Adding Clinical Data to Administrative Data: AHRQ-sponsored Pilot and Planning Projects

AHRQ 2008 Annual Conference

Slide 1

Adding Clinical Data to Administrative Data: AHRQ-sponsored Pilot & Planning Projects

AHRQ Team:
Roxanne Andrews, Ph.D.
Anne Elixhauser, Ph.D.
September 9, 2008

Slide 2

Outline

• Rationale for AHRQ contracts to add clinical data to administrative data.
• Overview of AHRQ-sponsored projects.
• First-year activities of pilot projects.

Slide 3

Limitations of Administrative Data for Quality Measurement

• Lack clinically important information.
  • Limited to ICD-9-CM diagnosis codes.
• Often do not include present on admission (POA) indicator for diagnoses.
• Questions for hospital-specific reporting.
  • Inadequate for risk adjustment to predict individual patient's risk of mortality.
  • Concern about penalizing providers with the sickest patients.

Slide 4

Rationale for Adding Clinical Data

• AHRQ-sponsored study showed adding a few clinical data elements significantly improves quality assessment using administrative data.
• Important, cost-effective, additions:
  • POA
  • Lab values (numeric) on admission.
  • (Potentially) vital signs.

Slide 5

AHRQ Contracts to Add Clinical Data to Statewide Administrative Data

• Purpose:
  • Jumpstart the enhancement of administrative data.
  • Expand data capacities for statewide data organizations participating in the Healthcare Cost and Utilization Project (HCUP).
• Solicited proposals for two types of contracts:
  1. In-depth pilots.
     • To add or link hospital clinical information to administrative data.
     • Sept. 2007-Sept. 2009
  2. Planning contracts.
     • For organizations not yet ready to engage in pilots.
     • But seek to enhance their administrative data.
     • Sept. 2007-Mar. 2009

Slide 6

Awards to Statewide Data Organizations

Pilots

• Florida Center for Health Information and Policy Analysis, Agency for Health Care Administration (AHCA).
• Minnesota Hospital Association (MHA).
• Virginia Health Information (VHI).

Planning

• Washington Center for Health Statistics, State Department of Health.

Slide 7

Objectives of Pilots

• Establish feasibility of linking clinical and administrative data.
• Develop reproducible approach.
• Set the stage for integrating clinical and administrative data streams in the future.

Slide 8

Project Requirements

• Identify and select clinical data elements to add to administrative data.
• Translate clinical data from electronic format.
• Electronically transfer data from at least five hospitals to the data organization.
• Process data into a multi-hospital database.
• Collaborate with stakeholders.
• Engage in peer-to-peer learning, information sharing, dissemination.

Slide 9

First Year's Activities

• Develop Final Implementation Plan.
• Recruit hospitals.
• Develop data collection method.
• Begin data collection.
• Participate in peer learning network & disseminate lessons learned.

Slide 10

Recruit Hospitals

• Build the business case.
  • Advantages of adding clinical data to admin data.
  • Incentives for participation, e.g.
    • Data quality feedback.
    • Hospital quality feedback reports.
• Assess hospital readiness.
  • Electronic lab data.
  • Logical Observation Identifier Names and Codes (LOINC) coding.
  • HL-7 transmission.

Slide 11

Recruitment Very Successful

The table presents the "Number of Hospitals Expected" for various "Projects."

• Contract Requirement: 5.
• Florida: 20+.
• Minnesota: 25-30.
• Virginia: 30+.

Slide 12

The screen shot shows the home page from AHCA's Web site.

• http://www.fhin.net/FHIN/HITinitiatives/AHRQaddingClinData.shtml

Slide 13

The screen shot shows the home page from MHA's Web site.

• http://www.mnhospitals.org/index/ahrq-project

Slide 14

The screen shot shows the home page from VHI's Web site.

• http://www.vhi.org/hybriddata.asp

Slide 15

Develop Data Collection Method

• Select data elements to be collected
  • POA
  • Lab data elements
  • Linking data elements
• Develop standard data submission format
  • LOINC coding of lab names
• Develop methods for transmitting data
  • HL7 to be used by some Minnesota hospitals
  • HL7 fields to be used in Virginia
• Instruct hospitals on how to submit data

Slide 16

Types of Lab Tests to be Included: Chemistry

• aspartate aminotransferase (AST)
• Albumin
• Alkaline Phosphatase
• Amylase
• Bicarbonate
• Bilirubin Total
• B-type natriuretic peptide (BNP)
• Calcium
• C-Reactive Protein
• Creatine Kinase (CPK)
• Creatine Kinase MB
• Creatinine
• Glucose
• Lactic Acid
• Potassium
• Pro-BNP
• Sodium
• Troponin I
• Troponin T
• Urea Nitrogen (BUN)

Slide 17

Types of Lab Tests to be Included: Other

• Blood Gas
  • Arterial O2 Saturation.
  • Arterial pCO2.
  • Arterial pH.
  • Arterial pO2.
  • Base Excess.
  • Bicarbonate.
  • FIO2.
• Hematology.
  • Hemoglobin.
  • International Normalized Ratio (INR).
  • Neutrophil Bands.
  • Partial Thromboplastin Time.
  • Platelet Count.
  • Prothrombin Time.

Slide 18

Type Information To Be Collected on Lab Tests

• LOINC code for lab test name.
• Observation value (lab result).
• Observation unit of measure.
• Date/time of observation.

Slide 19

Participate in Peer Learning Network

• Monthly conference calls with other pilot and planning state data organizations.
• Document sharing.
• California and the Veteran's Administration have joined to share their knowledge on similar activities.

Slide 20

Sharing Lessons Learned with Other Organizations

• Interim Information on HCUP-US:
  • Implementation Plans
  • Project summaries
  • Links to project Web sites
  • http://www.hcup-us.ahrq.gov/reports/clinicaldata.jsp

Slide 21

The screen shot shows the home page for HCUP's Web site.

• http://www.hcup-us.ahrq.gov/reports/clinicaldata.jsp

Slide 22

Future Activities

• Complete Projects:
  • Collect clinical data and link with administrative data.
  • Produce multi-hospital data set.
  • Assess data quality.
  • Use data to produce hospital-level reports on quality.
  • Provide hospitals feedback.
• Final Lessons:
  • Final report from each site.
  • Synthesis of lessons across sites by Thomson Reuters & National Academy for State Health Policy (NASHP).

Slide 23

Contact information

• Roxanne Andrews
  • roxanne.andrews@ahrq.hhs.gov
  • 301-427-1403
• Anne Elixhauser
  • anne.elixhauser@ahrq.hhs.gov
  • 301-427-1411