Healthcare Data Sets
For the country, such as the United States, which has the private healthcare system that operates in accordance with the market laws, the problem of assessment of its quality, accessibility, and efficiency, as well as the reporting of the obtained results is particularly relevant. In order to address it, a wide array of data sets used for storing, processing, and transmitting the healthcare information has been developed. It should be noted that the information provided by these sets is of interest not only to the government agencies and the media, but also to the consumers of healthcare products and services since it helps them make the most feasible choice out of all the options offered by the American healthcare industry. This fact adds to the relevance of the following research. Therefore, this paper focuses on the analysis of the three most widely used healthcare data sets (HEDIS, OASIS, and UHDDS), providing insight into the types and sources of data they use, the settings they are used in, and the purpose of the information they contain. Additionally, it gives a brief description of the reporting procedures for each of the three sets.
The Healthcare Effectiveness Data and Information Set (HEDIS) is a data set that is widely used in the setting of managed care. Its peculiarity lies in the fact that it primarily targets at consumers of healthcare services rather than specialists, allowing them to compare the performance of a particular health plan to that of the other plans, as well as the regional or national benchmarks (NCQA, 2015).
Despite the consumer-oriented nature of HEDIS, the data it provides is also used for tracking of year-to-year performance of the healthcare system. Additionally, the collected data is used for further healthcare system improvement, as well as for HEDIS measures. Moreover, the commercial data provided by the set is used to calculate the abovementioned performance benchmarks. Finally, purchasers, consultants, and the media use HEDIS data to conduct a comparative analysis of the performance of particular health plans (NCQA, 2015).
In addition to the primary data, such as the availability and effectiveness of care, its stability and costs, which are obtained from medical records, HEDIS uses the information, namely the demographic one (age, race, sex, and educational level of patients) from several secondary sources. In particular, they include information taken from the government sources, namely census data, as well as from the computerized special-purpose databases, namelyeducation facilities (Wager, Lee, & Glaser, 2013).
The process of reporting of HEDIS data involves the disclosure of the obtained results to the public (e.g. consumers of healthcare services). However, prior to that, the data must be collected by the clinical staff during the period from January to May through medical charts, insurance claims, as well as medical office visits. Additionally, the necessary information may be gathered through surveys that are conducted by external organizations that have an approval of the National Committee for Quality Assurance (NCQA). The collected data should be checked by an auditing firm which is also approved by the NCQA (NCQA, 2015). It should be noted that the committee sets a hard deadline for gathering of the abovementioned data, namely this process must be completed by May 15 (Thompson, 2015). For a fee, the organization provides an access to its online reporting tool (called Quality Compass), which contains detailed information on all the measures regarding reporting and auditing of the collected data. It is intended to be used by employers and healthcare consultants that purchase health plans for groups of people (NCQA, 2015). As for governmental agencies and the media, they report HEDIS data upon its release. HEDIS reports are issued in the middle of each year (from July to October) every year and cover the information gathered within the reporting year (from January to December) (Thompson, 2015).
The Uniform Hospital Discharge Data Set (UHDDS) is primarily used for reporting data on the treatment of patients in acute, short- and long-term care healthcare centers. It contains a minimum set of items that is based on standard definitions. As a result, it provides consistent information for a wide range of users. It is primarily required for reporting patients covered by Medicare and Medicaid programs, but a lot of health care payers use it as a billing system (Abdelhak & Hanken, 2015).
Despite the fact that the UHDDS was initially developed for reporting of data regarding hospital cases, the field of its use expanded significantly in the following years. As a result, the instructions for the selection of the primary and secondary diagnoses that are provided by the UHDDS can be applied in many types of settings. They include acute, short-, and long-term care centers, psychiatric clinics, rehabilitation centers, also the organizations engaged in provision of home healthcare services and many others (Abdelhak & Hanken, 2015).
The UHDDS includes such data items as principal diagnosis and secondary diagnoses that are considered significant for the specific case and all the significant medical procedures. Additionally, it presents the general information on the patient (age, sex, and race) and the specific case (the expected payer, and the ID of the hospital) (Abdelhak & Hanken, 2015). As a result, the UHDDS provides comparable data that can be used for determining the hospitals which are considered to be the best for treating patients. In turn, these facilities may serve as models for improvement of the healthcare system, namely for reduction of re-admittance rates. Additionally, the UHDDS data can be used to compare the reimbursement rates for a particular medical procedure in different healthcare centers (Abdelhak & Hanken, 2015). As a result, one of its purposes is establishment of a standardized system of reimbursement at the national level.
Apart from the primary sources of data, such as medical records, the UHDDS also uses several secondary sources, including the electronic (the databases of healthcare facilities) and physical ones (the passport data of patients) (Wager et al., 2013).
In accordance with the UHDDS guidelines, all significant procedures that were performed in a particular hospital case must be reported. These include surgical manipulations, the ones that present any procedural or anesthetic risks, or require special training from the personnel. In case some diagnoses are reported, the principal one must be designated. For each particular case, the report on the procedures and diagnoses must be completed by a physician who is responsible for providing those (Wager et al., 2013). The reportable diagnoses and procedures are to be coded in accordance with the International Classification of Diseases Tenth Revision Procedure Coding System (ICD-10-PCS) by the individuals who are authorized to perform such inpatient services. It should be noted that UHDDS does not present any specific information on the frequency of reporting, as well as the format of the submitted documents; it only emphasizes the importance of adherence to the standards presented by ICD-10-PCS (Wager et al., 2013).
The Outcome and Assessment Information Set (OASIS) is a data set that was developed to enable the systematic and comprehensive assessment of patient home healthcare outcomes, as well as to define risk factors that may affect them. As a result, the primary type of setting for the OASIS is a home health agency (HHA). In general, the outcome of home healthcare may be defined in different ways. However, in case of the OASIS, it refers to changes in health status of a patient during a particular period of time (i.e., between several time points) (Wager et al., 2013).
As a result, the data provided by the OASIS is used for measurement of outcomes of different cases of home healthcare and consequent improvement of healthcare system performance . It may also be used to provide insight into the health level of the population, including different social groups, as well as the overall efficiency of the healthcare system (Wager et al., 2013).
The OASIS includes items that encompass the following types of data: social, demographic, and environmental factors, as well as the health and functional status attributes of adult patients. Additionally, the setting contains the selected attributes of health service utilization. The different types of attributes are meant to be a part of the comprehensive assessment of patient’s health status. In addition to the primary sources of data such as the clinical records of a patient and the results of the direct observation, the OASIS data set must be supplemented with additional assessment items, the nature of which relies on the choice of a healthcare agency involved in the process of assessment. As a result, the set utilizes several secondary data sources of different types. In general, they include both internal (plan-of-treatment forms) and external (Medicare claims) computerized special purpose databases, as well as the published government sources, namely census data (CMS, 2015).
The necessary information is collected by using the mentioned sources at several time points – the start of care, 60-day follow-ups, and patient’s discharge. The collected data is to be reported within 30 days after the completion of care assessment, meaning there is no precise reporting schedule (CMS, 2015). However, the guides including the questions of the healthcare specialists are issued and published on a quarterly basis. The reporting procedure is carried out in accordance with the following algorithm. First of all, each report must be encoded by using the software that includes the OASIS data set and supports the standard electronic record layout and data dictionary that are approved by the Centers of Medicare and Medicaid Services (CMS). As a result, the data become of a standardized format and can be transmitted in a digital form either to the CMS OASIS contractor or the state agency. It also must include an identification number of the medical facility that was assigned to it by the CMS. Additionally, the transmitted data must reflect health status of the beneficiary at the time of his/her assessment (CMS, 2015).
To conclude, it should be said that each of the reviewed data sets has a specific field of use, as well as different purposes of using information it provides. However, due to similarities in the types of setting they are used in, there is a possibility that the data they contain may be interchangeable. In particular, both OASIS and UHDDS can be used in the setting of home health agency, but with different goals (the patient’s health status assessment and the reporting of the principal procedures) while the HEDIS covers the area of managed care, which may include all of the settings mentioned in the papers. As a result, it is possible to assume that the further development of these data sets may lead to the creation of a uniform system of gathering, assessment, auditing, and reporting of the healthcare data, which will contribute to healthcare system improvement in the U.S. as a whole.