The use of claims-based data in inpatient public reporting and pay-for-performance programs: Is there opportunity for improvement?

Hazel R. Crews, Amy R. Chamness, Colin L. Terry, Paul Helft

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Purpose: This study examined whether self-reported, facility-based data validation practices for claims submissions of cases flagged as Patient Safety Indicators (PSIs) match professional and regulatory standards. Methods: The National Association of Healthcare Quality members who work in an inpatient setting were invited to complete an anonymous survey to self-report their practices around facility-based data validation of PSI cases. Results: The authors found widespread variation in how PSI administrative data are internally validated; inconsistency in the education and training required of staff who participate in this process; and relatively poor compliance with physician query guidelines and documentation amendment standards. Conclusions: The self-described wide variation and non-adherence to professional and regulatory standards within the facility-based validation process for PSIs raise concerns about the use of these data to make meaningful judgments about quality and safety. The authors recommend a standardized approach to reporting and validation be implemented for use of PSIs in public reporting and pay-for-performance programs.

Original languageEnglish (US)
Pages (from-to)379-395
Number of pages17
JournalJournal for Healthcare Quality
Volume38
Issue number6
StatePublished - 2016

Keywords

  • AHRQ
  • Claims-based data reimbursement
  • Pay-for-performance programs
  • PSI
  • Public reporting

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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