Comparative Data

Health care organizations collect and maintain large amounts of data in various information systems during the course of day to day business. A hospital or clinic will maintain patient registration records, diagnosis information, insurance plan data, dataon physicians, just to name a few. A clinical laboratory will maintain data on test requisitions, patients, ordering physicians and clinics, etc. This trove of data is then utilized to assist in the organization's operations by optimizing specific functions. Administrative reports are used in this reflective manner to assist in evaluating, and ultimately improving, the general operations. For instance, cost analysis reports, discharge rate, Medicare reimbursement rate reports, etc., may show how an organization is performing over time in specific key areas. However, the real value of an organization’s health care data comes when the data is methodically compared against data from other sources, either internal or external.

According to Wagner, Lee and Glasser, health care data designed to measure specific outcome an organization are known as outcome measures. For instance, the percentage of Medicare claims denied could be an outcome measure at a clinic or hospital. Outcome measures are used in a comparative nature to help optimize the function of an organization. They may be compared to an internal standard or goal or they may be compared against a publicly available standard or benchmark, set by a state licensing agency, accrediting organization or other or body. Using an outcome measure in such a comparative manner is known as benchmark processing. One can imagine an organization using benchmark processing, against an internal benchmark or goal, for the percentage of Medicare claims denied. And further, imagine the power of comparing your clinic’s Medicare denial rate to that of clinics across the country, or clinics with similar specializations within your state.

The concept of the balanced score card takes multiple outcome measures together, each weighted according to a specific goal, and compared against an internal or external standard. The balanced score card allows an organization to focus and adjust the score card parameters, to balance them on those criteria deemed most important to organization’s specific mission. For instance, a clinic that specializes in end of life care may be less concerned with mortality rates and more so with patient quality of life, satisfaction and comfort. A balanced score card approach allows an organization to evaluate and improve their operations around their mission or goals, by weighting their outcome measures accordingly.

The clinical value compass, first produced by the Joint Commission in 1996, attempts to identify the four main competing values a clinic strives to achieve. Each of which, when taken to an extreme will have a negative effect on the remaining competing values. The idea is to keep each of the competing values in balance, so each receives the optimal attention and resources without negatively affecting the others. It provides for a measurement framework where it endeavors to link outcome measures directly to the competing values. The clinical value compass is laid out in the form of a cardinal coordinate compass where each of the competing values corresponds to a cardinal direction: (1) North - functional status, risk status, and well- being; (2) South – costs (direct healthcare costs for physicians, hospitals, drugs, and so on and indirect social costs incurred by the family, employer and community; (3) East - satisfaction with healthcare and perceived benefit; and (4) West - clinical outcomes (such as mortality, morbidity and complications).

The overall goal of the clinical value compass is to provide guidance to health care organizations, to improve their function, lower costs and generally improve the health care provided. “[The health care] provider will need to measure the value of care for similar patient populations, analyze the internal delivery processes, and determine if these changes lead to better outcomes and lower costs.” (Nelson, Mohr, Batalden. 1996.) Projects or initiatives meant to improve health care are urged consider all four quadrants of the compass, even if the primary goal is focused on a single quadrant.

Health care organizations produce an immense amount of data which can be retrospectively used to improve the function of the organization and the overall health care it provides. Outcome measures are invaluable at showing how an organization is performing when compared against an internal or external standard for benchmark processing. Many outcome measures may taken together, properly weighted, and compared for a balanced score card approach. The Joint Commission in 1996 outlined a comprehensive guide for improving health care known as the clinical value compass, which attempts to categorize outcome measures into one of the four competing values. The point of which is to keep the four competing values in balance. If managed properly, no single outcome measure will throw the balance of the compass off, and hinder the remaining competing values..

Wager, K. A., Lee, F. W., Glaser, J. P., & Wager, K. A. (2009). Health care information systems: A practical approach for health care management. San Francisco, CA: Jossey-Bass.

Nelson, Eugene C., Mohr, Julie J., Batalden, Paul B., Plume, Stephen K. “Improving Health Care, Part 1: The Clincal Value Compass.” The Joint Commission Journal on Quality Improvement 22.4 (1996)