Fill data gaps

Fill data gaps

You may not have all of the data you need for your measurement strategy. Patient experience and cost data in particular may be especially difficult to come by. Here we offer strategies to help get needed data.


Your measurement strategy may require new data collection. This is not uncommon—based on our experience, community health centers are most likely to find gaps in patient experience and cost data. This section describes some ways to measure patient experience and cost and offers advice about how to fill data gaps.

In this video, Dr. Boutwell talks about data gaps and two easy ways to fill them:

  • Think about what additional information you can easily collect.
  • Reach out to partners, including hospitals, payers and other community providers.

Fill gaps in patient experience data

Measuring patient experience can be challenging and time consuming. Community health centers may have limited resources to administer patient surveys and prioritize data analysis, which are necessary to using patient experience to guide quality improvement. It can be tricky to select appropriate survey items and instruments. Yet, some community health centers have developed innovative approaches to gathering data from patients. Read more under “See What Your Colleagues Are Doing.” They also advise that it is important to consider cost, administration complexity (e.g., survey sampling), and availability of existing survey items for topics of interest.

Fill gaps in cost data

Measuring cost is essential to analyze value. But, some health plans may be reticent to share data. It may be too difficult to identify one community health center’s patients from all enrollees, too time-consuming, or health plans may lack bandwidth to do this extra work. Yet, some community health centers have succeeded in getting data from payers. Here’s their advice:

Work with payers

Find community health center and health plan leaders—for example, chief financial officers, chief operating officers, controllers—who can champion data exchange. Champions can facilitate relationship building between community health centers and health plans. They are able to articulate to others, such as colleagues in contracts or information technology, the benefits of data exchange and explain why community health centers need data to demonstrate value.

Start with a small data request from a health plan. For example, ask for data on the 100 costliest patients in your chosen topic area (e.g., hypertension or diabetes) to target for a quality improvement initiative. Use data gathered later on the same patients to demonstrate the value of your initiative. Showing the benefits to the plan may persuade the plan to expand data sharing to other populations.

Work with hospitals

If working with payers is impractical, you could obtain hospital data to develop resource utilization measures as a proxy for cost. Avoidable emergency department utilization is one often-used cost proxy to consider. Others include 30-day readmissions, ambulatory sensitive inpatient hospital admissions, and non-emergent use of the emergency department.

Establish data agreements

Finally, execute a data-sharing agreement with the health plan and set up a secure server before exchanging data. You might use a business associate agreement (BAA) or a data use agreement (DUA). These agreements help community health centers and health plans to articulate data use for approved purposes and to ensure secure transfer, storage, and destruction of personal health information.

Test measures in clinical settings and get staff input

For new measures, and even for existing measures, you will want to collect the measures in a clinical setting, get staff input, and then refine your measurement strategy, if needed, to make sure you are including the best possible measures to demonstrate value.

Questions to ask include: Do the data meet original expectations? Can you get the data on a timely, regular basis? Are the data accurate and reliable? Are providers or other staff entering it consistently?

The review process creates a wonderful opportunity for providers and staff to verify accuracy and/or point out where tweaks are needed. Ask what they think can be improved. The broader the inclusion and conversations around measurement and improvement, the more likely that you will create a data-focused culture within the community health center and sustain improvement efforts.

In this video, Dr. Boutwell describes one community health center’s experience with refining measures based on clinical experience. 

As your organization becomes more conscious of measurement and adept with data collection, measuring progress in health, patient experience, and costs will become easier. Keep in mind that a meaningful measurement strategy can take a lot of work, time, and iterations to get the measures to where you want them to be in terms of accuracy and reliability. 

Case study part 3: Hypertension quality improvement program

The following is a continuation of the case study begun in Step 2. Next, Part 3 of the case study will demonstrate how to fill any gaps in data you may have in order to measure health, patient experience, and cost with the ultimate goal of studying value for your hypertension quality improvement program.

To prepare for value-based payment, you first focused on a small measurement and analysis project, your hypertension quality improvement program (step 2), and you chose measures that will demonstrate value (step 3). Since you will be using health data that are already reported out for UDS (percent of patients with hypertension with blood pressure levels under control), your next steps are to fill in gaps in patient experience and cost by collecting new patient experience data and approach your health center’s health plans to begin getting total cost of care data.

For patient experience, you have decided to collect new data by implementing a new survey targeting only the hypertension quality improvement program patients. Now, you work with your clinical staff to decide on measures that will not be overly burdensome to collect across the nine clinic sites in your health center organization. To capture patient experience, the team decides to ask patients one survey question at the end of their visit: “How satisfied are you with the care you received today?” Patients can respond that they are not at all satisfied, somewhat satisfied, or very satisfied. You give patients a slip of paper at the end of their visit with this question and the scale to answer anonymously. Patients drop the slip of paper in a box at the end of their visit. Patients seem happy to do this and since your clinical staff tallies the scores every other week, they do not feel overwhelmed.

For cost, you have decided to use the ambulatory sensitive hospital admission rate among program participants to fill the data gap in the short term. In the long term, in order to measure cost for this and other value-based quality improvement initiatives, you identify contacts at health plans your health center works with to obtain total cost of care data for your health center’s patients. After setting up business associate agreements to protect data confidentiality, you will give the health plans the names, dates of birth, and social security numbers of patients who seek care at the nine clinic sites within your health center organization. The health plans will identify the patients’ claims, and will provide you with patients’ total expenditures for a time period you both agree on.

In the next step, you will work on data visuals to assess value.

See what your colleagues are doing

Here are innovative ways that community health centers are filling gaps in patient experience and cost data.

Patient experience

While Northeast Valley Health Corporation (NEVHC) uses a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey that allows for benchmarking with other community health centers, NEVCHC also uses other tools to measure patient experience.

One of these is a POM (Pulse One Minute) survey that consists of just two questions:

  • Thinking about your overall experience during today’s visit at this health center, including your provider, care team, clerks and receptionists, what worked and what can be improved?
  • Using any number between 0 to 10, where 0 is the worst possible experience and 10 is the best possible experience, what number would you use to rate today’s experience?

NEVHC fielded the survey three times in one year and then made changes to services based on survey results.

West County Health Centers used CAHPS surveys intermittently for years but ultimately created its own 35-question, paper-based patient satisfaction survey, along with other tools, to measure patient experience.

West County Health Centers also piloted an iPad-based survey called Ticket. Ticket is visually appealing and provides an electronic platform that is more engaging to patients than traditional paper-based surveys. Further, it eases data collection burden because staff no longer need to manually enter paper-based survey data into an electronic format.