508 Compliant Slides

Data Linkage Training Project for Vital
Statistics and Medicaid Claims Data presents
Uses for Linked Data
April 28, 2014
12:30-1:30 pm ET
Agenda
• Welcome and Introductions
• Introduction to Using Linked Datasets
• State Examples
– Louisiana
– Experiences from other states?
• Using Linked Datasets for Performance Measurement: Review
of the Two Core Measures
• Introduction to the Common Project: A State Fact Sheet
• Next Steps
2
How to Use Linked Data Sets
• Purpose of Today’s Event
• Considerations
– In what ways can your state’s use of maternal and
infant health data be improved by linking claims
and birth certificate data?
– How does the number of Medicaid births
identified using the birth certificate compare to
the number of Medicaid births derived from the
linked data set?
3
Ways to Use Linked Data
•
•
•
•
•
Performance Measure Reporting
Program Monitoring and Evaluation
Quality Improvement
Surveillance
Research
4
Linked Medicaid data use in Louisiana
Lyn Kieltyka, PhD
State Maternal and Child Health Epidemiologist
Bureau of Family Health
Louisiana Office of Public Health
Reporting
Title V Block Grant: Health Status Capacity Indicator #5
Comparison of Medicaid to non-Medicaid populations
Medicaid
Infant mortality
First trimester
prenatal care
*
Rate per 1,000 live births
Rate*
Total
N
Rate*
N
457
10.1
113
5.7
570
8.8
%
N
%
N
%
5,416
12.0
1,506
7.6
6,922
10.7
37,573
83.6
18,930
96.5
56,503
87.5
N
Low birth weight
Non-Medicaid
N
Rate*
Comparison between Data Sources
Medicaid-Birth linked
Medicaid
PRAMS
Yes
No
Total
Yes
106,251
6,117
112,368
No
4,234
72,784
77,018
110,485
78,901
189,386
Total
Sensitivity Analysis Results
100
96.2
Percent (%)
80
92.3
94.6
94.5
60
40
20
0
Sensitivity
Specificity
Positive Previctive
Negative
Value
Predictive Value
Needs Assessment and
Mortality Reduction Program Planning
Louisiana
Louisiana Medicaid
Birth
Weight
Fetal
Deaths
Neonatal
PostNeonatal
Birth
Weight
Fetal
Deaths
Neonatal
PostNeonatal
5001499 g
4.1
4.1
4.1
5001499 g
5.1
5.1
5.1
1500 +
g
1.7
1.6
2.7
1500 +
g
2.0
1.7
3.6
Total Mortality Rate 10.1 per 1,000
Total Mortality Rate 12.4 per 1,000
Perinatal Periods of Risk (PPOR) Concept Map
Birth Weight
Fetal Deaths
Neonatal
Post-Neonatal
500-1499 g
Maternal Health/
Prematurity
Maternal Health/
Prematurity
Maternal Health/
Prematurity
1500 + g
Maternal Care
Newborn Care
Infant Health
Nurse Family Partnership
Program Planning
• Program eligibility: first-time, Medicaid eligible
women
Medicaid
1713
1291
Non-Medicaid
795
483
Total births
2508
1774
East Baton Rouge
1693
845
2538
Calcasieu
Rapides
Bossier
Caddo
St. Tammany
743
596
392
1114
657
310
194
349
501
496
1053
790
741
1615
1153
Parish [county]
Jefferson
Orleans
Comparing first-time Medicaid-paid deliveries by parish to program enrollment,
helps target future outreach where a higher percent of eligible women live.
Service Eligibility Program Planning
Medicaid type
Very low birth weight
Low birth weight
Total births
N
%
N
%
N
%
800
2.4
3943
12.0
32961
73.0
LaCHIP
32
1.8
161
9.2
1749
3.9
SSI
59
4.8
264
21.5
1226
2.7
TANF
13
1.1
146
12.6
1156
2.5
OTHER
255
3.2
1224
15.1
8089
17.9
TOTAL
1159
2.6
5738
12.7
45181
100.0
LaMOMS
LaMOMS is Louisiana’s expanded eligibility Medicaid program for pregnant women.
These women will lose coverage 60 days postpartum. Educating them on other program
options before coverage ends can improve opportunities to sustain or improve health.
Risk Factor Analyses
Is there a relationship between Medicaid-paid deliveries and infant mortality in Louisiana?
Distribution of Live Births, Infant Deaths, and Infant Mortality Rate
among Medicaid and non-Medicaid paid deliveries, Louisiana
Results indicated that White Medicaid women were 20% more likely to experience an
infant death while Black Medicaid women were 30% less likely, after controlling for other factors.
Special Projects / Complex Analyses
• Burden of Chronic Conditions during
pregnancy among Medicaid women
• Validation of medical indication on birth
certificate for deliveries < 39 weeks gestation
Medicaid Preconception Health
Peer-to-Peer Learning Project
Prevalence of Selected Indicators, Medicaid and Total, Louisiana PRAMS
Preconception
(Prepregnancy) Risk
and Protective Factors
Interconception/
Postpartum Risk and
Protective Factors
Tobacco use
Alcohol use
Multi-vitamin use
Intended pregnancy
Stress – partner
Stress – traumatic event
Stress – financial
Stress – family illness
Overweight
Obesity
Diabetes before pregnancy
Diabetes during pregnancy
Nonuse of Contraceptives
Prior LBW
Prior Preterm
Use of Contraceptives
Tobacco use
Pre-pregnancy Medicaid
All births
23.0
23.3
37.4
30.2
35.8
17.7
49.1
37.6
18.5
23.6
3.0
6.4
56.4
20.8
22.0
85.4
19.0
23.7
46.2
35.8
45.3
36.0
13.3
52.8
34.7
21.2
21.3
1.5
8.2
58.8
14.8
17.0
86.4
18.7
Medicaid Medical Directors Learning Network
Characteristics of Mothers: Early Elective C‐Sections and Early Elective Inductions Louisiana
Early Elective C-Sections (< 39 weeks)
Early Elective Inductions (< 39 weeks)
94% 96%
84%
63%
44%
51%
58%
25%
16%
3%
Age 30 and
Older
White
non-Hispanic
One or more
Previous
Pregnancies
History of
Previous CSection
Of all women who had an early elective C‐Section or an early elective induction, percentage with characteristic.
Source: Academy Health analysis of state‐reported data for Medicaid Medical Directors’ Perinatal Project.
Questions?
Discussion: How have other states used
linked data?
• How has your state used linked data?
• Annotated bibliography of state and research
uses for linked data
16
16
Using Linked Datasets for
Performance Measurement:
Review of Two Child Core Set Measures
Miriam Drapkin, MPH
Research Analyst
Mathematica Policy Research
17
Overview of Two Child Core Set Measures That
Can Be Calculated Using Linked Data
• Low Birth Weight (LBW)
– Measure Steward: CDC
(National Center for
Health Statistics)
– Percentage of live births
weighing less than 2,500
grams
• Cesarean Rate for
Nulliparous Singleton
Vertex (CSEC)
– Measure Steward:
California Maternal
Quality Care Collaborative
– Percentage of low-risk
first birth women who
had a cesarean section
Detailed Technical Specifications for calculating these measures are
available at:
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/ByTopics/Quality-of-Care/Downloads/Medicaid-and-CHIP-Child-Core-SetManual.pdf
18
Using Linked Data for LBW and CSEC Measures
Low Birth Weight
Cesarean Delivery
Numerator
Data Source
Vital records
Vital records alone or linked with
Medicaid data
Denominator
Data Source
Vital records alone or linked with
Medicaid data
Vital records alone or linked with
Medicaid data
Benefit of
Linkage
Identifies a greater number of
Medicaid births than would be
identified in vital records alone
Captures more clinical data in
Medicaid claims than would be
available in vital records alone
Note: Measure-eligible population includes Medicaid and CHIP enrollees.
19
Spotlight on Low Birth Weight (LBW) Measure
• The LBW measure tracks a relatively stable outcome, and
requires a large denominator (20,000 births) to detect
significant differences in performance, or changes over
time
• Linked data are particularly useful for calculating the LBW
measure because they help to identify more births covered
by Medicaid, since the payer source variable in vital records
is frequently unreliable
• The Technical Specifications provide guidance about
calculating the LBW denominator from vital records linked
with claims data, in order to more accurately capture
Medicaid and CHIP births
20
Spotlight on Cesarean Section (CSEC) Measure
• Linked data are particularly useful for the CSEC measure
because they help to:
– Identify births covered by Medicaid, since the payer source
variable in vital records is frequently unreliable
– Obtain accurate diagnostic/procedure data more frequently
present in Medicaid claims (such as DRGs and ICD-9 codes) than
in vital records
• Although risk adjustment is not currently required for Core
Set reporting of the CSEC measure, states can use variables
in linked claims data in order to conduct “hotspot” analyses
for targeting quality improvement projects
21
Questions?
22
Introduction to the Common
Project
Common Project: State Fact Sheet
• During the final months of the project, states will
create a fact sheet on their rates for the following
two measures in the Core Set of Children’s Health
Care Quality Measures for Medicaid and CHIP:
– CSEC 0471 CMQCC Cesarean Rate for Nulliparous Singleton
Vertex
– LBW 1382 CDC Live Births Weighing Less than 2,500 Grams
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-ofCare/CHIPRA-Initial-Core-Set-of-Childrens-Health-Care-Quality-Measures.html
24
State Fact Sheet Minimum Contents
• Background
• Methods
• Findings (LBW, C-section)
–
–
–
–
Overall prevalence
Prevalence by payer (i.e., Medicaid, private, self/none)
Prevalence by payer and age, race/ethnicity
At least 3 tables or figures
• Conclusions/Recommendations
• References
25
Links to Example Fact Sheets
• https://www.idph.state.ia.us/hpcdp/common/pdf/fa
mily_health/2010_low_birth_rate.pdf
• http://www.health.state.mn.us/divs/chs/raceethn/lb
wfact2.pdf
• http://health.hawaii.gov/mchb/files/2013/05/medic
aid.pdf
• http://adph.org/healthstats/assets/CesareanDeliveri
es2004.pdf
26
Next Steps
• Begin work on common project
• Commit to linking data for QI purposes
• Save the Date:
– Next web training: May 19, 2014 (note: this is the 3rd
Monday of the month)
– Topic: Q&A about linkage process thus far and moving
forward
– Please send any questions you would like addressed during
the May training to [email protected]
by May 6th
27

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