Integrating Data into Organizational Improvement

Primary and Administrative Data

Quality measurement in healthcare organizations utilizes data from both clinical and business/financial operations. Although patient care and financial data represent two distinct disciplines, they can be combined in quality reporting to form a more complete picture of the level of quality in terms of acceptable health care outcomes and good financial performance.

Clinical (Primary) Data

The source of clinical data, known as primary data, is the medical record or health information system. Data elements abstracted from patient care records can be entered into databases which are used to compile information about specific patient populations, clinical treatment processes, surgical procedures and outcomes of care. For example, a quality report could be generated from the quality management database containing the number of surgical patients treated at the hospital for the month, and how many of them received a prophylactic antibiotic prior to surgery (a clinical process measure).

Administrative Data

While primary data provides the details about clinical processes and outcomes, business operations that support patient care generate data as well. Financial and business data are called administrative data, and can be also be extracted from aggregate or summarized clinical data, like patient volume, length of stay, or the diagnosis codes listed on a billing form. Many quality measures used for inpatient and outpatient quality reporting are based on administrative data, because they are readily available. However, administrative data elements in themselves do not completely represent financial or clinical performance. Clinical and administrative data need to be analyzed together. For example, from a clinical standpoint, a shorter length of stay for heart failure patients may be a positive finding. However, if those patients are discharged and then readmitted to the hospital within 30 days with worsening cardiac output, it leads to increased costs and utilization of resources, which indicates a breakdown in a clinical process and negatively impacts financial performance.

It is important to note that administrative data is often published in quality reports, such as the Joint Commission Quality Check report and CMS’ Hospital Compare. The data in these reports do not give details behind the results, but they can trigger quality improvement projects. Health care organizations can analyze administrative data and drill down to the primary data to identify the source of quality issues.