Feasibility and Utility of Adding Disease-Specific Outcome Measures to Administrative Databases To Improve Disease Management

doi:10.1059/0003-4819-127-8_Part_2-199710151-00060

Feasibility and Utility of Adding Disease-Specific Outcome Measures to Administrative Databases To Improve Disease Management

Matthew H. Liang, MD, MPH; and
Nancy Shadick, MD, MPH

From Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “Measuring Quality, Outcomes, and Cost of Care Using Large Databases: The Sixth Regenstrief Conference.” To see a complete list of the articles included in this supplement, please view its Table of Contents. Acknowledgments: The authors thank Dr. Frederic Wolinsky for comments on an earlier draft. Grant Support: By grant P60-36308 from the National Institutes of Health. Dr. Shadick is a recipient of an Arthritis Investigator Award from the Arthritis Foundation. Requests for Reprints: Matthew H. Liang, MD, MPH, Division of Rheumatology, Immunology, and Allergy, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Current Author Addresses: Drs. Liang and Shadick: Division of Rheumatology, Immunology, and Allergy, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Abstract

To increase the utility of administrative databases, it has been recommended that they include disease-specific, patient-centered outcome measures. This paper reviews practical and theoretical considerations and the critical evidence to support this recommendation. The strengths and weaknesses of the recommended approach are illustrated by examples of disease-specific measures for arthritis and musculoskeletal diseases. Current experience suggests that routine capture of these measures in administrative databases has formidable practical problems and would be unlikely to affect patient care. They could be used as gross indicators of a population's experience but would be insensitive to clinically meaningful improvement on the level of the individual patient. By themselves, these measures are unlikely to identify actionable strategies to improve outcomes, but they could improve efficiency. Overall, implementing this type of disease management improvement strategy would have little value in direct patient care and would be costly.