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Appendix B SAMPLE LETTER TO HOSPITAL ADMINISTRATOR Dear The Institute of Medicine has contracted with the Social Security Administration to assess the reliability of a statistical file on short- term hospitalizations maintained centrally by SSA for research purposes. The study objective is to examine the usefulness of this information for program evaluation and, in particular, to determine whether it is suffi- ciently reliable to be used as baseline data for evaluating the impact of Professional Standards Review Organizations. The study is being conducted by an expert steering committee and project staff under the chairmanship of Robert J. Haggerty, M.D., Roger I. Lee Professor of Public Health at Harvard University. It has been approved by the governing board of the National Research Council. A brief summary of the goals and activities of the Institute is enclosed. The purpose of this letter is to request your assistance in con- ducting the study. More specifically, we are asking you to permit a member of our field team to abstract approximately 75 pre-selected med- ical records within your medical record department. For a portion of those records it will also be necessary to review the claim form sub- mitted to the fiscal intermediary. The information of interest is limited to patient demographic characteristics, dates of admission and discharge, and diagnoses and procedures. Data on hospital charges will not be reviewed or recorded. The field work will be conducted by four highly skilled Registered Record Administrators (RRAs) with extensive research and administrative experience, who have been specially trained by Faye Brown, a former pres- ident of the American Medical Record Association. Because of their proven competence, they will be able to complete their work with no significant disruption of your regular routine, although some staff time will be re- quired to retrieve the records in advance of their visit. 73

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74 Appendix B Since the study does necessitate the review of medical records, we are very concerned about confidentiality and have taken special pre- cautions in this regard. The unique patient number will only be used to access the relevant record and assist in compiling the abstracted information. In no instance will the name of the patient or physician be recorded. The resulting report will contain only statistical sum- maries, which will not permit the identification of patient, physician, or hospital. Similarly, this information will not be provided to the federal government. To indicate your willingness to participate in the study would you please sign the enclosed form and return it to us in the self- addressed envelope. We would be very grateful if you could indicate on the form the names of the directors of your medical record and bill- ing departments, who will then be contacted by a member of our field team. If you have any questions about the study, our staff director, Linda Demlo, Ph.D., will be happy to respond. Please call her collect at 202-389-6148. Your hospital was selected through a very carefully designed sampling procedure, and your participation is essential if the results of the study are to be truly generalizable. The findings should have broad applicability for health services research and evaluation in general and may also help to determine the utility of information de- rived from the MADOC (Medicare Analysis of Days of Care) and more recent MEDPAR (Medicare Provider Analysis and Review) information systems for internal hospital management. We will be pleased to share with you the results of the completed study. We sincerely hope it will be possible for you to join us in this important undertaking. Enclosures cc: Director, Medical Record Department Director, Billing Department Sincerely yours, David A. Hamburg President Institute of Medicine