DNP 825 Topic 6 Discussion Question Two
DNP 825 Topic 6 Discussion Question Two
How can large, aggregated databases be used to improve population health?
Key Attributes of Databases
In reviewing the considerable variation in databases that might be accessed, controlled, or acquired by HDOs, the committee sought a simple way to characterize them by key attributes. It decided on two critical dimensions of databases: comprehensiveness and inclusiveness. (Because these terms are used with distinct meanings in this report, they are italicized whenever used.)
Comprehensiveness. Comprehensiveness describes the completeness of records of patient care events and information relevant to an individual patient (Table 2-1).4 It refers to the amount of information one has on an individual both for each patient encounter with
the health care system and for all of a patient’s encounters over time (USDHHS, 1991, refers to this as completeness). A record that is comprehensive contains: demographic data, administrative data, health risks and health status, patient medical history, current management of health conditions, and outcomes data. Each category is described briefly below.
Demographic data consist of facts such as age (or date of birth), gender, race and ethnic origin, marital status, address of residence, names of and other information about immediate family members, and emergency information. Information about employment status (and employer), schooling and education, and some indicator of socioeconomic class might also appear.
Administrative data include facts about health insurance such as eligibility and membership, dual coverage (when relevant), and required copayments and deductibles for a given benefit package. With respect to services provided (e.g., diagnostic tests or outpatient procedures), such data also typically include charges and perhaps amounts paid. Administrative data commonly identify providers with a unique identifier and possibly give additional provider-specific facts; the latter might include kind of practitioner (physician, podiatrist, psychologist), physician specialty, and nature of institution (general or specialty hospital, physician office or clinic, home care agency, nursing home, and so forth).
Health risks and health status Health risk information reflects behavior and lifestyle (e.g., whether an individual uses tobacco products or engages regularly in strenuous exercise) and facts about family history and genetic factors (e.g., whether an individual has first-degree family members with a specific type of cancer or a propensity for musculoskeletal disease).
Health status (or health-related quality of life), generally reported by individuals themselves, reflects domains of health such as physical functioning, mental and emotional well-being, cognitive functioning, social and role functioning, and perceptions of one’s health in the past, present, and future and compared with that of one’s peers. Health status and quality-of-life measures are commonly considered outcomes of health care, but evaluators and researchers also need such information to take account in their analyses of the mix of patients and the range of severity of health conditions.
Patient medical history involves data on previous medical encounters such as hospital admissions, surgical procedures, pregnancies and live births, and the like; it also includes information on past medical problems and possibly family history or events (e.g., alcoholism or parental divorce). Again, although such facts are significant for good patient care, they may also be important for case-mix and severity adjustment.
Current medical management includes the content of encounter forms or parts of the patient record. Such information might reflect health screening, current health problems and diagnoses, allergies (especially those to medications), diagnostic or therapeutic procedures performed, laboratory tests carried out, medications prescribed, and counseling provided.
Outcomes data encompass a wide choice of measures of the effects of health care and the aftermath of various health problems across a spectrum from death to high levels of functioning and well-being; they can also reflect health care events such as readmission to hospital or unexpected complications or side effects of care. Finally, they often include measures of satisfaction with care. Outcomes assessed weeks or months after health care events, and by means of reports directly from individuals (or family members), are desirable, although these are likely to be the least commonly found in the secondary databases under consideration here.
The more comprehensive the database is, the more current and possibly more sensitive information about individuals is likely to be. This suggests that comprehensiveness as envisioned here will have a direct correlation with concerns about privacy and confidentiality. By analogy, the Department of Defense treats information with increasingly higher levels of security as it becomes more comprehensive, even when the aggregated information is not considered sensitive.