THE UNIFORM CLINICAL-DATA SET - AN EVALUATION OF THE PROPOSED NATIONAL DATABASE FOR MEDICARES QUALITY REVIEW PROGRAM

The accuracy, reliability, and validity of the Medicare Peer Review Or ganization (PRO) review process have all been questioned. Evidence con cerning the PRO program's effect on cost and quality of care remains l acking. The Health Care Financing Administration has thus committed it self to reform, and the uniform Clinical Data Set (UCDS) has been prop osed as the national database for Medicare's quality review program. T he UCDS is an automated, computerized data set designed to standardize the evaluation of quality. It should allow an objective, consistent, and efficient process for peer review, based on explicit decision crit eria and on aggregated information about patterns of care and quality. But is this truly so? We review the existing evidence on the UCDS and compare it with the current PRO reviews of quality, concluding that a lthough the UCDS can potentially improve the accuracy and the reliabil ity of data abstraction and the validity of reviews, this remains to b e shown. Preliminary data on the UCDS suggest that work is needed befo re it can meet appropriate expectations for a national database for qu ality assessments. We also propose a model for reviews of quality in w hich we show that reviews of care done in the context of internal qual ity improvement programs will differ in goals and intensity from revie ws of care done at the national level. We suggest that the UCDS has a unique, but limited role-that of national surveillance of practice pat terns. Detailed assessments of quality are more appropriately done at local or institutional levels.