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.
McDonald CJ. Quality Measures and Electronic Medical Systems. JAMA. 1999;282(12):1181–1182. doi:10.1001/jama.282.12.1181
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