implementation of a pay-for-performance program, these measures should be updated to reflect the most up-to-date research.

Data Limitations

Data are collected using a variety of methods, primary among these being administrative claims and medical chart review. Retrievable electronic data are most frequently collected as administrative claims (commonly referred to as claims data or admin data), which are electronic medical bills submitted by providers to payers. Data derived from these electronic data include demographic information (e.g., patient age and gender), type of insurance coverage, and information regarding services received (e.g., cost, type, and place of service; lengths of stay; procedures performed; laboratory results; medications prescribed). In other cases, providers must abstract clinical data from individual medical charts (referred to as chart data) that currently are not retrievable electronically. Chart data include information such as results of diagnostic tests and procedures, medications, and therapeutic procedures.

There are many trade-offs involved in collecting data from the different sources, such as that between the burden of data collection and the value of the data collected. Collection of admin data requires only sorting of electronic data; thus this method is relatively quick and inexpensive. By contrast, collection of chart data requires that a nurse, physician, or some other certified person with medical knowledge go through each medical chart to abstract the data. This is not only time-consuming, but also costly. With regard to the importance of the data collected, admin data frequently do not adequately capture specific clinical information (e.g., whether cholesterol levels were controlled to less than 100 mg/dL) in the absence of electronic laboratory data. The latter can be found in some health plans and medical groups, but must otherwise be obtained through chart review. Judgments about the relative merits of admin versus chart data also need to take into account the frequency of collection and the accuracy and reliability of the data. Both modes of data collection are used; however, both are limited in the amount of information yielded, as well as the resources required to collect the data.

As pay-for-performance rewards can be based only on data that are collected, the data collection must be timely and capture the intermediate and ultimate outcomes of care while not imposing an undue burden on providers. Data systems are increasingly being designed with the capacity to collect more “meaningful” data electronically; this capability will be greatly accelerated by the adoption of health information technologies (see Chapter 5). The committee carefully weighed these considerations when assessing the types of measures on which to base pay for performance, but be-



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