APCDs hold promise as a way for policymakers, payers, providers, and consumers to gain information about health care quality, cost, and utilization and use it to help achieve higher quality, lower cost care. In addition, APCD measures can help us:
- Understand utilization patterns in national and local health care systems.
- Understand how patients move through the system.
- Assess the variety of providers touching a patient during an episode of care to inform studies on the attribution of measures to providers.
Measurement using APCDs is still a developing field. However, across multiple phases we identified:
- Increasing interest and activities aimed at improving and using APCD data.
- Varied measures in high-priority clinical areas theoretically feasible using APCD data.
- Well-populated key data elements, many of which were systematically coded between States.
- Ongoing national activities that aim to address some of the limitations of ACPD data for measurement.
Future efforts can provide useful information and tools for using APCD in health care measurement. Specifically, mental health and pediatric care are areas where APCD data can uniquely contribute to population health. Measures that cut across the health care system and value-based measure suites should also be considered for future measure development.
This study was a preliminary assessment of APCDs as a source of measurement data. Additional and detailed data analyses are required before the full assessment of APCD-based measures can be completed. These analyses should first focus on key data elements stratified by claim type. This will require building a dataset by removing potential duplicates or claims that have been replaced by a final paid claim, if necessary.
Next, the consistency of data elements across measured entities, such as payers or providers, should be assessed to determine whether any consistent bias exists. This review is particularly important for diagnosis and procedure information, where the data are variable and differences between the claim data submitted may result in biased measures.
Finally, some select measures should be applied to the data to assess trends across measured entities and time, reliability of key data elements, and validity of measure scores. Aside from measure analyses, the continued efforts to improve documentation will provide a record of changes and improvements in the data. Benchmarking efforts will provide more context for data users and valuable public data.
With ongoing efforts, APCDs remain the most comprehensive source of data for monitoring population health and health care across the full system, assessing interventions aimed at improving population health, and assisting in assessing the value of health care.