Jalandria Gurley, FNP-BC and Dr. Mari Tietze, Associate ProfessorResearch in Nursing NURS5023Texas Woman’s UniversityT. Boone Pickens Institute of Health Sciences-Dallas CenterThe Houston J. and Florence A. Doswell College of Nursing

Analysis of HypertensionUsing the State-wide THCIC*

Database of Acute Care Discharge Claims

* Texas Health Care Information Collection

May 3, 2013

Objectives• Data source overview• Data description of codes used for analysis

– Diagnostic Related Groupings (DRG*) code– Diagnosis code

• Study background• Study design and methodology• Results• Conclusion

2* = Diagnostic Related Groupings, also knows as Medicare Severity DRGs

Data Source• Data file: Texas Health Care Information

Collection (THCIC) inpatient discharge claims Public Use Data File (PUDF) from 2011Q3

• Total of 504 hospitals in THCIC list; 80.1% or all Texas hospitals [n = 629]

• Reference source: www.dshs.state.tx.us/thcic

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Data Source

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THCIC Creation

Legislation THCIC was created by Chapter 108 of the Health and Safety Code.

Texas Health Care Information Collection

Center for Health Statistics

On September 1, 2004 the THCIC joined the Texas Department of Health, the Texas

Commission on Alcohol and Drug Abuse, and part of the Texas Department of Mental

Health and Mental Retardation to form the Texas Department of State Health Services.

All functions of THCIC continue in the Center for Health Statistics. The THCIC was

created by the 74th Texas Legislature in 1995.

THCIC's primary purpose is to provide data that will enable Texas consumers and

health plan purchasers to make informed health care decisions. THCIC's charge is to

collect data and report on the quality performance of hospitals and health

maintenance organizations operating in Texas. The goal is to provide information that

will enable consumers to have an impact on the cost and quality of health care in

Texas.

Source: http://www.dshs.state.tx.us/thcic/GeneralInfo.shtm

Data Source

HIPAA Administrative Simplification Statute and Rules

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To improve the efficiency and effectiveness of the health care system, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, included Administrative Simplification provisions that required HHS to adopt national standards for electronic health care transactions and code sets, unique health identifiers, and security.

At the same time, Congress recognized that advances in electronic technology could erode the privacy of health information. Consequently, Congress incorporated into HIPAA provisions that mandated the adoption of Federal privacy protections for individually identifiable health information.  

This Rule sets national standards for protecting the confidentiality, integrity, and availability of electronic protected health information. Compliance with the Security Rule was required as of April 20, 2005 (April 20, 2006 for small health plans).

Office of Civil Rights administers and enforces the Privacy Rule and the Security Rule.

Source: http://www.hhs.gov/ocr/privacy/hipaa/administrative/

Data Source

Produce Lines by Service for 2010

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Data Description

Row Product Line Claim Count1 Behavioral Health 175,0872 Cardiology 257,3593 Cardiovascular

Surgery34,386

4 Diabetes 26,4755 Gastroenterology 140,9476 General Surgery 210,0187 Gynecology 56,9648 Medicine 397,5469 Neonate 55,194

10 Neurology 114,34411 Neurosurgery 64,12012 Normal Newborn 328,42613 Obstetrics 407,30014 Oncology 64,74515 Orthopedics 157,04516 Other Surgery 9,13117 Pulmonary 232,76818 Rehabilitation 67,38219 Transplant 2,40820 Ungroupable 4,35721 Urology 85,65622 Vascular Surgery 49,411

  Summary 2,941,069

DRG Codes• In October 2007, MS-DRGs increased to 745 from 335 CMS version

• Diagnosis-related group (DRG) is a system to classify hospital cases into one of approximately 500 groups, also referred to as DRGs, expected to have similar hospital resource use, developed for Medicare as part of the prospective payment system. DRGs are assigned by a "grouper" program based on ICD diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used in the US since 1983 to determine how much Medicare pays the hospital, since patients within each category are similar clinically and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs).

Source: http://en.wikipedia.org/wiki/Diagnosis-related_group

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Data Description

DRG Codes by Major Diagnostic Category (MDC)

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DRG Code(s) MDC Description

1‑ 15 PRE-MDC20‑ 103 MDC 01: DISEASES & DISORDERS OF THE NERVOUS SYSTEM

113‑ 125 MDC 02: DISEASES & DISORDERS OF THE EYE129‑ 159 MDC 03: DISEASES & DISORDERS OF THE EAR, NOSE, MOUTH & THROAT163‑ 208 MDC 04: DISEASES & DISORDERS OF THE RESPIRATORY SYSTEM216‑ 316 MDC 05: DISEASES & DISORDERS OF THE CIRCULATORY SYSTEM326‑ 395 MDC 06: DISEASES & DISORDERS OF THE DIGESTIVE SYSTEM405‑ 446 MDC 07: DISEASES & DISORDERS OF THE HEPATOBILIARY SYSTEM & PANCREAS453‑ 566 MDC 08: DISEASES & DISORDERS OF THE MUSCULOSKELETAL SYSTEM & CONN TISSUE570‑ 607 MDC 09: DISEASES & DISORDERS OF THE SKIN, SUBCUTANEOUS TISSUE & BREAST614‑ 645 MDC 10: ENDOCRINE, NUTRITIONAL & METABOLIC DISEASES & DISORDERS653‑ 700 MDC 11: DISEASES & DISORDERS OF THE KIDNEY & URINARY TRACT707‑ 730 MDC 12: DISEASES & DISORDERS OF THE MALE REPRODUCTIVE SYSTEM734‑ 761 MDC 13: DISEASES & DISORDERS OF THE FEMALE REPRODUCTIVE SYSTEM765‑ 768 MDC 14: PREGNANCY, CHILDBIRTH & THE PUERPERIUM791‑ 792 MDC 15: NEWBORNS & OTHER NEONATES WITH CONDTN ORIG IN PERINATAL PERIOD

799‑ 816MDC 16: DISEASES & DISORDERS OF BLOOD, BLOOD FORMING ORGANS, IMMUNOLOG DISORD

820‑ 848MDC 17: MYELOPROLIFERATIVE DISEASES & DISORDERS, POORLY DIFFERENTIATED NEOPLASM

853‑ 872 MDC 18: INFECTIOUS & PARASITIC DISEASES, SYSTEMIC OR UNSPECIFIED SITES876‑ 887 MDC 19: MENTAL DISEASES & DISORDERS895‑ 897 MDC 20: ALCOHOL/DRUG USE & ALCOHOL/DRUG INDUCED ORGANIC MENTAL DISORDERS901‑ 923 MDC 21: INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS928‑ 929 MDC 22: BURNS939‑ 950 MDC 23: FACTORS INFLUENCING HLTH STAT & OTHR CONTACTS WITH HLTH SERVCS957‑ 965 MDC 24: MULTIPLE SIGNIFICANT TRAUMA969‑ 976 MDC 25: HUMAN IMMUNODEFICIENCY VIRUS INFECTIONS981‑ 989 UNRELATED OPERATING ROOM PROCEDURES998‑ 999 INVALID AND UNGROUPABLE DRGS

Data Description

Diagnosis Codes• The International Statistical Classification of Diseases and Related Health Problems

(most commonly known by the abbreviation ICD) is a medical classification that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Under this system, every health condition can be assigned to a unique category and given a code, up to six characters long.

• The International Classification of Diseases is published by the World Health Organization (WHO) and used worldwide for morbidity and mortality statistics, reimbursement systems, and automated decision support in medicine. This system is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics. The ICD is a core classification of the WHO Family of International Classifications (WHO-FIC).[1]

• The ICD is revised periodically and is currently in its tenth edition. • [1]: http://www.who.int/classifications/en/

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Data Description

ICD-9 Code Categories• Diseases and Injuries Tabular Index• 1. INFECTIOUS AND PARASITIC DISEASES (001-139)• 2. NEOPLASMS (140-239)• 3. ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES, AND IMMUNITY DISORDERS (240-279)• 4. DISEASES OF THE BLOOD AND BLOOD-FORMING ORGANS (280-289)• 5. MENTAL DISORDERS (290-319)• 6. DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS (320-389)• 7. DISEASES OF THE CIRCULATORY SYSTEM (390-459)• 8. DISEASES OF THE RESPIRATORY SYSTEM (460-519)• 9. DISEASES OF THE DIGESTIVE SYSTEM (520-579)• 10. DISEASES OF THE GENITOURINARY SYSTEM (580-629)• 11. COMPLICATIONS OF PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM (630-679)• 12. DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE (680-709)• 13. DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE (710-739)• 14. CONGENITAL ANOMALIES (740-759)• 15. CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD (760-779)• 16. SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS (780-799)• 17. INJURY AND POISONING (800-999)• SUPPLEMENTARY CLASSIFICATION OF FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVIC

ES (V01-V89)• SUPPLEMENTARY CLASSIFICATION OF EXTERNAL CAUSES OF INJURY AND POISONING (E800-E999)

Source: http://icd9cm.chrisendres.com/index.php?action=contents 10

Data Description

Study Background

• Hypertension is a chronic disease characterized by an elevation of blood pressure leading to a many multiple complications

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Background and PICO

Research Question

In Dallas County admissions with hypertension, is there a difference in hospital service delivery for [variable of interest] during 2011 in the [geo

area of interest] area?

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Background and PICO

This is a sample research question

Design/Methodology• Retrospective, non-experimental (observational)

study design using administrative discharge claims data from the THCIC public use data file (PUDF)

• Discharge claims of interest were extracted as a Microsoft Excel file using the IBM/Cognos business intelligent tool

• Microsoft Excel file was then opened in IBM SPSS version 20.0 and subjected to statistical analysis

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Design/Method

Operational Definition(s)• Adult admissions -- discharge claims/cases, age 18 - 54• Heart failure -- DRG heart failure code(s) 291 “Heart

failure with major co-morbidities and complications”• Hospital service delivery -- total hospital charge average• Males versus females -- claim-based gender code for

gender• Timeframe -- from 2010Q1 to 2010Q4• Dallas-Fort Worth area – Patient home location of

Dallas and Tarrant counties

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Background and PICO

This is a sample operational def. list

Claims/Cases by Race

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Results

Claims/Cases by Age and Gender

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Results

Claims/Cases by DRG

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Results

Median Total Hospital Charge by DRG Severity

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Is Dependent Variable Normally Distributed?

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Results

Normality of Distribution

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Outliner Distribution

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Design/Method

Source: Cronk, B.C. (2008). How to Use SPSS: A Step-by-Step Guide to Analysis and Interpretation, 5th Edition. Glendale, CA.: Pyrczak Publishing.

Statistical Analysis

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Results

Example: Independent samples t-

Test [Pallant p. 232] or M

ann-

Whitney U Test [p. 220] comparin

g

total charges for males vs. fe

males

Conculsion

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Conclusion

List 2 or 3

key observations

Contact or Questions

[STUDENT NAME]Supported by

Dr. Mari Tietze, PhD, RN-BC, FHIMSSTexas Woman’s University

T. Boone Pickens Institute of Health Sciences-Dallas CenterThe Houston J. and Florence A. Doswell College of Nursing

mtietze@twu.edu214-689-6792