Post on 07-Jul-2015
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Combining Data Warehousing and Predictive
Modeling to Open New Possibilities for Guiding
Clinical And Management Decision Making
Nathaniel Israel
San Francisco Department of Public Health
nathaniel.israel@sfdph.org
Stephen Guerin
Redfish Group / Santa Fe Complex
stephen@sfcomplex.org
San Francisco
Department of
Public Health
Goals:
• Briefly describe common frameworks for utilizing behavioral health data for decision support
• Describe a particular implementation of a decision support framework in SF County
• Describe a particular visualization strategy, Agent Based Modeling (ABM)
• Demonstrate potential uses of ABM in decision support
Basic Frameworks
• Billing data give us the “What” of client
flow
– Access, Engagement, Services, Linkages
• Clinical data give us a “Why” re: client flow
– Allow us to answer the question, “Was
movement clinically appropriate?”
• Example: time in hospital / residential care
Billing Data
A E S L
Hospital X Addt’l X X
Residential X Addt’l X X
Intensive OP X X X X
Outpatient X X X X /
Addt’l
Clinical Data
• CANS Data:
– System Snapshot of Needs and Functioning
– Agency -Level Trajectories re: sub-population
needs and outcomes
– Client –Level Outcomes
System-Level Profile
System-Level Profile
Agency Trajectories
Population Trajectory: HSA
0
5
10
15
20
25
1 2 3
Assessment Number (6-month intervals)
Avera
ge N
um
ber
of
Acti
on
ab
le
Item
s P
er
Cli
en
t
A Better Way, Inc. Alternative Family Services, Inc. CASARC
Foster Care Mental Health IPP HSA - AVERAGE
Client –Level Outcomes
• Theory: Complex Systems Research
– Agent-Based Modeling
– Data Visualization
• Applied Examples:
– Emergency Response Planning
– Pharmaceutical R&D Portfolio
• Florida Case Study
• Ongoing San Francisco Project
• Theory: Complex Systems Research
– Agent-Based Modeling
– Data Visualization
• Applied Examples
– Emergency Response Planning
– Pharmaceutical R&D Portfolio
• Florida Case Study
• Ongoing San Francisco Project
Complex Adaptive Systems
How Systems Organize
Why Systems Organize
Josh Thorp, stigmergic.net
Flocking and Schooling
Josh Thorp, stigmergic.net
A simple agent’s behavior
Attract
Repel
Ants and Pheromones
• Theory: Complex Systems Research
– Agent-Based Modeling
– Data Visualization
• Applied Examples:
– Emergency Response Planning
– Pharmaceutical R&D Portfolio
• Florida Case Study
• Ongoing San Francisco Project
Zozobra Crowd Dynamics
Roberto Clemente Bridge
Open to pedestrian traffic only
Fans use bridge to downtown and to closest “T” stations
MANAGING CASE FLOWS
Eli Lilly’s R&D Portfolio Planning
Eli Lilly R&D Portfolio Scheduling
time
$
cost
revenue
Eli Lilly R&D Workflow Simulation and Portfolio Scheduling
• Theory: Complex Systems Research
– Agent-Based Modeling
– Data Visualization
• Applied Examples:
– Emergency Response Planning
– Pharmaceutical R&D Portfolio
• Florida Case Study
• Ongoing San Francisco Project
Input is simple spreadsheet
Client Trajectories
Number of Days in a Placement
Client Trajectories
Number of Days in a Placement
Client Trajectories
Distance Metric
Dendrogram
Capturing Direction of Flow
Capturing Direction of Flow
Number of Days in a Placement
Capturing Direction of Flow
Number of Transitions between Placements
Agent-based Clustering
(Frey and Dueck, 2007) Science Magazine
Agent-based Clustering
• Theory: Complex Systems Research
– Agent-Based Modeling
– Data Visualization
• Applied Examples:
– Emergency Response Planning
– Pharmaceutical R&D Portfolio
• Florida Case Study
• Ongoing San Francisco Project
Visualization Project Scope
1) clients’ movement between levels of care
over time.
2) agencies client movement over time.
3) service use by demographic and clinical
characteristics, including gender, age,
ethnicity, and diagnosis.
Nate’s “What” client flows from Billing DataWill be integrating the “Why” from Clinical Data
0
100
200
300
400
500
600
700
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Co
un
t
Age (as of 6/30/2008)
Patient Ages
0 2000 4000 6000 8000 10000 12000
Family Mosaic ProjectWestside Integrated CYF Svc
RAMS CYF OPTEDGEWOOD CHILDRENS RI EPSDT
OMI Family Ctr Children SvcInstituto Fam DeLaRaza
Seneca Concord CTF OP (closed)SF BOYS & GIRLS HOME #1 (St. Vincents)
Craig CumminsInstituto Fam DeLaRaza SED
Kevin D HardingMICHAEL SCOTT
Infant Parent Prg-IPP ChildcarRAMS Employee Development Prgm
SFCFTC UC CAF Program OPInfant Parent Prg-IPP NPA (Neuropsych Assmt)
WESTSIDE CALWORKS COUNSELINGJack Travis
CMHDA NON MD TIER1 (Value Options PPN)LANGLEY PORTER CLINIC MD
Transition-Age Youth ProgramHUGH MOLESWORTH
Norman ZukowskyRAMS Fu-Yau EPSDT
WESTSIDE CALWORKS COUNS(RAMS)WARREN TAYLOR
Peter BrowningAlexandre V Zinchenco
THE ANCHOR PROGRAMCONARD-JACKSON STREET HOUSEGROVE ST CRISIS RES BAKER PLCS
Judith L SpeedGregory BrownLouis J Roussel
Tim S HuiCynthia S Yang
RAMS PAES Counseling Ser OPFRED R STODDARD
#N/ABaker Places Grove Street OPT
# of Services by Reporting Unit
No
t al
l RU
s ar
e d
isp
laye
d
0 2000 4000 6000 8000 10000 12000
Family Mosaic Project
Seneca Res Out Patient (CTF-Community Tx Facility)
YGC - Youth Guidance Center
Chinatown Child Dev Center
Seneca Center WRAP
MISSION FAMILY CENTER
EDGEWOOD CHILDREN'S OUT PATIEN
Southeast Child/Family
SOUTHEAST CHILD & FAMILY CTR 2
Westside Integrated CYF Svc
Edgewood Day Treatment ("Day Day Treatment")
Seneca Residential Day TX
Oakes Children's Center DT
McAuley Day Treatment
URBAN SERVICES YMCA
walden adolescent Intensive DT
EDGEWOOD CTR CHIL & FAM EPSDT
Edgewood Child EPSDT DAY TX (Residential Day Treatment)
RAMS CYF OPT
FSA Tender Lion EPSDT
# of Services by Reporting Unit (top 20)
0 5000 10000 15000 20000 25000 30000
Individual Therapy
Indiv Psych 90806 45-74 min
CASE CONF,NON MD,15MIN H2015 5
INDIVIDUAL PSYCH AB3632 45-74M
Pharmacolgcl mgmt w/brief psy
Assessment Non MediCal
GROUP THERAPY AB3632
I E P - AB3632
FAMILY THERAPY W/PT AB3632
Hospital Visit Subsqnt 35 min
Brief Medication Visit
Individual 45-50 min 90806 (4)
Individual 45-50 min 90806 (3)
Individual 45-50 min 90806 (9)
INT IND PSY AB3632 45-74 MINS
CASE MGMNT PLACEMENT SFGH/SD
Init Psychiatric Exam 90801(6)
FAMILY THERAPY W PT 90847 (4)
Init Psychiatric Exam 90801(5)
COMM PSY SUP SRV 90MIN H0036 9
GRP THERAPY PER PERS 90853 (1)
Hospital Visit Init 50 min
CLIENT REPORT PREP AB3632
CASE CONF,NON MD,15MIN H2015 3
EMERGENCY DEPT VISIT EVAL 5150
FAMILY THER W/O PT 90846 (8)
Interact Psych Diag AB3632
# of Procedure Codes
No
t al
l RU
s ar
e d
isp
laye
d
0 5000 10000 15000 20000 25000 30000
Individual Therapy
Case Management Brokerage
Collateral
Day Trx Inten Full Child
Assessment & Evaluation
Medication Support/Monitoring
Indiv Psych 90806 45-74 min
Day Trx Intensive Full AB3632
Crisis Intervention No MediCal
Individual AB3632
Family Therapy with patient
Day Trx Rehab Full Day
CASE CONF,NON MD,15MIN H2015 5
Collateral AB3632
Day Trx Rehab Full Day AB3632
Individual 45-50 min 90806 (5)
Individual 45-50 min 90806 (6)
Assessment AB3632
INDIVIDUAL PSYCH AB3632 45-74M
Group Therapy
# of procedure codes (top 20)
Opensource or Free Toolsfor visualization and agent-based modeling
• Netlogohttp://ccl.northwestern.edu/netlogo/
• Processinghttp://www.processing.org
• Nodeboxhttp://www.nodebox.net
• Open Frameworkshttp://www.openframeworks.cc/
• HTML5 with Javascript
Combining Data Warehousing and Predictive
Modeling to Open New Possibilities for Guiding
Clinical And Management Decision Making
Nathaniel Israel
San Francisco Department of Public Health
nathaniel.israel@sfdph.org
Stephen Guerin
Redfish Group / Santa Fe Complex
stephen@sfcomplex.org
San Francisco
Department of
Public Health
Eli Lilly R&D Portfolio Scheduling
time
$
cost
revenue
Eli Lilly R&D Workflow Simulation and Portfolio Scheduling
Project Scope
Visualize client flow through the public mental health service system based on Medicaid billing data:
1) Visualize clients’ movement (service use) between levels of care over time.
2) Visualize each agency’s clients’ movement (service use) over time.
3) Visualize clients’ service use by demographic and clinical characteristics, including
gender, age, ethnicity, and diagnosis.
This visualization will allow system stakeholders to understand a) how clients are moving through the system (using services at different levels of care)b) whether / how this flow varies by provider within and across levels of care and c) whether / how this flow varies by client demographic characteristics.
The delivered program will also allow for the upload of new data to inform the visualizations, and for the comparison of clients’ service utilization across two distinct periods of time.
A procedure document will be included with the program and this document will provide step-by-step instructions that enable users to upload new data to the program. The program will be available to users wherever it is installed and service data is uploaded.
Project FlowData
• Verify initial data
• Additional sources
Model
• Data Model
• Agent-based Model
Visualizations
• Case flow Animations
• Network Navigation
Deployment
• Analyst
• Web
• Table
Project FlowData
• Verify initial data
• Additional sources
Model
• Data Model
• Agent-based Model
Visualizations
• Case flow Animations
• Network Navigation
Deployment
• Analyst
• Web
• Table
Project Timeline
Project Timeline
Project FlowData
• Verify initial data
• Additional sources
Model
• Data Model
• Agent-based Model
Visualizations
• Case flow Animations
• Network Navigation
Deployment
• Analyst
• Web
• Table
Project FlowData
• Verify initial data
• Additional sources
Model
• Data Model
• Agent-based Model
Visualizations
• Case flow Animations
• Network Navigation
Deployment
• Analyst
• Web
• Table
Source: Juice Analytics
Data Issues
• Client Primary RUs with no mapping in provider table
• RUs in services with no mapping in provider table:
Project FlowData
• Verify initial data
• Additional sources
Model
• Data Model
• Agent-based Model
Visualizations
• Case flow Animations
• Network Navigation
Deployment
• Analyst
• Web
• Table