Using DSS Clinical and Economic Data in Quality of Care Research

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Using DSS Clinical and Economic Data in Quality
of Care Research

• HSRD National Meeting, March 10, 2004

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Jeanie Lowe, Rocky Mountain Network DSS
ManagerElizabeth McSherry, MD, MPH, DSS
Director of Development, BedfordDean Reker,
PhD, RN, Research Scientist, Kansas City
VAMCMargaret Ross Kraft, PhD,RN, Research
Associate, VIReC Assistant Professor, Loyola
University Chicago
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Decision Support System (DSS)

• VHA national automated management information
  system
• Uses extract mechanism to capture data from
  existing clinical and financial systems
• Includes inpatient, outpatient extended care

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DSS

• Production Data
• Patient specific data
• processed for each facility
• and stored by VISNs in
• AAC
• National Data
• Data rolled up as National
• Data Extracts (NDE)

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• Cost and Effectiveness of
• A Specific Surgery
• Using DSS Surgery and Pharmacy Data

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Study Sample

• Enrollment from January 1999 to November 2001
• Follow-up ended November 2003
• Enrolled 2164 patients across 14 sites
• 1983 of the enrollees actually had the surgical
  procedure
• Analysis ongoing/methods only

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DSS Data Used

• Production Level Data
• Intermediate Products
• Cost Data
• RVU Data
• Labor
• Other
• Prescription Data

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Production Level Data

• Out-patient search was multi-level by CPT codes/
  SSN/Date to determine the encounter number
  (combination of the SSN and date)
• Inpatient search was by SSN, IP number, and date

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DSS Structure

• Departments
• S311 Surgery-OR
• G3S1 Anesthesia-OR
• Intermediate Products
• From National Product List
• End Product
• Inpatient Stay with Surgical
  Procedure
• Outpatient Visit with Surgical
  Procedure

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Intermediate Products

• IP 3850 General Surgical Service General
  Anesthesia Time
• IP 3938 General Surgical Service OR Time
• IP 3942 General Surgical Service Room Clean
  time

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Intermediate Products (contd)

• IP 3943 General Surgical Service Surgeon Time
• IP 3944 General Surgical Service Recovery Time.

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The End Product

• A patient encounter, either inpatient or
  outpatient, which includes a bundle of
  intermediate products

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Data Issues

• FY 1999 data were unavailable since they had
  already been archived
• IP numbers did not appear to be used consistently
  across sites, creating missing data

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RVU Data

• Collected from the 14 study sites for the
  departments of interest
• S311
• G3S1
• and for the intermediate products of interest.
• IP 3850 IP 3938
• IP 3942 IP 3943
• IP 3944

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RVUs

• weighted units of measure that allow for the
  relative comparison between differing
  complexities and mixes of procedures
  Eclipsys
• Indicate relative value between products in the
  same department.

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RVUs(Relative Value Units)

• Labor Expressed in minutes of time.
• VL 1 Technicians
• VL 2 Nurses (RNs, LPNs, Aides)
• VL 4 Physicians
• VL 5 Contract Labor
• FDL Fixed Direct Labor

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RVUs (Cont)

• Other Costs Expressed in dollars
• Supplies
• FDE Fixed Direct Expenses
• FDO Fixed Direct Other

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DSS/PBM PharmacyData Comparison CSP Study
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DSS/PBM Pharmacy Comparison

• Population
• 1,591 Patients in the CSP Study
• Prescriptions
• Outpatient
• FY2002
• Fills and refills
• 42,469 prescriptions

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DSS/PBM Pharmacy Comparison

• Methods
• Desirable Methods
• NDC National Drug Code
• Different Formats
• DSS standard 12-digit format
• PBM multiple formats
• Different Source
• Product Name
• PBM VA Product Name (64)
• DSS Shortened Product Name (30)

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DSS/PBM Pharmacy Comparison

• Matching Routine Used
• SSN/Date/Total Quantity/ of Rx
• Matched Days
• 1st three characters of the VA Product Name
• Unmatched product
• Unmatched Days
• Manual comparison of Prescriptions

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DSS/PBM Pharmacy Comparison Preliminary Results
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DSS/PBM Pharmacy Comparison Preliminary Results
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DSS/PBM Pharmacy Comparison

• Limitations
• Outpatient only (PBM)
• Cohort not representative of whole population
• Conclusions
• DSS and PBM Pharmacy extracts capture same
  prescriptions
• DSS or PBM?
• Access
• Contents
• PBM has dosing instructions (sig)
• DSS costs include labor and overhead

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DSS/PBM Pharmacy Comparison

• Future Reviews
• Larger or more representative cohort
• Inpatient prescriptions
• Comparison of current data with VistA profiles

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Utility of DSS

• Average minutes of labor for the surgical
  procedures in this study
• Intermediate product costs
• Total costs for the end product
• Opportunity to do a comparison between DSS
  Pharmacy Data and PBM Data