Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities. III. Perceived Mismatches Between Information Needs and Available Information

04/30/1997

KEY POINTS

  • Health information needs can be classified into three main types: (1) components and structure of the system (that is, inputs to care), (2) operational process and performance features, and (3) the policy-relevant outcomes of health care delivery. Historically, more information has been collected on structure and resources, with less captured on both operational process and outcomes, particularly in the ambulatory settings. However gaps exist within each of the three major types of health information needs.
  • Periodic reviews of the adequacy of available information have highlighted data gaps, including some of those we identify here. In particular, these reviews have highlighted the limitations in complete and standardized transaction level information on encounters or services, in the capture of clinically meaningful data elements, and in the development of outcomes information.
  • What appears new in this evolving environment is: (1) the need for information on the structure of the health system and the linkages among its components; (2) the limitations in process data on operational performance or outcomes and in the ability to link it to particular accountable entities, geographic divisions, subpopulations, or similar health plans/providers; (3) the erosion of transaction or service data due to the growth of managed care and self-insurance; and (4) the increasing concern about data gaps by a wide variety of stakeholders due to the perception of increasingly competitive markets.
  • Stakeholders identified a number of critical questions they were unable to answer given the absence of better and more complete data. To answer their questions, better information is needed on the ways provider entities are linked to health plans and integrated systems and the arrangements through which these linkages are defined. There also needs to be better transaction and service level data, with appropriate clinical detail and structural links to support analysis of operational performance and outcomes.
  • National data are not sufficient in today’s environment. The stakeholders we interviewed perceive a need for information at the state and local market levels. Further, they want data to be flexible enough to support diverse analyses and timely enough to be relevant when the health care system is changing rapidly.

The information needs of different users are much the same, and so the same information may meet a variety of functional uses at any given time and across time. We first provide a context for a discussion of new and emerging health system information needs by reviewing the current types and sources of supply side information and how they have been assessed. We then assess current health system issues and outstanding supply side information needs. The information in this section is based on interviews, documents, and other materials reviewed for this project.

Consistent with the earlier discussion, we classify health information needs into three main types: (1) components and structure of the system (that is, inputs to care), (2) operational process and performance features, and (3) the policy relevant outcomes of health care delivery. Historically, the greatest amount of information has been collected on structure and resource issues, with less known about both outcomes and operational process, particularly in the ambulatory care setting. However, gaps exist within each of the three major types of health information needs. To identify such gaps, we subclassify information needs within each category into discrete types of issues or concerns relevant to that category. We also review the issues and needs that cut across categories, and we conclude with a summary of key gaps identified.

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