Including disenrollees in CAHPS managed care health plan assessment reporting

This study addresses the question whether basing plan quality ratings on the data of both enrollees and disenrollees provides more accurate reporting. We test whether including disenrollee data in calculating the CAHPS scores, reported in health plan assessments, will result in lower scores indicating lower plan quality. Adding disenrollees results in statistically significant score decreases. Factors likely to result in larger score changes when disenrollees are included are explored. The study concludes that though final determinations should rest on more extensive data, that there is evidence to suggest that including disenrollee feedback improves accuracy.     

Validity of original studies in health technology assessment reports: significance of standardized assessment and reporting

OBJECTIVES: As health technology assessments (HTA) may have considerable impact on health-care decisions, it is essential to guarantee the expected quality of these assessments. Variations in the methods used or lack of transparency can affect the important role of HTA reports. METHODS: In our study, we analyzed the methods used in two corresponding HTA reports to assess the validity of two key papers, which were included in both reports. Also the discussions and the final conclusions of both reports were compared. RESULTS: The authors of the two HTA reports used different instruments to assess the validity of the original studies. A minor problem is differences that were found in the assessments of identical validity aspects of the included studies and in the information provided in the HTA reports. A more serious problem was found in both HTA reports which identified the weakness of the key papers and expressed these limitations in the discussions (read mainly by scientists) but not in the conclusions (read mainly by policy-makers). CONCLUSIONS: The results of this study may be important for any institution that prepares recommendations for policy-makers. In the case of HTA reports, no new checklists are necessary as the checklist offered by the INAHTA contains the needed information. It may be necessary, however, to consider an "intramural quality board," which helps the member organizations guarantee both the transparency of the original studies included in HTA reports and the transparency of the HTA report itself.     

Community-based health reporting

A development monitoring service at the local level was established in 1978/79 in several communities in Kerala State (India) to collect socioeconomic and health-related data. These were collected from key community members and by household surveys using paid local staff as interviewers. Selected results for five years from three geographically distinct areas are presented, for three categories of data: health service infrastructure, infant mortality and overall morbidity, and weight and height of children under 10 years old. The three areas were a fishing village (A), a relatively remote highland community (B) and an agricultural area close to the state capital (C). During the five-year period there were rather modest improvements in the delivery of health and other services. Infant mortality rates fluctuated between 14 and 91 per 1,000 live births, reflecting the fact that the sample size (10,000 to around 25,000 for each area) was inadequate for calculating that rate. Morbidity rates also fluctuated markedly, without showing any definite trend. However, morbidity was defined as illness resulting in the inability to carry out normal activities, thus excluding cases of worm infestation and much diarrhoea, for example. A detailed analysis of reported symptoms for one year showed that respiratory tract diseases accounted for about half the cases of illness reported. The percentage of children with abnormally low weight- or height-for-age fell markedly in one area over three successive years (height-for-age from 41.6% to 33.2%, weight-for-age from 58.5% to 44.7%), but were significantly greater in another area with a higher average income, indicating that economic factors alone were not responsible for the improvement.(ABSTRACT TRUNCATED AT 250 WORDS)     

Occupational health reporting systems--USA

The three-fold purpose of this paper is to (1) describe the occupational hazard and health effect information systems used by the National Institute for Occupational Safety and Health (NIOSH), (2) highlight the parts of these data systems that are relevant to the topic of this dermatologic disease and chronic trauma workshop, and (3) to note the inadequacies of existing data systems in the United States.     

Occupational health reporting systems in Sweden

Legislation covering worker's compensation influences occupational health reporting and data gathering. Five programs recently enacted in Sweden are outlined and discussed. These include: 1) Labour Market No-Fault Liability Insurance, 1974; 2) The National Sickness Insurance Act, 1977; 3) The Work Injury Insurance Act, 1977; 4) The Work Environment Act, 1977; 5) The Occupational Injury Information System, 1979.     

Perspectives on gender sensitive health reporting

Based on the different health status of women and men the advantages of gender-sensitive compared to gender-differentiated health reporting are pointed out. The main focus is on considerations how gender-sensitive perspectives can be implemented within health monitoring at federal level. Possible guidelines are suggested.     

Measurement of health,health inequality,and reporting heterogeneity

Using representative survey data of the German Socio-Economic Panel Study (SOEP) for 2006, we show that the magnitude of health inequality measures like the concentration index (CI) depends crucially on the underlying health measure. The highest degree of inequality is found when dichotomized subjective health measures like health satisfaction or self-assessed health (SAH) are employed. With the use of SF12, a generic health measure, the inequality indicator is reduced by a factor of ten. We show that the process of dichotomizing variables leads to such huge differences. Cardinalizing SAH by means of the SF12 leads to similar results to those with the pure SF12 measure. Employing generic health measures used with other populations like the Canadian HUI-III or the Finnish 15D to cardinalize SAH has a significant impact on the degree of inequality measured. Finally, by contrasting the physical health component of the SF12 to the unambiguously objective grip strength measure, we provide evidence of the presence of income-related reporting heterogeneity in generic health measures.     

Standardized health plan reporting in four areas of preventive health care

PURPOSE: This paper discusses first-year reporting by commercial managed care organizations (MCOs) of new measures in the 2000 Health Plan Employer Data and Information Set (HEDIS). The four measures include screening for chlamydia in young women, controlling blood pressure to <140/90mmHg in patients with hypertension, prescribing appropriate medications for persons with asthma (treatment adherence), and providing counseling to women about managing menopause (survey measure). METHODS: In 2000, some 384 commercial MCOs submitted HEDIS results to the National Committee for Quality Assurance (NCQA). Results of the four new HEDIS measures were linked with audit reports and other health plan data-reporting characteristics collected by NCQA. Performance variables were stratified by MCOs' willingness to report their results publicly, size of enrollment, performance on other (non-first year) HEDIS measures, and data collection issues. RESULTS: The mean average performance on the four measures was lowest in chlamydia screening in women (16% for ages 21 to 26 years) and highest for use of appropriate medications for people with asthma (59% for ages 18 to 56 years). The mean average of controlling high blood pressure was 39%. Scores on the management of menopause (MoM) measure ranged from 33.7 (for rating of information) to 72.6 (for exposure to counseling). CONCLUSIONS: The initial MCO baseline rates reported here suggest that much work is needed to improve the quality of care in these areas. Plan characteristics shown to be associated with higher performance on existing HEDIS measures do not predict performance on the new measures. In addition, fewer plans reported on the new measures than on established HEDIS measures. To ensure continued improvement in chlamydia screening in women, controlling high blood pressure, use of appropriate medications for people with asthma, and MoM, incentives for tracking and reporting on these health issues must be explored.     

Disease reporting from an automated laboratory-based reporting system to a state health department via local county health departments

OBJECTIVE: The authors assessed the completeness of disease reporting from a managed care organization's automated laboratory-based reporting system to the California Department of Health Services (CDHS) via local public health departments. METHODS: The authors identified all positive laboratory tests for 1997 from the computerized database of Kaiser Permanente Northern California for seven infections for which there are statutory reporting requirements: Campylobacter jejuni, Chlamydia trachomatis, Cryptosporidium parvum, hepatitis A, Neisseria meningitidis, Neisseria gonorrhoeae, and Salmonella (N = 7,331 reports). Cases were then matched by computer query to records of cases reported to CDHS. To determine why cases were not found in CDHS records, a sample of un-matched cases was searched at two county health departments. RESULTS: Overall, 84.5% (95% CI 83.4, 85.6) of the laboratory reports submitted with accompanying demographic information were successfully matched with cases in the CDHS disease surveillance database. Frequency of matching for specific diseases ranged from 79.4% (95% CI 75.6, 83.3) for N. gonorrhoeae to 88.4% (95% CI 85.3, 91.6) for C. jejuni. Reports were more likely to be matched when the county of residence was the same as the county of the health care facility. At the county level, reasons for failure of cases to be forwarded to CDHS included: errors due to manual data entry, failure to forward information from the county of diagnosis to the county of residence, and incorrect disease coding. CONCLUSION: Automated laboratory-based reporting is highly effective, but some data are lost with off-line transfer of information. To optimize surveillance accuracy and completeness, reporting at all levels should be done via direct electronic data transfer.     

Where occupational health reporting systems go wrong

Reporting of occupational illness occurs in two statistical systems maintained by the Bureau of Labor Statistics. The first system, the core program established under the Occupational Safety and Health Act of 1970, provides national data by industry from direct reporting of employers in annual (mail) surveys. The second system, based on worker's compensation records, provides data on the characteristics of injuries and illnesses and the workers involved. Although skin diseases are reported separately in both systems, there is usually insufficient detail to establish etiology precisely. Conceptual and practical problems hamper the building of a substantive occupational illness data base.     

Responsibility of health providers in domestic violence reporting

Domestic violence reporting by health providers contributes to the epidemiological assessment of the magnitude of the problem, which allows the development of specific programs and actions. The aim of the study was to assess the level of responsibility of these providers towards reporting violence, especially domestic violence, and potential related legal and ethical implications. The Brazilian legislation and ethics code of Medicine, Dentistry, Nursing and Psychology were studied. Legal sanctions are found in the Criminal Law of Misdemeanor Offenses, the Child and Adolescent Statute, the Elderly Statute and in the law establishing mandatory reporting of violence against women. There are also penalties in all ethics codes reviewed. It is concluded that health providers have the legal duty of reporting known domestic violence cases and they can even be charged with omission.     

Optimal quality reporting in markets for health plans

Quality reports about health plans and providers are becoming more prevalent in health care markets. This paper casts the decision about what information to report to consumers about health plans as a policy decision. In a market with adverse selection, complete information about quality leads to inefficient outcomes. In a Rothschild-Stiglitz model, we show that averaging quality information into a summary report can enforce pooling in health insurance, and by choice of the right weights in the averaged report, a payer or regulator can induce first-best quality choices. The optimal quality report is as powerful as optimal risk adjustment in correcting adverse selection inefficiencies.     

Subjective health measures and state dependent reporting errors

The use of subjective health measures in empirical models of labour supply and retirement decisions has frequently been criticized. Responses to questions concerning health may be biased due to financial incentives and the willingness to conform to social rules. The eligibility conditions for some social security allowances, notably Disability Insurance benefits, are contingent upon bad health. Even if the decision to apply for a disability allowance is to some extent motivated by financial considerations or a relatively strong preference for leisure, respondents will be inclined to play down these motives and emphasize the importance of their health condition. As a consequence, reporting errors may depend on the labour market status of the respondent and self-reported health variables will be endogenous in labour supply and retirement models. The objective of this paper is to assess the importance of state dependent reporting errors in survey responses and to propose and estimate a model that can be used to account for this kind of systematic mis-reporting. The estimation results indicate that among respondents receiving Disability Allowance, reporting errors are large and systematic. Using such subjective health measures in retirement models may therefore seriously bias the parameter estimates and the conclusions drawn from these.     

Public reporting of quality information on Medicaid health plans

Transparency through public reporting of quality data is key to achieving the Institute of Medicine's (IOM) vision for 21st century health care. This article reviews the status of States' voluntary public reporting of Medicaid managed care (MMC) quality data, and analyzes these data. Twenty-one States, including 17 of the 20 largest managed care States, have made plan-level data publicly available online, although the data are sometimes thin, with few measures reported, hard-to-access, and old. We conclude that CMS could better leverage the power of public reporting for quality improvement (QI) by increasing the visibility of health plan employer data and information set (HEDISV) data that States already collect.