Performance Improvement 2003. Center for Organization and Delivery Studies


AHRQ Market File: Feasibility Project Report

This project examined the feasibility of developing and maintaining a data system that could be used by researchers to study healthcare markets. The research consultant conducted an evaluation of data sources used in research on healthcare markets. That initial effort resulted in a report that identified and described over 80 different data sources that could potentially be used to conduct research on the characteristics of healthcare markets. The report described a healthcare market data system and described the feasibility of establishing such a system. The report included five chapters. Chapter 1 outlines the tasks required for system development. Chapter 2 presents staffing requirements and estimated total ‘loaded’ personnel costs for the first year of operation. Chapter 4 contains a discussion of possible methods for addressing data issues that will need to be resolved if AHRQ decides to move forward and develop the healthcare market data system. The final chapter, Chapter 5, is a discussion of recommendations regarding the development and implementation of a healthcare market data system. Recommendations included: having ready access to some subset of data; the need for wide coverage in the types of data sets that can be accessed through the system; achieving high quality data set documentation and related data resources; and assuring an intuitive and easy to use web site, a streamlined process of ordering data files, and responsive technical assistance.

FEDERAL CONTACT: Michael Hagan, 301-427-1409 PIC ID: 7484

PERFORMER: Center for Health Policy Studies, Columbia, MD


Validating the Healthcare Cost and Utilization Project Quality Indicators

In 1994, the Agency for Healthcare Research and Quality developed the Healthcare Cost and Utilization Project (HCUP) Quality Indicators (QIs) in response to the increasing demand for information regarding the quality of health care. These measures, based on discharge data, were intended to flag potential quality problems in hospitals or regions. The purpose of this project was to refine the original set of HCUP QIs (HCUP I) and recommend a revised indicator set (HCUP II). Specifically, this project aimed to: (1) identify quality indicators reported in the literature and in use by health care organizations, (2) evaluate HCUP I and other indicators using literature review and novel empirical methods, and (3) make recommendations for the HCUP II set and further research. The project deferred evaluation of indicators of complications to a separate study and report. This project identified 45 indicators that were promising for use as quality screens, demonstrating through literature review and empirical analyses that useful information regarding quality of health care can be gleaned from routinely collected administrative data. However, these indicators had important limitations and could benefit from further research. Techniques such as risk adjustment and multivariate smoothing could reduce the impact of some of these limitations, but other limitations remained. There were two major recommendations for further action and research:

(1)  the need to improve HCUP data and subsequently the HCUP QIs to address some of the noted limitations, and (2) the need for further research into quality measurement and the reality of these limitations. The HCUP QIs could benefit from the inclusion of additional data, some of which can be routinely obtained in some states.

FEDERAL CONTACT: Anne Elixhauser, 301-427-1411 PIC ID: 7671

PERFORMER: Research Triangle Institute, Research Triangle Park, NC


Vision Rehabilitation Within Models of Care and Benefit Plans

AHRQ undertook this study to: (1) assess the scientific evidence on the effectiveness of services to improve functioning of persons with vision impairment, (2) survey and analyze how rehabilitation services are included in health delivery systems and health benefit plans, and (3) identify opportunities for AHRQ, to contribute to advancement of knowledge, practices, and policy deliberations with regard to vision rehabilitation services. This report was based on an extensive literature synthesis supplemented by interviews with clinical experts, provider organizations and researchers in the field. The preliminary results were critiqued in conference discussions with researchers, service delivery leaders, and leaders of consumer organizations. The report provides some background on the etiologies of low vision, some discussion of the apparent under use of clinical preventive services and treatments to halt or slow progression of disease. The main focus was on rehabilitation services that were poorly coordinated with clinical providers and relied on scattered sources of financing. The limited likelihood for cure or rehabilitation for many case of vision deterioration led the study team to suggest that stronger prevention guidelines be discussed by the Preventive Services Task force, and that AHRQ encourage greater patient awareness of benefits of early detection of eye disease, which in many cases could benefit from early intervention. However, for the rapidly growing incidence of age-related macular degeneration more progress in knowledge about prevention and intervention is needed.

FEDERAL CONTACT: Bernard Friedman, 301-427-1404 PIC ID: 7495

PERFORMER: Lewin Group, San Francisco, CA

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