Medicare: Improved Patient Outcome Analyses Could Enhance Quality Assessment
PEMD-88-23
Published: Jun 27, 1988. Publicly Released: Jul 11, 1988.
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Highlights
Pursuant to a congressional request, GAO examined the Health Care Financing Administration's (HCFA) analysis and use of existing administrative data to monitor the outcome of care received by Medicare patients.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to strengthen HCFA analyses of mortality data by testing and incorporating more sophisticated adjustments that exploit more fully the available diagnostic information. |
Closed – Implemented
Sophisticated adjustments have been developed by HCFA staff, but apparently will not be used in new hospital mortality analyses scheduled to be released soon.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to employ data for several years when analyzing outcomes such as mortality rates for small groups of cases across individual hospitals. Hospitals that demonstrate a consistent pattern of observed outcomes that deviate significantly from the expected should be considered the prime candidates for intensified review, as should hospitals whose deviation beyond the range of expected mortality in a single year is based on a number of cases large enough to reduce the effect of random variation. |
Closed – Implemented
Hospital mortality analyses for 1988 included data from 1986 and 1987.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to expand HCFA analysis of comparative outcomes among patient subgroups, such as those defined by diagnostic and demographic characteristics. If substantial differences in outcomes among such groups are found after adjusting for differences in patient severity, HCFA should experiment with strategies for targeting quality-of-care reviews based on these analyses. |
Closed – Not Implemented
It has been more than 3 years since the report was issued. There is no prospect of further agency implementation.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to assess periodically the relative strengths and limitations of available approaches for analyzing Medicare patient outcomes data in terms of their substantive focus, technical adequacy, and degree of validation (i.e., their overall effectiveness in identifying patterns of patient care with quality problems). These assessments should guide the selection of analytical approaches used in future HCFA reviews of Medicare patient outcomes. HCFA should ensure that analyses of Medicare patient outcomes from administrative files employ approaches that have been validated to some degree through independent data sources, and any results publicly released should describe the extent of that validation. |
Closed – Implemented
Limited validation studies have been conducted, but not all have been released. Further validation studies have not been initiated.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to evaluate periodically, through medical record reviews of a nationally representative sample of Medicare patients, the percentage of cases with missing and inaccurate data in the Medicare Statistical System for each of the individual data elements used by HCFA to analyze Medicare outcomes. The results of such assessments should be publicly reported, and corrective action taken for those data elements crucial for reliable outcome analyses. Meanwhile, all analyses of Medicare mortality rates and other outcomes should include an explanation that their findings could be in error by an unknown amount due to potential data inaccuracies. |
Closed – Not Implemented
It has been more than 3 years since the report was issued. There is no prospect of further agency implementation.
|
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Topics
Evaluation methodsHospital care servicesMedical information systemsMedical recordsMedicarePatient care servicesQuality assuranceStatistical dataStatistical methodsMortality