December 2007
Prepared by:
Stephanie S. Teleki, Melony e.s. Sorbero, Lee Hilborne, Susan Lovejoy, Lily Bradley, Ateev Mehrotra, Cheryl l. Damberg
RAND Corporation
This product is part of the RAND
Health working paper series.
RAND working papers are intended
to share researchers’ latest findings
and to solicit additional peer review.
Prepared for:
Office of the Assistant Secretary for Planning
and Evaluation (ASPE)
U.S. Department of Health and Human Services
(HHS)
This work was sponsored by ASPE and CMS under Task Order No. DHHSP2330000T under Contract No. 100-03-0019, for which Susan Bogasky served as the Project Officer.. The findings and conclusions of this report are those of the authors and do not necessarily represent the views of ASPE or HHS. |
This report is available on the Internet at:
http://aspe.hhs.gov/health/reports/08/outpatient.html
Outpatient.pdf (135 pages)
How to Obtain a Printed Copy
PREFACE
TABLE OF FIGURES
TABLE OF TABLES
EXECUTIVE SUMMARY
ACKNOWLEDGEMENTS
GLOSSARY OF ABBREVIATIONS
I. INTRODUCTION
Background
Purpose of this Study
II. ANALYTIC FRAMEWORK AND METHODS
Defining the Hospital Outpatient Setting
Methods
Analysis of Medicare Hospital Outpatient Data
Scan of Existing Measures
Discussions with Medical Specialty Societies and Hospital Associations
Synthesis of Findings from Environmental Scan
III. FINDINGS FROM THE ENVIRONMENTAL SCAN
Findings from Analysis of Medicare Data
Overall Findings
Common Reasons for Visits in the Hospital Outpatient Setting and Emergency Department
Most Commonly Provided Services/Procedures and Associated Diagnoses in the Hospital Outpatient Setting and Emergency Department
Services/Procedures and Associated Diagnoses Representing the Largest Share of Costs in the Hospital Outpatient Setting and Emergency Department
Most Frequent Used Drugs and Biologicals in the Hospital Outpatient Setting and Emergency Department
Findings from the Scan of Existing Measures and Discussions
Existing Measures
Measures in the Development Pipeline
Measures that Are Lacking
IV. SYNTHESIS OF EXISTING MEASURES AND IDENTIFICATION OF GAPS
Mapping of Clinical Measures
Syntheses of Measures
Synthesis of Measures Relating to Reasons for Visits
Synthesis of Measures Relating to Services/Procedures
Synthesis of Measures Relating to Drugs and Biologicals
Identification of Gaps in Measures
Effectiveness
Efficiency
Equity
Patient-Centeredness
Safety
Timeliness
Challenges in Performance Measurement
V. CONCLUSIONS
Study Limitations and Considerations for Future Analysis and Measurement Development
Next Steps for Consideration
APPENDIX A: ADDITIONAL MEASURES UNDER CONSIDERATION FOR INCLUSION IN HOSPITAL OUTPATIENT QUALITY DATA REPORTING PROGRAM (HOP QDRP) 65
APPENDIX B: LIST OF ORGANIZATIONS INCLUDED IN ENVIRONMENTAL SCAN DISCUSSIONS
APPENDIX C: DIAGNOSES ASSOCIATED WITH VISITS TO HOSPITAL OUTPATIENT AND EMERGENCY DEPARTMENTS BY MEDICARE BENEFICIARIES, 2005 \
APPENDIX D: MEASURES POTENTIALLY RELEVANT TO THE HOSPITAL OUTPATIENT SETTING AND EMERGENCY DEPARTMENT
APPENDIX E: DESCRIPTION OF PRIMARY DEVELOPERS OF CANDIDATE MEASURES
REFERENCES
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Last updated: 1/10/2008