Slide 1

Health Analytics at Georgia Tech: From Information to Knowledge to Decision Making Nicoleta Serban, PhD and Julie Swann, PhD Industrial and Systems Engineering Georgia Institute of Technology May 2014 Slide 2 Data Science Framework Information Infrastructure Management Data Representation Sampling Knowledge Computation Tools Decisions System engineering 2 Data architectures Data integration, sharing and federation Data privacy rules Data wrangling Data mining Machine learning Statistical inference Network analysis Simulations Visualization Deriving hypotheses Validating hypotheses Eliciting causal relations Designing, planning, and optimizing Testing, ranking, scoring System dynamics Slide 3 Scope of Data in Healthcare Data TypesExamples 1.Disease Registry 2.Disease Progression 3.Electronic Health Records 4.Facility Info 5.Medical Claims Data 6.National Survey or Examination Data 7.State Databases 8.General 1.Cystic Fibrosis 2.Natural History models 3.Queries (CHOA, VHA) on specific projects 4.VA satellite clinics 5.Medicaid (children and pregnant women, GA + 13 other states, 2005-2009) 6.NHANES, HCUP KIDS 7.GAs Oasis, HCUP SEDD and SID 8.Census, National Provider Index, GIS Slide 4 Medicaid claims data will be used as a test bed for the decision- making support tools targeting knowledge representing the care of children with Medicaid. Slide 5 CMS Medicaid Claims Data MAX Claims Data Personal Summary: patients, demographics, birthdate, etc. Inpatient: claims, diagnoses, procedures, LOS, payment Other Therapy: claims for physician, lab, clinic, outpatient Long Term Care: facility type, date of service, etc. Prescription Drug: paid drug claims Patient-level Identifiable-Files with locations and a provider-ID Years 2005 2009 for 14 states (+2010-2011 upcoming) SE: Georgia, Alabama, Arkansas, Louisiana, Mississippi, N. Carolina, S. Carolina, Tennessee, Texas Other: California, Minnesota, New York, Pennsylvania Study population: children and pregnant women 5 GT Project Champion: Beth Mynatt (IPaT, GT) GT Lead on Information Technology: Matt Sanders (GTRI) GT Research Leads: Nicoleta Serban and Julie Swann Slide 6 Medicaid Project: Approved Topics 1)MEASURING AND EXPLAINING INEQUITIES: To assess the impact of healthcare system characteristics vs. inequities in healthcare, including geographical, use, quality, expenditure and outcomes among Medicaid children enrollees, especially in states with historic inequities like in the southeast. 2)OPTIMIZING INTERVENTIONS AND DELIVERY SYSTEMS To analyze flows and policies across the system, e.g., the match between supply and demand, and financially, both geographically and across time, along with the corresponding costs or outcomes, to analyze improved methods of delivery including medical homes. 6 Slide 7 Medicaid Project: Implementation Information: Identifiable patient-level claims 5 years+14 states = 266,839,307,070 Observations 2 Terabytes of information Data: Represented as patient care trajectories: utilization, cost and patient characteristics Sampled by disease 7 Challenge #1HIPPA and CMS data safeguards compliance Challenge #1: HIPPA and CMS data safeguards compliance - data environment: access, sharing, linking, storage Challenge #2Database backbone Challenge #2: Database backbone - projected research needs - projected computational needs Challenge #3: Data Processing - unavailability of tools to process-mine claims - additional data and information needs - expert opinion & collaborations Slide 8 Medicaid Project: Safeguards Data stored in secured location at Georgia Tech, with access to the identifiable patient files by a limited set of employees approved by CMS & IRB Sharing of aggregated data is allowed with collaborators, if consistent with research protocol Cells should have at least 11 entries Data undergoes review process at GT before release from data workstation Significant liability involved if breach occurs 8 Slide 9 Medicaid Project: Health Analytics Data Baseline Metrics Care Pathway Access & Outcomes Knowledge Systematic disparities in access, outcomes and cost Network of providers Profiles of patient-level care pathways 9 Process Mining Spatial Statistical Models Functional Data Analysis Unsupervised classification Sequence clustering Markov-decision processes Optimization Slide 10 Medicaid Project: Health Analytics Decision Making: Policy interventions Network Interventions Knowledge: Systematic disparities in access, outcomes and cost Network of providers Profiles of patient-level care pathways 10 Markov-decision processes Causal Inference Optimization Modeling Simulations Slide 11 Medicaid Project: Research Scope Limitations Research must fit within the scope proposed to CMS Analysis of raw data must be conducted at GT Process for analyzing data is onerous, time-consuming, and expensive The most recent (~2) years of data are not available Positives We can benchmark GA against 13 other states Patients and/or providers can be followed longitudinally Permission of pursuing research topics and publication of the related findings is not required to be submitted to CMS or GT 11 Slide 12 Medicaid Project: Opportunities proof of conceptDeveloping the proof of concept in building large infrastructures for protected information center for deployment of toolsBecoming the center for deployment of tools for mining claims data rigor in health analyticsAdvancing rigor in health analytics EducatingEducating students and visiting researchers Informing policy makingInforming policy making in understanding and managing the healthcare system Slide 13 Health analytics at GT bridges fundamental mathematical and computational modeling with health service research and health economics as a means of translating health and healthcare data into knowledge and decision making. Slide 14 Health Analytics: Serban & Swann Group Healthcare Access & Outcomes Measurement Linking Access & Outcomes Interventions Policy & Network Interventions Cost-effectiveness: Telemedicine Pediatric Asthma Baseline Metrics Care Pathways in Utilization & Cost Collaborations between GT ISyE, GT IPaT, Childrens, CDC, VHA, DCH, DPH and other health entities 14 Slide 15 We define healthcare access as the equal opportunity of people to get appropriate care to maintain or improve their health. We focus primarily on making inferences on spatial access, which is particularly important for managing chronic diseases where regular visits and adherence to recommended care practices can reduce severe outcomes. Slide 16 Healthcare Access: Five Dimensions Slide 17 Measure Status Quo Infer Disparities Evaluate Interventions Link to Outcomes Health Analytics and Access Measurement Estimating spatial access of different populations by taking into account supply and demand trade-offs and system constraints. Inference: Equity Studying systematic disparities in access to services between population groups. Inference: Linking to Outcomes Understand how access is associated to health outcomes geographically and longitudinally Evaluating Interventions Informed decision making in healthcare delivery -- policy and network interventions targeting improvement in spatial access with a significant projected impact on outcomes 17 Slide 18 Data: National Provider Index (NPI), Medicaid claims, Bureau Census, Geographic Information System among other sources Study Population: Children in 14 states Measurement Model: Matching patients to providers using optimization modeling estimated at the census tract level Spatial Access Measures: Travel distance/time, Congestion & Coverage Access Measures: Pediatric Primary Care Slide 19 o Large discrepancies between urban and rural care. o High congestion across state except for some cities. o High coverage in broad regions surrounding the most populated cities. Low coverage in many rural areas. o Yellow and red regions indicate areas where the non-Medicaid patients' availability of services is superior to Medicaid patients, while blue regions indicate areas where the reverse is true GEORGIA: Disparities across geography CongestionCoverage GEORGIA: Disparities between Medicaid & non-Medicaid Congestion Coverage Access Measures: Pediatric Primary Care Slide 20 Data: Health Cost and Utilization Project (NC) DPH OASIS (GA) Study Population: Children ages 4-17 in GA & NC Geographic Access: travel distance between patients and matched providers using optimization estimated at the census tract level Outcome measure: ED visit & hospitalization rates at the county level Access ~ Outcomes: Pediatric Asthma Slide 21 Access is significant alone and in interactions with other factors Impact of access varies with geography Improving access is expected to reduce the occurrence of severe outcomes. Access ~ Outcomes: Pediatric Asthma Slide 22 Data: clinical information derived from the Cystic Fibrosis Foundation Registry Study Population: 229,968 observations on 7823 patients from 2002 to 2011. Geographic Access: realized travel distance from the zip code of each patient to the care centers. Outcome measure: %FEV 1, a common outcome for research in cystic fibrosis Access ~ Outcomes: Cystic Fibrosis Slide 23 Not a consistent relationship between geographic access and outcomes Access is significant for some age groups but not for all State based analysis shows other factors impact outcome levels The distribution of %FEV 1 & CF center locations in Georgia Access ~ Outcomes: Cystic Fibrosis Slide 24 A policy intervention is a type of an action that involves design, revision, implementation or translation of a health policy for reducing costs and for improving health outcomes, healthcare access and quality. A network intervention refers to an action that involves altering an existing network of care, including networks consisting of medical facilities. Slide 25 Policy Interventions 25 Improving Access to Pediatricians for Medicaid Population Considered policies that would: Improve patients mobility. Increase percentage of physicians accepting any Medicaid patients. Increase percentage of caseload physicians devote to Medicaid patients. Simulate policy change by altering inputs in the access measurement models. Evaluate impact at the state-wide and local level with respect to access and health outcomes. Slide 26 Network Interventions Research Question Research Question: How can the existing network be modified to meet specified goals? Evaluation Criteria Evaluation Criteria: Equity, Effectiveness, EfficiencyInterventions Open new facilities Expand hours Mobile clinics, telemedicine Slide 27 Cost-Effectiveness: Telemedicine Telemedicine: Originated in the Netherlands in the early 1900s More than 100 definitions of telemedicine (WHO, 2010) Time Magazine has called telemedicine healing by wire Countries of implementation: Almost everywhere on the globe! Provider-driven implementations in the US (e.g., VHA) Example of an implementation: Tele-ophthalmology at VHA Cost-effectiveness: Diabetic Retinopathy Screening 27 Slide 28 Step 1: Model Individual Disease Progression Data: Sample of veterans with diabetes (Atlanta) Model: Markov Decision Model Step 2: Simulate individual disease profiles Data: VHA & General parameter input Model: Estimated Disease Progression Model Step 3: Compare traditional to telemedicine Simulate screening with and without telemedicine Utility measures: Quality Adjusted Life Years (QALY) vs. costs of the program 28 Cost-Effectiveness: Telemedicine Slide 29 Cost-Effectiveness: Cost vs. QALY Ratio 29 Cost-effectiveness for pool sizes of 3500 or larger (~9000 VHA patients in Atlanta area) Cost-effectiveness for patients between the ages of 50-80 Slide 30 Our research spans multiple directions, including deriving a set of baseline measures for asthma care, linking access to outcomes, and identifying care pathways in utilization and cost. The end point is to design policy and network interventions to improve health outcomes and access with limited resources. Slide 31 Baseline: Utilization, Cost & Treatment Objective: develop a set of baseline metrics for pediatric asthma to be used in designing and evaluating interventions to have the greatest impact with limited resources. Pilot Study: Children population with Medicaid insurance ages 4-17 in Georgia, 2009 31 Slide 32 The Other population (e.g., mostly Hispanic) has the most visits per patient and the African American population has the most patients per 1000 children on Medicaid. 32 There are no differences in visits per patient, but the number of patients per 1000 children decreases with age. Baseline: Utilization Metrics by Race & Age Slide 33 Baseline: Cost Metrics by Race 33 The Other population has the highest charge per visit, followed by the African American population. Payment amount and prepaid value show no significant differences. The Other population has the highest charge per enrollee per month, followed by the African American population. Slide 34 Baseline: Treatment Control Metrics 34 The African American population has a lower medication ratio than the other two populations, indicating a lower use of long term controller medication. Fulton county and the surrounding areas have the lowest medication ratio in the state. Slide 35 Baseline: Treatment Adherence Metrics Slide 36 Care Pathways: Utilization & Cost Objective: To identify underlying care pathways and to visualize the utilization relational system for pediatric asthma care in the Medicaid system using large patient-level claims data. Pilot Study: Children population with Medicaid insurance ages 4-17 in Georgia, 2009 36 Slide 37 Care Pathways: Utilization 37 Slide 38 Care Pathways: Cost to MCOs 38 Slide 39 39 Care Pathways: Cost to the Medicaid System Slide 40 Care Pathways: Cost & Utilization 40 Slide 41 Acknowledgements Supporting Institutes and Organizations -National Science Foundation (CAREER Award) -Institute of People and Technology -Childrens Healthcare of Atlanta Research Team IT Staff IT Staff: Matthew Sanders and Paul Diederich Postdoctoral fellow Postdoctoral fellow: Dr. Monica Gentili Undergraduate students Undergraduate students: Sarah Drath, Pravara Harati, Qiming Zhang, Sean Monahan PhD Graduate students PhD Graduate students: Erin Garcia, Ross Hilton, Ben Johnson, Kevin Johnson, Zihao Li, Rodrique Ngueyep, Richard Zheng Slide 42 Contact Us Nicoleta Serban nserban@isye.gatech.edu or 404-385-7255@isye.gatech.edu Julie Swann jswann@isye.gatech.edu or 404-385-3054 jswann@isye.gatech.edu