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Healthcare Utilization in Preschool-Age Children

Healthcare Utilization in Preschool-Age Children. 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 1 st well-child visits

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Healthcare Utilization in Preschool-Age Children

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  1. Healthcare Utilization in Preschool-Age Children • Deb Koester • Joseph Thomas • Sudeshna Paul • Bruce Craig • Michael Weiner • Laura Sands

  2. 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

  3. 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 N = 9618

  4. Erythromycin and Pyloric Stenosis PS yes no yes E no 14,876

  5. Pyloric stenosis • Dx’s = pyloric stenosis

  6. Pyloric stenosis • Dx’s = pyloric stenosis • ICD9 = 750.5

  7. Pyloric stenosis • Dx’s = pyloric stenosis • ICD9 = 750.5 • ICD9 = 537.0

  8. Pyloric stenosis • Dx’s = pyloric stenosis • ICD9 = 750.5 • ICD9 = 537.0 • Radiology

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

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

  11. Pyloric stenosis • Dx’s = pyloric stenosis • ICD9 = 750.5 • ICD9 = 537.0 • Radiology • Transfers to Riley? • Riley • Text Reports • Discharge Summaries • Op Notes**

  12. Macrolide prescriptions • Electronic data • Confirmed true Rx by reviewing infants’ medical records

  13. Pharmacy ordered 421

  14. Pharmacy ordered trans- action 339 82

  15. Pharmacy the “outpatient” MRF ordered 5 trans- action 0 324 15 77

  16. Pharmacy the “outpatient” MRF ordered 5 trans- action 0 281 43 3 2 0 12 75 48 the old “lab” MRF

  17. 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

  18. Infant systemic erythromycin Pyloric Stenosis yes no yes 6 463 (1.28%) 469 Erythromycin no 14,370 14,407 (0.26%) 37 14,833 43 RR =4.98 (2.11, 11.74)

  19. Infant systemic erythromycin Age at Rx #infants with PS #infants with Rx #infants with PS #infants without Rx RR 1.28% (6/469) 0.26% (38/14,407) 4.98 (2.1, 11.7) <3 months

  20. Infant systemic erythromycin Age at Rx #infants with PS #infants with Rx #infants with PS #infants without Rx RR 10.51 (4.5, 24.7) 2.65% (6/226) 0.25% (37/14,650) <2 weeks 1.28% (6/469) 0.26% (38/14,407) 4.98 (2.1, 11.7) <3 months

  21. Mapping Children’s Injuries

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

  23. Chief Complaints “SICK” “sick”

  24. Wishard Chief Complaints

  25. Chief Complaints “SICK” “sick” “SICK’” “SICK’;” “SICK” “SICK AS 3 DOGS” “SICKO” “SIDK” “SIICK” “SIKC” “SIKCK” “SIC”

  26. Wishard Chief Complaints

  27. 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 • Full Retrospective Study • Aggregate Data • Individual-Level Analytic Data Set • Deidentified • Limited • Identified

  28. 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

  29. 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

  30. 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

  31. 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

  32. Types of Projects • Full Retrospective Study

  33. Data Sources Existing • RMRS • INPC Hospitals • Wishard • Clarian • Community • St. Francis • St. Vincent • a growing list… • Medicaid etc.

  34. Data Sources Existing • RMRS • INPC Hospitals • Wishard • Clarian • Community • St. Francis • St. Vincent • a growing list… • Medicaid etc. Global ID

  35. Data Sources Existing • RMRS • INPC Hospitals • Wishard • Clarian • Community • St. Francis • St. Vincent • a growing list… • Medicaid etc. Global ID New • you can bring us data you’ve collected • &/or we can help you build a database

  36. Types of Electronic Data • 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

  37. About the 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

  38. Logistics • IRB • Other Permissions • Price Tag • Contact Information Marc Rosenman mrosenma@iupui.edu 317-423-5513

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