Developing quality of acute care indicators through claims data augmentation

To demonstrate the use of quality indicators developed through claims data augmentation.

A retrospective examination of field-tested acute care quality indicators and methods used in developing them to identify opportunities for quality improvement was used. The settings were 46 acute care hospitals and physician staffs serving Medicare beneficiaries in Vermont and New Hampshire, with more than 60,000 Medicare inpatient admissions per year. The objective was to measure hospital and provider initiatives in quality improvement projects.

More than 100 projects have been developed from hospital-specific comparative analyses and presentations about peer group profiles on indicator and outcome variables. Successfully completed projects have resulted in significant improvements in patient out comes, including reduced acute myocardial infarction mortality, reduced rates of discharges against medical advice, and increased use of pressure sore prevention and prophylactic antibiotics guidelines.

Certain essential enabling data elements permit construction of a credible claims-based acute care quality indicator dataset. Unique individual patient identifiers and validated deaths are essential for conducting readmission and mortality analyses, respectively. Risk adjustment is necessary for making provider comparisons on indicators influenced by patient severity of illness. Cross-validation of outcome patterns with multiple indicators, and project successes have built provider interest and confidence in the use of such a data base.