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. 2012:2012:988-96.
Epub 2012 Nov 3.

Issues in creating and maintaining value sets for clinical quality measures

Rainer Winnenburg  1 , Olivier Bodenreider
Affiliations

Issues in creating and maintaining value sets for clinical quality measures

Rainer Winnenburg et al. AMIA Annu Symp Proc. 2012.

Abstract

Objective: To develop methods for assessing the validity, consistency and currency of value sets for clinical quality measures, in order to support the developers of quality measures in which such value sets are used.

Methods: We assessed the well-formedness of the codes (in a given code system), the existence and currency of the codes in the corresponding code system, using the UMLS and RxNorm terminology services. We also investigated the overlap among value sets using the Jaccard similarity measure.

Results: We extracted 163,788 codes (76,062 unique codes) from 1463 unique value sets in the 113 quality measures published by the National Quality Forum (NQF) in December 2011. Overall, 5% of the codes are invalid (4% of the unique codes). We also found 67 duplicate value sets and 10 pairs of value sets exhibiting a high degree of similarity (Jaccard > .9).

Conclusion: Invalid codes affect a large proportion of the value sets (19%). 79% of the quality Measures have at least one value set exhibiting errors. However, 50% of the quality measures exhibit errors in less than 10 % of their value sets. The existence of duplicate and highly-similar value sets suggests the need for an authoritative repository of value sets and related tooling in order to support the development of quality measures.

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Figures

Figure 1
Figure 1
Organization of Quality measures. Each spreadsheet contains data for a specific part of clinical care (e.g. Appropriate testing for children with pharyngitis). For each aspect (e.g., Group A Streptococcus Test, etc.), a GROUPING complies one or several code lists, each specific to one code system (e.g., CPT, LOINC, SNOMED CT, ICD9, etc.).
Figure 2
Figure 2
Assessing the validity of code.
Figure 3
Figure 3
Typical examples for code lists with multiple names
Figure 4
Figure 4
Effect of invalid codes on value sets and Quality Measures
See this image and copyright information in PMC

References

    1. National Quality Forum (NQF) Available from: http://www.qualityforum.org.
    1. International Organization for Standardization (ISO) Available from: http://www.iso.org/iso/en/ISOOnline.frontpage.
    1. Health Level Seven International (HL7) Object Identifier Registry Available from: http://www.hl7.org/oid/
    1. McCray AT, Srinivasan S, Browne AC. Lexical methods for managing variation in biomedical terminologies. Proc Annu Symp Comput Appl Med Care; 1994. pp. 235–9. - PMC - PubMed
    1. Nelson SJ, et al. Normalized names for clinical drugs: RxNorm at 6 years. Journal of the American Medical Informatics Association : JAMIA. 2011;18(4):441–8. - PMC - PubMed

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