How scores were computed

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 summary highlights how scores were computed and how key decisions were made.

Measures ("topics")

Each measure, or "topic", is calculated based on a "numerator" divided by a "denominator." The numerator represents the number of people who actually received a recommended health care service. The denominator represents the number of people who should have received that health care service. These results are calculated as the percent of patients who received the health care service for each doctor's office.

Category assignment for public reporting

An average rate (percentage) and standard deviation were calculated from all doctor's offices. The standard deviation is a measure of how much variation there is among doctors' offices from the average. Doctors' offices with percentages higher than one standard deviation above the average are reported as "better." Doctors' offices with percentages more than one standard deviation below the average are reported as "below." Approximately 2/3 of doctors' offices are reported as "average." The same average and standard deviation calculations based on doctors' offices were used to place medical groups into categories. Only doctors' offices with at least 25 people who should have received the service were included in the calculations.

How measures ("topics") were selected

Nationally endorsed and broadly accepted measures were selected to assess a narrow but non-controversial subset of primary care that crosses the age span.

Data source

Claims data were submitted by Oregon's largest health plans: CareOregon; HealthNet of Oregon; Kaiser Permanente; Lifewise Health Plan of Oregon; ODS Health Plan; PacificSource Health Plans; Providence Health Plans; and Regence BlueCross BlueShield. Data submission procedures comply with Health Insurance Portability and Accountability Act (HIPAA).

Data measurement period

Data are from 2006 through first quarter of 2009. The measurement period varies by measure, but in general, the data come from 2008 and 2009.

Measure ("topics") specifications

Specifications were adopted from the National Quality Forum which are based on the widely used Healthcare Effectiveness Data and Information Set (HEDIS) standards that were in effect during the measurement period.

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 period. Doctors were linked to offices and medical groups using a practitioner directory developed for Oregon.

Publicly reported doctors' offices and medical groups

Results are presented for clinics and medical groups with four or more primary care practitioners (doctors, nurse practitioners and physician assistants) with at least 25 patients in the denominator of the measure. A medical group score may include information for clinics that are too small to be reported separately. Scores are shown only if an office or medical group has treated at least 25 patients who meet requirements for that topic during the time period for reporting.

• If the phrase "Results not available" appears, it means the office did not have enough patients for one of the topics on the page, but did have enough patients for other topics on the page.
• If the phrase "Results under review" appears, it means that a doctor's office or medical group asked to have their scores be reconsidered by Partner for Quality Care because they believe the score may be inaccurate. The phrase "Results under review" means the score is still being evaluated.

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 (Diabetes and Women's Prevention), the sort order is based on the average of the score categories ("Better," "Average," or "Below") 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

Oregon's clinic-level medians are compared to the National Committee for Quality Assurance (NCQA) administrative claims quality scores for voluntarily participating health plans.

More detailed technical information is available here.

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