Eggers P W, Greer J, Jencks S
Program Evaluation Branch, Health Standards and Quality Bureau, Health Care Financing Administration, Baltimore, MD.
Am J Kidney Dis. 1994 Aug;24(2):247-54. doi: 10.1016/s0272-6386(12)80190-9.
The Health Care Financing Administration maintains a wide array of data systems that are essential to the functioning of the Medicare program. These data, collected and maintained for the purposes of ensuring entitlements and payment for services, also can be used to monitor programmatic changes and to define potential problem areas. The end-stage renal disease (ESRD) Program Management and Medical Information System (PMMIS) is a subset of the larger Medicare statistical system. It is a historic record of all Medicare ESRD beneficiaries dating back to 1978. Basic Medicare enrollment information on ESRD beneficiaries is enhanced with the addition of information on the cause of renal failure, type of dialysis therapy, transplantation history, and cause of death. The ESRD PMMIS has been put to a number of uses in the past decade or so, ranging from basic descriptive epidemiology to analyses of mortality rates to assessments of programmatic issues such as the composite rate and dialyzer reuse. Because of the limited clinical detail in the PMMIS, there are many specific questions that cannot be adequately addressed. With approval of the Food and Drug Administration and Medicare coverage of erythropoietin, a erythropoietin monitoring system was developed to assess utilization trends of this anemia control drug. Within a few months it became evident that dosing levels for erythropoietin were much lower than expected from the clinical trials. Following a change in the payment method from a fixed amount to one based on dose level, dosing has increased markedly. However, hematocrit levels still remain below optimal levels. This lack of hematocrit response has led the Health Care Financing Administration, in concert with the renal community, to target anemia control as a potential health care quality improvement project. This paper presents an example of the type of data presentation that can be derived from the current PMMIS. The Health Standards and Quality Bureau has made a commitment to a program of continuous quality improvement. Part of this process is the provision of descriptive data that can be the starting point for an iterative approach to quality improvement.
医疗保健财务管理局维护着一系列对医疗保险计划运作至关重要的数据系统。这些为确保应享权利和服务支付而收集和维护的数据，也可用于监测计划变化并确定潜在问题领域。终末期肾病（ESRD）计划管理与医疗信息系统（PMMIS）是更大的医疗保险统计系统的一个子集。它是所有医疗保险ESRD受益人的历史记录，可追溯到1978年。ESRD受益人的基本医疗保险参保信息通过添加肾衰竭病因、透析治疗类型、移植史和死亡原因等信息得到了扩充。在过去十年左右的时间里，ESRD PMMIS有多种用途，从基本的描述性流行病学分析到死亡率分析，再到对诸如综合费率和透析器复用等计划问题的评估。由于PMMIS中的临床细节有限，有许多具体问题无法得到充分解决。随着食品药品监督管理局的批准以及医疗保险对促红细胞生成素的覆盖，开发了一个促红细胞生成素监测系统来评估这种贫血控制药物的使用趋势。几个月内就明显看出促红细胞生成素的给药水平远低于临床试验预期。在支付方式从固定金额改为基于剂量水平后，给药量显著增加。然而，血细胞比容水平仍低于最佳水平。这种血细胞比容反应不足促使医疗保健财务管理局与肾脏学界共同将贫血控制作为一个潜在的医疗质量改进项目。本文给出了一个可从当前PMMIS得出的数据呈现类型的示例。健康标准与质量局已承诺实施一项持续质量改进计划。这个过程的一部分是提供描述性数据，这些数据可以作为质量改进迭代方法的起点。
