Establish an Emergency Department and Hospital Discharge Monitoring System in Montana

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Establish an Emergency Department and Hospital
Discharge Monitoring System in Montana
Todd S. Harwell, MPH Montana DPHHS
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Why make hospital and ED discharge data
reportable?

• DPHHS mission - to improve the health status of
  Montanans to the highest possible level.
• A cornerstone activity to achieve this mission is
  to conduct public health monitoring to determine
  the health status of Montanans.
• Monitoring is critical to guide our actions to
  improve health and inform policy deliberations
  and legislation.
• Existing data sources are available to help
  achieve this goal (e.g., vital records, cancer
  registry).
• The major gap in our ability to effectively
  assess the health status of Montanans is the
  absence of timely, thorough, morbidity data.

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What are other States doing?

• Multiple other States have successfully
  implemented ED and hospital discharge data
  monitoring programs.
• As of 2007, the majority of states (39 including
  the District of Columbia) have legislation in
  place to require reporting of hospital discharge
  data.
• Twenty-eight of those states collect hospital
  discharge data directly, and 11 contract with
  private organizations (e.g., hospital
  associations) for data collection.
• Twenty-seven states are collecting ED data.
• Important health information derived from
  hospital discharge and ED data in those states
  should also be readily available in Montana.

4
What currently is being done in Montana?

• Montana Hospital Association has a voluntary
  hospital discharge data program established since
  1999.
• Majority of non-Federal hospitals provide
  electronic hospital discharge data to a
  contracted MHA vendor who processes these data
  and provide minimal reports to MHA and
  participating hospitals.
• Data are collected from the UB billing form used
  by hospitals to bill for services.
• Data have some major limitations
• ED data are not systematically collected
• Indentifiers are not collected (unduplicate
  recurrent events)
• E-codes, used to define the specific cause of an
  injury (e.g., diagnosis skull fracture cause
  of injury occupant in a motor vehicle crash)
  are not systematically collected
• Race/Ethnicity information is not collected
• MT DPHHS has an agreement with MHA and purchases
  the existing hospital discharge data set.

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An example of the limitations to the current
monitoring system in Montana

• Number of deaths due to unintentional poisoning
  in Montana has been increasing over the past 8
  years.
• Using death records we can tell that this
  increase began in 1999, and that the use of
  prescription drugs (e.g., methadone, oxycodone)
  is related to this increase.
• However, important morbidity data to investigate
  this problem for the general Montana population
  are not available.
• Lack of systematic collection of e-codes in the
  hospital discharge data set, and the lack of ED
  data prohibit this type of investigation.

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What essential improvements should be made to
this system to increase the quality and
usefulness of hospital and ED data?

• Data improvements
• Collect identifiers for each case to un-duplicate
  the admission events, and provide a mechanism to
  identify repeat/recurrent health events as well
  as link these data sets to other data sets such
  as death records.
• Ensure completion of the e-code fields that
  define the exact cause of injury to allow for
  analyses focusing on injuries, a leading cause of
  death in Montanans aged 1 to 44.
• Get access to data fields for Zip code and cost
  information to conduct more detailed geographic
  analyses and population-based cost-related
  studies. Key variables needed already exist on
  the UB form.
• Collect data regarding race/ethnicity.
• Establish ED discharge data collection system
  that includes/address the above.

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Confidentiality and HIPAA

• As with all public health monitoring data, this
  information would be analyzed in aggregate,
  maintaining individual patient confidentiality
  and strictly following federal and state
  standards such as HIPAA.
• DPHHS collects identifiers for other reportable
  conditions including communicable diseases,
  cancer, live births, and deaths and has had no
  issues or problems with maintaining patient
  confidentiality.

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Next Steps

• DPHHS is submitting legislation to require ED and
  hospital discharge data reporting to the
  Department.
• DPHHS has submitted a request for 150,000 to
  support 1 FTE epidemiologist and budget for this
  program.
• Work collaboratively with MHA and the hospitals
  to enhance the existing data collection system in
  Montana. Oregon state has taken a similar
  approach.
• Targets
• By June 2010, all hospitals in Montana (excluding
  Federal and State hospitals) will submit hospital
  discharge data to DPHHS.
• By June 2011, all hospitals in Montana (excluding
  Federal and State hospitals) will submit
  emergency department discharge data to DPHHS.
• Ongoing, DPHHS will publish and disseminate
  quarterly reports utilizing the emergency
  department and hospital discharge data to assess
  the health status of Montanans.
• Ongoing, DPHHS staff for this program will work
  collaboratively with other state and local public
  health programs, and other health organizations
  to support the utilization of emergency
  department and hospital discharge data.

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We should be able to do this!
Table 2. Pediatric emergency department (ED)
rates for asthma by race/ethnicity, New Jersey,
2004-2005.
Kruse LK, et al. Disparities in asthma
hospitalizations among children seen in the
emergency department. J Asthma 200744(10)833-837
. Data source NJ ED and hospitalization data
files 2004-2005, children aged 1-19. Includes
children seen in ED only plus children
hospitalized from the ED.
10
Do Montanans support a primary seat belt law?