EDM FORUM VIRTUAL BROWN BAG PRESENTATIONMarion Sills

Aims and Objectives

Objective: To to build, deploy and assess a safety-net focused distributed data network in which to conduct observational comparative effectiveness research (CER) on healthcare delivery system (HDS) factors and health outcomes for patients with chronic disease

• Hypothesis• There is a positive association between a practice’s medical home

characteristics and its patients’ chronic disease control

Context of SAFTINet Project

• Distributed data network of existing clinical and claims data

Support CER

Enhanced with patient-reported outcome (PRO) data

Focus on: Safety net practices

Chronic disease

HDS factors

Context of SAFTINet Project

• Distributed data network of existing clinical and claims data

Support CER

Enhanced with PRO data

Focus on: Safety net practices

Chronic disease

HDS factors

• low income patients who receive care in public safety net clinics

• 100 FQHCs (and look-alikes) in CO, TN, VT and CA

Context of SAFTINet Project

• Distributed data network of existing clinical and claims data

Support CER

Enhanced with PRO data

Focus on: Safety net practices

Chronic disease

HDS factors

4 chronic disease cohorts: • asthma (adults and children)• high blood pressure • hypercholesterolemia

Context of SAFTINet Project

• Distributed data network of existing clinical and claims data

Support CER

Enhanced with PRO data

Focus on: Safety net practices

Chronic disease

HDS factors

practice-level characteristics consistent with the patient centered medical home (PCMH) model

Federated database of existing claims and EHR data

Patient cohortsPatient-reported outcome measures

Leveraging SAFTINet Infrastructure for CER

Engaged stakeholders

SAFTINet Common Data Model

Table Name DescriptionPerson Demographic information about a Person (patient)Drug Exposure Association between a Person and a Drug at a specific timeDrug Era Association between a Person and a Drug over a specific time periodCondition Occurrence

A diagnosis or condition that has been recorded about a person at a certain time

Condition Era A diagnoses or conditions that over a period of timeObservation Period Time intervals at which health care information may be availableObservation Symptoms, clinical observations, lab tests etc. about the PersonProcedure Occurrence

Procedures carried out on the Person

Visit Occurrence Visits for health care services of the PersonDeath Time and cause of death of the PersonDrug Cost For each Drug Exposure record additional information about cost and

paymentsProcedure Cost For each Procedure additional information about cost and paymentsLocation Physical AddressesProvider Information about health care providersOrganization Information about health care organizationsCare Site Information about the site of carePayer Plan Period Information about the coverage plan of the payerCohort Person, Provider or Visit cohorts

Study Design and Methods • An observational, longitudinal cohort study of primary care

patients with asthma• Primary data collection

• Medical home characteristics (practice level)• Patient-reported asthma outcomes (self-report surveys)

• Secondary use of existing clinical and claims data

• Practices• 50 primary care practices• 4 healthcare organizations

• Patients• Underserved populations (~30% Medicaid)• 250,000 patients per year• An estimated 20,000 have a diagnosis of asthma

Study Design and Methods

• Cohort definition• >2 encounters with

diagnosis of asthma within 18 months, separated by >28 days

• Child cohort: 2-17 years old

• Adult cohort: 18-60 years old (18-55 years for men)

• Excluded if other chronic lung disease

• >1 visit at a study practice

Table Name DescriptionPerson Demographic information about

a Person (patient)Condition Occurrence

A diagnosis or condition that has been recorded about a person at a certain time

Condition Era

A diagnoses or conditions that over a period of time

Observation Period

Time intervals at which health care information may be available

Observation Symptoms, clinical observations, lab tests etc. about the Person

Care Site Information about the site of care

Study Design and Methods• Asthma control: 2 measures• ACT score• Utilization indicative of exacerbation

• Asthma-related ED or inpatient visit• >3 outpatient visits for asthma in 14 days• Prescription for systemic steroids• Albuterol administered during an encounter

Study Design and Methods

Preliminary Findings

Preliminary Findings

Preliminary Findings

Preliminary Findings• Total mean DoCCS score and mean team-based care

domain score were lower (worse) among practices • caring for more patients • caring for more Hispanic/Latino and non-English-speaking patients

• Mean patient-centered care domain score was lower among practices caring for fewer behavioral health patients

Preliminary Findings• ACTs completed

Design Challenges: Availability of Data

• Challenges• Accurately defining cohorts of patients

with asthma and assessing outcomes based on multiple data sources • 100%: Electronic health records,

administrative data (EHR)• ~30%: Medicaid claims and enrollment

data• ??%: Patient-reported outcomes (PRO)

• OCER goal: “real world” populations• Inclusion of patients with ONLY

complete data limits:• Sample size• Generalizability• Sensitivity and subgroup analysis

EHR

PRO

Claims

Federated database of existing claims and EHR data

Patient cohortsPatient-reported outcome measures

Lessons LearnedEngaged stakeholders

How the infrastructure can support CER in the future• Infrastructure permits CER with reduced burden on

clinical practices that otherwise have little slack/resources for engaging in research

• SAFTINet engagement community/infrastructure can help ensure the stakeholder-centeredness of the value of future research

Dissemination Plans, Future Studies• Manuscripts related to primary hypothesis: association

between HDS and outcomes in each disease cohort• Expand stakeholder-engagement component to facilitate

improved focus on patient- and provider-centered outcomes

• SAFTINet special interest groups already pursuing other research ideas involving SAFTINet data• interest in identifying and characterizing patients at risk for high-

cost utilization • interest in standardizing methods for data quality assessment

• Dissemination helps “market” SAFTINet for future engagement with the research infrastructure