Clinical quality measurement. Comparing chart review and automated methodologies.
OBJECTIVE
This study investigates the use of data from automated systems within a large managed care plan to create indicators of clinical quality.


METHODS
Measures from the first year of Health Plan Employer Data and Information Set, HEDIS 2.0, are used to compare chart review and automated analysis methodologies. The contributions of various data systems in creating clinical quality measures are evaluated.


RESULTS
Chart review data usually are better for creating clinical quality indicators, although the level of agreement between the two methodologies often is quite high. Computerized patient record systems are found to be the most reliable automated data source, and automated claims are found to be the least reliable. This study's findings suggest that automated encounter systems may provide relatively reliable data.


CONCLUSIONS
Managed care plans may not want to rely on automated data alone for clinical quality measurement. The results reported here support the use of combined methodologies such as the "hybrid" method, which utilizes both automated and chart-review data.
Dresser
M V
MV
Harvard Pilgrim Healthcare, Inc., Brookline, MA, USA.
Feingold
L
L
Rosenkranz
S L
SL
Coltin
K L
KL
D015982:Bias; D003625:Data Collection / Q000379:methods*; D003627:Data Interpretation, Statistical; D001330:Electronic Data Processing / Q000379:methods*; D006264:Health Benefit Plans, Employee / Q000592:standards; D006801:Humans; D008329:Managed Care Programs / Q000592:standards*; D008404:Massachusetts; D008485:Medical Audit / Q000379:methods*; D016347:Medical Records Systems, Computerized; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity