Deb Koester Joseph Thomas Sudeshna Paul Bruce Craig Michael Weiner Laura Sands Healthcare Utilization in Preschool-Age Children

5 year olds in 2003, 2004 the 18-month period before September 1 st well-child visits compare utilization among those with and without well child visits Indiana Medicaid data continuous enrollment not in a managed care organization Healthcare Utilization in Preschool-Age Children

5 year olds in 2003, 2004 the 18-month period before September 1 st well-child visits compare utilization among those with and without well child visits Indiana Medicaid data continuous enrollment not in a managed care organization Healthcare Utilization in Preschool-Age Children N = 9618

PS E yes no 14,876 Erythromycin and Pyloric Stenosis

Dx’s = pyloric stenosis Pyloric stenosis

Dx’s = pyloric stenosis ICD9 = Pyloric stenosis

Dx’s = pyloric stenosis ICD9 = ICD9 = Pyloric stenosis

Dx’s = pyloric stenosis ICD9 = ICD9 = Radiology Pyloric stenosis

Dx’s = pyloric stenosis ICD9 = ICD9 = Radiology Transfers to Riley? Pyloric stenosis

Dx’s = pyloric stenosis ICD9 = ICD9 = Radiology Transfers to Riley? Riley Pyloric stenosis

Dx’s = pyloric stenosis ICD9 = ICD9 = Radiology Transfers to Riley? Riley Text Reports Discharge Summaries Op Notes** Pyloric stenosis

Electronic data Confirmed true Rx by reviewing infants’ medical records Macrolide prescriptions

421 Pharmacy ordered

33982 Pharmacy ordered trans- action

Pharmacy ordered trans- action the “outpatient” MRF

Pharmacy ordered the “outpatient” MRF the old “lab” MRF trans- action

Exposure to Erythromycin 483 patients were identified Upon review of all 483 in Inquiry, 14 (3%) were removed from drug group ordered and then d/c’d immediately (8) “250 mg tabs” (6) 469 patients in the exposure group

Infant systemic erythromycin Pyloric Stenosis Erythromycin RR =4.98 (2.11, 11.74) ,37014, yes no 43 14,833 (1.28%) (0.26%)

Age at Rx Infant systemic erythromycin #infants with PS #infants with Rx #infants with PS #infants without Rx RR <3 months 1.28% (6/469) 0.26% (38/14,407) 4.98 (2.1, 11.7)

Age at Rx Infant systemic erythromycin #infants with PS #infants with Rx #infants with PS #infants without Rx RR <2 weeks <3 months 2.65% (6/226) 1.28% (6/469) 0.25% (37/14,650) 0.26% (38/14,407) (4.5, 24.7) 4.98 (2.1, 11.7)

Mapping Children’s Injuries

ICD9 Codes and E Codes Chief Complaint Data Address Data

Chief Complaints “SICK” “sick”

Wishard Chief Complaints

Chief Complaints “SICK” “sick” “SICK’” “SICK’;” “SICK” “SICK AS 3 DOGS” “SICKO” “SIDK” “SIICK” “SIKC” “SIKCK” “SIC”

Wishard Chief Complaints

Estimate the N with ________ Quick Checks, and Discussion of Feasibility Generate a List for Chart Review Generate a List for Recruitment (e.g., by ResNet) Help Investigators with their own databases Full Retrospective Study  Aggregate Data  Individual-Level Analytic Data Set  Deidentified  Limited  Identified Types of Projects

Estimate the N with ________ Quick Checks, and Discussion of Feasibility  N of patients with coronary artery disease in 2006, and ≥ 1 visit to an IUMG primary care medicine clinic Types of Projects

Estimate the N with ________ Quick Checks, and Discussion of Feasibility Generate a List for Chart Review  Patients with HIV and other criteria Types of Projects

Estimate the N with ________ Quick Checks, and Discussion of Feasibility Generate a List for Chart Review Generate a List for Recruitment  Patients > 50 years old in IUMG primary care medicine Types of Projects

Estimate the N with ________ Quick Checks, and Discussion of Feasibility Generate a List for Chart Review Generate a List for Recruitment (e.g., by ResNet) Help Investigators with their own databases  setting up forms for data entry into Microsoft Access Types of Projects

Full Retrospective Study Types of Projects

RMRS INPC Hospitals Wishard Clarian Community St. Francis St. Vincent a growing list… Medicaid etc. Data Sources Existing

RMRS INPC Hospitals Wishard Clarian Community St. Francis St. Vincent a growing list… Medicaid etc. Data Sources Existing Global ID

RMRS INPC Hospitals Wishard Clarian Community St. Francis St. Vincent a growing list… Medicaid etc. Data Sources Existing you can bring us data you’ve collected &/or we can help you build a database New Global ID

Lab Results Imaging Studies Orders Visits: Inpatient, ER, and Outpatient Rx Age, Sex, Race Insurance status at check-in Text Reports, e.g.  Discharge Summaries  Op Notes Charges Types of Electronic Data

The Data are a Work-in-Progress Shaped by the Real World clinical and billing considerations work flows interfaces History Shelf Life Need for Triangulation scrutiny >1 method written charts Perspectives About the Data

IRB Other Permissions Price Tag Contact Information Marc Rosenman Logistics