certain settings. Experts in clinical care and measurement recommend that recently piloted processes be expanded and that current larger-scale empirical work be tested on other samples and in other venues.

For instance, clinical quality measures for diabetes care and heart/stroke care included in Bridges to Excellence/NCQA Provider Recognition Programs are available for use in assessing efficiency performance (Tom Lee, personal communication, 2004). The End of Life metrics developed by the Dartmouth Atlas team (Wennberg et al., 2002) have been proposed as a proxy for hospital system efficiency (Eugene Nelson, personal communication, 2004). Active research programs and demonstrations by the NQF, the NCQA, Bridges to Excellence, the Leapfrog Group, research groups, and others are rapidly advancing the measurement of quality using medical records and administration data. These efforts need to be shared and combined on an ongoing basis into the measurement of health care value.

Validated Clinical (Medical Service, Pharmacy) and Financial Data

A number of studies have examined the validity of self-reported data, medical records, and administrative data and found that, with some caveats, claims data are adequate for many purposes related to value measurement. Although recent, these studies may not be generalizable to future information systems in which the electronic medical record, integrated services/encounter data, and advanced cost accounting systems are the norm. Concurrent with efforts to measure efficiency and performance are demonstrations and experiments in facility-based standardized records and information systems that can form the basis for reliable measurement of services, quality, and providers across sites and health systems (Physician Practice Connections for the Bridges to Excellence rewards program, Physician Office Link, the product of a collaboration between NCQA and Bridges to Excellence).

Although these efforts will undoubtedly lead to important answers and recommendations, ongoing empirical work should include sampling and analysis of:

  1. medical records for office visits and inpatient stays to validate data that appear on and are extracted from claims-based files and similar administrative records;

  2. cost data collected from multiple sources, including facility-specific, payer-specific records of billed charges, allowed charges, paid charges, and retroactive adjustments to assess the validity of resource measures;

  3. physician or group panel member characteristics including age, sex, race/ethnicity, and zipcode (to measure average socioeconomic status) relative to the service area or plan population. This can serve several purposes.

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