The Use of Claims-Based Data in Inpatient Public Reporting and Pay-for-Performance Programs: Is There Opportunity for Improvement?

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. The National Association of Healthcare Quality members who work in an inpatient setting were in...

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Bibliographic Details
Published in:	Journal for healthcare quality Vol. 38; no. 6; pp. 379 - 395
Main Authors:	Crews, Hazel R, Chamness, Amy R, Terry, Colin L, Helft, Paul R
Format:	Journal Article
Language:	English
Published:	United States 01-11-2016
Subjects:	Health administration Humans Inpatients Patient Generated Health Data Patient Safety Quality Indicators, Health Care Reimbursement, Incentive United States United States Agency for Healthcare Research and Quality
Online Access:	Get full text
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Summary:	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. 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. 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. The self-described wide variation and nonadherence 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1062-2551 1945-1474
DOI:	10.1097/JHQ.0000000000000041