1. Broward Regional Health Planning Council HEALTH DATA WAREHOUSE June 18, 2009 Mike De Lucca, President/CEO mdelucca@brhpc.org Michele Rosiere, Division Director mrosiere@brhpc.org www.BRHPC.org 954.561.9681

2. HEALTH DATA WAREHOUSE MILESTONES 2007 Health Foundation of South Florida funded BRHPC’s 2 Year Broward PQI Pilot which included community priority setting and targeted initiatives. 2008 Blue Foundation for a Healthy Florida funded 1 Year Statewide PQI & ED expansion. BRHPC collaborated with the 11 Florida Local Health Planning Councils which represent Florida’s 67 Counties. 2009 BRHPC Expanded PQI Initiative to the Health Data Warehouse adding Chronic Conditions, Suicide E-Codes, & ED Acuity & Severity 2Broward Regional Health Planning Council

3. BRHPC HEALTH DATA WAREHOUSE Collaborated with Local Health Planning Councils Representing Florida’s 67 Counties Developed web-based statewide infrastructure: o To identify, prioritize and address community health issues o Identify potential quality concerns o Identify areas needing further study & investigation o Track changes over time o Facilitate decision making by federal, state and local policy makers; healthcare leaders; clinicians; etc. o Maximizes existing resources 3Broward Regional Health Planning Council

4. BRHPC HEALTH DATA WAREHOUSE Prevention Quality Indicators Chronic Condition Hospitalizations Suicide E-Codes Self-Inflicted Injury Emergency Department Acuity /Severity QUERIES 4Broward Regional Health Planning Council

5. 5 SIGNING UP FOR THE HEALTH DATA WAREHOUSE 1) Go to www.brhpc.org 2) Click on the “>>Please click here to login” link in the Health Data Warehouse Website Login section.

6. Broward Regional Health Planning Council6 SIGNING UP FOR THE HEALTH DATA WAREHOUSE 3) Click on REGISTER to create a new user account.

7. Broward Regional Health Planning Council7 SIGNING UP FOR THE HEALTH DATA WAREHOUSE 4) Please enter at least your email address and a password in the boxes below and then click the register button to create your new account.

8. Broward Regional Health Planning Council8 SIGNING UP FOR THE HEALTH DATA WAREHOUSE Once you have complete the registration process you will be directed to the main Health Data Warehouse page.

9. PQI CATEGORIES ACUTE Dehydration Bacterial pneumonia Urinary tract infection CIRCULATORY Hypertension Congestive heart failure Angina DIABETES Short-term complication of diabetes Long-term complication of diabetes Uncontrolled diabetes Lower- extremity amputation RESPIRATORY Chronic obstructive pulmonary disease Asthma OTHER Perforated Appendix Low Birth Weight Broward Regional Health Planning Council9

10. CHRONIC CONDITION INPATIENT UTILIZATION Chronic Conditions last 12 months or longer and (a)places limitations on self-care, independent living & social interactions; and/or (b) results in need for ongoing intervention with medical products, services and special equipment. Chronic condition identification utilizes o all five-digit ICD-9-CM diagnosis codes, o excludes external cause of injury codes (E codes). 10Broward Regional Health Planning Council AIDS Asthma Diabetes Congestive Heart Failure Hypertension

11. SUICIDE SURVEILLANCE SELF INFLICTED INJURY E-CODES E-Code Categories E950-Solid or liquid substances E9500-Analgesics antipyretics and antirheumatics E9501-Barbiturates E9502-Other sedatives and hypnotics E9503-Tranquilizers and other psychotropic agents E9504-Other specified drugs and medicinal substances E9505-Unspecified drug or medicinal substance E9506-Agricultural and horticultural chemical, pharmaceutical E9507-Corrosive and caustic substances E9509-Other and unspecified solid and liquid substances E950-Other & unspecified solid & liquid substances Total E951-Other utility gas – Total E9520-Motor vehicle exhaust gas E9521-Other carbon monoxide E952-Unspecified gases and vapors – Total E953-Hanging strangulation and suffocation Broward Regional Health Planning Council11 External Cause of Injury Code Overview  E-Codes represent diagnostic categories utilizing the 9th revision of the International Classification of Diseases (ICD-9).  E-codes differ from nature of injury codes (N- codes)by providing data on the cause, rather than type, of injury. For example, a traumatic head injury, coded with an N-code, could result from a car accident or gunshot wound, both coded with E-codes.  Additionally, E-codes distinguish self-inflicted injuries, essential information for suicide surveillance. Data Source: Agency for Health Care Administration Hospital Inpatient Data

12. EMERGENCY DEPARTMENT ACUITY (CPT) STRATIFICATION Broward Regional Health Planning Council12 99285 high, immediate significant life or physiologic function threat 99284 high requires urgent physician evaluation 99283 moderate severity99282low severity99281 self limited/minor

13. EMERGENCY DEPARTMENT AMBULATORY NYU ALGORITHM EMERGENCY VS. AVOIDABLE EMERGENT/ED NEEDED NOT PREVENTABLE/ AVOIDABLE EMERGENT/ED NEEDED PREVENTABLE/AVOIDABLE EMERGENT ED NEEDED PRIMARY CARE TREATABLE NOT EMERGENT ED NOT APPROPRIATE OTHER INJURY, ALCOHOL & SUBSTANCE, MENTAL HEALTH & UNCLASSIFIED 13Broward Regional Health Planning Council

14. USING THE PREVENTION QUALITY INDICATORS (PQI) MODULE TO PRODUCE A REPORT Report 1: Using the (PQI) module to produce a report for: All Counties, Year = 2007, All Quarters, With Charge Information, Showing the Observed Rates, Stratified by Hospital/Gender, Using the standard exclusion of cases where Patient County does not equal Hospital County. Select “All of Florida”, 2007 and All Quarters selections. Broward Regional Health Planning Council14

15. REPORT CRITERIA SELECTION Fig2: (1) Select “Yes” for “Show Charge information”, “Show Rates” and “Same Patient & Hospital County”. (2) Then select the stratifers Hospital and Gender. (Notice, that when we select “Hospital” as one the stratifiers a popup box is displayed explaining why the Denominator/Rates cannot be displayed for all PQIs except PQI-2 and PQI-9). (3) click on the “Generate Report” button. Broward Regional Health Planning Council15

16. GENERATE REPORT Broward Regional Health Planning Council16

17. SAMPLE PQI QUERY RESULT #1 Fig5: The report has finished downloading and is displayed. (1) At the very top you will notice the definition of our report (2007, All of Florida, All Qtrs and the stratifiers) (2) Near the top in the middle there is a link to the help/tutorial. Clicking on “For Help click here” displayed a popup window with the tutorial. (3) Near the top right is where you can export the report. You can export to CSV/Excel and PDF formats. For PDF formats there are 3 different page size/orientation choices (Please choose based on the width of the report) (4) Notice that for PQI-1 there are no Denominators or Obs.Rate as explained on Fig2 above. Broward Regional Health Planning Council17

18. SAMPLE PQI QUERY RESULT #2 Broward Regional Health Planning Council18 Fig6: This is the same report as in Fig5 above demonstrating that for PQI-2 there are Denominators and Obs.Rates. As an example, we take “Morton Plant North Bay Hospital” and see that for 2007 there were 10 (Numerator) cases of perforated appendicitis out of 42 (Denominator) cases of appendicitis fitting the AHRQPQI-1 definition.

19. EXCLUSIONS Broward Regional Health Planning Council19

20. MODULE DATA SOURCES Acuity Stratification, Avoidable - NYU Algorithm Source - Florida AHCA Emergency Department (ED) Patient Data Prevention Quality Indicators, Chronic Conditions, Suicide Incidence - Source: Florida AHCA Inpatient Discharge Data Note: For all Modules, cases with different Patient Counties and Hospital Counties are now included. It is up to the user, when running reports on the website, to decide whether to exclude these cases. Broward Regional Health Planning Council20