Using clinical and functional data for quality improvement in outcomes measurement consortia.

BACKGROUND: Using standardized measures, American Group Practice Association care providers compiled a national database from which patients could be tracked, allowing for epidemiologic comparisons among treatments, sources of care, and results. Within five years, the consortia expanded from 6 to 55 clinics and from a focus on total hip replacement surgery to eight different health conditions. DATA COLLECTION PROCESS: Reflecting areas of significant public concern, high prevalence, high cost, or research needs, both patient- and provider-source data are collected at group practices at standardized intervals: 6 months, 12 months, and annually thereafter. OUTCOMES DATA MANAGEMENT AND REPORTING: A readily adaptable database infrastructure allows data-collection tools to adapt individual questions to changing conditions in the health care environment while maintaining the integrity of the whole structure. Aggregate-level reports complement individual clinics' own internal analysis efforts by providing a context for the interpretation of results. CASE STUDIES: In a total hip replacement consortium (including more than 2,300 patients), early findings have shown that patients do not fully recover from surgery as quickly as they themselves anticipated. In the cataract consortium, data scores on near, distant, day, night, glare, and overall vision scales improve considerably after cataract surgery, giving clinics a new tool to monitor and improve performance. In the asthma consortium, one clinic reevaluated the distribution of peak flow meters and the reasons for their underuse after noting the low number of patients in the clinic that had peak flow meters. LESSONS LEARNED: Provider participation in study design, instrumentation, data analysis, and feedback is important, and physician buy-in and support are critical to the success of any outcomes initiative. Missing data are the greatest limitations of a longitudinal data set and are difficult to collect through follow-up. There is still much to be learned about what functional status and well being measures can show about the relationship between health care services and patient health.