Data Integration Efforts and Challenges

Scott M. Bilder, Ph.D.Institute for Health, Health Care Policy, and Aging

ResearchRutgers, The State University of New Jersey

(bilder@rci.rutgers.edu)

Because Minds Matter: Collaborating to Strengthen Psychotropic Medication Management for Children

and Youth in Foster CareAugust 27-28, 2012

MEDNETo 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 Organizationo Multi-state Steering Committee /

Learning Workgroup.o Workgroups (with representation

from participating states).• 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 Issueso Identifying and tracking youth across

time and data systems.o Keeping up with status/eligibility

changes.o Identifying health services not captured

in claims data.o Establishing sufficient look-back periods

for treatment initiators.o Establishing common data structures to

support analysis and reporting.

Data Integration

Data Sources

Medicaid FFS Claims

Medicaid

Eligibility Files Medicare

(A, B, D)

Medicaid

Encounter Data

State Mental Health Agency

Data

Mental Health

Carveouts

State Childrens’ Services

Data

Data UsersProviders

andPrescribersConsumers

MentalHealthClinics

StateMedicaidAgencies

State MentalHealth

AgenciesState

Children’sServices

DATA INTEGRATION

Data Integrationo 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 Integrationo 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 Complianceo 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 Developmento Polypharmacyo Adherenceo Excessive doseo Cardiometabolica

lly challenging antipsychotics

o Metabolic/lipid monitoring

o Psychotropics in very young children

o Diagnoses consistent with psychotropic treatment

o Services consistent with psychotropic treatment

Metric Developmento Metrics committee identifies needs with

input from all stakeholders.o Initial discussions within metrics committee

result in a draft conceptual summary. o Programming code is developed and results

of applying metric are evaluated.o Conceptual summary is presented to

stakeholder committee.o 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

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.