Envisioning the National Health Care Quality Report (2001) / Chapter Skim
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Data Sources for the National Health Care Quality Report
Data Sources for the National Health Care Quality Report
Pages 103-138
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From page 103... ...
To support measures of effectiveness and safety, AHRQ should draw from a combination of public and private data sources such as claims and other administrative data, sur' Sections of this chapter are drawn from a paper on data sources for the National Health Care Quality Report commissioned by the committee from Marsha Gold (20004.
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From page 104... ...
Although these criteria are not exhaustive, they do include the essential ideal features that should characterize data sources for the Quality Report in the future. When current data collection efforts do not fulfill these criteria, AHRQ should explore ways to enhance existent data sources and establish new data collection and reporting systems that exhibit these characteristics, in collaboration with the appropriate entities in the public and private sectors.
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From page 105... ...
Over the coming decade, the evolution of a comprehensive health information infrastructure including standardized, electronic clinical data systems will greatly facilitate the definition of an integrated and comprehensive data set for the Quality Report. 105 Elsewhere, the committee has recommended the definition of a wideranging set of measures for the National Health Care Quality Data Set based on the proposed framework and specified criteria (see Recommendations 1, 2 and 4.)
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From page 106... ...
Since health care is inherently a local phenomenon, further detail on the quality of care for geographic units smaller than states is usually required to address potential problems at the provider and organizational levels. However, this level of detail should generally correspond to other regional or specialized reports since the purpose of the National Health Care Quality Report is to examine the quality of care provided by the system as a whole, not by individual providers, localities, or health plans.
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From page 107... ...
In addition, it is recommended that quality data be reportable at the individual state level in the long term; therefore, data sources that provide this level of detail—or have the potential to do so—should be preferred. Also, data sources (in particular, those based on population surveys)
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From page 108... ...
As a practical matter, however, the way data elements are defined may change or be improved over time, potentially enriching the content of the Quality Report but jeopardizing the ability to compare quality Tom one period to the next. Whenever possible, maintaining the continuity of data sources over time and across sources ought to be an important objective.
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From page 109... ...
Public Accessibility of the Data As mentioned in the discussion of credibility, data for the Quality Report should be widely accepted and respected. One way to achieve this is to focus on data in the public domain, either because they are drawn from a public data source or because they are drawn from a private data source that is routinely available to public agencies.
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From page 110... ...
The following is a description of potential public and private data sources that can be used in the National Health Care Quality Data Set in the next several years. It should be noted that the distinction between public and private data sources is not always a clear one.
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From page 111... ...
, the Agency for Healthcare Research and Quality, the Health Care Financing Administration (HCFA) for Medicare, the Federal Employees Health Benefits Program (FEHBP)
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From page 112... ...
These include the collection of data needed "to study the relationships between health care quality, outcomes, access, use, and cost, measure changes over time, and monitor the overall national impact of Federal and State policy changes on health care," as well as "the quality of care and patient outcomes for frequently occurring clinical conditions for a nationally representative sample of the population including rural residents" (Healthcare Research and Quality Act, 1999~. In response to the Healthcare Research and Quality Act, AHRQ is planning changes for MEPS that may include expanding the survey's coverage of such topics as preventive care and the treatment of particular medical conditions.
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From page 113... ...
. Medicare Quality Data HCFA collects a range of other data that specifically support quality measurement, such as the Medicare Health Plan Employer Data and Information Set/Consumer Assessment of Health Plans Survey (HEDIS/CAHPS)
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From page 114... ...
y Medical Care Survey and National Hospital Ambulatory Medical Care Survey The main surveys on ambulatory care are the National Ambulatory Medical Care Survey (NAMCS) , which collects data on a sample of visits to physicians' offices, and the related National Hospital Ambulatory Medical Care Survey (NHAMCS)
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From page 115... ...
Questions about preventive services have been expanded and asked more routinely in recent years. The NHIS includes basic information collected annually, other items collected on a periodic basis, and topical items collected on a one-time basis as special supplements (National Center for Health Statistics, 2000c)
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From page 116... ...
Private Data Sources As mentioned in Chapter 1, the committee held a call for measures for the National Health Care Quality Report and requested submissions from the private sector.3 The 138 measures submitted covered most of the components of quality and consumer perspectives on health care needs set forth in the framework. However, many of the measures were not part of regular data collection efforts (see Appendix C for the list of measures submitted)
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From page 117... ...
The initial set of ORYX measures on pneumonia, AMI, and heart failure includes 17 that are from the sixth contract cycle for HCFA peer review organizations (PROs) (see section that follows)
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From page 118... ...
In addition, Quality Compass contains the data for HEDIS/CAHPS, which features measures drawn Tom adult CAMPS measures regarding consumer satisfaction and experience with health care, including aspects of timeliness and patient centeredness (Schilling, 2000~. EVALUATING DATA SOURCES FOR THE NATIONAL HEALTH CARE QUALITY DATA SET IN THE SHORT TER1\I Applying the criteria described at the beginning of the chapter to individual public and private data sources helps to clarify their relative advantages and disadvantages.
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From page 119... ...
are better suited to perform the kind of thorough analysis that this activity requires.4 Table 4.1 presents an evaluation of some major public data sources by the data source selection criteria described above. Because all of the public and private data sources analyzed here are reasonably credible and valid, evaluation of these criteria is not included in the table.
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From page 120... ...
a 1 = safety, 2 = effectiveness, 3 = patient centeredness, 4 = timeliness. b 1 = staying healthy, 2 = getting better, 3 = living with illness or disability, 4 = coping with the end of life.
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From page 121... ...
fTargeted eligibility criteria for inclusions. Medicare claims data applies only to beneficiaries in fee-forservice Medicare.
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From page 122... ...
HCFA, Health Care Financing Administration; JCAHO, Joint Commission on Accreditation of Healthcare Organizations; NCQA, National Committee for Quality Assurance. a 1 = safety, 2 = effectiveness, 3 = patient centeredness, and 4 = timeliness.
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From page 123... ...
By 2001, all managed care organizations accredited by NCQA must permit their performance measures to be reported publicly. SOURCES: Elstein, 2000; Hankey, 1999; Institute of Medicine and National Research Council, 2000; National Committee for Quality Assurance, 2000; Schilling, 2000; Schyve, 2000.
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From page 124... ...
In addition, PRO data have the particular potential to supplement public data sources on the health care quality aspect of effectiveness, at least for a given contract cycle or annual edition of the Quality Report. Coverage of Health Care Quality Components This section looks more closely at the coverage that public and private data sources offer for the components of quality and consumer perspectives on health care needs included in the framework.
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From page 125... ...
reported to JCAHO; data on hospital-acquired infections collected by the Centers for Disease Control and Prevention's (CDC's) National Nosocomial Infections Surveillance System; and selected adverse hospital outcomes tracked by HCUP (Agency for Healthcare Research and Quality, 2000c; Centers for Disease Control and Prevention, 2000c; Joint Commission on the Accreditation of Healthcare Organizations, 2000c)
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From page 126... ...
Followback surveys with providers and insurers may not be sufficient to fill in all of the needed information. This situation is likely to change soon, given that the Healthcare Research and Quality Act calls for improved MEPS coverage of condition-based treatment (Healthcare Research and Quality Act, 1999~.
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From page 127... ...
However, even if the proposed questions are added, this leaves at best minimal coverage of effective partnerships. The Quality Report should identify sources that include questions on important aspects of effective partnerships, such as the degree of cultural competence (essential to customize health care for an increasingly diverse population)
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DATA SOURCES FOR THE NATIONAL HEALTH CARE QUALITY REPORT In the short term, a mosaic of existent data sources will be used to create the National Health Care Quality Data Set, which in turn will be used to examine a
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From page 129... ...
Data Sources in the Short Term The Dartmouth Atlas of Health Care in the United States is an example of an annual report that uses the variety of existent public and private data sources to examine aspects of health care quality, including effectiveness (Dartmouth Medical School, Center for the Evaluative Clinical Sciences, 1998~. In particular, the atlas makes extensive use of Medicare claims data to analyze whether beneficiaries received treatments, services, or drugs that have been proven effective or are believed to be so.
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From page 130... ...
After existent data sources have been used to identify areas of effectiveness and timeliness in which closer study is needed, AHRQ could turn to targeted medical record abstraction, at least in the short term, given that electronic clinical data are not available. Information supplied by medical records includes medical history; diagnostic data such as information from the physical examination performed; presence of other diseases or comorbidities; clinical information such as the results of laboratory tests; and description of the treatment plan (Institute of Medicine and National Research Council, 1999~.
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From page 131... ...
This would greatly facilitate access to information currently registered in paper medical records and should be part of a new health information infrastructure that contributes to quality reporting and improvement. Another short-term challenge with data sources should be acknowledged: it is especially difficult to obtain population-based measures for processes of care that affect relatively small populations.
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From page 132... ...
NCVHS recently issued a report to the Secretary of Health and Human Services with recommendations for the definition of uniform data standards for the electronic exchange of patient medical record information (National Committee on Vital and Health Statistics, 2000~. The implementation of these standards should facilitate the development of a health information infrastructure that could support the type of Quality Report recommended by this committee.
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From page 133... ...
SUMMARY The focus of this chapter has been on data sources for the National Health Care Quality Report. The chapter has presented selection criteria to help guide the choice of data sources for the National Health Care Quality Data Set, along with a preliminary evaluation of how well several public and private data sources meet the criteria.
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From page 134... ...
Ultimately, a new health information infrastructure based on existent and new data sources (including computerized clinical data systems, population surveys, and specialized data systems) will be essential to generate an adequate database for the production of the Quality Report.
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From page 135... ...
2000. Data Sources and Potential Indicators for a National Quality Report.
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From page 136... ...
1936. Healthcare Research and Quality Act.
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From page 137... ...
Presentation to the Institute of Medicine Committee on the National Quality Report on Health Care Delivery, August 21. National Center for Health Statistics.
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From page 138... ...
1998. Issues Related to Patient Medical Record Information: Testimony to National Committee on Vital and Health Statistics, Subcommittee on Standards and Security ton-line]
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