title: Limitation of a single clinical data source for measuring physicians' performance on quality indicators.
abstract: OBJECTIVE
  To determine the extent to which relying on only one source of data leads to incomplete assessment of pneumococcal polysaccharide vaccine (PPV) or mammography.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  An urban Midwestern academic medical center in 1998/99.
  
  
  METHODS
  Medicare beneficiaries aged 65 and older with at least one health encounter.
  
  
  METHODS
  Completion of PPV and mammography was assessed using local and Medicare records. The study compared sources of records and assessed association between services and demographics and comorbidity.
  
  
  RESULTS
  Adding Medicare data to local data increased the computed 1-year PPV from 8.8% (264/3,002) to 15.0% and increased the 1998/99 mammography rate from 40% (343/847) to 67%. Local data sources missed 40% of PPV and 39% of mammography; Centers for Medicare and Medicaid Services sources missed 50% of PPV and 2% of mammography. The vaccinated were younger than the nonvaccinated (74 vs 76, P<.001). African Americans and those with more comorbidity were less likely to receive PPV over 8 years. Of 555 patients with a Medicare record of mammography, whites and those without Medicaid were significantly less likely to have a local record of mammography (P<.001).
  
  
  CONCLUSIONS
  Neither administrative nor local clinical records provide a complete or accurate assessment of these quality indicators. Accurate assessment of quality indicators requires pooling data from multiple sources across a broad region.
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, 46202, USA. mw@cogit.net
authors.forename: Michael
authors.initials: M
authors.lastname: Weiner
authors.forename: Zakwan
authors.initials: Z
authors.lastname: Quwatli
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perkins
authors.forename: John N
authors.initials: JN
authors.lastname: Lewis
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000517:prevention & control; D003430:Cross-Sectional Studies; D004650:Employee Performance Appraisal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D007196:Indiana; D008327:Mammography; D006278:Medicare / Q000592:standards*; D017060:Patient Satisfaction; D010820:Physicians / Q000592:standards*; D011008:Pneumococcal Infections / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000627:therapeutic use; D011315:Preventive Medicine; D017064:Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D019037:Urban Health Services / Q000592:standards*
chemical_list: D022242:Pneumococcal Vaccines