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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