. "23. An Administration Response to the Institute of Medicine Report from the Health Care Financing Administration." Medicare: New Directions in Quality Assurance Proceedings. Washington, DC: The National Academies Press, 1991.
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Medicare: New Directions in Quality Assurance
project was to begin to develop in the PROs the capability to feed back data on patterns of care and of outcome to the provider community and to evaluate the impacts of such an educational activity on practice.
We have contracted with the Medical College of Wisconsin, through the Wisconsin PRO, to develop a data management and analysis infrastructure to enable the PROs to analyze the existing large Medicare claims data bases as well as the emerging clinical data bases. The hardware configuration has been designed, the software is being written at this time, and the testing of the system in four PROs will begin shortly.
We are currently negotiating a project with the New Hampshire PRO and the Dartmouth School of Medicine to develop epidemiologic and analytic software and supporting hardware for PROs to use in assessing care provided in the area of internal medicine. The products here, as in the previous project, would be made available to PROs and would be in the public domain.
We are currently in the process of producing analytic information for PROs on 38 different procedures and/or diagnoses. The information would be analyzed nationally and by state, Metropolitan States Statistical Area, county, and hospital market area. We will present mortality, readmission, and expenditure information. The information would be risk-adjusted for a variety of demographic, socioeconomic, and patient characteristic variables. This is another example of the kind of analysis that PROs could eventually conduct for themselves with software that HCFA would provide.
We have undertaken several collaborative analytic efforts with academic medical centers making use of the HCFA claims and clinical data bases. The intent is to stimulate greater academic involvement with the PRO program and bring to it the biostatistical and epidemiologic skills necessary for a successful transition of the program. These efforts have involved the University of Maryland School of Medicine, the University of Pennsylvania College of Medicine, the Dartmouth School of Medicine, Boston University Hospital, and the Medical College of Wisconsin. The latter two have resulted in a joint effort with the PRO of Wisconsin (project 2 above). In addition, proposals have been received from several PROs to conduct evaluations of the quality of care in collaboration with Northwestern University, the Harvard School of Public Health, the University of Minnesota School of Public Health, the University of Michigan School of Public Health, and the RAND Corporation.