Validation

To verify the accuracy of information collected, each quarter a small sample of the data that hospitals submit to the QIO Clinical Warehouse is validated. All hospitals that have submitted abstracted data for six or more cases (discharges) across the four CMS national inpatient topics (Acute Myocardial Infarction, Heart Failure, Pneumonia and Surgical Infection Prevention) during the previous quarter are included in the process.

For each hospital, cases from across the four inpatient topics are randomly selected for validation review by the CMS Clinical Data Abstraction Center (CDAC). The CDAC requests copies of the medical records for reabstraction, then submits data from that validation review to the QIO Clinical Warehouse. A hospital’s data is considered to be “validated” if its overall validation (agreement) score is greater than or equal to (›) 80 percent. If the overall validation rate is less than (‹) 80 percent, the hospital has 10 business days (from the date the result was posted) to submit an appeal to its Quality Improvement Organization (QIO).

All data that has been successfully submitted and is in the QIO Clinical Warehouse is subject to the hospital data validation process. An overview of the processes that make up the entire hospital data validation process are described below:

For each calendar quarter, all hospitals submitting abstracted data will be identified.
For each hospital, all abstracted charts will be enumerated.
A simple random sample of five charts per quarter will be identified from all hospitals with a minimum of six discharges in the QIO Clinical Warehouse. The sample is selected from all the cases submitted and is not topic-specific.
The CDAC will request the paper medical records for each of the sampled charts.
The CDAC will re-abstract the chart using the CMS Abstraction & Reporting Tool (CART). The relevant differences will be identified and the CDAC will assign a reason code to each difference noted.
The results of the re-abstraction will be stored in the QIO Clinical Warehouse and made available to the QIO to provide feedback to each hospital.
Hospitals will receive educational feedback including an overall reliability rate and case details on each abstraction.
Based upon the CDAC re-abstraction, the percent agreement at the element level will be calculated. Hospitals that reach or exceed the 80% pre-determined threshold would be considered to be supplying valid data for that quarter.
Measures for which there are found to be significant errors may not be posted on the website.

Visit QualityNet for more information on validation (link opens a new window)

Questions?

For questions regarding Validation contact Sue Bethel, RN Review Coordinator at 303.695.3300, extension 3330 or sbethel@coqio.sdps.org.

The Colorado Foundation for Medical Care (CFMC), the Medicare quality improvement organization for Colorado, prepared this material under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS Policy.