comparisons should account for unobserved as well as observed differences in patients seen in each setting. KEYWORDS fee-for-service care, instrumental variable, MISSION Act, outpatient surgery, selection bias, Veteran Health Administration What is known on this topic * Prior comparisons of VHA and community care quality outcomes often find VHA care superior. * These studies have not always considered unobserved as well as observed differences in patients referred out of VHA. What this study adds * In elective outpatient hernia surgery, analyses that fail to account for the selection of higher-risk patients to community care find poorer postoperative outcomes in non-VHA surgeries. * In 2-stage analytical models that account for unobserved as well as observed differences between patients seen in the VHA versus the community, there was no evidence of quality differences between settings., 1 | INTRODUCTION The Veterans Health Administration (VHA) is one of the country's largest integrated health care systems, offering comprehensive health services to eligible military Veterans. Through the VHA, Veterans [...]