Analytics In Healthcare and Capturing the Patient Journey

Analytics In
Healthcare
and Capturing
the Patient
Journey
APRIL 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
Is Data Preparation Really That
Hard?
Forbest.com “Cleaning Big Data: Most Time-Consuming, Least Enjoyable”
http://blogs.sas.com/content/hiddeninsights/2013/10/11/how-well-are-you-managing-the-analytical-life-cycle/
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?
“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.”
https://www.cancercare.on.ca/ocs/qpi/dispathmgmt/pathways/colopath/
What really does the patient journey look like?
www.deepjapan.org
How do we capture this in the available datasets?
Two possible sources
for surgery data
Health Analysts’ Toolkit, Health Analytics Branch, Winter 2012
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
CHDB
▪ Each observation represents a
discharge
▪ Each observation represents one
claim (NOT visit or activity)
▪ Patients transferred to another facility
(after discharge) possibly for the
same condition are in multiple
observations
▪ 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
CHDB
▪ Surgery information is captured
by CCI codes
▪ Surgery information is captured
by OHIP fee codes
▪ “CCI specifies more precisely
than ever before what
interventions and services health
professionals provide. ”
▪ Schedule benefit:
▪ Multiple fields to capture
interventions
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
Code
Surgery Code Description
Surgery Category
Disease
Site
1NK87
DN
Excision partial, small intestine endoscopic
(laparoscopic) approach; Enterocolostomy
anastomosis technique
Excision partial, small intestine endoscopic
(laparoscopic) approach; Enteroenterostomy
anastomosis technique
Excision partial, small intestine open approach;
Enterocolostomy anastomosis technique
Excision partial, large intestine endoscopic
(laparoscopic)
approach; Colorectal anastomosis technique
Excision partial, large intestine endoscopic
(laparoscopic)
approach; Colocolostomy anastomosis technique
Excision partial, large intestine endoscopic
(laparoscopic)
approach; Enterocolostomy anastomosis technique
Excision partial, large intestine open approach;
Colorectal anastomosis technique
Excision partial, large intestine open approach;
Enterocolostomy anastomosis technique
Excision partial, large intestine open approach;
Colocolostomy anastomosis technique
Excision total, large intestine endoscopic
(laparoscopic)
approach; Ileorectal (endorectal, ileoproctostomy)
anastomosis technique
A - Resection of colon without
stoma, with anastomosis
Colon
Surgical
Resection
Indicator
Nonresective
A - Resection of colon without
stoma, with anastomosis
Colon
Nonresective
A - Resection of colon without
stoma, with anastomosis
A - Resection of colon without
stoma, with anastomosis
Colon
Nonresective
Colon
Resective
A - Resection of colon without
stoma, with anastomosis
Colon
Resective
A - Resection of colon without
stoma, with anastomosis
Colon
Resective
A - Resection of colon without
stoma, with anastomosis
A - Resection of colon without
stoma, with anastomosis
A - Resection of colon without
stoma, with anastomosis
A - Resection of colon without
stoma, with anastomosis
Colon
Resective
Colon
Resective
Colon
Resective
Colon
Resective
1NK87
DP
1NK87
RE
1NM87
DE
1NM87
DF
1NM87
DN
1NM87
RD
1NM87
RE
1NM87
RN
1NM89
DF
CCI codes for
surgical resection
List not exhaustive
OHIP
Fee
Code
S166
Fee Code Description
Disease
Site
Colon
S167*
Resection with anastomosis – small and large intestine terminal ileum, cecum
and ascending colon (right hemicolectomy)
Resection with anastomosis – large intestine
Surgical
Resection
Indicator
Resective
Colon
Resective
S168
Ileostomy - subtotal colectomy
Colon
Resective
S169
Resection with anastomosis – total colectomy with ileo-rectal anastomosis
Colon
Resective
S171*
Colon
Resective
Colon
Resective
S188
Resection with anastomosis – left hemicolectomy with anterior resection or
proctosigmoidectomy (anastomosis below peritoneal reflection and mobilization
of splenic flexure)
Resection with anastomosis – total colectomy with mucosal protectomy with ilea
pouch, ileoanal anastomosis and loop ileostomy
Bowel resection without anastomosis (colostomy and mucous fistula)
Colon
Resective
E793
Laparoscopic or laparoscopic assisted
Colon
Modifier Code
S172
OHIP fee codes for
surgical resection
Might not be exhaustive
Comparison of the two databases: activity dates
DAD
CHDB
▪ Admission date
▪ Service date
▪ Discharge date
▪ Admission date
▪ Intervention date
Not absolutely comparable
Comparison of the two databases: summary
▪ 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)
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-O3, OHIP diagnosis codes), etc.
▪ Read database documentation and ask colleagues around you
End result: Save time!
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
Questions?
Thank you!
Contact: Shirley.Li@cancercare.on.ca or
proc1125@gmail.com