Comparison of Administrative Data and Medical Records to Measure the Quality of Medical Care Provided to Vulnerable Older Patients

BACKGROUND: Administrative data are used to determine performance for publicly reported in health plan "report cards," accreditation status, and reimbursement. However, it is unclear how performance based on administrative data and medical records compare. METHODS: We compared applicability, eligibility, and performance on 182 measures of health care quality using medical records and administrative data during a 13-month period for a random sample of 399 vulnerable older patients enrolled in managed care. RESULTS: Of 182 quality indicators (QIs) spanning 22 conditions, 145 (80%) were applicable only to medical records and 37 (20%) to either medical records or administrative data. Among 48 QIs specific to geriatric conditions, all were applicable to medical records; 2 of these also were applicable to administrative data. Eligibility for the 37 QIs that were applicable to both medical records and administrative data was similar for both data sources (94% agreement, kappa = 0.74). With the use of medical records, 152 of the 182 the QIs that were applicable to medical records were triggered and yielded an overall performance of 55%. Using administrative data, 30 of the 37 QIs that were applicable to administrative data were triggered and yielded overall performance of 83% (P < 0.05 vs. medical records). Restricting to QIs applicable to both data sources, overall performance was 84% and 83% (P = 0.21) for medical records and administrative data, respectively. CONCLUSIONS: The number and spectrum of QIs that can be measured for vulnerable elderly patients is far greater for medical records than for administrative data. Although summary estimates of health care quality derived from administrative data and medical records do not differ when using identical measures, summary scores from these data sources vary substantially when the totality of care that can be measured by each data source is measured

Data mining · Family medicine · Measure (data warehouse) · Medical care · Medical emergency · Medical record · MEDLINE · Political science · Quality (philosophy) · Computer Science · Frailty in Older Adults · Medicine · Patient Satisfaction in Healthcare · Primary Care and Health Outcomes

• Lessons learned in the development of process quality indicators for cancer care in Japan

  Open Access•Takahiro Higashi•BioPsychoSocial Medicine•2010

  Añadir item

• The trade-off between costs and outcome after cardiac surgery. Evidence from an Italian administrative registry

  Open Access•Enza Caruso, Andrea Rossi Zadra•Health Policy•2020

  Añadir item

• Measuring Use and Cost of Care for Patients With Mood Disorders

  T MICHAEL KASHNER, Michael D Stensland et al.•Medical Care•2009

  Añadir item

• Measuring the Quality of Care Provided to Dually Enrolled Medicare and Medicaid Beneficiaries Living in Nursing Homes

  David S Zingmond, Debra Saliba et al.•Medical Care•2009

  Añadir item

• Measuring the Quality of Care Provided to Community Dwelling Vulnerable Elders Dually Enrolled in Medicare and Medicaid

  David S Zingmond, Kathleen H Wilber et al.•Medical Care•2007

  Añadir item

• Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care

  Ashish K Jha, Jonathan B Perlin et al.•New England Journal of Medicine•2003

  Añadir item

• Bias in the Coding of Hospital Discharge Data and Its Implications for Quality Assessment

  Patrick S Romano, David Mark et al.•Medical Care•1994

  Añadir item

• Validity of Procedure Codes in International Classification of Diseases, 9th revision, Clinical Modification Administrative Data

  Hude Quan, Gerry A Parsons et al.•Medical Care•2004

  Añadir item