Whose Data Is It, Anyway?

Cheryl Clark, for HealthLeaders Media , April 18, 2013

These few paragraphs, to those who know they exist, are exposing some tension inside the societies that run these registries. "Remember," Wachter says, "these are member organizations. And they're therefore trying to support their members in providing good care. But I think some have a hard time sometimes making hard decisions that might make some of their members unhappy."

The outcomes being measured, for example, "may have some wiggle room or bias. Or the data aren't audited."

To the degree that registries are seen as the answer to physician accountability that leads to bonus payments, as appears to be the case, "then you have a formula that may not add up," he says.

"We have to rethink this," Wachter says, "whether the societies are the right organizations to run these registries, and if they are—and they very well might be because they have buy-in from their members—we probably need to make sure the measures are unambiguously good measures, that their definitions are unambiguous, and that there's a believable audit strategy… because there are some conflicts that are baked into this formula."

Some say there also should be some mechanism to assure these registries produce meaningful quality improvement lessons, perhaps by sharing tips from peers with better results.

This week's study by Harvard researchers Sunil Eappen, MD, and Atul Gawande, MD, in the Journal of the American Medical Associationillustrates why a careful tracking, with details of adverse events and complications, is something these registries must prove they can do well.

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2 comments on "Whose Data Is It, Anyway?"

Jason Uppal (4/21/2013 at 9:33 PM)
I am an engineer by training and worked many years in several industries in business transformation. Quality improvement is a fundamental component of business transformation. The mistake the healthcare industry is making the same mistake Detroit automotive industry made 35 years ago. Quality improvement measures such as internal process audits, compliance audits, adverse events are used to ensure the process effectiveness, not to taut your quality score. If you want to measure quality of healthcare at a hospital let them publish patient satisfaction, patient outcome for an episode, length of stay, total cost to achieve that outcome. Those measure matter to the public. When I buy a car, I don't care how many times the assembly line was stopped by a worker because a non compliant product, I care how often I need to take it back to the dealer for fixes that should have never occurred and what I paid for it.

Jane Alop (4/19/2013 at 12:03 AM)
I agree, publicly paid serviced should be transparent to public, but we have to remember it might be also confusing information to public. What is the purpose - to pay less (optimum) or to have a better health care quality? Usually the answer is P4P what means in some cases we pay more for good quality and in some cases we will not pay for poor performance. In both cases we need criteria to identify the quality of provided care and this can be done only by clinicians and patients and its pros and contras are proved in thousands surveys not mentioning the quality of the data from specialty registers this data come from. In Estonia we are very cautious thinking P4P implementation thanks to Alan Maynard report. Estonian Health Insurance Fund, who is a main purchaser, aim is to have better and on equal level quality in whole country. For that purpose we [INVALID] yearly a feedback report to hospitals using the data from invoices the hospitals send to insurance fund to get paid. Based on this data we calculate common quality indicators. Yes, this is a very robust analyze and we all have to remember the data is not specially collected for quality assessment, this data are from a financial document. But this is also the value of it - insurance fund database is most complete database as everyone want to be paid :). Second - the provided services are coded based on insurance fund pricelist all provider have to use. If someone is not happy with results and put the question about data quality it always goes back to hospital as insurance fund don´t change the account information sent by the hospital. The main purpose of this report is to provide feedback to hospitals that they can compare themselves to other hospitals in Estonia and to provoke IN hospital discussion about possibilities of quality inprovement. It is also the way to do benchmarking. And we don´t spend any extra money for collecting this data :) - we are a very small country and can use very limited amount of resources.




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