NHLBI Workshop

Data Needs for Cardiovascular Events, Management, and Outcomes

Small Working Group: Quality of Care and Outcomes - Dr. David Goff, Group Leader

Out Patient Quality of Care

• Expand/optimize National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS)
  • Increase sample size for CVD conditions
  • Validation?
  • Performance indicators (e.g., National Committee for Quality Assurance (NCQA))
  • Short-term timeline
    
• Make use of Centers for Medicare & Medicaid Services (CMS) data when med data available
  • Need managed care claims as well as fee-for service claims
  • Validation?
  • Performance indicators (e.g., NCQA)
  • Limited to those 65 yrs or older
  • Long-term timeline
    

Out Patient Health-Related Quality of Life (HRQL)

• Expand/optimize Medicare Current Beneficiary Survey (MCBS)
  • Measures HRQL
  • Links claims and collects med use
  • Increase sample size for CVD conditions
  • Limited to those 65 yrs or older
  • Short-term timeline
    
• Alternative
  • Expand scope of work of CMS Quality Improvement Organizations (QIO)
    • Long-term testing feasibility needed
    • Limited to those 65 yrs or older
      

In-Patient Quality of Care & HRQL

• Expand/optimize National Inpatient Sample (NIS) and National Hospital Discharge Survey (NHDS)
  • Validation
  • Classification (incident v. recurrent)
  • Performance indicators (e.g., JCAHO)
  • Procedure indications regarding appropriateness
    
• Medium to long-term timeline
• Don't count on sponsored databases long-term, e.g., GWTG, NRMI, GAP
• In patient HRQL lower priority except as baseline
  
  • Generally expected to be poor at time of discharge
  • Transitional/out patient HRQL may be more relevant

Transitional Quality of Care & HRQL

• Expand/optimize MCBS
  • Optimize sample size for CVD events
  • Validation?
  • Classification (incident v. recurrent)
  • Performance indicators (e.g., NCQA)
  • HRQL measured
  • Limited to those 65 yrs or older
  • Short-term timeline
    
• Expand scope of work of QIO
  • Timeliness barriers
  • Limited to those 65 yrs or older
  • Long-term timeline
    

Long Term Care Quality of Care & HRQL

• Expand/optimize Minimum Data Set (MDS) and National Nursing Home Survey (NNHS)
• Optimize sample size for CVD events
• Validation?
• Performance indicators (e.g., NCQA)
• HRQL measured (at least in MDS)
• Short-term timeline
  

Other Issues

• Thin national perspective
  • State-based sampling to enable state and local supplements
  • Sentinel surveillance research sites
    
    • Validation
    • In-depth data collection
    • Methodologic research
      
• Data standards
• Electronic medical record capacity
• Interoperability
• Disease management
• Process
  
  • Request for Applications (RFAs) to establish sites to
    • Analyze existing surveillance data
    • Enhance/expand current systems
    • Develop new methods & systems
      
  • Unique patient identifier needed to link across databases
  • Need to link with-in databases to account for multiple entries per person
    

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