. "Health Databases and Health Database Organizations: Uses, Benefits, and Concerns." Health Data in the Information Age: Use, Disclosure, and Privacy. Washington, DC: The National Academies Press, 1994.
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TABLE 2-2 Inclusiveness: Populations Covered as a Critical Dimension of Health Care Databases
All persons physically resident in the 50 states, District of Columbia, Puerto Rico, and the Trust Territories
All persons resident in a defined geopolitical or other describable area, such as an MSA
HMO, indemnity, Medicaid, none
Site and care setting
Hospital, nursing home, clinic
Disease, injury type
Cancer, trauma registry
Age or other demographic characteristic
Age 65 or older, belonging to a defined ethnic or racial group
NOTE: MSA = Metropolitan statistical area.
can and do appear in more than one such database. The potential benefits of the database, however, will increase as the database moves toward being inclusive of the entire population of a defined geographic area.
HDOs will have to be clear about what groups are missing when describing their databases and the results of their analyses. Perhaps more important, HDOs should seek ways to ensure that all relevant populations are included, so that their analyses accurately reflect the population of the region and, thereby, yield estimates of the levels of underuse of health care in their respective regions.
Table 2-3 summarizes these two attributes.6 The dummy matrix, al-
The congressional Physician Payment Review Commission (PPRC) has been in the forefront of advocates for a national data system (PPRC, 1992, 1993). In its 1992 annual report, PPRC described an "all-patient database" [emphasis in the original], conceptualized as a "network of local or regional data processing centers ... to streamline the transfer of administrative information for payment and service-use tracking purposes" (p. 269). The report goes on to posit "parallel organizing entities ... to coordinate the use of these data [and] the data processing centers and the organizing entities would make up an all-patient data network" (p. 269). The commissioners also envisioned the network evolving into a "means to link and assimilate more detailed clinical information." Although the general thrust of the PPRC idea is consonant with the long-range views of this IOM committee, the specific understanding of what a database or network is differs. In defining an all-patient database, the commissioners appear to have in mind what this committee terms inclusiveness; what the PPRC report lays out as "core data elements'' in that database approaches what the IOM report calls comprehensiveness.