• Deb Koester• Joseph Thomas• Sudeshna Paul• Bruce Craig• Michael Weiner• Laura Sands

Healthcare Utilization in Preschool-Age Children

• 5 year olds in 2003, 2004• the 18-month period before September 1st • well-child visits• compare utilization among those with and

without well child visits• Indiana Medicaid data• continuous enrollment• not in a managed care organization

Healthcare Utilization in Preschool-Age Children

• 5 year olds in 2003, 2004• the 18-month period before September 1st • well-child visits• compare utilization among those with and

without well child visits• Indiana Medicaid data• continuous enrollment• not in a managed care organization

Healthcare Utilization in Preschool-Age Children

N = 9618

PS

E

yes

yes

no

no

14,876

Erythromycin and Pyloric Stenosis

• Dx’s = pyloric stenosis

Pyloric stenosis

• Dx’s = pyloric stenosis• ICD9 = 750.5

Pyloric stenosis

• Dx’s = pyloric stenosis• ICD9 = 750.5• ICD9 = 537.0

Pyloric stenosis

• Dx’s = pyloric stenosis• ICD9 = 750.5• ICD9 = 537.0• Radiology

Pyloric stenosis

• Dx’s = pyloric stenosis• ICD9 = 750.5• ICD9 = 537.0• Radiology• Transfers to Riley?

Pyloric stenosis

• Dx’s = pyloric stenosis• ICD9 = 750.5• ICD9 = 537.0• Radiology• Transfers to Riley?• Riley

Pyloric stenosis

• Dx’s = pyloric stenosis• ICD9 = 750.5• ICD9 = 537.0• Radiology• Transfers to Riley?• Riley• Text Reports

• Discharge Summaries• Op Notes**

Pyloric stenosis

• Electronic data

• Confirmed true Rx by reviewing infants’ medical records

Macrolide prescriptions

421

Pharmacyordered

339 82

Pharmacyordered

trans-action

5

324 15 77

0

Pharmacyordered

trans-action

the “outpatient” MRF

12

281

5

43 3 2

7548

0

0

Pharmacyordered

the “outpatient” MRF

the old “lab” MRF

trans-action

Exposure to Erythromycin

• 483 patients were identified

• Upon review of all 483 in Inquiry, 14 (3%) were removed from drug group

•ordered and then d/c’d immediately (8)

•“250 mg tabs” (6)

• 469 patients in the exposure group

Infant systemic erythromycin

Pyloric Stenosis

Erythromycin

RR =4.98(2.11, 11.74)

6

37

463

14,370 14,407

469

yes

yes

no

no

43 14,833

(1.28%)

(0.26%)

Ageat Rx

Infant systemic erythromycin

#infants with PS#infants with Rx

#infants with PS#infants without Rx RR

<3 months 1.28%(6/469)

0.26%(38/14,407)

4.98(2.1, 11.7)

Ageat Rx

Infant systemic erythromycin

#infants with PS#infants with Rx

#infants with PS#infants without Rx RR

<2 weeks

<3 months

2.65%(6/226)

1.28%(6/469)

0.25%(37/14,650)

0.26%(38/14,407)

10.51(4.5, 24.7)

4.98(2.1, 11.7)

Mapping Children’s Injuries

•ICD9 Codes and E Codes•Chief Complaint Data•Address Data

Chief Complaints

“SICK”“sick”

0

10,00020,000

30,00040,000

50,00060,000

70,00080,000

90,000100,000

110,000

2003

CC = "SICK" Total N of CC

Wishard Chief Complaints

Chief Complaints

“SICK”“sick”“SICK’”“SICK’;”“SICK”“SICK AS 3 DOGS”“SICKO”“SIDK”“SIICK”“SIKC”“SIKCK”“SIC”

0

10,00020,000

30,00040,000

50,00060,000

70,00080,000

90,000100,000

110,000

2000 2002 2004 2006

CC = "SICK" Total N of CC

Wishard Chief Complaints

• Estimate the N with ________Quick Checks, and Discussion of Feasibility

• Generate a List for Chart Review

• Generate a List for Recruitment (e.g., by ResNet)

• Help Investigators with their own databases

• Full Retrospective Study Aggregate Data Individual-Level Analytic Data Set

Deidentified Limited Identified

Types of Projects

• Estimate the N with ________Quick Checks, and Discussion of Feasibility

N of patients with coronary artery disease in 2006,and ≥ 1 visit to an IUMG primary care

medicine clinic

Types of Projects

• Estimate the N with ________Quick Checks, and Discussion of Feasibility

• Generate a List for Chart Review

Patients with HIV and other criteria

Types of Projects

• Estimate the N with ________Quick Checks, and Discussion of Feasibility

• Generate a List for Chart Review

• Generate a List for Recruitment

Patients > 50 years old in IUMG primary care medicine

Types of Projects

• Estimate the N with ________Quick Checks, and Discussion of Feasibility

• Generate a List for Chart Review

• Generate a List for Recruitment (e.g., by ResNet)

• Help Investigators with their own databases

setting up forms for data entry into Microsoft Access

Types of Projects

• Full Retrospective Study

Types of Projects

• RMRS• INPC Hospitals

• Wishard• Clarian• Community• St. Francis• St. Vincent• a growing list…

• Medicaid etc.

Data Sources

Existing

• RMRS• INPC Hospitals

• Wishard• Clarian• Community• St. Francis• St. Vincent• a growing list…

• Medicaid etc.

Data Sources

Existing

Global ID

• RMRS• INPC Hospitals

• Wishard• Clarian• Community• St. Francis• St. Vincent• a growing list…

• Medicaid etc.

Data Sources

Existing

• you can bring us data you’ve collected

• &/or we can help you build a database

New

Global ID

• Lab Results• Imaging Studies• Orders• Visits: Inpatient, ER, and Outpatient• Rx• Age, Sex, Race• Insurance status at check-in• Text Reports, e.g.

Discharge Summaries Op Notes

• Charges

Types of Electronic Data

• The Data are a Work-in-Progress• Shaped by the Real World

• clinical and billing considerations• work flows• interfaces

• History• Shelf Life• Need for Triangulation

• scrutiny• >1 method• written charts

• Perspectives

About the Data

• IRB

• Other Permissions

• Price Tag

• Contact InformationMarc Rosenmanmrosenma@iupui.edu

317-423-5513

Logistics