Getting a Complete Picture of Care Quality

by  Jennifer DeVoe, MD, DPhil, OCHIN

“Quality Measures” – a term you’ve been hearing a lot recently.  Under healthcare reform, payment will shift to focus on patient outcomes rather than on services.  But how are patient outcomes measured?  Community Health Centers (CHCs) have always been required to measure and improve the quality of care they deliver. However, such efforts have typically been constrained by limited access to timely information.  External evaluations of quality are traditionally pulled from medical insurance claims data.

A new study from OCHIN, Inc., found that insurance claims data gave an incomplete picture of the preventive services provided to patients.  Researchers have known for years that insurance claims data are incomplete, but claims data are often used because they are readily available and fairly uniform.

The study, titled Electronic Health Records vs. Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers, concludes that networked EHRs provide new opportunities for obtaining more comprehensive data regarding health services received – especially among populations with breaks in insurance. Relying solely on Medicaid claims data is likely to substantially underestimate the quality of care.

The electronic health record (EHR) contains more complete information than Medicaid Claims data alone. Researchers evaluated the documentation of preventive services of 2,100 Medicaid patients with diabetes at 50 Oregon CHCs. They found that a significant percentage of preventive services administered were documented in EHRs but not included in Medicaid claims – including essential influenza vaccinations, cholesterol screenings and hemoglobin A1c blood tests.

Policy implications of the findings are that robust EHR data from CHC networks can provide a new resource for policy makers to better understand health services delivery in CHC populations and how EHR databases—such as the one being built and maintained by OCHIN—will be key to the study of how health reform policies implemented under the Patient Protection and Affordable Care Act of 2010 (PPACA) affect the uninsured and underinsured.

What does this mean for you?

• First, depending on your patients’ payer statistics, certain groups may be left out of claims data.  Oregon is in the process of creating an All-Payer, All-Claims database, which is a huge data warehouse of insurance claims from all insurance companies plus Medicare and Medicaid.  It’s very important to realize that any care that patients receive while they are uninsured will not be contained in this database.  This impacts primary care providers directly because it means that even when your practice does a great job of getting uninsured patients the preventive and enabling services they need, these efforts could be overlooked if evaluations are done using claims data along.

• Second, if you use an EHR, be thorough and consistent when you enter data.  Developing robust EHR databases for use in quality performance measurement will aid in providing more comprehensive data about the quality and cost of health care. Gaining this more complete picture will allow state policy-makers to monitor efforts to reduce health care costs and improve both care quality and population health.  Complete data can show statewide variation in care, including whether evidence-based guidelines and best practice clinical standards are being followed and how they affect cost and quality.  Data can then be grouped by community and show variations across counties, regions, or other areas.

OCHIN, a member of Northwest Regional Primary Care Association, is a national non-profit organization headquartered in Portland, Oregon that provides integrated Health Information Technology – software products and services to community health clinics, mental health services, rural/critical care hospitals and small practices serving the medically underserved. OCHIN has a Practice-based Research Network, registered with the Agency for Health Research and Quality with a mission to improve the health of underserved populations, enhance quality of care, and inform health policy through research.

DeVoe JE, Gold R, McIntire P, Puro J, Chauvie S. (2011) Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers. Annals of Family Medicine 9:351-358.  http://www.annfammed.org/content/9/4/351.full