# Presentation: 322438

## Adding Clinical Data to Administrative Data: AHRQ-sponsored Pilot & Planning Projects 

**AHRQ Team:**
**Roxanne Andrews, Ph.D.**
**Anne Elixhauser, Ph.D****. **
**September 9, 2008**

## Outline 

***Outline****** ***

- Rationale for AHRQ contracts to add clinical data to administrative data
- Overview of AHRQ-sponsored projects
- First-year activities of pilot projects

## Limitations of Administrative Data for Quality Measurement

***Limitations of Administrative Data for Quality Measurement***

- Lack clinically important information
- Limited to ICD-9-CM diagnosis codes
- Often do not include present on admission (POA) indicator for diagnoses
- 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

## Rationale for Adding Clinical Data 

***Rationale for Adding****** Clinical Data****** ***

- AHRQ-sponsored study showed adding a few clinical data elements significantly improves quality assessment using administrative data
- Important, cost-effective, additions:
- POA
- Lab values (numeric) on admission
- (Potentially) vital signs

## AHRQ Contracts to Add Clinical Data to Statewide Administrative Data

***AHRQ Contracts to ******Add Clinical Data to Statewide Administrative Data***

- Purpose:
- Jumpstart the enhancement of administrative data
- Expand data capacities for statewide data organizations participating in HCUP
- Solicited proposals for two types of contracts:
- In-depth pilots
- To add or link hospital clinical information to administrative data
- Sept. 2007 – Sept. 2009
- Planning contracts
- For organizations not yet ready to engage in pilots
- But seek to enhance their administrative data
- Sept. 2007 – Mar. 2009

## Awards to Statewide Data Organizations

_***Pilots***_
**Florida** Center for Health Information and Policy Analysis, Agency for Health Care Administration
**Minnesota** Hospital Association
**Virginia** Health Information* *
_***Planning***_
**Washington** Center for Health Statistics, State Department of Health

## Objectives of Pilots

***Objectives of Pilots***

- Establish feasibility of linking clinical and administrative data
- Develop reproducible approach
- Set the stage for integrating clinical and administrative data streams in the future

## Project Requirements

***Project Requirements***

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

## First Year’s Activities

***First Year’s Activities***

- Develop Final Implementation Plan
- Recruit hospitals
- Develop data collection method
- Begin data collection
- Participate in peer learning network & disseminate lessons learned

## Recruit Hospitals

***Recruit Hospitals***

- 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
- Electronic lab data
- LOINC coding
- HL-7 transmission

## Recruitment Very Successful

| Project | Number of Hospitals Expected |
| --- | --- |
| Contract Requirement | 5 |
| Florida | 20+ |
| Minnesota | 25-30 |
| Virginia | 30+ |

## http://www.fhin.net/FHIN/HITinitiatives/AHRQaddingClinData.shtml

## http://www.mnhospitals.org/index/ahrq-project

## http://www.vhi.org/hybriddata.asp

## Develop Data Collection Method

***Develop Data Collection Method***

- Select data elements to be collected
- POA
- Lab data elements
- Linking data elements
- Develop standard data submission format
- LOINC coding of lab names
- 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

## Types of Lab Tests to be Included: Chemistry 

- AST
- Albumin
- Alkaline Phosphatase
- Amylase
- Bicarbonate
- Bilirubin Total
- BNP
- Calcium
- C-Reactive Protein
- Creatine Kinase (CPK)

- Creatine Kinase MB
- Creatinine
- Glucose
- Lactic Acid
- Potassium
- Pro-BNP
- Sodium
- Troponin I
- Troponin T
- Urea Nitrogen (BUN)

## Types of Lab Tests to be Included: Other 

_**BLOOD GAS**_
- Arterial O2 Saturation
- Arterial pCO2
- Arterial pH
- Arterial pO2
- Base Excess
- Bicarbonate
- FIO2

_**HEMATOLOGY**_
- Hemoglobin
- INR
- Neutrophil Bands
- Partial Thromboplastin Time
- Platelet Count
- Prothrombin Time

## Type Information To Be Collected on Lab Tests

- LOINC code for lab test name
- Observation value (lab result)
- Observation unit of measure
- Date/time of observation

## Participate in Peer Learning Network

***Participate in Peer Learning Network***

- Monthly conference calls with other pilot and planning state data organizations
- Document sharing
- California and the Veteran’s Administration have joined to share their knowledge on similar activities

## Sharing Lessons Learned with Other Organizations

***Sharing Lessons Learned with Other Organizations***

- Interim Information on HCUP-US
- Implementation Plans
- Project summaries
- Links to project websites
- www.hcup-us.ahrq.gov/reports/clinicaldata.jsp

## http://www.hcup-us.ahrq.gov/reports/clinicaldata.jsp

## Future Activities

***Future Activities***

- _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 report from each site
- Synthesis of lessons across sites by Thomson Reuters & National Academy for State Health Policy (NASHP)

## Contact information 

- Roxanne Andrews
- _[roxanne.andrews@ahrq.hhs.gov](mailto:roxanne.andrews@ahrq.hhs.gov)_
- 301-427-1403
- Anne Elixhauser
- _[anne.elixhauser@ahrq.hhs.gov](mailto:anne.elixhauser@ahrq.hhs.gov)_
- 301-427-1411