Slide Presentation from the AHRQ 2008 Annual Conference
On September 9, 2008, Roxanne Andrews, Ph.D., and Anne Elixhauser, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (2.3 MB; Plugin Software Help).
Adding Clinical Data to Administrative Data: AHRQ-sponsored Pilot & Planning Projects
Roxanne Andrews, Ph.D.
Anne Elixhauser, Ph.D.
September 9, 2008
- Rationale for AHRQ contracts to add clinical data to administrative data.
- Overview of AHRQ-sponsored projects.
- First-year activities of pilot projects.
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.
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:
- Lab values (numeric) on admission.
- (Potentially) vital signs.
AHRQ Contracts to Add Clinical Data to Statewide Administrative Data
- 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:
- In-depth pilots.
- To add or link hospital clinical information to administrative data.
- Sept. 2007-Sept. 2009
- Planning contracts.
- For organizations not yet ready to engage in pilots.
- But seek to enhance their administrative data.
- Sept. 2007-Mar. 2009
Awards to Statewide Data Organizations
- Florida Center for Health Information and Policy Analysis, Agency for Health Care Administration (AHCA).
- Minnesota Hospital Association (MHA).
- Virginia Health Information (VHI).
- Washington Center for Health Statistics, State Department of Health.
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.
- 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.
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.
- 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.
Recruitment Very Successful
The table presents the "Number of Hospitals Expected" for various "Projects."
- Contract Requirement: 5.
- Florida: 20+.
- Minnesota: 25-30.
- Virginia: 30+.
The screen shot shows the home page from AHCA's Web site.
The screen shot shows the home page from MHA's Web site.
The screen shot shows the home page from VHI's Web site.
Develop Data Collection Method
- Select data elements to be collected
- 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
Types of Lab Tests to be Included: Chemistry
- aspartate aminotransferase (AST)
- Alkaline Phosphatase
- Bilirubin Total
- B-type natriuretic peptide (BNP)
- C-Reactive Protein
- Creatine Kinase (CPK)
- Creatine Kinase MB
- Lactic Acid
- Troponin I
- Troponin T
- Urea Nitrogen (BUN)
Types of Lab Tests to be Included: Other
- Blood Gas
- Arterial O2 Saturation.
- Arterial pCO2.
- Arterial pH.
- Arterial pO2.
- Base Excess.
Normalized Ratio (INR).
- Neutrophil Bands.
- Partial Thromboplastin Time.
- Platelet Count.
- Prothrombin Time.
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.
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.
Sharing Lessons Learned with Other Organizations
- Interim Information on HCUP-US:
The screen shot shows the home page for HCUP's Web site.
- 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).
- Roxanne Andrews
- Anne Elixhauser
Current as of January 2009
Adding Clinical Data to Administrative Data: AHRQ-sponsored Pilot & Planning Projects. Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualmtg08/090908slides/AndrewsElix1.htm