Health and Demographics
Using Integrated Data Systems for
Comprehensive State Budgeting
W. David Patterson, Ph.D.
Salt Lake City, Utah
September 4, 2014
ACTIONABLE INTELLIGENCE FOR SOCIAL POLICY
AISP Network of Integrated Data Systems
ISP
22% of the
U.S. Population
A MacArthur-Funded Initiative
Integrating Data To Improve Services
Education
Justice
Child Welfare
Employment
And Earnings
Housing
Health Care
Disabilities
Mental Health
Public Safety
4
CLOSING THE GAP:
Multi-system Populations & Developmental Handoffs
Identify & lessen risks to
poor outcomes
Improve the QUALITY
of Education, Health, &
Human Services
Connect Communities
to support populations
5
Who are we?
• Mission: “It is the entire human experience that influences
health and social well-being and should therefore be
captured in an integrated data system.”
• Staff: 35 employees, 2/3 statisticians trained in either
theoretical statistics or their substantive disciplines. The
remaining staff are focused on supporting
information/knowledge deployment skills such as software
development and data base administration, or business
operations.
• Budget: Roughly $6m annually, with less than 15% through
general appropriations or assigned fees.
Evolution of the
Data Warehouse
• Philosophy developed over time and experience
eventually becoming a recognized example
nationally.
• Characteristics of a successful data warehouse:
o Data must be housed in a neutral setting
o Data holder can not be a regulator, payer, or provider of
services
o Data holder can have no power base, can not upset balance
of power
o Provides equal access for all users
o Promotes research and use
o Data must be secured and individual privacy protected
o Data release must be approved by data owner or by multistakeholder councils and committees
Proviso
117.13. (GP: SC Health & Human Services Data Warehouse) “There is
hereby established within the Office of Research and Statistics, South
Carolina Budget and Control Board, the South Carolina Health and
Human Services Data Warehouse. The purpose of the Warehouse is to
ensure that the operation of health and human services agencies may
be enhanced by coordination and integration of client information. To
integrate client information, client data from health and human services
state agencies will be linked to improve client outcome measures,
enabling state agencies to analyze coordination and continuity of care
issues. The addition of these data will enhance existing agency systems
by providing client data from other state agency programs to assist in
the provision of client services. Certain client information shall be
delivered to the Office of Research and Statistics in order to assist in the
development and maintenance of this Warehouse…”
Elder Services
& Assessments
Employment &
Wage
Disabilities &
Special Needs
Vocational
Rehabilitation
Homeless
MIS*
SLED
Employment
Training
Programs
Unemployment
Claims
Legal/Safety
Services
Juvenile
Justice
Social Services
Probation,
Parole & Pardon
Claims Systems
Corrections
Education
LEGEND
All Payer Health
Care Databases
Health Professions
Social Services
First Steps
Behavioral Health
Health
Department
Alcohol & Drug
Services
Disease
Registries*
Mental Health
State Employee
Health Services
Health
Professions
Home Health
Care
Emergency
Room Visits
Child Care
Medicaid
Services
Free Clinic
Visits*
Outpatient
Surgeries
Hospitalizations
Community
Health Centers*
Health
Department
Education
Employment and
Workforce
Disease
Registries
Other State
Agencies
* Limited data available
Tracking System
• Series of algorithms to create a unique identifier for
each individual
• Unique identifier stays with the individual over time
• Enables staff to “link across” multiple providers and
settings
• Protects the confidentiality of the individual
• Requests to link across systems must be approved
by all participating agencies and organizations
Personal identifiers are never stored with the statistical
data; the unique identifier is appended to the statistical
record and is not derived from identifiable information.
Information Products
Analytic Products
• Agency Collaboration
• Researcher
Collaboration
o
o
o
o
Data linkage
De-identified datasets
GIS support
Analytic support
• Public Website
o Descriptive statistics
o Ability to query data sources
and generate ad-hoc reports
•
•
•
•
•
•
Application Partners
ABC Tablet Application
Community Long Term
Care Application
Ages and Stages
Questionnaire
Dept. of Education
Data Warehouse
Purpose Built Screening
and Referral Systems
South Carolina Health
Information Exchange
Example 1: Health Care Price
Transparency
Example 2: Telepsychiatry
Program Support and Evaluation
Roles of the Data Warehouse in
the SC Telepsychiatry Initiative
Program Operation
• Provision of Medicaid
Data
• Provision of DMH data
into SC Health
Information Exchange
(SCHIEx)
• Integration of DMH
Electronic Medical
Record system with
SCHIEx
Program Evaluation
• Linkage of program
specific data into
Integrated System
• Provision of additional
linked elements from
the data warehouse,
most notably UB 92/04
• Statistical and analytic
support
Clinical Office Locations
Columbia, SC
(3)
Charleston, SC
(2)
Aiken, SC
(2)
Future
Site(s)
Last Update: 04/18/2013
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Consultation Process
Patient Presents in ED
ED Physician Requests Consult
Psychiatrist Reviews CIS/SCHIEx, EMR
Patient Consulted
Video Encounter Ends
Psychiatrist Electronically Signs Consult
Recommendations Sent to ED
Hospital Dispositions the Patient
Last Update: 04/18/2013
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Evaluation Strategy
• Propensity scoring with optimal matching used to
match patients treated at intervention EDs to those
treated at non-intervention EDs in South Carolina
• Compared two groups on utilization and cost
outcomes using standard econometric techniques
Narasimhan, Druss et al NIMH and NIH R01
Baseline Characteristics
Age
Female
White
Black
Weekend Admission
Telepsychiatry
Control
N=7,261
35.7
49.8%
73.1 %
23.8%
38.6%
N=7,261
35.7
49.8%
73.1 %
23.8%
38.6%
Narasimhan, Druss et al NIMH and NIH
R01
Service Use
Admission
LOS at index visit (in
days)
30 day OP f/u
90 day OP f/u
Telepsychiatry
Control
N=7,261
22%
N=7,261
11%
0.43
46%
1.35
16%
54%
20%
P
<0.001
<0.001
<0.001
<0.001
<0.001
Index 30 day IP cost
Index 30 day hospital
cost (IP+ED)*
$8,290
$11,224
$12,634
$14,052
Narasimhan, Druss et al NIMH and NIH R01
0.002
What can we learn from
these efforts?
• Integrated data systems can “close the loop”
between practitioners, applied analysts, and basic
researchers
• Integrated data systems can help create and
sustain public, private, and not for profit
partnerships around issues
• Integrated data systems reduce costs by
repurposing existing data, producing “economies of
scale”