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Joining Forces to Improve Data for HSR, Quality Monitoring, and Reporting : 

Joining Forces to Improve Data for HSR, Quality Monitoring, and Reporting Irene Fraser, Ph.D. Director, Center for Delivery, Organization and Markets June 25, 2006

Overview: 

Overview Where we need to be: For consumer choice, P4P, quality improvement, need timely, cheap, actionable, credible all-payer data at the level where decisions are made Where we are now: Widespread use of administrative data, with its advantages and disadvantages The promise of an EMR, but much work before it can be used for these purposes The vision Join forces, building on administrative data & potential of EMR, to create robust data for future Illustration Hospital data

Hospital Administrative Data – Why Are They Used for HSR & Quality Monitoring & Improvement: 

Hospital Administrative Data – Why Are They Used for HSR & Quality Monitoring & Improvement Available for all hospitals, all patients Aggregated data sets available at state & national levels Little extra data collection burden Fairly standardized across hospitals Easy for analysts to access Core data set useful for a wide-range of purposes Diagnoses & procedures, pt characteristics, payer, information on stay

Hospital Administrative Data – Collected for Billing, Used for Many Purposes : 

Hospital Administrative Data – Collected for Billing, Used for Many Purposes Informing policy deliberations and legislation Motorcycle injuries study prevents repeal of helmet laws Rotavirus vaccine revived after study demonstrated no link with intussusception National benchmarks National Healthcare Quality Report and National Healthcare Disparities Report

Hospital Administrative Data – Collected for Billing, Used for Many Purposes (cont’): 

Hospital Administrative Data – Collected for Billing, Used for Many Purposes (cont’) Injury surveillance and prevention Public health, disease surveillance, disease registries Effect of traffic restrictions during Olympic Games on asthma hospitalizations Public health planning, community assessments Florida’s Community Health Assessment Resource Tool Set See “Value of Hospital Discharge Data”: http://www.hcup-us.ahrq.gov/reports/final_report.pdf

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Example: Use Prevention Indicators to Target CHF Interventions

Hospital Administrative Data – Collected for Billing, Used for Many Purposes (cont’d): 

Hospital Administrative Data – Collected for Billing, Used for Many Purposes (cont’d) Quality assessment and performance improvement Dayton hospitals shared data on AMI mortality rates & acted on the data: 36% reduction after 3 yrs Public reporting for prudent consumer choice Comparisons of hospital cost and quality e.g. Colorado web-based reporting on quality

Eight States Use AHRQ QIs for Public Hospital Reporting: 

Eight States Use AHRQ QIs for Public Hospital Reporting Texas New York Wisconsin (parts of state) Colorado Oregon Massachusetts Utah Florida

Aggregation Is Key: 

Aggregation Is Key Encounter-level data aggregated at different levels: Patient Hospital Geographic areas county, region, state, nation Population groups socioeconomic, payer, race/ethnicity Conditions or procedures Markets

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Example: State & Nationwide Aggregation of Administrative Data Patient enters hospital Hospital sends billing data to state-level data organizations States store data in varying formats to meet local needs Billing record created AHRQ standardizes data to create uniform research databases AHRQ creates tools for use with HCUP data

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HI AZ CA UT CT FL GA IA IL KS MA MD MO NJ NY OR PA SC TN CO WA WI VA ME MI TX WV KY NC VT RI NE MN AL DE MT ID MS NV ND SD NM OH IN LA AR OK NH States with Inpatient Databases AK WY HCUP Partner Does Not Collect Inpatient Data Legend DC Non-HCUP Partner

Limitations of Administrative Data: 

Limitations of Administrative Data Some inconsistencies across states and providers Identifiers to allow linkages across settings (episode of care) Timeliness for some applications Clinical detail Diagnoses present on admission Severity of illness Diagnostic test results Vital signs Functional status Behavioral risk factors

Joining Forces: 

Joining Forces Generally, clinical detail added to administrative data through manual medical record abstraction But many data elements are available electronically in some hospitals With expansion of EMRs, opportunity to merge administrative & EMR data

Electronic Medical Record: 

Electronic Medical Record Purpose- support a continuous healing environment that promotes high quality and efficient patient health care [not research] Hospitals are independently making key decisions when purchasing and implementing EMRs Research, public reporting, etc. can’t be done directly with EMR data

EMR Adoption Decisions for Care that Affect Data for Other Uses: 

EMR Adoption Decisions for Care that Affect Data for Other Uses Functionality e.g., clinical decision support, order entry, medication administration record Customization according to organizational standards and conventions Data to include in EMR Data that remains in ancillary applications (e.g., admitting, laboratory, pharmacy, radiology) Pre-populating for historical information

Administrative vs. EMR Data for HSR, Monitoring, Reporting: 

Administrative vs. EMR Data for HSR, Monitoring, Reporting

Glimpse of a Vision: 

Glimpse of a Vision Clinically rich, standardized encounter data Available in close to real time Key EMR data merged w/ administrative data Data covers multiple sites Ultimately covers continuum of care User-friendly, multi-purpose data files HSR, quality improvement, benchmarks Easily accessible Privacy & data security measures

Steps to Date: 

Steps to Date Meeting with stakeholders and experts HCUP partner meetings AHRQ’s National Advisory Council HCUP Expert Meeting May 2006 Joining Forces Meeting Research and analysis Study on Value of Administrative Data Study on cost-benefit of adding specific data elements

Next Steps: 

Next Steps Use technology to make current administrative faster and more accurate Enrich clinical elements in administrative data Provide tools for using improved administrative data Pilot and spread trailblazing approaches to expand, link and use administrative data for reporting Forge a common longer-term strategy

Home Pagehttp://www.AHRQ.gov: 

irene.fraser@ahrq.hhs.gov Home Page http://www.AHRQ.gov