Assessing quality using administrative data
Assessing quality using administrative data
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DOI：
10.7326/0003-4819-127-8_part_2-199710151-00048
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发表时间：
1997-10-15
影响因子：
39.2
通讯作者：
Iezzoni, LI
中科院分区：
文献类型：
--
作者：
Iezzoni, LI
行政数据来自于管理医疗保健服务、将成员登记到健康保险计划以及报销服务。行政数据的主要生产者是联邦政府、州政府和私人医疗保险公司。虽然行政数据的临床内容仅包括患者的人口统计学特征和诊断以及程序代码，但这些数据通常用于评估医疗保健的质量。行政数据是现成的，是廉价的收购，猿计算机可读，通常包括大量的人口，他们已经确定了惊人的做法变化在小的地理区域和支持的研究结果的护理。许多医院报告卡（比较病人死亡率）和医生档案（比较资源消耗）都来自行政数据。然而，临床信息和计费环境的差距损害了从管理数据中获得有效质量评估的能力。除了一些例外，行政数据允许有限的洞察护理过程的质量，疏忽或委员会的错误，以及护理的适当性。此外，关于行政数据的准确性和完整性的问题比比皆是。目前的行政数据可能是最有用的筛选工具，突出的领域，质量应该进行更深入的调查。电子临床信息的日益普及将改变未来管理数据的性质，增加质量衡量的机会。
Administrative data result from administering health care delivery, enrolling members into health insurance plans, and reimbursing for services. The primary producers of administrative data are the federal government, state governments, and private health care insurers. Although the clinical content of administrative data includes only the demographic characteristics and diagnoses of patients and codes for procedures, these data are often used to evaluate the quality of health care. Administrative data are readily available, are inexpensive to acquire, ape computer readable, and typically encompass large populations, They have identified startling practice variations across small geographic areas and supported research about outcomes of care. Many hospital report cards (which compare patient mortality rates) and physician profiles (which compare resource consumption) are derived from administrative data. However, gaps in clinical in-formation and the billing context compromise the ability to derive valid quality appraisals from administrative data. With some exceptions, administrative data allow limited insight into the quality of processes of care, errors of omission or commission, and the appropriateness of care. In addition, questions about the accuracy and completeness of administrative data abound. Current administrative data are probably most useful as screening tools that highlight areas in which quality should be investigated in greater depth. The growing availability of electronic clinical information will change the nature of administrative data in the future, enhancing opportunities for quality measurement.