The project data mart includes data for four fiscal years for IHS active users in 14 project sites. The FY2010 data include information on a purposeful sample of almost 440,000 persons; the data mart includes data for more than 540,000 persons. Due to the project timeframe, we were able to conduct a limited number of analyses using data for FY2010. The data may be used for a number of potential projects; we provide an overview of some.
The study could include data for multiple years (e.g., FY2007-2010), and researchers could use complex statistical techniques to examine the relationships between the number and types of services and health measures, such as process measures (e.g., use of laboratory services, prescription refill patterns), health status as measured by clinical outcomes, service utilization (e.g., ED visits, hospital admissions and inpatient days, hospital admissions and days identified as ambulatory sensitive), and costs. Analyses could control for project site characteristics such as the range of inpatient services and project site population size. Data on socioeconomic status could be included in such analyses through use of Census 2010 county measures for education and income. Statistical approaches for addressing distributional issues related to the outcome variables and selection bias issues that occur with observational data may be employed.
The data may be used to define clinical services of interest and to examine their utilization at specific project sites. Patient outcomes and costs associated with the provision of such services may be assessed. This project requires enhancements to the data mart to improve measures of advanced practice pharmacy services.
A clinical opportunity to improve a health outcome may be defined as an office visit by a person with diabetes or CVD for whom available data on clinical outcomes such as glycemic, blood pressure, and LDL cholesterol control indicate that one or more of these outcomes may need to be addressed during the visit (e.g., a high HbA1c value). Data for services following the visit may be used to assess if laboratory testing, medication changes, and ECM service use occurred after the visit. If such service use occurred following the visit, the office visit may be classified as a clinical opportunity that resulted in actions that may improve the patient’s health.
Persons with chronic disease may be high users of prescribed medications. The pharmacy data may be used to assess existing medication utilization and options for improving drug use.
Project 5: Assessing the influence of the IPC model on utilization of ED and hospital inpatient services
A number of firms provide software to assess the provision of hospital ED and inpatient services. Existing software may be used to assess preventable hospital readmissions, lengths of stay, and types of ED utilization (e.g., by classifying visits according to urgency and optimal location for treatment). Analyses using such software may provide information useful to understanding current service use and potential enhancements to services, as well as to examining utilization across Service Units at various stages of IPC implementation.