Arkansas Department of Health and MONAHRQ (Text Version)

Slide presentation from the AHRQ 2011 conference.

On September 19, 2011, Connie Marie Ardwin made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (1.1 MB). .


Slide 1

Slide 1. Arkansas Department of Health and MONAHRQ

Arkansas Department of Health and MONAHRQ

Presented by:
Connie Marie Ardwin

Slide 2

Slide 2. Introduction

Introduction

  • Hospital Discharge Data Section, Arkansas Department of Health.
  • Collecting inpatient discharge data since 1997.
  • Includes many additional fields; refined over time to improve data quality and annual report.
  • In the past, had "Request for Information" form when specific or aggregate data was needed.
  • Today, take the next step to make our county and area level aggregate data publicly available.

Slide 3

Who will use the site?

  • Hospital Discharge Data Section → In House.
  • Arkansas Hospital → Contributors.
  • Public Health Employee → Service users and analysts.
  • Local Community → Service users and analysts.
  • Future Inpatient → Service users and analysts.
  • Researcher → Service users and analysts.

Slide 4

What makes Arkansas different?

  • Arkansas has 75 counties:
    • 41 of these are serviced by a single hospital.
    • 20 do not have access to a hospital within county borders.
  • Arkansas has 108 hospitals:
    • 52 of these are Acute Care and 29 are CAH.
  • Arkansas State law and policy:
    • Centralized Health Department tasked with data collection.
    • Requires that hospital and provider level information not be disclosed publicly without hospital consent.
    • Requires that our Data Submittal Guide (rules for formatting and sending data) go through legislative process.
    • Currently only collect inpatient data, however we have begun the legislative process for collecting ED data starting in 2012.

Slide 5

How has AR been reporting?

Slide 6

How will we use MONAHRQ?

  • Internally:
    • To check our analyses done by SAS.
    • To provide hospitals information on their facility.
  • Publicly:
    • To report county level rates and quality measures.
    • To enhance our Annual Report.
  • Password Protected:
    • We had originally considered asking hospitals if they would like their data to be included in a masked 'hospital level, utilization' Web site.

Slide 7

How did AR implement MONAHRQ?

  • Had to have staff available:
    • Look at the uses of MONAHRQ and which aspects would benefit us.
    • Learn how to use MONAHRQ.
  • Had to have the right political climate:
    • Public reporting is a hot topic.
    • Work with our Hospital Association to get word out about our publications (Annual Report).

Slide 8

Slide 8. Software and IT Issues

Software and IT Issues

  • Software is extremely easy to set up and use.
  • AR data required lots of prep work:
    • Mapping the dataset → SAS to MQ map.doc. Mapping File was made using the HCUP resources for mapping.
    • Easier to work qualifying logic before loading than after.
    • Double and triple check the #s.

Slide 9

Slide 9. Software and IT Issues

Software and IT Issues

  • Software is extremely easy to set up and use.
  • Data requires lots of prep work:
    • Mapping the dataset.
    • Easier to work qualifying logic before loading than after → Our data is collected as a flat file from the hospitals, then all hospitals are combined into a Master dataset for the year and stored as a SAS dataset.
      We use a SAS program to roll up / map the data elements, drop unnecessary elements, and use the MONAHRQ logic to delete non-qualifying records.
    • Double and triple check the #s.

Slide 10

Slide 10. Software and IT Issues

Software and IT Issues

  • Software is extremely easy to set up and use.
  • Data requires lots of prep work:
    • Mapping the dataset.
    • Easier to work qualifying logic before loading than after.
    • Double and triple check the #s →Never assume that because it worked last time that the numbers are good this time. Double check all numbers.
      Example: I changed from using the total charges stored as a character to the total charges stored as a number. I removed the decimal point, and got a surprised question: "We could save three billion dollars if we reduced hospitalizations for Congestive Heart Failure by 50%?

Slide 11

Hosting and HTML Issues

Hosting and HTML Issues

  • Generated pages can be linked to from our SharePoint site, but not incorporated into them. → They can also be converted to a SharePoint site, but that would be costly.
    The static IP address assigned to the pages where they are to be stored is very user unfriendly. So, we are obtaining a .gov address through our DIS department that will redirect to the static IP address.
  • The company hosting our department site had trouble understanding what we needed to add, as they did not know what MONAHRQ generated.

Slide 12

Slide 12. Hosting and HTML Issues

Hosting and HTML Issues

  • Generated pages can be linked to from our SharePoint site, but not incorporated into them.
  • The company hosting our department site had trouble understanding what we needed to add, as they did not know what MONAHRQ generated. → After many E-mails, file transfers, phone calls, and sit downs we figured out how to describe what we need.
    "We need a link from our section of the ADH Web site to the homepage (index) where our generated pages are stored. The web pages we generate are all relative. We will need the .gov address to redirect to this address.

Slide 13

Hosting and HTML Issues

  • HTML text changes:
    • Some definitions, such as Cost Savings, need further clarification.
    • Add Disclaimers to certain pages, such as how this data does not include Arkansas patients that were treated in an out of state facility.
  • Apply the "Look and Feel" of the ADH site to the MONAHRQ pages; this cannot be easily done without the help of Web Design personnel.
  • We have been told that we can add visitor counters and a link for contacting us if there are questions, however we have not been informed how to go about adding these to the pages.

Slide 14

Slide 14. Home Page—Generated

Home Page—Generated

Image: A screen shot of the Arkansas Department of Health Web site is shown.

Slide 15

Slide 15. Home Page—Altered

Home Page—Altered

Image: A screen shot of the Arkansas Department of Health Discharge Data Report web page is shown.

Slide 16

Slide 16. How the ADH uses MONAHRQ

How the ADH uses MONAHRQ

  • MONAHRQ is used internally by our Hospital Discharge Data Section.
  • Error check our data.
  • Error check our mappings.
  • Compare utilization statistics.

To the right of the text is an image of a Data Load Summary page.

Slide 17

Slide 17. How the ADH uses MONAHRQ

How the ADH uses MONAHRQ

  • MONAHRQ is used internally by our Hospital Discharge Data Section.
  • Error check our data. → Invalid diagnosis codes and procedure codes.
    Incorrect line ups: Present on Admissions and Days to Procedure present without a ICD-9 code or missing when there was.
  • Compare utilization statistics.

Slide 18

Slide 18. How the ADH uses MONAHRQ

How the ADH uses MONAHRQ

  • MONAHRQ is used internally by our Hospital Discharge Data Section.
  • Error check our data.
  • Error check our mappings. → Invalid mappings: race/ethnicity, days to procedure, source of payment, patient disposition, source and type of admission.
  • Compare utilization statistics.

Slide 19

Slide 19. How the ADH uses MONAHRQ

How the ADH uses MONAHRQ

  • MONAHRQ is used internally by our Hospital Discharge Data Section.
  • Error check our data.
  • Error check our mappings.
  • Compare utilization statistics. → Discharges, Length of Stay, Charges, Cost, and means
    By:
    Status, Patient demographics, Hospital demographics.

Slide 20

Slide 20. How the ADH uses MONAHRQ

How the ADH uses MONAHRQ

  • A section of MONAHRQ has been approved to be used publicly within an online published document.
  • Produce the PQI section of our Annual Report.
  • This information is now online and available for everyone to view!

Hospital Discharge Page

Slide 21

Slide 21. Help with setting up MONAHRQ

Help with setting up MONAHRQ

Slide 22

Slide 22. Public Reporting

Public Reporting

ChallengesSolutions
Collecting hospital data.Law requires hospitals to report.
Getting accurate data.Get corrections on records from hospitals until less than 1% error by our checks.
Border counties have a high population % going to out of state hospital.Requesting out of state hospital data and using the exchange.
Protecting patient information, particularly in low population counties.Make sure all counties reported on have a high enough denominator—currently done by hand.

Slide 23

Slide 23. Public Reporting

Public Reporting

ChallengesSolutions
Law does not allow to publish hospital level or identifying information.
  • Do not publish the hospital utilization and rates sections of the Web site.
  • Group hospitals up into a peer group and report on the group.
Numerous (75) counties, the majority with a small population, cause many of the county rates to be suppressed.Considered rolling our counties up into larger reporting regions in future, but we are keeping it at the county level for now.

 

Slide 24

Slide 24. Impact of MONAHRQ

Impact of MONAHRQ

  • Internal exposure to MONAHRQ within the Health Statistics Branch has generated a lot of interest in both the software and reporting elements.
  • Hospital Discharge Data Section.
  • Other Departments.

Slide 25

Slide 25. Impact of MONAHRQ

Impact of MONAHRQ

Hospital Discharge Data Section

  • Internal exposure to MONAHRQ within the Health Statistics Branch has generated a lot of interest in both the software and reporting elements.
  • Will ease reporting to and on hospitals, including some requests for information.
  • Paved way for adding estimated costs.
  • Added reliable Quality Indicators by county.

Slide 26

Slide 26. Impact of MONAHRQ

Impact of MONAHRQ

  • Internal exposure to MONAHRQ within the Health Statistics Branch has generated a lot of interest in both the software and reporting elements.

Other Departments / Reporting

  • Critical Access Hospitals (special reporting).
  • Emergency Department Data (hope to start collecting in 2012).
  • Epidemiology (like to see a future version with injury indicators—CDC).

Slide 27

Slide 27.  Future of MONAHRQ use in AR

Future of MONAHRQ use in AR

  • We hope to have our first hospital inpatient public reporting site go live as early as October this year. Technical issues could push this launch back to November.
  • We plan on speaking with our Hospital Association about options for making the Utilization and Quality Ratings available to the hospitals.

Slide 28

Questions?

Page last reviewed March 2012
Internet Citation: Arkansas Department of Health and MONAHRQ (Text Version). March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/ardwin/index.html