1. Arkansas Department of Health and MONAHRQ Presented by: Connie Marie Ardwin

2. Introduction Hospital Discharge Data Section, Arkansas Department of Health Collecting inpatient discharge data since 1997 Includes many additional fields; refined over time to improve data quality and annual report. In the past, had “Request for Information” form when specific or aggregate data was needed Today, take the next step to make our county and area level aggregate data publicly available

3. Who will use the site? Hospital Discharge Data Section Arkansas Hospital Public Health Employee Local Community Future Inpatient Researcher In house Contributors Service users and analysts

4. What makes Arkansas different? Arkansas has 75 counties – 41 of these are serviced by a single hospital – 20 do not have access to a hospital within county borders Arkansas has 108 hospitals – 52 of these are Acute Care and 29 are CAH Arkansas State law and policy – Centralized Health Department tasked with data collection – Requires that hospital and provider level information not be disclosed publicly without hospital consent – Requires that our Data Submittal Guide (rules for formatting and sending data) go through legislative process – Currently only collect inpatient data, however we have begun the legislative process for collecting ED data starting in 2012.

5. How has AR been reporting? Publicly – Annual Report – http://www.healthy.arkansas.gov/programsServices/h ealthStatistics/Documents/HospitalDischarge/2009Ho spitalDischargeAnnualReport.pdf http://www.healthy.arkansas.gov/programsServices/h ealthStatistics/Documents/HospitalDischarge/2009Ho spitalDischargeAnnualReport.pdf Privately / In House – Requests for Information – Detailed summary of hospital utilization provided for each hospital upon request – Datasets or aggregate data summaries for researchers and other State departments

6. How will we use MONAHRQ? Internally – To check our analyses done by SAS – To provide hospitals information on their facility Publicly – To report county level rates and quality measures – To enhance our Annual Report Password Protected – We had originally considered asking hospitals if they would like their data to be included in a masked ‘hospital level, utilization’ website.

7. How did AR implement MONAHRQ? Had to have staff available – Look at the uses of MONAHRQ and which aspects would benefit us. – Learn how to use MONAHRQ Had to have the right political climate – Public reporting is a hot topic – Work with our Hospital Association to get word out about our publications (Annual Report)

8. Software and IT Issues Software is extremely easy to set up and use. AR data required lots of prep work. – Mapping the dataset – Easier to work qualifying logic before loading than after – Double and triple check the #s Mapping File was made using the HCUP resources for mapping. SAS to MQ map.doc

9. Software and IT Issues Software is extremely easy to set up and use. Data requires lots of prep work. – Mapping the dataset – Easier to work qualifying logic before loading than after – Double and triple check the #s Our data is collected as a flat file from the hospitals, then all hospitals are combined into a Master dataset for the year and stored as a SAS dataset. We use a SAS program to roll up / map the data elements, drop unnecessary elements, and use the MONAHRQ logic to delete non-qualifying records.

10. Software and IT Issues Software is extremely easy to set up and use. Data requires lots of prep work. – Mapping the dataset – Easier to work qualifying logic before loading than after – Double and triple check the #s Never assume that because it worked last time that the numbers are good this time. Double check all numbers. Example: I changed from using the total charges stored as a character to the total charges stored as a number. I removed the decimal point, and got a surprised question: “We could save three billion dollars if we reduced hospitalizations for Congestive Heart Failure by 50%?

11. Hosting and HTML Issues Generated pages can be linked to from our SharePoint site, but not incorporated into them. The company hosting our department site had trouble understanding what we needed to add, as they did not know what MONAHRQ generated. They can also be converted to a SharePoint site, but that would be costly. The static IP address assigned to the pages where they are to be stored is very user un- friendly. So, we are obtaining a.gov address through our DIS department that will redirect to the static IP address.

12. Hosting and HTML Issues Generated pages can be linked to from our SharePoint site, but not incorporated into them. The company hosting our department site had trouble understanding what we needed to add, as they did not know what MONAHRQ generated. After many emails, file transfers, phone calls, and sit downs we figured out how to describe what we need. “We need a link from our section of the ADH website to the homepage (index) where our generated pages are stored. The web pages we generate are all relative. We will need the.gov address to redirect to this address.

13. Hosting and HTML Issues HTML text changes – Some definitions, such as Cost Savings, need further clarification. – Add Disclaimers to certain pages, such as how this data does not include Arkansas patients that were treated in an out of state facility. Apply the “Look and Feel” of the ADH site to the MONAHRQ pages; this cannot be easily done without the help of Web Design personnel. We have been told that we can add visitor counters and a link for contacting us if there are questions, however we have not been informed how to go about adding these to the pages.

14. Home Page - Generated

15. Home Page - Altered

16. How the ADH uses MONAHRQ MONAHRQ is used internally by our Hospital Discharge Data Section. Error check our data. Error check our mappings. Compare utilization statistics.

17. How the ADH uses MONAHRQ MONAHRQ is used internally by our Hospital Discharge Data Section. Error check our data. Error check our mappings. Compare utilization statistics. Invalid values: diagnosis codes and procedure codes Incorrect line ups: Present on Admissions and Days to Procedure present without a ICD-9 code or missing when there was.

18. How the ADH uses MONAHRQ MONAHRQ is used internally by our Hospital Discharge Data Section. Error check our data. Error check our mappings. Compare utilization statistics. Invalid mappings: race/ethnicity, days to procedure, source of payment, patient disposition, source and type of admission.

19. How the ADH uses MONAHRQ MONAHRQ is used internally by our Hospital Discharge Data Section. Error check our data. Error check our mappings. Compare utilization statistics. Discharges, Length of Stay, Charges, Cost, and means By Status, Patient demographics, Hospital demographics

20. How the ADH uses MONAHRQ A section of MONAHRQ has been approved to be used publicly within an online published document. Produce the PQI section of our Annual Report. This information is now online and available for everyone to view! Hospital Discharge Page

21. Help with setting up MONAHRQ Email monahrq@ahrq.govmonahrq@ahrq.gov AHRQ Quality Indicators Web Site http://www.qualityindicators.ahrq.gov/ HCUP Data Elements http://www.hcup- us.ahrq.gov/db/state/siddist/siddist_ddeavailb yyear.jsp

22. Public Reporting Challenges Collecting hospital data Getting accurate data Border counties have a high population % going to out of state hospital Protecting patient information, particularly in low population counties Solutions Law requires hospitals to report Get corrections on records from hospitals until less than 1% error by our checks Requesting out of state hospital data and using the Exchange Make sure all counties reported on have a high enough denominator – currently done by hand

23. Public Reporting Challenges Law does not allow to publish hospital level or identifying information Numerous (75) counties, the majority with a small population, cause many of the county rates to be suppressed. Solutions Do not publish the hospital utilization and rates sections of the website Group hospitals up into a peer group and report on the group Considered rolling our counties up into larger reporting regions in future, but we are keeping it at the county level for now.

24. Impact of MONAHRQ Internal exposure to MONAHRQ within the Health Statistics Branch has generated a lot of interest in both the software and reporting elements. Hospital Discharge Data Section Other Departments

25. Impact of MONAHRQ Internal exposure to MONAHRQ within the Health Statistics Branch has generated a lot of interest in both the software and reporting elements. Hospital Discharge Data Section Will ease reporting to and on hospitals, including some requests for information Paved way for adding estimated costs Added reliable Quality Indicators by county

26. Impact of MONAHRQ Internal exposure to MONAHRQ within the Health Statistics Branch has generated a lot of interest in both the software and reporting elements. Other Departments / Reporting Critical Access Hospitals (special reporting) Emergency Department Data (hope to start collecting in 2012) Epidemiology (like to see a future version with Injury Indicators – CDC)

27. Future of MONAHRQ use in AR We hope to have our first hospital inpatient public reporting site go live as early as October this year. Technical issues could push this launch back to November. We plan on speaking with our Hospital Association about options for making the Utilization and Quality Ratings available to the hospitals.

28. Questions? If you have any additional questions you can contact me at: Connie.Ardwin@arkansas.gov Phone # 501-280-4064 Thank you.