250307c - CONSTRUCTION AND VALIDATION OF QUALITY AUDIT CRITERIA FOR INSURANCE OPERATIONAL PERFORMANCE AT KING ABDULLAH BIN ABDULAZIZ UNIVERSITY HOSPITAL

Agenda of Meeting with KAAUH/PNU Researchers prepared by Prof Omar Hasan Kasule MB ChB (MUK), MPH (Harvard), DrPH (Harvard). 

 

1.0 RESEARCH TEAM

Name	Role in research	Specialty	Organization	Position
Riyadh AlAhmad	PI	Family Medicine	KAAUH, PNU	Consultant
Omar Hasan Kasule	Co-PI	Data analysis	Research Center, PNU	Senior Research Scientist
Nayef AlBukairi	Co-PI	IT	KAAU, PNU	Director TRAKCARE
Naser Hussein Shwaihet	Co-PI	Quality Assurance	KAAU, PNU	Director Quality Assurance
Ahmad AlAskar	Co-PI	Finance	KAAUH, PNU	Director, Revenue Cycle

 

2.0 OBJECTIVES:

• Construct and validate quality and performance criteria (6 months).
• Implement the criteria at the 3 main hospitals in Riyadh.
• Generalize the criteria to other hospitals.

 

3.0 METHODS:

• Assemble the Research team.
• Study of existing systems, processes, and outcomes.
• Sampling 300 insurance claims.
• Initial review and interviews.
• Initial listing and definition of audit and performance criteria.
• Initial listing of outcome variables.
• Audit of the insurance claims using the criteria.
• Audit/analysis of quality and performance criteria.

 

4.0 DATA MANAGEMENT:

• Check for completeness, consistency, and accuracy.
• Turn text data into numerical data.
• Define variables: values, labels, sorting, transpose, transform, weights.
• Edit data: multiple responses, duplications, outliers, missing data (impute).