Pediatrics. 2014 Jun;133(6):e1676-82. doi: 10.1542/peds.2013-4277.
To evaluate selected Children's Health Insurance Program Reauthorization Act claims-based quality measures using claims data alone, electronic health record (EHR) data alone, and both data sources combined.
Our population included pediatric patients from 46 clinics in the OCHIN network of community health centers, who were continuously enrolled in Oregon's public health insurance program during 2010. Within this population, we calculated selected pediatric care quality measures according to the Children's Health Insurance Program Reauthorization Act technical specifications within administrative claims. We then calculated these measures in the same cohort, by using EHR data, by using the technical specifications plus clinical data previously shown to enhance capture of a given measure. We used the k statistic to determine agreement in measurement when using claims versus EHR data. Finally, we measured quality of care delivered to the study population, when using a combined dataset of linked, patient-level administrative claims and EHR data.
When using administrative claims data, 1.0% of children (aged 3-17) had a BMI percentile recorded, compared with 71.9% based on the EHR data (k agreement [k] # 0.01), and 72.0% in the combined dataset. Among children turning 2 in 2010, 20.2% received all recommended immunizations according to the administrative claims data, 17.2% according to the EHR data (k = 0.82), and 21.4% according to the combined dataset.
Children's care quality measures may not be accurate when assessed using only administrative claims. Adding EHR data to administrative claims data may yield more complete measurement.
仅使用索赔数据、电子健康记录 (EHR) 数据或两者结合来评估《儿童健康保险计划再授权法案》（Children's Health Insurance Program Reauthorization Act，CHIPRA）选定的基于索赔的质量措施。
我们的研究人群包括来自 OCHIN 网络中 46 家社区卫生中心的儿科患者，这些患者在 2010 年期间持续参加俄勒冈州的公共健康保险计划。在该人群中，我们根据《儿童健康保险计划再授权法案》的技术规范，在管理索赔中计算了选定的儿科保健质量措施。然后，我们使用 EHR 数据，根据技术规范以及先前被证明可增强特定措施捕获的临床数据，在同一队列中计算了这些措施。我们使用 k 统计量来确定使用索赔数据与 EHR 数据进行测量时的一致性。最后，我们使用链接的患者级管理索赔和 EHR 数据的综合数据集，来衡量向研究人群提供的医疗服务质量。
使用管理索赔数据时，有 1.0%（年龄 3-17 岁）的儿童记录了 BMI 百分位数，而基于 EHR 数据的比例为 71.9%（k 一致性 [k]#0.01），在综合数据集则为 72.0%。在 2010 年满 2 岁的儿童中，根据管理索赔数据，有 20.2%的儿童接受了所有推荐的免疫接种，根据 EHR 数据则为 17.2%（k=0.82），根据综合数据集则为 21.4%。
仅使用管理索赔数据评估时，儿童保健质量措施可能不准确。将 EHR 数据添加到管理索赔数据中可能会得到更完整的测量结果。
