Health Services Research at HMSA : Health Services Research at HMSA Deb Taira, Sc.D.
Research Manager
February 16, 2006
Slide2 : Why Research?
“The burden of harm conveyed by the collective impact of all of our health care quality problems (overuse, underuse, misuse) is staggering. It requires the urgent attention of all the stakeholders…”
Institute of Medicine National Roundtable on Healthcare Quality, 2000
Slide3 : What is Research? Research is systematic investigation designed to yield generalizable results
Goal: Improve quality and support cost-effective care
Slide4 : Why Research at HMSA?
Slide5 : Health Plan Benefit
Structure,
Cost
Fee structure Treatment plan Cost and Quality Patient factors
Age, gender,
Ethnicity,
Behaviors,
Preferences,
Income,
Environment MD factors
Age, gender,
Ethnicity,
Specialty,
Evidence,
Guidelines,
CME Employer Government
Slide6 : Why Research at HMSA? Improves quality of care
Reduces inefficiencies through detection of overuse, underuse, and misuse
Increases rigor in planning/documentation
Supports key decisions
Encourages evidence-based approaches
Provides supplemental revenues through research grants
Data : Data Member
Administrative data: age, gender, island or region, morbidity level (ACG), health plan type, days of enrollment, diagnoses, procedures, medications, cost, principal physician
Satisfaction surveys: ethnicity, education, satisfaction
Census: census tract income level
Physician: specialty, practice region, board certification, health center affiliation
Some Examples : Some Examples
Slide9 : Q1a. How does the physical health status of HMSA satisfaction survey respondents compare to that of the average American? Worse
Same
Better
Slide10 : Q1b. How does the mental health status of HMSA survey respondents compare to that of the average American? Worse
Same
Better
Slide11 : ANSWERS: Q1a=1; Q1b=3 national
norm Citation: Taira et al. Managed Care Interface, 2001
Slide12 : Q2. Which racial/ethnic group was least compliant with osteoporosis medications? Caucasian
Chinese
Filipino
Japanese
Hawaiian
Slide13 : * Relative Days of Persistence on Osteoporosis Medication Relative to Caucasians ANSWER Q2= 3 Filipino
Slide14 : Q3a. What percent of elderly PPO members report skipping medications due to cost? <5%
5%-10%
10-15%
>15%
Slide15 : Q3b. What percent of elderly 65cplus members report skipping medications due to cost? <5%
5%-10%
10-15%
>15%
Slide16 : Percent of Elderly Members Who Skip Medications Due to Cost ANSWER: Q3a=2; Q3b=3 Citation: Taira et al. American Journal of Managed Care, 2002
Slide17 : Q4. Which group of patients tended to be more compliant with their anti-hypertensive medications?
Patients seeing a MD of same age
Patients seeing a MD of same ethnicity
Patients seeing a MD of same gender
All of the above
None of the above
Slide18 :
Impact of Seeing a Physician of Similar Age No significant differences Abstract submitted to the American College of Cardiology
Slide19 :
Impact of Seeing a Physician of Similar Gender No significant differences Abstract submitted to the American College of Cardiology
Slide20 :
Impact of Seeing a Physician of Similar Ethnicity No significant differences ANSWER Q4=5 None of the above
Slide21 : Q5. Which Ethnic/Racial Group Had the Lowest Rate of Obesity (based on self-report height and weight from the MSS Survey)?
Caucasian
Chinese
Filipino
Hawaiian
Japanese
Portuguese
Slide22 : ANSWER: Q5= 2 Chinese Percent Obese
Slide23 : Data Strengths Large number of enrollees (n=677,000)
Three types of coverage (HMO, PPO, Medicare cost contract)
Clinical information includes diagnoses, procedures, medications
Utilization measures include hospitalizations, ED visits, costs
Information on patient and physician characteristics
Data extract system near completion
Slide24 : Data Limitations Not good for estimating prevalence of disease (excludes uninsured, most QUEST, most of Medicare, military, etc.)
Limited clinical detail
Limited hospital data (not know medications)
No information on smoking, exercise, etc
No information on uncovered services, pharmaceuticals (e.g. aspirin use)
Study Proposal : Study Proposal Background (1 paragraph)
Objective(s)
Study population (and how to identify them)
Time period
Variables
Methodology
Policy implications
HIPAA considerations
Benefit to HMSA members