Measuring the quality of diabetes care using administrative data: Is there bias?
Measuring the quality of diabetes care using administrative data: Is there bias?
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DOI：
10.1111/j.1475-6773.2003.00191.x
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发表时间：
2003-12-01
影响因子：
3.4
通讯作者：
Guadagnoli, E
中科院分区：
文献类型：
--
作者：
Keating, NL;Landrum, MB;Guadagnoli, E
目标.卫生保健组织经常只使用管理数据来衡量护理过程。我们评估了使用没有病历数据的管理数据测量糖尿病护理过程是否可能低估某些患者群体对公认标准的依从性。数据来源/研究设置。1998年期间，使用管理和医疗记录数据对参加明尼苏达州三个健康计划的1,335名糖尿病患者进行质量指标评估。横断面回顾性研究，评估血红蛋白A1 c检测，低密度脂蛋白胆固醇检测和视网膜病变筛查的两个数据来源。分析检查是否病人或诊所的特点与质量指标检测不足时，行政数据没有补充医疗记录数据。数据收集/提取方法。健康计划提供了行政数据，和训练有素的摘要收集医疗记录数据。如果用医疗记录数据补充行政数据，就可以确定质量指标，但仅用行政数据往往无法确定这些指标。在调整后的分析中，老年患者更有可能在管理数据中检测不到血红蛋白A1 c（与< 45岁的患者相比，65至74岁的患者OR 2.95，95%CI 1.09至7.96，75岁及以上的患者OR 4.20，95%CI 1.81至9.77）。使用管理数据，黑人患者比白色患者更可能有视网膜病变筛查未检出（2.57，95% CI 1.16至5.70）。在不同的健康计划的患者也不同的可能性有质量指标检测不足。糖尿病质量指标可能被低估更频繁地为老年人和黑人患者和医生，诊所，和计划谁照顾这些患者时，质量测量是基于管理数据。这表明，护理这些患者的提供者可能会受到公开发布这些数据或使用这些数据来确定经济激励措施的影响。
Objectives. Health care organizations often measure processes of care using only administrative data. We assessed whether measuring processes of diabetes care using administrative data without medical record data is likely to underdetect compliance with accepted standards for certain groups of patients.Data Sources/Study Setting. Assessment of quality indicators during 1998 using administrative and medical records data for a cohort of 1,335 diabetic patients enrolled in three Minnesota health plans.Study Design. Cross-sectional retrospective study assessing hemoglobin A1c testing, LDL cholesterol testing, and retinopathy screening from the two data sources. Analyses examined whether patient or clinic characteristics were associated with underdetection of quality indicators when administrative data were not supplemented with medical record data.Data Collection/Extraction Methods. The health plans provided administrative data, and trained abstractors collected medical records data.Principal Findings. Quality indicators that would be identified if administrative data were supplemented with medical records data are often not identified using administrative data alone. In adjusted analyses, older patients were more likely to have hemoglobin A1c testing underdetected in administrative data (compared to patients < 45 years, OR 2.95, 95 percent CI 1.09 to 7.96 for patients 65 to 74 years, and OR 4.20, 95 percent Cl 1.81 to 9.77 for patients 75 years and older). Black patients were more likely than white patients to have retinopathy screening underdetected using administrative data (2.57, 95 percent Cl 1.16 to 5.70). Patients in different health plans also differed in the likelihood of having quality indicators underdetected.Conclusions. Diabetes quality indicators may be underdetected more frequently for elderly and black patients and the physicians, clinics, and plans who care for such patients when quality measurement is based on administrative data alone. This suggests that providers who care for such patients may be disproportionately affected by public release of such data or by its use in determining the magnitude of financial incentives.