The Method for Performance Measurement Matters: Diabetes Care Quality as Measured by Administrative Claims and Institutional Registry

• Published in: Health services research Vol. 51; no. 6; pp. 2206 - 2220
• Main Authors: McCoy, Rozalina G., Tulledge-Scheitel, Sidna M., Naessens, James M., Glasgow, Amy E., Stroebel, Robert J., Crane, Sarah J., Bunkers, Kari S., Shah, Nilay D.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.12.2016; Health Research and Educational Trust; John Wiley and Sons Inc
• Subjects: Accountable care organizations; Accountable Care Organizations - statistics & numerical data; Analysis; Attribution; Blood pressure; Cholesterol; Computerized medical records; Cross-Sectional Studies; Data acquisition; Data collection; Diabetes; Diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - therapy; Diabetes therapy; Discrepancies; Disease management; Electronic health records; Electronic Health Records - statistics & numerical data; Electronic records; Extraction; Female; Government programs; Health care; Health care delivery; Health care industry; Health promotion; Health records; Historical account; Humans; Identification methods; Insurance Claim Review - statistics & numerical data; Low density lipoprotein; Low density lipoproteins; Male; Mathematical analysis; Measurement; Measurement methods; Medical personnel; Medical records; Medical research; Medicare; Medicine, Experimental; Methods; Middle Aged; Minnesota; Patients; Performance evaluation; Performance measurement; Performance measures; population health; Quality and Outcomes of Care; quality improvement; Quality management; Quality of care; Quality of Health Care; Registries - statistics & numerical data; registry; Studies; United States; Minnesota; United States > US; registry; population health; Performance measures; quality improvement
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.12453

Objectives Performance measurement is used by health care providers, payers, and patients. Historically accomplished using administrative data, registries are used increasingly to track and improve care. We assess how measured diabetes care quality differs when calculated using claims versus registry. Data Sources/Study Setting Cross‐sectional analysis of administrative claims and electronic health records (EHRs) of patients in a multispecialty integrated health system in 2012 (n = 368,883). Study Design We calculated percent of patients attaining glycohemoglobin <8.0 percent, LDL cholesterol <100 mg/dL, blood pressure <140/90 mmHg, and nonsmoking (D4) in cohorts, identified by Medicare Accountable Care Organization/Minnesota Community Measures (ACO‐MNCM; claims‐based), Healthcare Effectiveness Data and Information Set (HEDIS; claims‐based), and registry (EHR‐based). Data Collection/Extraction Methods Claims were linked to EHR to create a dataset of performance‐eligible patients. Principal Findings ACO‐MNCM, HEDIS, and registry identified 6,475, 6,989, and 6,425 measurement‐eligible patients. Half were common among the methods; discrepancies were due to attribution, age restriction, and encounter requirements. D4 attainment was lower in ACO‐MNCM (36.09 percent) and HEDIS (37.51 percent) compared to registry (43.74 percent) cohorts. Conclusions Registry‐ and claims‐based performance measurement methods identify different patients, resulting in different rates of quality metric attainment with implications for innovative population health management.