AHRQ Pilot Project

Adding Clinical Data to Statewide Administrative Data

The Agency for Health Care Administration (AHCA), Florida Center for Health Information and Policy Analysis, was awarded a contract from the Agency for Healthcare Research and Quality (AHRQ) that runs through September 2009 for a pilot project to study new ways to approach hospital quality measures. The pilot project funding is provided to add clinical laboratory data to the hospital administrative data already collected by AHCA under statutory authority. By adding clinical data to administrative data, AHRQ hopes to develop better predictors for hospital quality indicators. Florida is one of three states, Washington State Department of Health Center for Health Statistics, Virginia Health Information (VHI), and Minnesota Hospital Association (MHA), that have received these grants.

One purpose of the pilot project is to demonstrate and evaluate the process required to 1) standardize laboratory data into a common nomenclature; 2) merge clinical data with hospital administrative data; 3) complete a statistical analysis of the merged dataset; 4) assess the added value of using clinical data to evaluate the quality of patient care within hospitals; 5) and describe all findings in a Final Report.

The Agency will work with 3M Health Information Systems, Inc (3M HIS) and the pilot hospitals to map their laboratory values to standardized LOINC terminology and to evaluate the extent to which the 3M risk-adjustment model can be used in public hospital performance comparisons and can be made more accurate with the availability of the clinical data.

The project will move through several discrete processes. To begin, AHCA recruited 18 hospitals, with various stages of health information technology, to participate in the pilot project. 3M HIS will work with each hospital to transform its unique coding of clinical data elements to a standardized set of terms using the Logical Observation Identifiers Names and Codes standard (LOINC). Hospitals will submit the standardized lab data and demographic data to AHCA via secure FTP. AHCA staff will load the clinical lab data into the Oracle database that holds the existing administrative inpatient data collected from the hospitals. The clinical and administrative datasets will then be joined into a single file for each hospital, combining the clinical with the administrative data. This combined file will then be sent to 3M HIS using secure FTP.

3M HIS will group the merged clinical and administrative data into All Patient Refined Diagnosis Related Groups (APR DRGs) for analysis. 3M HIS currently uses APR DRGs to risk adjust hospital-level quality measures such as mortality and readmissions. For APR DRGs with sufficient volume, 3M HIS will identify the individual clinical data elements, if any, that demonstrate an ability to improve the prediction of hospital-level quality measures. 3M will provide a summary of its findings to AHCA.

The final deliverable to AHRQ will be a report that details the processes of normalizing laboratory terminology, linking clinical and administrative datasets and assessing the added value in the use of clinical data to determine the quality of patient care within the hospitals in the pilot project.