Research Issues when Evaluating the Quality of Health Care

9. Selecting Quality of Care Measures

Exercise 4

This exercise asks you to identify which quality of care measure should be used for each of the research purposes listed.

Instructions:
The research purpose should drive the decision about what quality of care measures should be used.  For each of the following research purposes decide which measure would be most appropriate.

Quality of Care Measures:
Administrative
Medical records
Patient survey
Provider survey
Patient registry

Research Purposes:
1.  A researcher wishes to assess whether physicians explain side effects of a prescribed medication to patients in a way that they can understand.
2.  A researcher wants to study whether African American patients of an appropriate age receive mammograms at the same rate as Caucasian patients.
3.  A researcher wants to identify patients with cardiac disease that affects the left main artery to study outcomes in this group.
4.  A researcher wants to understand if physician awareness and/or agreement with professional society guidelines are related to the extent to which their actions conform with such guidelines.
5.  A researcher wants to study the age and sex distribution of lung cancer in Connecticut.

Answers:
1.  A researcher wishes to assess whether physicians explain side effects of a prescribed medication to patients in a way that they can understand.
[Patient survey]  A patient survey would be the best choice because such interactions are not regularly recorded in medical records and even if they are, only the patient can say whether the instructions were understandable.

2.  A researcher wants to study whether African American patients of an appropriate age receive mammograms at the same rate as Caucasian patients.
[Administrative]  Mammograms are usually indicated in administrative data by a billing code and may be more reliably recorded in administrative data than in medical records.  Patients are not reliable reporters of certain procedures.

3.  A researcher wants to identify patients with cardiac disease that affects the left main artery to study outcomes in this group.
[Medical records]  Anatomical information is usually only available in medical records.

4.  A researcher wants to understand if physician awareness and/or agreement with professional society guidelines are related to the extent to which their actions conform with such guidelines.
[Provider survey]  One can only learn about physician knowledge by asking them directly.

5.  A researcher wants to study the age and sex distribution of lung cancer in Connecticut.
[Patient registry]  A cancer registry probably is the best source of information in states with a well functioning registry.  This has the advantage of including individuals in different care systems throughout the state.