Understanding doctor's office scores

Measuring the quality of health care requires a number of complicated technical decisions. Partner for Quality Care manages a community-wide process to resolve these complex issues by seeking input from key health care stakeholders — those who give care, get care, and those who pay for health care. This section highlights how scores were computed and how key decisions were made.

 

How scores were computed

Scores for each measure, or "topic", are calculated by comparing the number of people who actually received a recommended health care service to the number of people who should have received that health care service. To determine who received recommended health care services, Partner for Quality Care receives claims (billing) data from Oregon’s largest health plans, the Oregon Health Authority’s Division of Medical Assistance Programs, and Medicare fee-for-service. The measures that include Medicare fee-for-service data include the following:

  • Heart Disease Care: Cholesterol Test
  • Women’s Health: Mammograms (Breast Cancer Screening)
  • Diabetes Care: Blood Sugar Test
  • Diabetes Care: Cholesterol Test

To learn more about the Qualified Entity program that allows us to receive and use Medicare fee-for-service data, visit cms.hhs.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/QEMedicareData/index.html. Our procedures comply with the Health Insurance Portability and Accountability Act (HIPAA).

 

How measures ("topics") were selected

Nationally endorsed measures were selected based on their usefulness to our community. Our goal is to help Oregonians better understand recommended care for common chronic conditions as well as essential preventive services.

 

Data measurement period

Data is from July 1, 2013 – June 30, 2014. The measurement period varies by measure, but in general, the data come from 2013 and 2014. Kaiser data included in these measures covers January 1, 2013 – December 31, 2013. This is due to a delay in data receipt and processing. It was determined that this round could be substituted because it overlaps the report period by 6 months, and Kaiser rates change minimally between Q Corp data rounds (<1%).

 

Assigning patients to a doctor's office

Accountability for a patient's care was assigned to a doctor's office based primarily on which adult primary care doctor the patient saw the most during the measurement year and the year prior. Doctors were linked to offices and medical groups using a provider directory developed for Oregon.

 

Sorting order

Results for doctors' offices and medical groups may be viewed alphabetically or based on score. Unless otherwise specified, results are automatically sorted based on score, from highest to lowest. For Heart Disease and Asthma Medication, the order is based on the actual percentage that was used to place doctors' offices and groups into the categories: "Better," "Average," or "Below." This percentage is not available on the website.

When there are multiple topics on one page (such as mammogram, pap test and chlamydia test for women's health), the sort order is based on the average of the scores ("Better," "Average," or "Below") for each topic rather than the underlying percentage. For the purposes of calculating the sorting order for these topics, a "Better" score is three points, an "Average" score is two points and "Below" is one point. If "Results not available" is the score for one of the topics, that score is excluded for the purposes of sorting.

In situations where clinics or medical groups are tied on the sort order, they are listed alphabetically.

 

National comparisons

Averages for Oregon clinics are compared to the National Committee for Quality Assurance (NCQA) quality scores that are computed using claims data from voluntarily participating health plans.

 

More detailed technical information is available here.