The Use of Claims-Based Data in Inpatient Public Reporting and Pay-for-Performance Programs: Is There Opportunity for Improvement?

Purpose: This study examined whether self-reported, facility-based data validation practices for claims submissions of cases flagged as Patient Safety Indicators (PSIs) match professional and regulatory standards.

Methods: The National Association of Healthcare Quality members who work in an inpatient setting were invited to complete an anonymous survey to self-report their practices around facility-based data validation of PSI cases.

Results: The authors found widespread variation in how PSI administrative data are internally validated; inconsistency in the education and training required of staff who participate in this process; and relatively poor compliance with physician query guidelines and documentation amendment standards.

Conclusions: The self-described wide variation and nonadherence to professional and regulatory standards within the facility-based validation process for PSIs raise concerns about the use of these data to make meaningful judgments about quality and safety. The authors recommend a standardized approach to reporting and validation be implemented for use of PSIs in public reporting and pay-for-performance programs.