From Data Capture to Useful Information PPRNet Practice Reports

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From Data Capture to Useful InformationPPRNet
Practice Reports Patient-Level Reports (PLR)

• Ruth G. Jenkins, PhD
• Medical University of South Carolina
• Charleston, South Carolina
• Practice Partner User Meeting
• July 22, 2007

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Agenda

• Data Processing Details
• Practice
• Practice Partner
• PPRNet
• Practice Report
• Contents
• Interpreting
• Patient-Level Report (PLR)
• Contents
• Interpreting
• Demonstration

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Purpose of Reports

• Practice Performance Feedback
• Evidence-based Guidelines
• Self Evaluation
• Guide Patient Care Decisions
• Guide Quality Improvement
• Aids Practice Research Participation
• Better Data
• Avoid Underuse, Overuse, Misuse
• Avoid Redundant Testing

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PPRNet Data Collection / Analyses
Practice
FTP
PP
Project Evaluation
PPRNet
Practice Report
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Practice Activities

• Patient Care
• Enter usable data
• Point of care entry
• Direct entry
• Visit Note Templates
• Transcription
• System interfaces
• Lab results system
• Lab equipment
• Data Extraction Program
• Run every quarter
• Transmit data to Practice Partner

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Usable DataMeaningful Data

• Data recorded with meaning
• HTN not OV
• Not embedded in the text of a progress note
• Structured or semi-structured
• Consistent wording for diagnoses or diagnostic
  codes in consistent place in patient record
• HTN
• Hypertension, NOS
• 401.9

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Practice Data Recording

• Patient Status Update
• Usual Provider Update
• Vital Signs
• Diagnoses / Problems / Procedures
• Directly on Lists
• Using visit note template
• Text Section Titles
• Laboratory Results
• Prescriptions
• Health Maintenance

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Data Extracted

• Limited demographics
• Diagnoses
• Procedures
• Medications
• Laboratory tests
• Vital signs
• Health maintenance

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Data Not Extracted

• Identifiers
• (other than birth-date, gender, race, zip code,
  internal tracking number)
• Text of notes

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Practice Partner Activities

• Receive quarterly data from practices
• Check data for errors
• Transmit data to PPRNet office
• Maintain extract program
• Technical support for extraction
• Indoctrinate new PPRNet practices

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PPRNet Data Activities

• Receive data from Practice Partner
• Load raw data into database
• Clean data
• Strip extraneous text
• .OV HTN
• DM
• Aggregate with previous data
• Remove duplicate data records

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PPRNet Data Activities (continued)

• Bridge Data to Common Nomenclature

HTN HBP HYPERTENSION,NOS F/U HTN ESSENTIAL
HTN 401.9 34,358 other text
Hypertension
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PPRNet Data Activities (continued)

• Determine patients eligible for specific
  guidelines
• e.g., identify patients with Diabetes Mellitus
• Link the different types of data for each patient
  to ascertain if the patient has met the guideline
  measure
• Calculate overall percent adherence for the
  practice to the guideline
• Create statistical process control charts showing
  this adherence over time

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PPRNet Data Activities (continued)

• Data Processing Tools include
• SAS Statistical Analysis System
• Data loading and processing
• Calculation of adherence measures
• Creation of SPC charts
• Microsoft Access, Excel
• Clinical bridging
• Generate Practice Reports and PLRs
• Adobe Acrobat
• On-line Practice Report

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Clinical Practice Guideline Measures

• Diabetes Mellitus (11)
• Cardiovascular Disease (16)
• Womens Health Care (4)
• Immunizations (8)
• Respiratory Disease (2)
• Mental Health / Substance Abuse (5)
• Nutrition / Obesity (2)
• Inappropriate Rx prescribing in the elderly (2)

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Types of Measures

• Process
• tests done
• medication prescribed
• Outcome
• clinical target reached

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Diabetes GuidelinesProcess Measures
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Diabetes GuidelinesOutcome Measures
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Practice Performance Report

• 50 Indicators
• 3 Summary Measures
• SPC Methodology
• Time trends
• Comparison with PPRNet benchmark (ABC)
• Comparison with national benchmarks (where
  available)

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Patient-Level Report (PLR)

• Generated each quarter
• End of last month of the quarter
• Excel Spreadsheet 1 patient per row
• Same guideline criteria as practice report
• All active patients 18 yo
• Children
• Asthma controller Age 5
• Chlamydia screening ? Age 16-25
• Tetanus vaccine Age 12
• Influenza vaccine Age 6 mon - 5 yr
• Meningococcal vaccine Age 11-19

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PLR

• Examine individual patient data
• Deficient in a certain guideline
• Identify patients for improvement
• Retrieve PLR from ATRIP folder on PPRNet web page
• Password is assigned when you join

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PLR Data

• 69 fields (columns)
• Practice/Patient demographics 7
• Practice ID, Patient ID, DOB, Sex, Age, Race,
  Provider
• Diagnoses 18
• HTN, DM, CHD, Hyperlipidemia, CHF, AFIB,
  Atherosclerosis, CVD, PVD, Hysterectomy, Asthma,
  COPD, Renal Disease, Liver Disease, Alcohol
  Abuse, Obesity, Tobacco Abuse, Depression

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PLR Data

• Blood pressure 4
• Last BP date and value
• 3 or more BP140/90? Y/N
• Laboratory Tests 14
• Date and value for last Cholesterol, LDL, HDL,
  Triglycerides, HgbA1c, Microalbumin, Glucose

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PLR Data

• Prescriptions 9
• Last date of anti-coagulant, ACE inhibitor,
  anti-platelet, lipid-lowering, beta blocker,
  spironolactone, inappropriate in elderly, rarely
  appropriate in elderly, asthma controller
• Womens Health 4
• Date of last pap smear, mammogram, bone density
  measure, chlamydia screening

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PLR Data

• Immunizations 6
• Date of last vaccine for tetanus, flu, pneumonia,
  Hepatitis A, Meningitis
• Mental Health, Substance Abuse, Diet 5
• Screening for Alcohol Abuse, Depression
• Counseling for Alcohol, Tobacco, Diet
• SQUID 2
• Number of eligible measures
• Proportion up-to-date or under control.

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SQUIDSummary Quality Index

• 50 indicators 37 measures
• Example
• 30 year old ? no chronic disease eligible for
  7 processes, 0 outcomes
• BP monitoring ? PAP Smear ?
• Total Cholesterol HDL
• Depression Screening Td vaccine ?
• Alcohol Screening
• SQUID 3 / 7 0.429

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Using the SQUID

• Identify pts with multiple problem areas
• May help in prioritizing outreach
• Practice reports that average SQUIDs across all
  pts give a sense of overall progress over time.

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Using the PLR

• Excels data filter
• Click the arrow in columns to filter. Arrow
  turns blue.
• Make your selection or choose Custom
• Pre-Programmed Macros

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Data Filter Example

• Women Filter on Sex F
• Ages 18 40 Custom filter on Age
• Greater than or 18 and
• Less than or 40
• No Pap Smear in 2 years
• Custom filter on Pap Date
• Less than or 7/22/05 or
• equals (blank)

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Pre-programmed Macros

• To enable macros, set security to Medium
• Click the box
• Filter further to narrow set
• Macro Example No Influenza Vaccine in past year
  for
• Pts 6 months - 5 yrs old or
• Pts 50 yrs old or
• Pts 18 - 49 yrs old with DM, Asthma, COPD,
• CHD, CHF, Renal Dis, Alcohol Abuse

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Click the box. The patient list filters by the
indicated criteria.
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Practice Partners DBGui

• Identify patients in your Patient Records
• Links PPRNet ID with Patient Records ID
• Copy DBGui.exe and PPUtility.dll from PPRNet web
  page to PPART directory.
• Click on DBGui.exe window opens
• Enter PPRNet ID in Internal ID field.

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Practice Improvement

• Study Practice Report
• Select measures to target for improvement
• Follow improvement over time
• Use PLR to identify individual patients
• Implement Quality
• Improvement Cycle

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Conclusions

• Usable data are essential
• Data management is a process
• Follow clinical processes and outcomes
  longitudinally over time
• Data Information
• Interpret the information
• Guide Improvement
• Support Decisions
• Evaluate Research Projects

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Demonstrations