The Prevention Index: using technology to improve quality assessment.
OBJECTIVE
To improve quality of care assessment for preventive medical services and reduce assessment costs through development of a comprehensive prevention quality assessment methodology based on electronic medical records (EMRs).


METHODS
Random sample of 775 adult and 201 child members of a large nonprofit managed care system.


METHODS
Problems with current, labor-intensive quality measures were identified and remedied using EMR capabilities. The Prevention Index (PI) was modeled by assessing five-year patterns of delivery of 24 prevention services to adult and child health maintenance organization (HMO) members and comparing those services to consensus recommendations and to selected Health Plan Employer Data and Information Set (HEDIS) scores for the HMO.


METHODS
Comprehensive chart reviews of 976 randomly selected members of a large managed care system were used to model the Prevention Index.


RESULTS
Current approaches to prevention quality assessment have serious limitations. The PI eliminates these limitations and can summarize care in a single comprehensive index that can be readily updated. The PI prioritizes services based on benefit, using a person-time approach, and separates preventive from diagnostic and therapeutic services.


CONCLUSIONS
Current methods for assessing quality are expensive, cannot be applied at all system levels, and have several methodological limitations. The PI, derived from EMRs, allows comprehensive assessment of prevention quality at every level of the system and at lower cost. Standardization of quality assessment capacities of EMRs will permit accurate cross-institutional comparisons.
Vogt
Thomas M
TM
Kaiser Permanente Center for Health Research-Hawaii, 501 Alakawa Street, Suite 201, Honolulu, HI 96817, USA.
Aickin
Mikel
M
Ahmed
Faruque
F
Schmidt
Mark
M
D000328:Adult; D002648:Child; D002662:Child Health Services / Q000592:standards / Q000706:statistics & numerical data; D003625:Data Collection / Q000379:methods*; D006254:Hawaii; D006279:Health Maintenance Organizations; D006292:Health Priorities; D006302:Health Services Research; D006801:Humans; D016347:Medical Records Systems, Computerized; D011314:Preventive Health Services / Q000592:standards* / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D012015:Reference Standards; D012189:Retrospective Studies