Using Clinical Data Standards to Measure Quality: A New Approach

Abstract

Background
 - Value-based payment for care requires the consistent, objective calculation
of care quality. Previous initiatives to calculate ambulatory quality measures have
relied on billing data or individual electronic health records (EHRs) to calculate and
report performance. New methods for quality measure calculation promoted by
federal regulations allow qualified clinical data registries to report quality outcomes
based on data aggregated across facilities and EHRs using interoperability standards.
Objective This research evaluates the use of clinical document interchange standards
as the basis for quality measurement.

Methods - Using data on 1,100 patients from 11 ambulatory care facilities and 5
different EHRs, challenges to quality measurement are identified and addressed for 17
certified quality measures.

Results - Iterative solutions were identified for 14 measures that improved patient
inclusion and measure calculation accuracy. Findings validate this approach to
improving measure accuracy while maintaining measure certification.
Conclusion Organizations that report care quality should be aware of how identified
issues affect quality measure selection and calculation. Quality measure authors
should consider increasing real-world validation and the consistency of measure logic
in respect to issues identified in this research.

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