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Limitation of a Single Clinical Data Source for Measuring Physicians' Performance on Quality Indicators
Author(s) -
Weiner Michael,
Quwatli Zakwan,
Perkins Anthony J.,
Lewis John N.,
Callahan Christopher M.
Publication year - 2006
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2006.00809.x
Subject(s) - medicine , mammography , medicaid , medical record , family medicine , comorbidity , capitation , demography , health care , breast cancer , cancer , sociology , economic growth , economics
OBJECTIVES: To determine the extent to which relying on only one source of data leads to incomplete assessment of pneumococcal polysaccharide vaccine (PPV) or mammography. DESIGN: Cross‐sectional survey. SETTING: An urban Midwestern academic medical center in 1998/99. PARTICIPANTS: Medicare beneficiaries aged 65 and older with at least one health encounter. MEASUREMENTS: Completion of PPV and mammography was assessed using local and Medicare records. The study compared sources of records and assessed association between services and demographics and comorbidity. RESULTS: Adding Medicare data to local data increased the computed 1‐year PPV from 8.8% (264/3,002) to 15.0% and increased the 1998/99 mammography rate from 40% (343/847) to 67%. Local data sources missed 40% of PPV and 39% of mammography; Centers for Medicare and Medicaid Services sources missed 50% of PPV and 2% of mammography. The vaccinated were younger than the nonvaccinated (74 vs 76, P <.001). African Americans and those with more comorbidity were less likely to receive PPV over 8 years. Of 555 patients with a Medicare record of mammography, whites and those without Medicaid were significantly less likely to have a local record of mammography ( P <.001). CONCLUSION: Neither administrative nor local clinical records provide a complete or accurate assessment of these quality indicators. Accurate assessment of quality indicators requires pooling data from multiple sources across a broad region.