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
Slide7 : 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
Slide13 : 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
Slide14 : 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 Page http://www.AHRQ.gov :
irene.fraser@ahrq.hhs.gov Home Page http://www.AHRQ.gov