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Tables of Contents for Health Information Systems
Chapter/Section Title
Page #
Page Count
About the Series Directions in Health Services Research and Policy
v
2
Foreword
vii
8
Figures
xv
2
Tables
xvii
4
Acknowledgments
xxi
2
Acronyms
xxiii
INTRODUCTION
1
6
What Do Stakeholders What to Know?
1
1
What Is Wrong with Current Health System Information?
2
5
Part 1 Health Information Systems: An Overview for Policymakers
7
36
Chapter One BUILDING AN INTEGRATED INFORMATION SYSTEM
7
8
Data Sources for an Integrated Information System
7
2
What Kind of Data Should an Integrated Information System Include?
9
4
What Questions Do Stakeholders Want Answered?
9
2
When Do Stakeholders Need Answers?
11
1
What Are the Consequences of Acting on Inaccurate Information?
12
1
When Is Expert Help Required?
13
2
Chapter Two DATA SOURCES FOR AN INTEGRATED INFORMATION SYSTEM
15
12
Enrollment Data
15
2
Uses of Enrollment Data
15
1
Problems with Existing Enrollment Data
16
1
Administrative Data
17
3
Uses of Administrative Data
17
1
Problems with Existing Administrative Data
18
2
Clinical Data
20
2
Uses of Clinical Data
20
1
Problems with Existing Clinical Data
20
2
Survey Data
22
1
Uses of Survey Data
22
1
Problems with Survey Data
22
1
Other Data Sources
23
1
Strategies for Improving the Utility of Integrated Information Systems
24
1
For More Detail
24
3
Chapter Three WHAT CONSUMERS OF RESEARCH NEED TO KNOW ABOUT ANALYSIS
27
10
Formulating the Question
27
1
Designing the Data Study
28
2
Identifying the Data Source
30
1
Constructing the Analysis File
31
3
Restricting the File to a Subset of Individuals
31
1
Selecting Variables
32
1
Mergine Data from Different Sources
33
1
Initial Data Quality Checks
33
1
Selecting an Appropriate Analytic Technique
34
1
Interpreting the Results
34
1
For More Detail
35
2
Chapter Four THINKING STRATEGICALLY ABOUT INFORMATION SYSTEMS
37
6
Part 2 Technical Issues in Designing and Improving Health Information Systems
43
208
Chapter Five DESCRIPTION OF DATA SOURCES AND RELATED ISSUES
43
34
Introduction
43
1
Data Sources: Existing Systems
44
26
Administrative Data
44
12
Enrollment Data
56
3
Clinical Data
59
5
Survey Data
64
5
Other Data Sources
69
1
Problems and Potential Solutions to Improve the Utility of Health Data Systems
70
7
Lack of Unique Identifiers for Linking Purposes
70
4
Varying Levels of Data Quality
74
1
Nonuniformity of Data Elements Across Different Data Systems
75
1
Enhancements to the Existing Set of Data Elements
76
1
Chapter Six GENERAL ANALYSIS ISSUES
77
64
Formulating the Question
78
2
Designing the Study
80
3
Identifying the Data Source
83
4
Constructing and Analysis File
87
21
Restricting the File to a Subset of Individuals
87
3
Selecting Variables
90
3
Merging Data from Different Sources
93
2
Initial Data Quality Checks
95
13
A Sampler of Analytic Techniques
108
29
Description
109
5
Inference
114
13
Prediction
127
10
Interpreting the Results
137
4
Chapter Seven DEVELOPING AND USING A CLINICAL INFORMATION SYSTEM
141
48
Introduction
141
1
How Will a Clinical Information System Work?
142
1
How Do Clinical Data Differ from Administrative Data?
143
1
Why Is Severity Adjustment Important?
144
1
What Are the Characteristics of an Ideal Clinical Information System?
144
5
Diagnoses Must Be Valid
145
1
Data Must Be Uniform and Consistent
146
1
Data Must Allow for Severity or Risk Adjustment
147
1
Data Must Be Entered in "Real Time"
147
1
The Information Systems Must Contain Unique Identifiers for Patients and Providers
148
1
Data Must Be Comprehensive
148
1
Using Clinical Data to Adjust for Differences in Severity
149
2
What Are the Potential Uses of a Clinical Information System?
151
4
Quality of Care
151
1
Access to Care
152
1
Costs and Cost-Effectiveness
152
1
Performance of Health Plans and Providers
153
1
Effect of Public Health Programs
153
1
Effect of Policy Changes on Health
154
1
Disease Surveillance
154
1
Rate/Premium Setting
155
1
Deciding What Conditions to Target
155
4
Common Conditions
156
1
Limitations in Function
156
2
Common Procedures
158
1
Ambulatory Care
158
1
What Target Conditions Should Be Included?
159
2
Detailed Examples for Two Target Conditions
161
7
Breast Cancer Screening
161
2
Treatment of Coronary Artery Disease
163
5
Additional Target Conditions for Consideration
168
18
Preventive/Screening Services
168
12
Treatment of Chronic Conditions
180
5
Procedures
185
1
Can a Clinical Information System Answer All Clinical Questions?
186
3
Chapter Eight AN OVERVIEW OF METHODS FOR CONDUCTING SURVEYS
189
24
Introduction
189
1
Designing and Conducting a Survey
189
3
Sampling the Study Population
192
4
Methods of Sampling
192
1
Choosing a Sample Size
193
3
Modes of Survey Administration
196
2
Cross-Sectional, Longitudinal, and Repeated Cross-Sectional Designs
198
1
Content of the Survey
199
8
Preliminary Steps in Choosing Survey Questions
199
2
Questionnaire Construction
201
4
Question Order
205
2
Implementing the Survey
207
3
Introduction and Instruction
207
1
Maximizing Response Rates
208
2
Who Should Administer the Survey?
210
3
Chapter Nine AN OVERVIEW OF RISK ADJUSTMENT
213
38
Introduction
213
1
What Is Risk Adjustment?
214
1
What Factors Should Be Considered for Risk Adjustment?
214
2
Why Is Risk Adjustment Important?
216
2
How Is Risk Adjustment Used?
218
5
Setting Private Health Insurance Premiums
219
1
Establishing Hospital Payment Rates for Medicare
219
1
Determining Capitated Risk Contracts
220
1
Profiling the Performance of Providers
221
2
How Is a Risk-Adjustment System Evaluated?
223
2
Strength of Predictions
223
1
Incentives for Inefficient Care
224
1
Ease of Collecting Data
224
1
Ease of Audit and Gaming the System
225
1
What Can Be Done to Augment Prospective Risk Adjustment?
225
1
What Work Is Being Done to Improve the Ability to Risk-Adjust?
226
1
Predicting Costs Based on Prior Hospitalization
226
1
Predicting Outpatient Care Costs
227
1
What Is Severity Adjustment?
227
1
Why Is Severity Adjustment Important?
228
1
How Is Severity Adjustment Used?
229
11
When Is Severity Adjustment Necessary?
229
4
What Factors Should Be Considered for Adjustment?
233
3
What Data Sources Are Available for Severity Adjustment?
236
4
How to Choose a Severity-Adjustment System
240
11
MedisGroups (Original Version)
242
2
Computerized Severity Index
244
2
Managed Health Care Association Outcomes Management System Project
246
1
Type II Diabetes Patient Outcomes Research Team Project
247
4
Bibliography
251
20
Glossary
271
16
Index
287
9
About the Authors
296