PURPOSE: The technology and sophistication of health care utilization databases have expanded over the last decade to include results of lab tests, vital signs, and other clinical information. This review provides an assessment of the challenges of conducting Asthma/COPD outcomes research in national and regional datasets of different origins and their potential application towards the assessment of national health policy issues.
METHODS: Databases and their application to measuring outcomes for Asthma/COPD are described including national and local commercial insurance and Utah Medicaid reimbursement claims, University of Utah community clinics and national electronic medical records (EMR). The similarities and differences in measuring adherence to the Asthma and COPD evidence-based practice guidelines generated by the NIH and HEDIS quality indicators in these databases are examined. Case studies are used to assess the adherence to guidelines and gauging conforming to quality indicators before and after their publication, methodological and analytical challenges to conduct outcomes evaluations as well as strategies and techniques to overcome limitations.
RESULTS: The richness and depth of information on “real world” use of health services for large population-based patient cohorts at relatively low cost render such databases an attractive resource for outcomes research. An EMR is the only source of information for pulmonary function tests, but low frequency of its ordering in primary care may be an issue. Commercial and Medicaid databases afford an opportunity of assessing adherence by examining refill patterns. These data can be used to explore impact of variation in healthcare provision on clinical and economic outcomes. The extent to which databases have access to specific lab data and, therefore, the potential to evaluate outcomes varies.
CONCLUSION: Various sources of information exist to perform outcomes research. Pros and cons exist in each type of dataset. It is important to understand the desired endpoints and research questions when deciding upon a data source.
CLINICAL IMPLICATIONS: The ability to conduct Asthma/COPD outcomes research in national and regional datasets is critical to the assessment of national health policy issues.
DISCLOSURE: Carl Asche, None.