Tip of the week: Understanding indicator data sources

There are four main sources of the data: administrative data, clinically documented and coded clinical data, incident report data, and perception survey data:

• Administrative data: This is data that is obtained from patient registration (e.g., patient age, gender, residence status) or from charges for services or supplies.
• Clinically documented data: This data comes from explicit documentation—or lack of it—in the patient’s medical record. This data has been expensive to obtain because it must be abstracted from the written record, but as electronic medical records expand, the data should become more readily available. There are two types of clinically documented data: data directly taken, or abstracted, from the medical record; and data that is interpreted from the medical record and translated into a coding system. The claims data using the International Classification for Diseases system is used by medical records professionals to define the disease categories or Diagnosis Related Groups (DRG) and complications used for billing. Another example is CPT coding used for physician services.
• Incident report data: This data is based on observations, or perceptions, of individuals who file a report regarding the incident. The reporting individual may be a hospital staff member, a physician, or a patient. Although typically thought of as risk management report data, incident report data may be provided by case managers for quality concerns independent of the risk management system. Individual patient complaints are also a source of incident data.
• Perception survey data: This data moves beyond individual incidents to obtain more structured perceptions that can be aggregated and quantified. The data you get depends on the questions you ask, and patient satisfaction data is the most common example. It is important to note that the survey must ask specific questions about physician care issues to give relevant data on physician performance. As medical staff begin to measure more of the general competencies that are not related to technical skills, such as communication and professionalism, the use of perception surveys by hospital staff or other physicians will increase. The use of the 360-degree evaluation by the residency programs is an example of such a tool.

  Two notes of caution on the use of perception survey data: First, to be valid, the questions you ask should be on performance areas which the person surveyed can truly evaluate. For example, it is appropriate to ask a nurse about a physician’s communication skills but not about technical skills related to a physician’s privileges. Second, this type of data is best evaluated on a relative scale (e.g., percentile rank) than on the absolute score one receives.

This week’s tip is from Effective Peer Review, Second Edition, by Robert J. Marder, MD.