Development of Emergency Department (ED) Community Health Indicators
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1 Development of Emergency Department (ED) Community Health Indicators Supported by: Agency for Healthcare Research and Quality (AHRQ) Substance Abuse and Mental Health Services Agency (SAMHSA)
2 Project Team Kathryn McDonald, PI Sheryl Davies, Research Associate/Project Director Research Staff: Eric Schmidt, Lauren Rohn, Ellen Schultz, Karey Shuhendler Statistical Consultant: Ben Goldstein Lead Clinical Collaborators: Maria Raven (UCSF, Emergency Medicine), M. Kit Delgado (U Penn/previously Stanford, Emergency Medicine), N. Ewen Wang (Stanford SOM, Emergency Medicine), Jose Maldonado (Stanford SOM, Psychiatry) Collaborating Organizations University of California at San Francisco Truven Health Analytics Telligen AHRQ: Carol Stocks, Ryan Mutter SAMHSA: Dee Owens, Kelley Smith
3 Data Acknowledgements We would like to acknowledge the following AHRQ Healthcare Cost and Utilization Project (HCUP) Data partners: Alaska State Hospital and Nursing Home Association, Arizona Department of Health Services, California Office of Statewide Health Planning and Development, Connecticut Hospital Association, Florida Agency for Health Care Administration, Georgia Hospital Association, Hawaii Health Information Corporation, Illinois Department of Public Health, Indiana Hospital Association, Iowa Hospital Association, Kansas Hospital Association, Kentucky Cabinet for Health and Family Services, Maryland Health Services Cost Review Commission, Massachusetts Center for Health Information and Analysis, Minnesota Hospital Association (provides data for Minnesota and North Dakota Hospitals), Missouri Hospital Industry Data Institute, Nebraska Hospital Association, Nevada Department of Health and Human Services, New Jersey Department of Health, New York State Department of Health, North Carolina Department of Health and Human Services, Ohio Hospital Association, South Carolina Budget & Control Board, South Dakota Association of Healthcare Organizations, Tennessee Hospital Association, Utah Department of Health, Vermont Association of Hospitals and Health Systems, Wisconsin Department of Health Services
4 AHRQ Quality Indicator Program Collection of fully specified indicators based on hospital discharge data No-cost software tools with extensive documentation Used widely National-State-Regional example applications Evaluation (research, quality improvement, policymaking) Standardizing comparisons Flagging potential concerns based on variation Current project: Develop and validate indicators of community health that use ED administrative claims data
5 Indicator Development Process Conceptual Framework Conceptual Development Definition of Community Literature Review Indicator Identification and Selection Qualitative Review Development of Administrative Data-based Indicators Specification Validation Dissemination
6 Using Emergency Department Data for Community Indicators (Numerator) ED window into social and community factors that impact health 1,2, 3 1 Malone et al. Social Sci and Med 1995;40(4): Weinerman et al. Am. J. Pub. Hlth 1966; 56: Billings et al. Emergency department use: The New York Story. Issue Brief (Commonwealth Fund). Nov 2000(434):1-12.
7 Defining Community (Denominator) for Indicators: Input from Community Panel What is a community? Community has two parts: 1. Geographic constraint (e.g. nation, state, city) 2. Population included (e.g. low SES, Medicare) Generically, how should community be defined? Ideally, how should community be defined for a multipurpose tool? Feasibly, how should community be defined for a multipurpose tool?
8 Denominator Recommendation: Based on Community Panel Input Ideally, denominator would be flexible to meet needs of the user But can t validate all potential user situations Solution: Validate using county, the most commonly advocated standardized definition. Create guidelines for flexible community definitions Minimum population Allowable heterogeneity of population
9 Identifying and Selecting Indicators Indicators identified through literature review Defined indicators and concepts Not constrained by data type Structured expert panel review AHRQ and SAMHSA priorities 119 Indicator concepts 12 Indicators for further development
10 Indicators Selected for Development General Health ED Visits for Acute ACSC ED Visits for Chronic ACSC ED Visits for Asthma ED Visits for Chronic Back Pain ED Visits for Non-traumatic Dental Conditions Admission Rate for Community Resource-Sensitive Conditions Behavioral Health ED Visits for Substance Use ED Visits for Non-psychotic Mental Illness ED Visits for Psychotic Disorders ED Revisits for Serious Mental Illness ED Revisits for Substance Use ED Visits for Intimate Partner Violence
11 Data Sets Used AHRQ Healthcare Cost and Utilization Project State Inpatient Databases (SID) Admissions originating in ED State Emergency Department Databases (SEDD) ED visits: treated and released, died in ED, AMA Year: States
12 State Level Variation GH 1 Dental ,000 State Rate
13 County Level Variation
14 Indicator Rate by Denominator Size GH1 Dental - Histogram by Quartiles of Denominator Size Number of Counties 1st Quartile ( ) 2nd Quartile ( ) 3rd Quartile ( ) th Quartile (70108+) Total Graphs by GH1DenomQuart Observed Rate
15 Next Steps Continued empirical analyses Structured panel review by clinical experts Fall 2013 (BH set); Winter 2014 (GP set) Beta testing and software refinement Dissemination Project completion: Behavioral health March 2014 General population Sept 2014
3+ 3+ N = 155, 442 3+ R 2 =.32 < < < 3+ N = 149, 685 3+ R 2 =.27 < < < 3+ N = 99, 752 3+ R 2 =.4 < < < 3+ N = 98, 887 3+ R 2 =.6 < < < 3+ N = 52, 624 3+ R 2 =.28 < < < 3+ N = 36, 281 3+ R 2 =.5 < < < 7+
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living Alaska 00 47,808 21,213 44.4 Alabama 01 20,661 3,288 15.9 Alabama 02 23,949 6,614 27.6 Alabama 03 20,225 3,247 16.1 Alabama 04 41,412 7,933 19.2 Alabama 05 34,388 11,863 34.5 Alabama 06 34,849 4,074
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Rank State District Count (HTC) 1 New York 05 150,499 141,567 94.1 2 New York 08 133,453 109,629 82.1 3 Massachusetts 07 158,518 120,827 76.2 4 Michigan 13 47,921 36,145 75.4 5 Illinois 04 508,677 379,527
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