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Before you decide which quality measures to report, it is helpful to know what kinds of data you will need to produce the scores for the measure. Sometimes, the data you want to report already exist because somebody else collected it. But in other cases, report sponsors have to collect the data themselves.

Depending on the measure, data can be collected from different sources, including medical records, patient surveys, and administrative databases used to pay bills or to manage care. Each of these sources may have other primary purposes, so there are advantages and challenges when they are used for the purposes of quality measurement and reporting.

Administrative Data

In the course of providing and paying for care, organizations generate administrative data on the characteristics of the population they serve as well as their use of services and charges for those services, often at the level of individual users. The data is gathered from claims, encounter, enrollment, and providers systems. Common data elements include type of service, number of units (e.g., days of service), diagnosis and procedure codes for clinical services, location of service, and amount billed and amount reimbursed.

Advantages of Administrative Data

• Available electronically.
• Less expensive than obtaining medical record data.
• Available for an entire population of patients and across payers.
• Fairly uniform (and improving) coding systems and practices.

Challenges of Administrative Data

• Limited clinical information.
• Questionable accuracy for public reporting because the primary purpose is billing.
• Completeness.
• Timeliness.

Patient Medical Records

A medical record is documentation of a patient's medical history and care. The advent of electronic medical records has increased the accessibility of patients’ files. Wider use of electronic medical record systems is expected to improve the ease and cost of using this information for quality measurement and reporting.

Advantages of Medical Records

• Rich in clinical detail.
• Viewed by providers as credible.

Challenges of Medical Records

• The cost, complexity, and time required to compile data when patients receive services across different sites, particularly if a different record format is used.
• Current use of paper for most records, which means that trained staff must manually abstract information.

Patient Surveys

Survey instruments capture self-reported information from patients about their health care experiences. Aspects covered include reports on the care, service, or treatment received and perceptions of the outcomes of care. Surveys are typically administered to a sample of patients by mail, by telephone, or via the Internet.

Advantages of Patient Surveys

• Captures types of information for which patients are the best source.
• Well-established methods for survey design and administration.
• Easy for consumers to understand and relate to survey results.

Challenges of Patient Surveys

• 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 the population as a whole (sampling bias), or the population is not represented in the responses (response bias).

Comments from Individual Patients

Comments from individual patients, often referred to as anecdotal information, include any type of information on health care quality that is gathered informally rather than by carefully designed research efforts. Anecdotal information is becoming increasingly more common as private Web sites make it possible for health care consumers to share their personal experiences with health plans, hospitals, and, most prominently, physicians.

Advantages of Patient Comments

• Compelling to consumers to read about other people’s experiences.
• Efficient means for conveying information and influencing people’s decisions and behavior.

Challenges of Patient Comments

• Not an impartial assessment of health care quality because comments are not collected systematically.
• Not representative of the patient population. For example, many Internet sites that present patient ratings of doctors often contain just a few reviews per doctor. Even if a doctor has many reviews, the reviews are still likely to represent only a fraction of his or her entire patient population—and not necessarily a balanced fraction.
• Likely to have an undue influence on people’s health care decisionmaking.

Learn more about the influence and use of individual patient comments.

Standardized Clinical Data

Certain kinds of facilities, such as nursing homes and home health agencies, are required to report detailed information about the status of each patient at set time intervals. The Minimum Data Set (MDS), the required information for nursing homes, and the Outcome and Assessment Information Set (OASIS), the data required by Medicare for certified home health agencies, store the data used in quality measures for these provider types.

Advantages of Standardized Clinical Data

• Uses existing data sets.
• Characterizes facility performance in multiple domains of care.

Challenges of Standardized Clinical Data

• May not address all topics of interest.

The Need for Standardization

The use of quality measures to support consumer choice requires a high degree of data validity and reliability. To make sure that comparisons among providers and health plans are fair and that the results represent actual performance, it is critical to collect data in a careful, consistent way using standardized definitions and procedures.

Also in "Select Measures to Report"

• The Six Domains of Health Care Quality
• Types of Measures You Can Report
• Understanding Data Sources
• Selecting the Right Measures for Your Report
• Measures of Quality for Different Health Care Settings
• Quality Measurement Resources