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

AHRQ 2008 Annual Conference

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).

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