Data Sources for Health Care Quality Measures
Before you decide which quality measures to report, it is helpful to know what kinds of data you will need to produce the scores for the measure. Sometimes, the data you want to report already exist because somebody else collected it. But in other cases, report sponsors have to collect the data themselves.
Depending on the measure, data can be collected from different sources, including medical records, patient surveys, and administrative databases used to pay bills or to manage care. Each of these sources may have other primary purposes, so there are advantages and challenges when they are used for the purposes of quality measurement and reporting.
In the course of providing and paying for care, organizations generate administrative data on the characteristics of the population they serve as well as their use of services and charges for those services, often at the level of individual users. The data is gathered from claims, encounter, enrollment, and providers systems. Common data elements include type of service, number of units (e.g., days of service), diagnosis and procedure codes for clinical services, location of service, and amount billed and amount reimbursed.
Advantages of Administrative Data
Challenges of Administrative Data
Patient Medical Records
A medical record is documentation of a patient's medical history and care. The advent of electronic medical records has increased the accessibility of patients’ files. Wider use of electronic medical record systems is expected to improve the ease and cost of using this information for quality measurement and reporting.
Advantages of Medical Records
Challenges of Medical Records
Survey instruments capture self-reported information from patients about their health care experiences. Aspects covered include reports on the care, service, or treatment received and perceptions of the outcomes of care. Surveys are typically administered to a sample of patients by mail, by telephone, or via the Internet.
Advantages of Patient Surveys
Challenges of Patient Surveys
Comments from Individual Patients
Comments from individual patients, often referred to as anecdotal information, include any type of information on health care quality that is gathered informally rather than by carefully designed research efforts. Anecdotal information is becoming increasingly more common as private Web sites make it possible for health care consumers to share their personal experiences with health plans, hospitals, and, most prominently, physicians.
Advantages of Patient Comments
Challenges of Patient Comments
Standardized Clinical Data
Certain kinds of facilities, such as nursing homes and home health agencies, are required to report detailed information about the status of each patient at set time intervals. The Minimum Data Set (MDS), the required information for nursing homes, and the Outcome and Assessment Information Set (OASIS), the data required by Medicare for certified home health agencies, store the data used in quality measures for these provider types.
Advantages of Standardized Clinical Data
Challenges of Standardized Clinical Data
The Need for Standardization
The use of quality measures to support consumer choice requires a high degree of data validity and reliability. To make sure that comparisons among providers and health plans are fair and that the results represent actual performance, it is critical to collect data in a careful, consistent way using standardized definitions and procedures.