The search strategy was built through an iterative process of refining a preliminary set of search terms. This preliminary set included:
all-payer OR all payer OR APCD, in various combinations, with:
|claims data||claims database AND charges|
|claims database||price transparency|
|claims data measure||price transparency taskforce|
|claims database report||price transparency report|
|claims data taskforce||quality AND cost|
|claims database (+ state)||quality AND price|
|claims database AND public reporting||quality AND charges|
|claims database AND price||quality AND utilization|
|claims database AND cost||episode|
These criteria were then refined based on a preliminary search to ensure that the searches yielded a set of the most relevant sources that were feasible to review within the project timeline. The final search strategy was to use as a “first term” one of the following: “all-payer” OR “all payer” OR “APCD” OR “all-payer claims data” OR “claims data.”
With the following terms as a “second term,” the team searched in the following order:
|Second Search Term||Additional Search Terms|
|cost||database AND public reporting|
|price||database AND measure|
|charges||database AND (state)|
|measure||price transparency AND taskforce|
|taskforce||price transparency AND report|
|database||quality AND cost|
|database AND cost||quality AND price|
|database AND price||quality AND charges|
|database AND charges||quality AND utilization|
|database AND report||Episode|
The literature review was conducted using PubMed, EconLit, Embase®, and Web of Science. The team also used the first three pages of a search from Google Scholar, sorted by relevance and date restricted (2008-2014). Our searches started from January 2008, when the first APCDs were formed.
In a preliminary search, Lexis-Nexis was also searched; however, the search results did not appear to add relevant sources beyond those already identified from other databases.
Inclusion criteria for the literature review were:
- Studies that state in the abstract that they address quality or price, cost, or charges using APCDs.
- Studies that state in the abstract that they use administrative databases (e.g., Medicare data, MPCDs) and that they assess variation in cost, charges, or price between providers or use claims to track episodes of care (inpatient and outpatient care delivery) or to track patients longitudinally.
Primary studies of measures using non-claims databases were not reviewed, as this literature is extensive, is out of scope, and has been covered elsewhere.
Also excluded were studies that relied exclusively on Healthcare Cost and Utilization Project (HCUP) data. In the preliminary search, the team reviewed studies using data from the following HCUP databases:
- National (Nationwide) Inpatient Sample (NIS),
- Kids Inpatient Database (KID),
- Nationwide Emergency Department Sample (NEDS),
- State Inpatient Databases (SID),
- State Emergency Department Databases (SEDD), and
- State Ambulatory Surgery and Services Databases (SASD).
We noted that these databases have very limited use for episode-based, longitudinal measures that cross settings.
In consultation with the task order officer (TOO), the project team excluded sources that rely exclusively on HCUP data, because AHRQ is well informed of the strengths of the HCUP databases and the visit-level measures that have been developed using them. Focusing on sources that propose or implement measurement using APCDs will allow the team to explore this innovative literature in greater depth. Go to Appendix A for additional details on the literature review methodology.
The environmental scan identified Web sites, including individual State APCD and other public reporting Web sites, that currently report overall and facility- and provider-specific measures of price, utilization, quality of care, episodes of care, and other measures based on APCDs. We focused efforts on major national or statewide transparency initiatives from January 2008 to the present.
The scan included several main categories of information:
- Online APCD Council materials
- Reports, task forces, policy briefs, webinars
- Overview reports
- State-specific or State-sponsored reports
- AHRQ expert materials
- Potential avenues to explore, as suggested by AHRQ
- Potential avenues to explore, as suggested by AHRQ
- Measure inventories
- National (e.g., NQMC [sections on Health Care Economics and Organizations and Health Care Quality, Access, and Evaluation], CMS, QualityNet, NQF, Leapfrog Group)
- State specific
- White papers
- Grey literature
- Trade/business publications
- Newspaper articles and blogs
After initial review, and in consultation with the AHRQ TOO, the team excluded all newspaper articles and blogs, as the information was either too superficial to provide technical information on measures for the guiding questions or was redundant with other resources reviewed in the literature review and environmental scan.
To conduct the scan, the team searched in Google using a similar set of search terms as in the literature review. The search was supplemented with recommendations from the team and the AHRQ TOO. Documents or Web sites found within those categories were reviewed, and sources were included if they had information relevant to one of the guiding questions or if they provided relevant context to the project.
The team received additional input from the Technical Expert Panel (TEP) and learning network (APCD Council and NAHDO) in January and February 2015 and incorporated the feedback into the literature review and environmental scan report. In particular, input was sought on any additional highly relevant trade association publications and toolkits, blogs, or other media and professional organization efforts that were not included in our draft materials.
By using a variety of source materials, the team generated a robust compendium of information regarding both what is known and what is not known about the current state of APCD