September 22/29, 1999

Quality Measures and Electronic Medical Systems

Author Affiliations

Author Affiliation: Dr McDonald is Distinguished Professor of Medicine, Indiana University School of Medicine, Indianapolis, and Director, Regenstrief Institute for Health Care, Indianapolis.

JAMA. 1999;282(12):1181-1182. doi:10.1001/jama.282.12.1181

The National Committee for Quality Assurance (NCQA) has chosen its quality measures wisely. NCQA has demanded that the measures address care processes that have a strong scientific base, and because of awareness of the cost of quality reviews, has chosen measures that can be defined in terms of data that are present in most administrative computer systems. For example, the denominator for the Health Plan Employer Data Information Set (HEDIS) measure of pneumoccocal immunization rate is derived from a computer search for patients eligible for pneumococcal vaccine, ie, those older than 65 years, or having an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis of heart failure, chronic lung disease, and a few other chronic diseases. Its numerator is derived by a search of procedure codes that indicate pneumococcal vaccine use or by a chart review of a sample of the denominator cases. Thus, a computer can do much of the review work.

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