however, is the need for much more and much better information on use of health care services and on the outcomes of that care. The needs are quite broad: health care reform; evaluation of clinical care and health care delivery; administration of health plans, groups, and facilities; and public health planning.

Policymakers, researchers, health professionals, purchasers, patients, and others continue to be frustrated in their attempts to acquire health information. They may not be able to determine with confidence the outcomes, quality, effectiveness, appropriateness, and costs of care for different segments of the population, for different settings, services, and providers, and for different mechanisms of health care delivery and reimbursement. When this is so, they can say little, with confidence, about the value of the investment in health care for population subgroups, regions, or the nation as a whole.

In principle, this information can be acquired through numerous avenues, such as surveys, electronic financial transactions for health insurance claims, computer-based patient records (CPRs), and disease registries. In practice, no one system will suit every need or produce information appropriate for every question. As introduced in Chapter 1, however, health database organizations (HDOs) hold considerable promise as a reasonably comprehensive source of the information needed to:

  • assess the health of the public and patterns of illness and injury;
  • identify unmet regional health needs;
  • document patterns of health care expenditures on inappropriate, wasteful, or potentially harmful services;
  • find cost-effective care providers; and
  • improve the quality of care in hospitals, practitioners' offices, clinics, and various other health care settings. 

The latter half of this chapter outlines these and other benefits of HDOs, the databases they access or control, and the analytic and information dissemination activities they undertake. It also discusses the applications that user groups might have for different types of databases. The committee advances some views on how major concerns about these databases, chiefly relating to the quality of their data, might be addressed, and it makes two recommendations. In preparation for those sections, the chapter next offers some definitions of key concepts and terms, explores the basic construct of HDOs (which the committee sees as the administrative and operational structure for regional health databases), and provides some examples of the variety of entities that now exist, are being implemented as this report was written, or are envisioned for the future.

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