Transcript Document

Data Integration
Efforts and Challenges
Because Minds Matter: Collaborating to Strengthen
Psychotropic Medication Management for Children
and Youth in Foster Care
August 27-28, 2012
Scott M. Bilder, Ph.D.
Institute for Health, Health Care Policy, and Aging Research
Rutgers, The State University of New Jersey
([email protected])
MEDNET
o AHRQ-funded initiative involving Rutgers,
Columbia, Academy Health, six states, and
others to:
• Develop a set of measures for antipsychotic use
patterns.
• Convene a cross-state network to review evidence,
policies, and practices.
• Implement quality improvement programs in each
state.
• Evaluate impact of efforts and share knowledge
obtained.
MEDNET Organization
o Multi-state Steering Committee / Learning
Workgroup.
o Workgroups (with representation from
participating states).
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Metrics Workgroup.
Foster Care Children Workgroup.
Duals/Medicare Part D Data Workgroup.
o State-specific QI teams,
including Project Leads, Data Leads, and Local
Stakeholder Committees.
Adapting Efforts to Foster Care
Context
o Maintain existing relationships while
developing new collaborations with child
welfare stakeholders.
o Broaden and diversify focus:
• Shared (core) issues.
• State-specific issues.
o Identify appropriate data systems and
experts.
o Create and/or adapt quality metrics.
Data Issues
o Identifying and tracking youth across time
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and data systems.
Keeping up with status/eligibility changes.
Identifying health services not captured in
claims data.
Establishing sufficient look-back periods for
treatment initiators.
Establishing common data structures to
support analysis and reporting.
Data Integration
Medicaid
FFS
Claims
State
Childrens’
Services
Data
Medicaid
Encounter
Data
Medicaid
Eligibility
Files
Data Sources
Mental
Health
Carveouts
Medicare
(A, B, D)
State Mental
Health
Agency Data
DATA INTEGRATION
State
Medicaid
Agencies
State Mental
Health
Agencies
Data Users
Mental
Health
Clinics
Consumers
State
Children’s
Services
Providers
and
Prescribers
Data Integration
o Multiple data silos are structured differently.
o Often the data are structured to support
very specific applications.
o Narrative data present additional
complications.
o Data integration must happen at several
levels:
• Linkable databases.
• Task-specific analytic files.
Data Integration
o Full-scale integration of multiple data sources is
often impractical given:
• Different organization.
• Different production schedules.
• The sheer number of data elements.
o We have found it useful to define a common
data framework.
• Using only those data elements that are needed.
• Focusing programming efforts.
• Focusing documentation efforts.
Privacy and Compliance
o Different data sources present unique
threats to privacy, and accompanying:
• Request processes and agreements.
• Person identifiers.
• Physical security requirements.
• Ongoing privacy review.
o Data that we are used to handling in
isolation may require additional efforts at
privacy protection when combined.
Metric Development
o Polypharmacy
o Psychotropics in very
o Adherence
young children
o Diagnoses
consistent with
psychotropic
treatment
o Services consistent
with psychotropic
treatment
o Excessive dose
o Cardiometabolically
challenging
antipsychotics
o Metabolic/lipid
monitoring
Metric Development
o Metrics committee identifies needs with input
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from all stakeholders.
Initial discussions within metrics committee
result in a draft conceptual summary.
Programming code is developed and results of
applying metric are evaluated.
Conceptual summary is presented to
stakeholder committee.
Metrics committee revisits evidence base on a
regular basis.
Initiative Under Development
o Develop partnerships to assist states in
effectively utilizing systems for psychotropic
medication monitoring and mental health
quality improvement for foster care youth.
• Facilitate knowledge sharing and integration.
• Provide technical assistance.
Initiative Under Development
o Develop, customize, and disseminate evidence
on treatment effectiveness, processes, and
quality management to states.
• Monitor evidence base.
• Create topic and technical briefs.
• Provide participating states with customized
products adapted to child welfare context.
• Conduct webinars, panel discussions, to bring
together multiple stakeholder perspectives.
Initiative Under Development
o Improve the informatics foundation for bringing
together multiple data sources.
• Develop and/or adapt health care quality metrics
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to foster care context.
Identify and share best practices for linking data
across and within state systems.
Develop a core multistate data model.
Implement a shared computing and
documentation infrastructure.
Collaborate with states and others to design and
conduct studies that make the most use of
enhanced, linked databases.