Power databases: 4th in a series
States coming on-line to map key health/policy relationships
By ELIZABETH CONNOR
Healthcare InfoTech Contributing Writer
New database and mapping linkages are being used in South Carolina to track and analyze everything from violent crime patterns to the shopping habits of African American heart patients.
And these are only among the more modest examples of South Carolina’s growing analytic capability and the efforts of some other states also often focused on healthcare issues.
South Carolina has built huge warehouses for hospital inpatient, outpatient, and emergency room data, as well as home health information. Physician data is next on the list. With these growing data banks, South Carolina’s health care analysts are able to flex some greatly expanded IT muscle to shape policies targeting public health problems.
The heart of South Carolina’s new data integration program is a $1 million, three-year project to enhance the U.S. Census T.I.G.E.R. map files that describe the state. As of 1997, the second year of the project, addressing and geocoding had been completed in counties serving about 58% of the state’s 3.7 million residents.
As an example of the uses of this growing database and the ability to manipulate it the city of Florence recently analyzed the vast array of data from medical and social services from clients in its Healthy Start program and plotted the location of birth outcomes. Identification of widely varying rates of so-called "problem babies" in adjacent neighborhoods prompted further investigation. Because the data helped state officials to so clearly define the problem and craft their questions, they identified what set apart the neighborhoods that produced good birth outcomes.
Pete Bailey oversees health and demographics data within the state’s Budget & Control Board (Columbia, SC), and says South Carolina’s progress in data collection and analysis is "a dream come true."
His goal, said Bailey, "is to literally jerk ourselves up from the bottom. If you believe in social change and that we can change the world but that it requires information these systems will allow you to do that."
At the same time, says Bailey, private-sector clients use the state’s data as often as other government agencies. The state is working with the South Carolina Medical Assoc iation (Columbia, SC) to develop a web-based program to allow physicians to monitor their use of health resources and compare their performance against professional norms.
Three other state efforts using IT to address public health problems are noteworthy:
• Missouri the "show me" state is living up to that motto with a web page that allows residents to query a vast array of public health and facility data about their state. In less time than it takes to describe the process, anyone with Internet access can answer a whole variety of questions, such as: What is the leading cause of death for your home county? Is the age-adjusted death rate for this condition significantly different from the statewide rate? How often are people from your county hospitalized for this disease?
The state’s data dissemination efforts focus on two areas, state and county profiles, and an interactive system called Missouri Information for Community Assessment (MICA). Garland Land, director of the state’s Center for Health Information and Management, says expanded public access to health data stems from an effort by state governments and the state’s hospitals encouraging local health needs assessments.
In 1995, the Missouri Hospital Association contracted with Andersen Consulting to develop a planning toolkit dubbed Community Health Assistance Resource Team, or CHART. The state Department of Health later required local health departments to perform health assessments and made available up to $10,000 per county for that purpose. While not all of Missouri’s 114 counties conducted the assessment the same way, the process did expand the grassroots awareness of the process and particulars of health planning.
The Missouri Hospital Association is in the second year of a five-year program to fund intervention projects based on the results of the local assessments. The contract funds, approximately $250,000 in the first year and $400,000 for subsequent years, are administered by the state Department of Health.
• When energy producers challenged North Dakota’s ambient air quality standards a few years ago, the state’s public health infrastructure had a response. By linking air quality data to health insurance claims data, public health officials were able to show a connection between poor air quality and increased demand for asthma care.
Though too small to have immediate practical significance, the statistical correlation put public health officials on their guard.
"It was the feeling of the department that that finding alone was enough to at least provide a foundation for a continuing survey of these people," says Alana Knudson-Buresh, PhD, chief of the state’s Department of Health preventive health section.
Projects like the asthma analysis are possible because of North Dakota’s intense commitment to sophisticated data analysis and its unique demographic circumstances. Since 1987, the state’s public health departments have had the statutory authority to collect from payors inpatient and similar data collected on what was then UB-82 forms. In 1991, the scope of the law was expanded to cover physician data such as that collected on Health Care Financing Administration 1500 forms.
Collection of the data from private payors is easier in North Dakota than it would be in most other states. The population is small about 640,000 and one insurer, Blue Cross-Blue Shield of North Dakota, claims to cover 75% of the state’s privately insured population, or about 370,000 people. As Knudson puts it, "Blue Cross-Blue Shield has the state wired."
North Dakota officials have been able, with the help of MedStat (Ann Arbor, MI), to construct a data warehouse that can address a staggering array of health policy questions. And the data warehouse is serving as Medicaid’s decision support system and preparing for additional health policy analyses. The North Dakota Lignite Energy Council, which state health officials had challenged by using data on air quality and health, has proposed to fund further research in the field.
• The state of Oregon is in the second year of a five-year grant from the Centers for Disease Control and Prevention (Atlanta), providing approximately $250,000 annually. With this funding, the state’s Medicaid and public health agencies are exploring how to integrate Medicaid program data with information available from various public health programs for health policy purposes.
Public health officials are hoping Medicaid encounter data will allow them to improve prevention and other public health interventions in three priority areas, diabetes, tobacco use, and childhood immunizations. In addition, timely and accurate encounter data will allow public health officials to use Medicaid enrollees as a sentinel population for tracking the effects of managed care on the population as a whole.
The demographics of Oregon’s Medicaid clients makes the group well suited for the purpose during a given year, one in seven of Oregon’s residents uses the Medicaid system and eligibility extends to populations beyond the traditional mothers and babies.
A guide to using data for health policy purposes is offered in a series of pamphlets recently published by Mathematica Policy Research (Washington), a consulting firm that has evaluated the experiences of seven states in the Robert Wood Johnson Foundation’s Information for State Health Policy Program. The six pamphlets cover how to enhance data for policy purposes, how to enhance access to data, how to use performance measures for policy purposes, how to analyze data, how to develop geographic information systems, and how to link databases.
Mathematica offers three recommendations for health data development: 1) develop strategies that address long-and short-term needs, 2) be aware of health data resources and issues, and 3) get the right staff.
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