title: Variation in outcomes of quality measurement by data source.
abstract: OBJECTIVE
  To evaluate selected Children's Health Insurance Program Reauthorization Act claims-based quality measures using claims data alone, electronic health record (EHR) data alone, and both data sources combined.
  
  
  METHODS
  Our population included pediatric patients from 46 clinics in the OCHIN network of community health centers, who were continuously enrolled in Oregon's public health insurance program during 2010. Within this population, we calculated selected pediatric care quality measures according to the Children's Health Insurance Program Reauthorization Act technical specifications within administrative claims. We then calculated these measures in the same cohort, by using EHR data, by using the technical specifications plus clinical data previously shown to enhance capture of a given measure. We used the k statistic to determine agreement in measurement when using claims versus EHR data. Finally, we measured quality of care delivered to the study population, when using a combined dataset of linked, patient-level administrative claims and EHR data.
  
  
  RESULTS
  When using administrative claims data, 1.0% of children (aged 3-17) had a BMI percentile recorded, compared with 71.9% based on the EHR data (k agreement [k] # 0.01), and 72.0% in the combined dataset. Among children turning 2 in 2010, 20.2% received all recommended immunizations according to the administrative claims data, 17.2% according to the EHR data (k = 0.82), and 21.4% according to the combined dataset.
  
  
  CONCLUSIONS
  Children's care quality measures may not be accurate when assessed using only administrative claims. Adding EHR data to administrative claims data may yield more complete measurement.
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.forename: Rachel
authors.initials: R
authors.lastname: Gold
authors.forename: Charles
authors.initials: C
authors.lastname: Gallia
authors.forename: Allison
authors.initials: A
authors.lastname: Casciato
authors.forename: Carrie J
authors.initials: CJ
authors.lastname: Tillotson
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D057286:Electronic Health Records / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000592:standards* / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000592:standards* / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000592:standards / Q000706:statistics & numerical data; D009922:Oregon; D017063:Outcome Assessment, Health Care / Q000592:standards / Q000706:statistics & numerical data; D010372:Pediatrics / Q000592:standards* / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012107:Research Design / Q000592:standards* / Q000706:statistics & numerical data*; D013221:State Health Plans / Q000592:standards* / Q000706:statistics & numerical data*; D014481:United States; D014611:Vaccination / Q000592:standards / Q000706:statistics & numerical data