TURING DATA INTO INSIGHT
DANA DELPIT, MBA
MELODY ROBINSON, MPH
GOAL AND OBJECTIVES
• Goal: Participants will explore and learn how multiple data sources both
clinical and non clinical can be used to improve health outcomes
• Objectives
• Define data
• Identify sources of data, the purpose for collecting and usage
• Learn how identify and use data to influence community work
Data quality and consistency are critical to
ensuring patient safety, communicating delivery
of health services, coordinating care, and
healthcare reporting.
WHAT IS DATA?
• Data is defined as, facts and statistics collected together for
reference or analysis.
• Facts or information used usually to calculate, analyze, or plan
something
DATA STANDARDS
• Data standards are "documented agreements on representations, formats,
and definitions of common data.
• Data fields and the content of those fields need to be standardized.
• Develop portals to describe how the data is recorded to ensure consistency
across multiple sources.
HOW IS DATA COLLECTED
• Nationally – Meaning Full Use, HEDIS, UDS
• Statewide– BRFSS (Behavioral Risk Factor Surveillance System), Youth Risk
Behavior survey
• Locally
• City –crime rate, employment rates, home ownership, school performance
• Community– crime rates, neighborhood population,
NATIONALLY REPORTED DATA
• Meaningful Use is a set of criteria for the use of EHR systems to improve patient care by
healthcare providers. The concept of meaningful use was developed by the National Quality
Forum (NQF); their ideas included improved population health, coordination of care, improved
safety, and patient engagement
• The "meaningful use" EHR Incentive Program was developed to allow care providers to
implement EHR technology in three stages. Stage 1 focuses on data capture and sharing of
data, stage 2 focuses on clinical processes such as information exchange and patientcontrolled data, and stage 3 aims to focus on improving patient outcomes. The incremental
phases allow care providers to adopt standards into their daily workflow.
MEANINGFUL USE MEASURES
Eligible Professionals – 15 Core Objectives
1. Computerized provider order entry (CPOE)
2. E-Prescribing (eRx)
3. Report ambulatory clinical quality measures to CMS/States
4. Implement one clinical decision support rule
5. Provide patients with an electronic copy of their health information, upon request
6. Provide clinical summaries for patients for each office visit
7. Drug-drug and drug-allergy interaction checks
MEANINGFUL USE MEASURES
8. Record demographics
9. Maintain an up-to-date problem list of current and active diagnoses
10. Maintain active medication list
11. Maintain active medication allergy list
12. Record and chart changes in vital signs
13. Record smoking status for patients 13 years or older
14. Capability to exchange key clinical information among providers of care and patient-authorized entities
electronically
15. Protect electronic health information
NATIONALLY REPORTED DATA
•
Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90
percent of America's health plans to measure performance on important dimensions of care and
service. Altogether, HEDIS consists of 81 measures across 5 domains of care. Because so many
plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it
possible to compare the performance of health plans on an "apples-to-apples" basis.
•
The HEDIS domains of care are:
• Effectiveness of care.
• Access/availability of care.
• Experience of care.
• Utilization and relative resource use.
• Health plan descriptive information.
NATIONALLY REPORTED DATA
• Uniform Data System (UDS) Resources
• Each year, Health Center Program grantees and look-alikes report on their
performance using the measures defined in the Uniform Data System (UDS).
This data is reported to HRSA annually
EXAMPLES OF UDS MEASURES
• Effectiveness of Care
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Cancer Screening
Lead screening in children
Adult BMI Assessment
Controlled HBP
Asthma Medication Ratio
Follow-up care for children prescripted medication for ADHA
Physical activity in Adults
HOW IS DATA USED ?
• The
healthcare industry is currently obsessed with outcome measures — and
for good reason. Today’s health systems must use the wealth of data they
have on hand to drive better quality and cost outcomes. But tracking outcome
measures alone is insufficient to reach these goals.
• To successfully use data to improve quality and cost, health systems must get
more granular with their data. They can’t just look at outcome measures. They
must also track the evidence-based process measures that drive better
outcomes.
HOW IS DATA USED
• Data is used to improve outcomes
• Improve the process of health care
• Used to determine opportunities for improvement
• Assessing the quality of health care
• Data can create a picture of the communities where we live, work and play
HOW DATA IS MEASURED IN HEALTHCARE
OUTCOME MEASURES
• Outcomes are often not closely linked to the quality of care, in part because
outcomes are affected by many social and clinical factors that are not related
to the treatment provided.
• We often do not have the information necessary to identify the most powerful
predictors of outcome that are not related to care. Even if we can identify the
predictors we are often unsure about how best to specify them.
(Source: Office of Behavioral & Social Sciences Research)
EXAMPLE OF BALANCE MEASURES
Decrease no
show rate
Maintain
clinical staff
productivity
Decreased
no show rate
Conduct
investigation
High no
show
rate
Develop a
plan and
test
POPULATION HEALTH
•
Population health is defined as the health outcomes of a group of individuals,
including the distribution of such outcomes within the group. (3,4) These groups
are often geographic populations such as nations or communities, but can also be
other groups such as employees, ethnic groups, disabled persons, prisoners, or any
other defined group. The health outcomes of such groups are of relevance to policy
makers in both the public and private sectors.
•
Note that population health is not just the overall health of a population but also
includes the distribution of health.
THE ROLE OF DATA IN POPULATION HEALTH
• Managing populations – whether an aggregation of patients or a physical
community – is a burgeoning field in healthcare as a way to improve care
while containing costs. Many of the IT initiatives currently underway are
related to population health in one way or another: electronic health
records, meaningful use, interoperability, accountable care organizations,
disease state management, pay-for-performance and patient-centered
medical home all have elements that relate to managing patients in groups.
POPULATION HEALTH
• Populations take many forms – differing geographically, ethnically, and by
age, gender and income. But the initial entry point into this science has been a
focus on groups of patients with the same chronic diseases, including diabetes,
asthma, congestive heart failure, hypertension, arthritis, sleep apnea, chronic
obstructive pulmonary disease and certain cancers.
POPULATION HEALTH
•
The informatics perspective can provide insights and opportunities to improve each of the seven ongoing
elements of any public health surveillance system (3). Examples include the following:
•
Planning and system design – Identifying information and sources that best address a surveillance goal;
identifying who will access information, by what methods and under what conditions; and improving
analysis or action by improving the surveillance system interaction with other information systems.
•
Data collection – Identifying potential bias associated with different collection methods (e.g., telephone
use or cultural attitudes toward technology); identifying appropriate use of structured data compared with
free text, most useful vocabulary, and data standards; and recommending technologies (e.g., global
positioning systems and radio-frequency identification) to support easier, faster, and higher-quality data
entry in the field.
•
Data management and collation – Identifying ways to share data across different computing/technology
platforms; linking new data with data from legacy systems; and identifying and remedying data-quality
problems while ensuring data privacy and security.
POPULATION HEALTH
•
Analysis – Identifying appropriate statistical and visualization applications; generating algorithms to alert users to
aberrations in health events; and leveraging high-performance computational resources for large data sets or
complex analyses.
•
Interpretation – Determining usefulness of comparing information from one surveillance program with other data sets
(related by time, place, person, or condition) for new perspectives and combining data of other sources and quality
to provide a context for interpretation.
•
Dissemination – Recommending appropriate displays of information for users and the best methods to reach the
intended audience; facilitating information finding; and identifying benefits for data providers.
•
Application to public health programs – Assessing the utility of having surveillance data directly flow into information
systems that support public health interventions and information elements or standards that facilitate this linkage of
surveillance to action and improving access to and use of information produced by a surveillance system for workers
in the field and health-care providers.
• Population Health Data Management can
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Identify gaps in service and care
Reveal data truths
Spot patterns
Give direction on strategies
HOW CAN CLINICAL DATA DRIVE THE WORK OF
THE COMMUNITY
ORGANIZING THE COMMUNITY
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Identify Community Partners / Coalitions
• Develop Relationships
• Share Data
• Share Identified Improvement Areas
Share with Community Partners
Share Identified Risks
Discuss Environmental Influences
Discuss Community Strategies to Improve
Develop a Project Plan (Campaign)
Maintain Relationships and Monitor Progress Toward the Project Goal
Continue to Share Data
COMMUNITY MOBILIZED
Community Prioritization and Planning
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Share the data (barriers / risk) with community partners
Identify possible contributors (Environment)
Discuss collaborative improvement strategies/solutions
Plan the change (project)
Make it happen
Continue to collect and analyze data
Maintain/monitor data for improvement
Share data with community partners on a regular bases at community meetings and forums
COMMUNITY INQUIRY AND ANALYSIS
The community identifies areas of concern
• Low literacy rates in children and adults
• Increased fighting among school age kids
• Increase high school drop out rate
• Increasing petty crime
• Increase in prescription drug use
COMMUNITY INQUIRY AND ANALYSIS
• The community neighborhood association received this data from community
partners and sources.
• The community begins to research the root causes of the problems by host
community forums with partners and community members
• From the forums natural leaders emerge to lead the efforts in the community,
as a result, they pool existing resources on the community…..
COMMUNITY ACTION
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The neighborhood schools get together and make it required that kids with low literacy test scores
attend an after school tutorial program staffed by volunteer education majors from the local university
and the local library, students receive meals there prepared by the church and the church provides
transportation for the kids to get home
•
The clinic provides a safe place for the kids to host group meeting-open to discuss whatever is on their
minds, staff by their behavioral health providers and social work students from the university, kids can
also schedule counseling sessions (drug use and conflict resolution) and primary health appointments, in
what the clinics calls “Teen Clinic” , staffed by young people from the community interested in careers in
health , so they can get some experience of working in the medical field. The church van is also
available for transportation to and from the clinic ( all during non-traditional hours). Counseling sessions
and support groups are available for adults as well
COMMUNITY ACTION
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A local YMCA not in the neighborhood partners with the library and Mrs. Smith a
retired teacher to host an adult literacy program in her home 2 days a week
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A local CBO works with partners to develop and implement a work force
development program for residents
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The local Police District and a local business partner to sponsor and coach a sports
league for community kids in many major sports, with a local restaurant owner
sponsoring the uniforms and water for games
WHAT WAS THE DATA PROVIDED BY THE CLINIC?
• The clinic provide data it received from inquiry into why they were receiving a
low return rate on patient satisfaction surveys and its youth behavioral survey,
and increase request from school counselor for behavioral health evaluation
for pediatric patients
• Increase request from adults and seniors in the community for refills on pain
meds reportedly stolen by family members
COMMUNITY INQUIRY AND ANALYSIS
• The community identifies areas of concern through a survey
• Increase in teen pregnancy rate
• Low utilization rate of the neighborhood clinic
• Lack of activities for kids and families
• Lack of local markets for fresh foods
COMMUNITY INQUIRY AND ANALYSIS
•
The community coalition receives this information from a graduate student at the local
university and decides they should take some action
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Through their inquiry (meeting with local partners and residents), the coalition learns
the play equipment in the local park is broken, there are no lights in the park and
light are hit or miss on the streets in the neighborhood at night
•
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Young people surveyed, feel they are unable to talk to their parents about anything
The last local market closed due to safety issues , making the community a food
desert
COMMUNITY INQUIRY AND ANALYSIS
• The community begins to research the root causes of the problems by host
community forums with partners and community members
• From the forums natural leaders emerge to lead the efforts in the community,
as a result, they pool existing resources on the community…..
COMMUNITY ACTION
•
The community lobbies their local council person to present their lack of park and
neighborhood lighting to the full council, for a quick resolve with the local utilities
company and the Parkway commission.
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Graduate chapters of local Greek Organization and Boys and Girl Town work with
the coalition to develop a plan for repair of the play equipment in the local park
and a mentoring program for girls and boys
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The coalition invites AARP to present to the community their plans for senior activities
in the neighborhood(walking clubs, computer adult computer classes)
COMMUNITY ACTION
• The local elementary school worked the location to write a grant to provide
extended hour school days, so the kids could have a tutorial program and
afterschool activities (sports and dance). Family night activities were offered
twice a month ( movie night, bingo, off site activities) all at no cost the families.
• The school social workers worked with a local CBO to provider parent, family
and child support groups to add the communication issues with children and
parents, and young parents identified by the clinic as needing parenting skills
were referred for support and education.
COMMUNITY ACTION
• The ladies Club of the local church present to the coalition, they plan for developing a community garden in
which they will maintain on an open lot in the neighborhood. The fresh fruits and vegetables will be available
to community residents for $10 a month donations, person unable to afford the cost can volunteer to work at
maintaining the garden. Children can volunteer also to learn about gardening through the development of a
4 H Club, the ladies will manage.
• The church will also work with a local food support organization to develop a community pantry to aid
families with limited resources with quality food and provide healthy cooking classes. Families and seniors
will receive monthly food boxes at no cost. Diabetic and Hypertensive patients from the local clinic were given
“prescription” for the pantry to aid in the management of their conditions
• The coalition leaders meet with the clinic’s CEO and leadership to discuss the results of the survey, and to make
them aware of the results and to explore ways the clinic can aid in the resolve of these issues.
COMMUNITY ACTION
• As a result of the clinic leadership meetings with the coalition, the clinic is made aware of how the community views them as an organization.
The clinic works with the three local schools to become a school linked clinic and offers clinic appoints starting at 7:00AM-7:00PM, so kids will
not have to miss school for appointments, students can be seen in the clinic during school hours , were as the clinic functions as the “ school nurse”
.
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The results of the survey showed young people were not using the clinic because, they felt people knew why they were coming to the clinic. The
leadership of the clinic met with the youth leaders of the community and worked to address the concerns of the young people and work to
integrate the needs of young people into the work flow of the clinic, so young patient could be seen on either floor of the clinic, by many
different providers and not in an identified teen area, the young people were educated through group sessions on the laws in their state on
adolescents accessing health care without parental consent.
• Adult utilization needs were also address by offering the extended hours, free prescription assistance, income based payment plans when
needed, the clinic worked with a hospital to provided free and/or discounted diagnostic and specialty services to patients
• The clinic wrote a grant to hire community members to serve as community workers to canvas the neighborhood hosting home health parties to
educate residents on health issues and resources and as a way to bring the needs and concerns of the community back to the clinic leadership,
parties for young people were called pizza protection parties
RESULTS
•
As a result of all of the efforts the clinic was able to report to the coalition, it’s
finding of their CQI results
• Patients were noted to have lower BMI, HP, A1c results
• Increases in new patients
• Increases in adolescents seeking and using the services of the clinic
• Decreases in teen pregnancy rates and STI
• PHQ results were trending in more patients being happy, felling safe in the
neighborhood and less depression
Questions
Thank You