State-and national-level momentum is building to create and maintain all-payer claims databases (APCDs), with increasing interest from multiple stakeholders in improving the value of health care in order to achieve the Triple Aim of better health, better quality, and more efficiency. APCDs are large-scale databases that systematically collect professional, facility, pharmacy, laboratory, and dental claims, as well as eligibility and provider files from private and public payers. AHRQ funded this literature review and environmental scan, which maps an approach to creating an inventory of measures of quality, cost, and utilization of care across settings for potential use with an APCD, noting gaps or current barriers to APCD measurement.
Contents
Executive Summary
Objective
Guiding Questions
Key Findings From Literature Review and Environmental Scan
Major Organizations and Key Contributors to APCDs and Measurement
Major Sources of Measures
Key Categories and Domains for Measures That Leverage APCD Data
Barriers to Using APCDs for Measurement and Potential Solutions
Methodological Issues or Barriers Pertaining to Using APCD Data for Measurement
Conclusion
Project Context
Objective
Background on APCDs
Rationale for Creating and Using an APCD
Unique Aspects of APCD Data
Limitations of APCD Data
Definitions
Guiding Questions
Methods
Search Strategy
Literature Review
Environmental Scan
Findings
Overview
Literature Review
Environmental Scan
Key Categories and Domains for Measures That Leverage Unique APCD Data
Level of Measurement
Measure Type
Measure Domains: Choice, Negotiation, Accountability, Population Health, and Policy
Frameworks of Cost or Price Measures
Sources of Measures for Use With APCDs
Literature Review
Barriers to Use of APCDs for Measurement: Data Completeness, Quality, Standardization, and Access
Barrier 1: Missing Data Elements
Barrier 2: Low Data Quality
Barrier 3: Lack of Data Standardization
Barrier 4: Difficulty With Data Linkage and Aggregation
Barrier 5: Lack of Data Access and Availability
Barrier 6: Policy Barriers and Resource Limitations
Methodological Issues Pertaining to Use of APCD Data for Measurement
Issue 1: Inadequate Measurement Science
Issue 2: Measure Specification
Issue 3: Measure Implementation Issues
Issue 4: Measure Gaps
Conclusion
References
Appendix A. Detailed Literature Search Methodology
Search Strategy Details
Abstraction
Appendix B. Journal Articles Included in Literature Review
Overviews
Research Articles
Appendix C. Environmental Scan Resources Included
AHRQ Expert Materials
APCD Council
Reports, Task Forces, Policy Briefs
Trade, Business, White Papers
Books
APCD Web Sites
Prepared for:
Agency for Healthcare Research and Quality
5600 Fishers Lane
Rockville, MD 20857
www.ahrq.gov
Prepared by:
Naomi S. Bardach, M.D., M.A.S.
Grace A. Lin, M.D., M.A.S.
Edie Wade, Ph.D.
Mitzi Dean, M.S., M.H.A.
Ellen Schultz, M.S. (Project Manager, Prime Contractor)
Kathryn McDonald, M.M. (Principal Investigator, Prime Contractor)
R. Adams Dudley, M.D., M.B.A.
Stanford University (Prime Contractor)
Center for Primary Care and Outcomes Research, School of Medicine
Center for Health Policy, Freeman Spogli Institute for International Studies
Additional Contributors:
APCD Council
Truven Health Analytics
The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality (AHRQ). No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services (HHS).
Disclaimer of Conflict of Interest
None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.
Funding Statement
This project was funded under Contract Number HHSA2902001200003I, Task Order 5, from AHRQ, U.S. Department of Health and Human Services. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or HHS.
Public Domain Notice
This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated.
Suggested citation: All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices and Evidence. Prepared under Contract No. 2902001200003I, Task Order 5. Rockville, MD: Agency for Healthcare Research and Quality; June 2017. AHRQ Publication No. 17-0022-2-EF.
