1. Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Adding Clinical Data to Administrative Data: AHRQ-sponsored Pilot & Planning Projects AHRQ Team: Roxanne Andrews, Ph.D. Anne Elixhauser, Ph.D. September 9, 2008

2. Advancing Excellence in Health Care 2 Outline Rationale for AHRQ contracts to add clinical data to administrative data Rationale for AHRQ contracts to add clinical data to administrative data Overview of AHRQ-sponsored projects Overview of AHRQ-sponsored projects First-year activities of pilot projects First-year activities of pilot projects

3. Advancing Excellence in Health Care 3 Limitations of Administrative Data for Quality Measurement Lack clinically important information Lack clinically important information – Limited to ICD-9-CM diagnosis codes Often do not include present on admission (POA) indicator for diagnoses Often do not include present on admission (POA) indicator for diagnoses Questions for hospital-specific reporting 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

4. Advancing Excellence in Health Care 4 Rationale for Adding Clinical Data AHRQ-sponsored study showed adding a few clinical data elements significantly improves quality assessment using administrative data AHRQ-sponsored study showed adding a few clinical data elements significantly improves quality assessment using administrative data Important, cost-effective, additions: Important, cost-effective, additions: – POA – Lab values (numeric) on admission – (Potentially) vital signs

5. Advancing Excellence in Health Care 5 AHRQ Contracts to Add Clinical Data to Statewide Administrative Data Purpose: Purpose: – Jumpstart the enhancement of administrative data – Expand data capacities for statewide data organizations participating in HCUP Solicited proposals for two types of contracts: 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

6. Advancing Excellence in Health Care Awards to Statewide Data Organizations Pilots Florida Center for Health Information and Policy Analysis, Agency for Health Care Administration Florida Center for Health Information and Policy Analysis, Agency for Health Care Administration Minnesota Hospital Association Minnesota Hospital Association Virginia Health Information Virginia Health InformationPlanning Washington Center for Health Statistics, State Department of Health Washington Center for Health Statistics, State Department of Health

7. Advancing Excellence in Health Care 7 Objectives of Pilots Establish feasibility of linking clinical and administrative data Establish feasibility of linking clinical and administrative data Develop reproducible approach Develop reproducible approach Set the stage for integrating clinical and administrative data streams in the future Set the stage for integrating clinical and administrative data streams in the future

8. Advancing Excellence in Health Care 8 Project Requirements Identify and select clinical data elements to add to administrative data Identify and select clinical data elements to add to administrative data Translate clinical data from electronic format Translate clinical data from electronic format Electronically transfer data from at least five hospitals to the data organization Electronically transfer data from at least five hospitals to the data organization Process data into a multi-hospital database Process data into a multi-hospital database Collaborate with stakeholders Collaborate with stakeholders Engage in peer-to-peer learning, information sharing, dissemination Engage in peer-to-peer learning, information sharing, dissemination

9. Advancing Excellence in Health Care 9 First Year’s Activities Develop Final Implementation Plan Develop Final Implementation Plan Recruit hospitals Recruit hospitals Develop data collection method Develop data collection method Begin data collection Begin data collection Participate in peer learning network & disseminate lessons learned Participate in peer learning network & disseminate lessons learned

10. Advancing Excellence in Health Care 10 Recruit Hospitals Build the business case 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 Assess hospital readiness – Electronic lab data – LOINC coding – HL-7 transmission

11. Advancing Excellence in Health Care Recruitment Very Successful Project Number of Hospitals Expected Contract Requirement 5 Florida20+ Minnesota25-30 Virginia30+

12. Advancing Excellence in Health Care 12 http://www.fhin.net/FHIN/HITinitiatives/AHRQaddingClinData.shtml

13. Advancing Excellence in Health Care 13 http://www.mnhospitals.org/index/ahrq-project

14. Advancing Excellence in Health Care 14 http://www.vhi.org/hybriddata.asp

15. Advancing Excellence in Health Care 15 Develop Data Collection Method Select data elements to be collected Select data elements to be collected – POA – Lab data elements – Linking data elements Develop standard data submission format Develop standard data submission format – LOINC coding of lab names Develop methods for transmitting data 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 Instruct hospitals on how to submit data

16. Advancing Excellence in Health Care Types of Lab Tests to be Included: Chemistry AST AST Albumin Albumin Alkaline Phosphatase Alkaline Phosphatase Amylase Amylase Bicarbonate Bicarbonate Bilirubin Total Bilirubin Total BNP BNP Calcium Calcium C-Reactive Protein C-Reactive Protein Creatine Kinase (CPK) Creatine Kinase (CPK) Creatine Kinase MB Creatine Kinase MB Creatinine Creatinine Glucose Glucose Lactic Acid Lactic Acid Potassium Potassium Pro-BNP Pro-BNP Sodium Sodium Troponin I Troponin I Troponin T Troponin T Urea Nitrogen (BUN) Urea Nitrogen (BUN)

17. Advancing Excellence in Health Care Types of Lab Tests to be Included: Other BLOOD GAS Arterial O2 Saturation Arterial O2 Saturation Arterial pCO2 Arterial pCO2 Arterial pH Arterial pH Arterial pO2 Arterial pO2 Base Excess Base Excess Bicarbonate Bicarbonate FIO2 FIO2HEMATOLOGY Hemoglobin Hemoglobin INR INR Neutrophil Bands Neutrophil Bands Partial Thromboplastin Time Partial Thromboplastin Time Platelet Count Platelet Count Prothrombin Time Prothrombin Time

18. Advancing Excellence in Health Care Type Information To Be Collected on Lab Tests LOINC code for lab test name LOINC code for lab test name Observation value (lab result) Observation value (lab result) Observation unit of measure Observation unit of measure Date/time of observation Date/time of observation

19. Advancing Excellence in Health Care 19 Participate in Peer Learning Network Monthly conference calls with other pilot and planning state data organizations Monthly conference calls with other pilot and planning state data organizations Document sharing Document sharing California and the Veteran’s Administration have joined to share their knowledge on similar activities California and the Veteran’s Administration have joined to share their knowledge on similar activities

20. Advancing Excellence in Health Care 20 Sharing Lessons Learned with Other Organizations Interim Information on HCUP-US Interim Information on HCUP-US – Implementation Plans – Project summaries – Links to project websites – www.hcup-us.ahrq.gov/reports/clinicaldata.jsp

21. Advancing Excellence in Health Care 21 http://www.hcup-us.ahrq.gov/reports/clinicaldata.jsp

22. Advancing Excellence in Health Care 22 Future Activities Complete Projects 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 Lessons – Final report from each site – Synthesis of lessons across sites by Thomson Reuters & National Academy for State Health PolicyNASHP) – Synthesis of lessons across sites by Thomson Reuters & National Academy for State Health Policy (NASHP)

23. Advancing Excellence in Health Care Contact information Roxanne Andrews Roxanne Andrews – roxanne.andrews@ahrq.hhs.gov roxanne.andrews@ahrq.hhs.gov – 301-427-1403 Anne Elixhauser Anne Elixhauser – anne.elixhauser@ahrq.hhs.gov anne.elixhauser@ahrq.hhs.gov – 301-427-1411