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+When to use the linkage?
When the scientific product using both data sources is superior to that based on one alone
When the scientific product is only possible when using both data sources (the question cannot be answered using either data source alone)
+What sorts of benefits does Medicare data provide?
Follow-up for all persons who are in the Medicare program (no non-response bias)
Consistent reporting across hospitals, clinics, etc.
Diagnoses
Procedures
Dates
Different sources of care
+What are the limitations of Medicare?
Results of lab tests
Conditions that aren’t diagnosed or with a missed diagnosis won’t be diagnosed in the Medicare data. Likewise, misdiagnosis is not corrected
Clinical intent isn’t known (we don’t know why, just that it was done)
Details for hospitalizations are limited to big-ticket items
Managed Care Enrollees won’t have detailed data
Few people have any information prior to the month before they turn 65
+Key steps for using the Medicare linkage
Limit to women in both datasets
Often limit to age 65 and older
Remove (or censor) people in managed care
Consider, the different definitions used by Medicare and WHI WHI only measures the first event (stroke, etc), Medicare will
measure all events WHI relies on self-report to initiate process Adding outcomes not based on Medicare is only done
prospectively. A Medicare-based definition can be applied retrospectively
Medicare does not measure behaviors, clinical severity, etc. well
