08-03-2023_BoardBook

Appendix

Table 1. Types of Data Sources for Health Care Quality Measures

Data Source

Description

Strengths

Limitations

Administrative

Organizations generate data on providing and paying for care. Data comes from claims, encounter, enrollment, and providers systems. Data elements include type of service, number of units, diagnosis and procedure codes, location of service, and amount billed and reimbursed.

Available electronically.

Limited clinical

information.

Less expensive than medical record data. Available for an entire population of patients and across payers. Fairly uniform coding systems and practices.

Questionable accuracy for public reporting because the primary purpose is billing.

Completeness.

Timeliness.

Patient Medical

Documentation of a

Rich in clinical

Cost, complexity, and time required to compile data when

Records

patient's medical history and care.

detail.

Viewed by providers as credible.

patients receive services across

different sites, particularly if a different record format is used.

Increased adoption of electronic health records by hospitals and office based physicians. Well-established methods for survey design and administration. Easy for consumers to understand and relate to survey results.

Patient Surveys

Survey instruments capture self-reported information from patients about their experiences on the care, service, or treatment and perceptions of the outcomes of care.

Cost of survey

administration.

Possibility of misleading results if questions are worded

poorly, survey administration

procedures are not standardized, the population sampled is not representative of

Surveys are typically

administered to a sample of patients by

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