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Analytics In Healthcare and Capturing the Patient JourneyAPRIL 8, 2016
SAS HEALTH USERS GROUP
SHIRLEY LI
Objective
Agenda
▪ Objective of presentation
▪ Overview of analytics in healthcare (in my view)
▪ Capturing the Patient Journey with Data
▪ What is the patient journey?
▪ How do we capture it?
▪ What datasets are available?
▪ Factors to consider?
▪ What information is captured?
▪ How is the information captured?
Disclaimer: All information presented are my owns thoughts and interpretation
Overview of Healthcare Analytics
What does SAS mean to you?
http://blogs.sas.com/content/sascom/2014/04/03/predictive-analytics-described-in-one-word/
Except….
HOT BUTTER STUDIO @ 2012
Goal
HOT BUTTER STUDIO @ 2012
How to get there? Analytical Life Cycle
http://blogs.sas.com/content/hiddeninsights/2013/10/11/how-well-are-you-managing-the-analytical-life-cycle/
Is Data Preparation Really That
Hard?
Forbest.com “Cleaning Big Data: Most Time-Consuming, Least Enjoyable”
How to capture the patient journey?
Vision and mission of a healthcare organization
▪ Vision
▪ Working together to create the best health systems in the world.
▪ Mission Statement
▪ Together, we will improve the performance of our health systems by driving quality, accountability, innovation and value.
What does the patient journey look like?
https://www.cancercare.on.ca/ocs/qpi/dispathmgmt/pathways/colopath/
What really does the patient journey look like?
https://www.cancercare.on.ca/ocs/qpi/dispathmgmt/pathways/colopath/
“Pathways are flowcharts that show a high-level overview of the care a cancer patient in Ontario should receive. Pathways focus on one type of cancer, during a specific phase of the cancer journey, with the understanding that the patient journey differs from one cancer to another.”
How do we capture this in the available datasets?
Health Analysts’ Toolkit, Health Analytics Branch, Winter 2012
Two possible sources
for surgery data
What information are captured in the datasets?
▪ Discharge Abstract Database (DAD):
▪ “patient-level data are collected at the time of service in participating institutions. After the discharge, a medical records coder at the hospital completes an abstract according to instructions in the CIHI abstracting manual.” (pg. 7)
▪ OHIP Claim’s history database:
▪ “provider billings through the Ontario Health Insurance Plan (OHIP)” (pg. 7)
▪ “CHDB is designed for the assessment and processing of claims, its use for other purposes—such as measuring utilization of services or estimating conditions based on diagnoses—is secondary. Care must be taken with interpretation and analysis.” (pg. 7)
Health Analysts’ Toolkit, Health Analytics Branch, Winter 2012
What is the relationship between the two databases?
Comparison of the two databases: unit of analysis
DAD
▪ Each observation represents a discharge
▪ Patients transferred to another facility (after discharge) possibly for the same condition are in multiple observations
CHDB
▪ Each observation represents one claim (NOT visit or activity)
▪ e.g. A visit to the doctor’s office can be captured by multiple observations depending on what procedures were performed
Not absolutely comparable
Comparison of the two databases: how information is captured
DAD
▪ Surgery information is captured by CCI codes
▪ “CCI specifies more precisely than ever before what interventions and services health professionals provide. ”
▪ Multiple fields to capture interventions
CHDB
▪ Surgery information is captured by OHIP fee codes
▪ Schedule benefit: http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/sob_master20160406.pdf
▪ Modifier fee codes for additional payment (e.g. laproscopic surgery E747)
Not absolutely comparable
CCI codes for surgical resectionList not exhaustive
CCI
Code
Surgery Code Description Surgery Category Disease
Site
Surgical
Resection
Indicator
1NK87
DN
Excision partial, small intestine endoscopic
(laparoscopic) approach; Enterocolostomy
anastomosis technique
A - Resection of colon without
stoma, with anastomosis
Colon Nonresective
1NK87
DP
Excision partial, small intestine endoscopic
(laparoscopic) approach; Enteroenterostomy
anastomosis technique
A - Resection of colon without
stoma, with anastomosis
Colon Nonresective
1NK87
RE
Excision partial, small intestine open approach;
Enterocolostomy anastomosis technique
A - Resection of colon without
stoma, with anastomosis
Colon Nonresective
1NM87
DE
Excision partial, large intestine endoscopic
(laparoscopic)
approach; Colorectal anastomosis technique
A - Resection of colon without
stoma, with anastomosis
Colon Resective
1NM87
DF
Excision partial, large intestine endoscopic
(laparoscopic)
approach; Colocolostomy anastomosis technique
A - Resection of colon without
stoma, with anastomosis
Colon Resective
1NM87
DN
Excision partial, large intestine endoscopic
(laparoscopic)
approach; Enterocolostomy anastomosis technique
A - Resection of colon without
stoma, with anastomosis
Colon Resective
1NM87
RD
Excision partial, large intestine open approach;
Colorectal anastomosis technique
A - Resection of colon without
stoma, with anastomosis
Colon Resective
1NM87
RE
Excision partial, large intestine open approach;
Enterocolostomy anastomosis technique
A - Resection of colon without
stoma, with anastomosis
Colon Resective
1NM87
RN
Excision partial, large intestine open approach;
Colocolostomy anastomosis technique
A - Resection of colon without
stoma, with anastomosis
Colon Resective
1NM89
DF
Excision total, large intestine endoscopic
(laparoscopic)
approach; Ileorectal (endorectal, ileoproctostomy)
anastomosis technique
A - Resection of colon without
stoma, with anastomosis
Colon Resective
OHIP fee codes for surgical resectionMight not be exhaustive
OHIP
Fee
Code
Fee Code Description Disease
Site
Surgical
Resection
Indicator
S166 Resection with anastomosis – small and large intestine terminal ileum, cecum
and ascending colon (right hemicolectomy)
Colon Resective
S167* Resection with anastomosis – large intestine Colon Resective
S168 Ileostomy - subtotal colectomy Colon Resective
S169 Resection with anastomosis – total colectomy with ileo-rectal anastomosis Colon Resective
S171* Resection with anastomosis – left hemicolectomy with anterior resection or
proctosigmoidectomy (anastomosis below peritoneal reflection and mobilization
of splenic flexure)
Colon Resective
S172 Resection with anastomosis – total colectomy with mucosal protectomy with ilea
pouch, ileoanal anastomosis and loop ileostomy
Colon Resective
S188 Bowel resection without anastomosis (colostomy and mucous fistula) Colon Resective
E793 Laparoscopic or laparoscopic assisted Colon Modifier Code
Comparison of the two databases: activity dates
DAD
▪ Admission date
▪ Discharge date
▪ Intervention date
CHDB
▪ Service date
▪ Admission date
Not absolutely comparable
▪ Not 100% match
▪ Dates can be different (actual mismatch vs. coding variability)
▪ Type of surgery can be different (actual mismatch vs. coding variability)
▪ Institution which the surgery occurred can be different (actual mismatch vs. coding variability)
Comparison of the two databases: summary
Might requires both sources to fully capture surgical resection information.
Reconciliation of mismatches is very time consuming!
…”its use for other purposes—such as measuring utilization of services or estimating conditions based on
diagnoses—is secondary”
Summary
▪ Prior to thinking about advanced analytics, make sure you know what data sources you need and what information you need▪ Sometimes multiple sources are needed (Warning! Matching can be
challenging)
▪ Understand how the data is captured prior to you extract data▪ Understand what is and is not captured in data sources
▪ Be aware of dates, unit of analysis, diagnosis codes (ICD-9, ICD10, ICD-O-3, OHIP diagnosis codes), etc.
▪ Read database documentation and ask colleagues around you
End result: Save time!
Questions?
Acknowledgments:
▪ All my colleagues in the Cancer Analytics Team within Analytics and Informatics, Cancer Care Ontario
▪ My team lead and manager: Kelly Woltman and Asmaa Maloul for their support of this presentation
▪ Disease Pathway Management, Clinical Program Quality Initiative, Cancer Care Ontario
Thank you!
Contact: [email protected] or [email protected]
