Reflection Paper
Baba0914
AC21620-Chapter21.pptxA Practical Approach to Analyzing Healthcare Data, Fourth Edition Chapter 2, Data in Healthcare
Susan White, PhD, RHIA, CHDA
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Learning Objectives
Compare and contrast reliability and validity
Categorize types of healthcare data
Connect the health care data flow to the data types and uses
Illustrate commonly used sources of external data
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Data Quality
Validity
Accuracy of the data
Ability of the data to measure the attribute it is intended to measure
Reliability
Repeatability or reproducibility of the results
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Types of Validity
Face validity
Does the metric appear to measure the quantity it was intended to measure?
Often assessed via expert opinion
Weakest form of validity measure, but should be the first step is assessing validity of a new test or metric
Content validity
Are the components of the metric necessary and sufficient to measure the quantity?
In survey design, this content validity ensures that there are not irrelevant questions
Construct validity
Is the measurement tool capturing the construct to be measured?
In survey design, this may be measured by asking similar questions about a topic (or construct) to ensure consistency in the responses
Criterion validity
Does the metric agree with an accepted gold standard for measuring the same quantity?
A new less expensive laboratory test may be compared against another accepted test for measuring the same quantity. If the test results agree, then the new test has criterion validity
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Types of Reliability
Inter-rater reliability – measures the reproducibility or consistency of the metric between two different raters
Intra-rater reliability – measures the reproducibility or consistency of the metric between two different time points using the same rater
Statistics to measure reliability
Kappa statistic or Cohen’s Kappa
Measures inter or intra rater reliability
0.41 to 0.60 – moderate
0.61 to 0.80 – substantial
0.81 to 1.00 – almost perfect
Cronbach’s Alpha
Measures internal consistency between questions
Acceptable level >= 0.70
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Types of Healthcare Data
Internal data
Electronic health records
Claims and billing data
Patient satisfaction surveys
External data
Registries (may be both internal/external)
Statewide databases
Medicare claims data
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Diagnostic Data
Transitioned to ICD-10-CM on 10/1/2015
Even after transition, both coding systems will be utilized for data profiling and analysis
ICD was designed as a disease tracking system, but used in the US as a payment driver under prospective payment systems
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Diagnostic Data - IPPS
CMS pays for inpatient services provided to Medicare patients via an inpatient prospective payment system (IPPS)
Payment is based on diagnosis related groups (DRG) – ICD-10 diagnosis and procedure codes are combined with other demographic data to ‘group’ patients in the DRGs for determination of payment
DRGs are further grouped into MDCs
ICD-10 and DRG codes are all updated based on the federal fiscal year starting on October 1.
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Diagnostic Data
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Procedural Data – ICD-10-PCS
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Procedural Data - CPT
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Pharmacy Data
National Drug Codes (NDC)
FDA website
http://www.fda.gov/Drugs/InformationOnDrugs/ucm142438.htm
Therapeutic Classification Groups
OVID Field Guide
http://resourcecenter.ovid.com/site/products/fieldguide/ipab/List_of_AHFS_Pharmacologic-.jsp
RxNorm
National Library of Medicine
http://www.nlm.nih.gov/research/umls/rxnorm/
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Administrative Data
Revenue Codes
Place of Service Codes
Claims Processing Codes
Relative Value Unit Data
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Revenue Codes
Four digit code
Used to categorize charges into ‘departments’ on UB-04 or 837I billing records
NOT necessarily the same department found in provider accounting system
Standard across providers
Allows comparison of departmental charges and costs across providers
http://www.resdac.org/sites/resdac.org/files/Revenue%20Center%20Table.txt
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Place of Service Codes
Used on professional claims (HCFA-1500 or 837P) to specify the type of location that the service was performed
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Healthcare Data Flow
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Claims Data
UB-04 Claim form (CMS-1450)
Hospital services
Submitted via 837I transaction set
5010 format
CMS-1500 Claim Form
Physician services
Submitted via 837P transaction set
5010 format
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Departmental Databases
Laboratory Information System (LIS)
May use Logical Observational Identifiers Names and Codes (LOINC)
Radiology Information System (RIS)
Images available through Picture Archiving and Communication System (PACS)
Patient Accounts Database
Includes financial data
Charges
Payments
Accounts receivable/accounts payable
Payroll
General ledger
May be called a practice management system in a physician office
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Other Internal Data
Registries
Cancer
Trauma
Birth
Diabetes
Implants
Transplants
Immunizations
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External Data
Medicare
Inpatient
Outpatient
Part B Utilization (Physician)
State Databases
HCUP
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Medicare Claims Data
MedPAR File
All Medicare inpatient claims for a given federal fiscal year (10/1 – 9/30)
Data source for many of the labs accompany text
One record for each inpatient stay
Used as the basis for IPPS DRG relative weight changes
Standard Analytic Outpatient File
All Medicare outpatient claims for a given calendar year
Multiple files that must be combined to summarize at the claim level
An extract of this file (HOPPS) is the basis for changes to OPPS APC relative weights
Part B Utilization File
Summary file by calendar year
Includes information by specialty and for top HCPCS codes:
Allowed services (volume)
Allowed charges
Payment amount
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CMS Payment Rule Impact Files
Released annually
Inpatient prospective payment (IPPS)
Outpatient prospective payment (OPPS)
Includes data elements that may be used for benchmarking
Hospital Demographics
Urban/rural setting
Region
Ownership
Teaching/non-teaching status
Number of beds
Operational Statistics
Volume
Average daily census
Payment adjustment factors
Ratio of cost to charge for cost estimation
Case mix index
Medicare percentage
Value based purchasing performance
Payment level (current and projected)
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Data.medicare.gov
Central repository for Medicare ‘compare’ databases
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State Databases
Utah
Office of Healthcare Statistics
Hospital utilization
Ambulatory surgery center utilization
Query tools to locate specific data
Massachusetts
Massachusetts Community Health Information Profile (MassCHIP)
Standard reports – ‘instant topics’
Downloadable query software for producing custom reports
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HCUP
http://hcupnet.ahrq.gov/
Data elements
Statistics on Hospital Stays
Readmission Rates
Emergency Department Use
AHRQ Quality Indicators
Online query system
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HCUP Sample Query
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