The Kaiser Permanente Medical Care Program is the largest and one of the oldest pre-paid group model health care systems in the United States .
KAISER PERMANENTE MEDICAL CARE
PROGRAM
The
Kaiser Permanente Medical Care Program is the largest and one of the oldest
pre-paid group model health care systems in the United States (Selby et al., 2005). With more than eight
million members in nine states, the programme is divided into eight
administra-tive regions, seven of which have their own research centers. Each
research center operates as a distinct entity, using only its own regional
databases. The two oldest research centres, in operation since the 1960s, are
the Division of Research of Kaiser Perma-nente Northern California and the
Center for Health Research of Kaiser Permanente Northwest (KPNW). Both centres
have made major contributions to phar-macoepidemiology, including developing
strategies for dealing with methodological issues endemic to the use of
clinical data for research, and developing approaches to overcoming biases
present in clinical databases, at least as applied to Kaiser Permanente
databases (Selby et al., 2005). Four
of the Kaiser HMOs participate in the HMO Research Network (see below).
Kaiser
Permanente’s largest and oldest regional entity is in Northern California, and
now serves approx-imately 3.1 million enrollees in a 14-county area that
includes the Oakland–San Francisco Bay and Sacramento metropolitan areas (Selby
et al., 2005). About 30% of the
population in the area covered by this region of Kaiser Permanente is enrolled,
mainly through employment; 13% receive some Medicare coverage, bringing the
proportion of members 65 and older close to the proportion in the general
population (Selby et al., 2005).
Race/ethnicity information is not collected routinely, but special member
surveys and other sources show a close similarity to the distri-bution of the
general population, based on census data (Selby et al., 2005). Comparisons of household income of the membership
with census data show a slight under-representation at the highest and lowest
income levels (Krieger, 1992; Selby et al.,
2005). After the first year or two of membership, during which there is a
relatively high turnover, enrollees tend to stay with the programme for
relatively long periods of time. A unique medical record number is used for all
encounters with the Kaiser Perma-nente program, making possible the linking of
vari-ous records. Computerized membership files contain records of all members
at a given point in time.
The
Pharmacy Information Management System has been operational in Kaiser
pharmacies since 1994, recording information on approximately 15 million
prescriptions per year. Information on each prescrip-tion is entered into the
database prior to its being dispensed, and includes patient and prescribing
physi-cian identification numbers, drug name, National Drug Code (NDC), dose,
therapeutic class, date dispensed and prescription cost. Nearly all
prescrip-tions are captured for the 94% of members who have the drug benefit
(Selby et al., 2005).
Other
databases include hospitalizations, avail-able since 1971; laboratory,
pathology and radiol-ogy/diagnostic imaging data, stored since 1992; and
information on outpatient visits, stored since 1994. Review of medical records
has not been obviated, however, and is recommended for validation of certain
computerized data.
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