All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices and Evidence

State-and national-level momentum is building to create and maintain all-payer claims databases (APCDs), with increasing interest from multiple stakeholders in improving the value of health care in order to achieve the Triple Aim of better health, better quality, and more efficiency. APCDs are large-scale databases that systematically collect professional, facility, pharmacy, laboratory, and dental claims, as well as eligibility and provider files from private and public payers. AHRQ funded this literature review and environmental scan, which maps an approach to creating an inventory of measures of quality, cost, and utilization of care across settings for potential use with an APCD, noting gaps or current barriers to APCD measurement.

Executive Summary
     Objective
    Guiding Questions
    Key Findings From Literature Review and Environmental Scan
        Major Organizations and Key Contributors to APCDs and Measurement
        Major Sources of Measures
        Key Categories and Domains for Measures That Leverage APCD Data
        Barriers to Using APCDs for Measurement and Potential Solutions
        Methodological Issues or Barriers Pertaining to Using APCD Data for Measurement
    Conclusion
Project Context
    Objective
    Background on APCDs
        Rationale for Creating and Using an APCD
        Unique Aspects of APCD Data
        Limitations of APCD Data
    Definitions
    Guiding Questions
Methods
    Search Strategy
    Literature Review
    Environmental Scan
Findings
    Overview
        Literature Review
        Environmental Scan
    Key Categories and Domains for Measures That Leverage Unique APCD Data
        Level of Measurement
        Measure Type
        Measure Domains: Choice, Negotiation, Accountability, Population Health, and Policy
        Frameworks of Cost or Price Measures
    Sources of Measures for Use With APCDs
        Literature Review
    Barriers to Use of APCDs for Measurement: Data Completeness, Quality, Standardization, and Access
        Barrier 1: Missing Data Elements
        Barrier 2: Low Data Quality
        Barrier 3: Lack of Data Standardization
        Barrier 4: Difficulty With Data Linkage and Aggregation
        Barrier 5: Lack of Data Access and Availability
        Barrier 6: Policy Barriers and Resource Limitations
    Methodological Issues Pertaining to Use of APCD Data for Measurement
        Issue 1: Inadequate Measurement Science
        Issue 2: Measure Specification
        Issue 3: Measure Implementation Issues
        Issue 4: Measure Gaps
Conclusion
References
Appendix A. Detailed Literature Search Methodology
    Search Strategy Details
    Abstraction
Appendix B. Journal Articles Included in Literature Review
    Overviews
    Research Articles
Appendix C. Environmental Scan Resources Included
    AHRQ Expert Materials
    APCD Council
    Reports, Task Forces, Policy Briefs
    Trade, Business, White Papers
    Books
    APCD Web Sites

Prepared for:

Agency for Healthcare Research and Quality
5600 Fishers Lane
Rockville, MD 20857
www.ahrq.gov

Prepared by:

Naomi S. Bardach, M.D., M.A.S.
Grace A. Lin, M.D., M.A.S.
Edie Wade, Ph.D.
Mitzi Dean, M.S., M.H.A.
Ellen Schultz, M.S. (Project Manager, Prime Contractor)
Kathryn McDonald, M.M. (Principal Investigator, Prime Contractor)
R. Adams Dudley, M.D., M.B.A.
Stanford University (Prime Contractor)
Center for Primary Care and Outcomes Research, School of Medicine
Center for Health Policy, Freeman Spogli Institute for International Studies

Additional Contributors:
APCD Council
Truven Health Analytics

The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality (AHRQ). No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services (HHS).

Disclaimer of Conflict of Interest

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

Funding Statement

This project was funded under Contract Number HHSA2902001200003I, Task Order 5, from AHRQ, U.S. Department of Health and Human Services. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or HHS.

Public Domain Notice

This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated.

Suggested citation: All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices and Evidence. Prepared under Contract No. 2902001200003I, Task Order 5. Rockville, MD: Agency for Healthcare Research and Quality; June 2017. AHRQ Publication No. 17-0022-2-EF.

Page last reviewed June 2017
Page originally created June 2017

Internet Citation: All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices and Evidence. Content last reviewed June 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/apcd/envscan/index.html