Current Topics in Obstetrics

1. Current Topics in Obstetrics BUMED Altarum Institute Kennel and Associates FOR OFFICIAL USE ONLY

2. Context • Projects Completed/In Progress: Adverse Outcome Measures GIS Location Analysis

3. Purpose: • Outline how this work has been done • Describe how analysts can participate • Define how this work impacts Navy Medicine • Outcome: • A better understanding of the analytical work in OB • Apply or request these techniques to be used at your MTF or area of interest FOR OFFICIAL USE ONLY

4. Overview • GIS Location Analysis for Outpatient Perinatal Services • Altarum Institute and Kennel & Associates • Adverse Outcome Report • Altarum Institute FOR OFFICIAL USE ONLY

5. GIS Location Analysis for Outpatient Perinatal Services Navy BUMED – Timothy Link Altarum Institute – John Hufford Kennell & Associates – Geof Hileman

6. Agenda FOR OFFICIAL USE ONLY

7. Problem Statement FOR OFFICIAL USE ONLY

8. Where We Left Off … • The next slide combines two FY 2010 measures for each ZIP Code in the NH Camp Pendleton catchment area on one map: Travel-time appears to be an important factor in OB provider choice.

9. 1 3 2 Purchased Care Non-Active Duty OB Admission Counts and Percent of Total Deliveries by Beneficiary Residence ZIP Code Camp Pendleton Catchment Area, FY 2010

10. A Retail Example • In the retail sector, store and other facility location site location decision support techniques are well-established. • The following, hypothetical and simplified, example (for instance, for a toy store) is based heavily on material obtained from Spatial Insights, Inc. (spatialinsights.com)

11. A Retail Example • Thematic “Quilt” Map showing 2010 population by Census Block Group • Difficult to make overall sense of area • Proximity Map showing population within 5 miles of  each Census Block • In this case, retailer “knows” that right radius

12. A Retail Example  Thematic “Quilt” Map showing 2010 average household income by Census Block Group Proximity Map showing average household income  within 5 miles of each Census Block

13. A Retail Example Our retailer “knows” that they are looking for areas having at least 150K population within 5 miles and median household income of at least $100,000. Overlaying (or spatially joining) these proximity maps yields the few locations with that combination

14. Proximity Maps for NH Camp Pendleton

15. Purchased Care Non-Active Duty OB Admissions by Beneficiary Residence ZIP Code Camp Pendleton Catchment Area, FY 2010

16. Purchased Care Non-Active Duty OB Admissions from Patient ZIP Codes within 30 minutes of each ZIP Code within Camp Pendleton Catchment Area, FY 2010

17. Purchased Care Non-Active Duty OB Admissions from within 30 minutes of each ZIP Code within NH Camp Pendleton Catchment Area ((excluding those within 30 minutes of NH CP) , FY 2010

18. The Rest of the Story • In our retail example, the planners “knew” the basic criteria and parameters driving sales, and therefore, optimal site selection. In our case, we don’t know: • Whether all purchased care admissions are created equal (i.e., that all are equally recoverable), nor • how many will ultimately be recoverable (i.e., will return be worth the facility investment involved). We need more information to make the best choice: we need an OB provider choice model to estimate to tell us which factors matter, and by how much. FOR OFFICIAL USE ONLY

19. To Be Continued … Objective: Maximize direct care share of deliveries in the San Diego / Pendleton area by varying the location of a potential new pre-natal clinic. • Step 1:Develop regression model to estimate the probability of delivering in the direct care system. • Travel times to direct and purchased care inpatient and outpatient locations will be among independent variables. • Note: This step uses the current NH Camp Pendleton location. + • Step 2: Apply model to various candidate clinic locations and determine optimal location(s) by observing projected workload. • First: Use new NH Camp Pendleton location to identify recapture • Second: Identify optimal clinic locations relative to new MTF

20. To Be Continued … Demographically, the model will tell the proportion of care that can be recovered from each ZIP Code, given the demographic profile of that ZIP Code, if a clinic were located in that ZIP Code. Geographically,the model will tell how that proportion declines as the clinic is placed in more distant ZIP Codes. Referring back to our proximity maps, we are taking the retail example to a higher degree of sophistication. We will use the model to predict the number of OB dispositions recoverable by a clinic placed in each ZIP Code, factoring in not only: Volume of workload originating in surrounding ZIP Codes; but Care that is demographically recoverable from those ZIP Codes, and also Distance from those ZIP Codes.

21. To Be Continued … • Proposed Data Elements • In developing the model, we need to identify those factors that influence whether a mother delivers in an MTF or in the civilian sector. These are the independent variables. Those that we have identified so far are in the following general categories:

22. To Be Continued … • Data Elements Proposed • Data about the mother:

23. To Be Continued … Data Elements Proposed Data about the delivery:

24. To Be Continued … Data Elements Proposed Data about geography/travel times:

25. Questions? John Hufford Altarum Institute 734-302-4614 John.Hufford@altarum.org Tim Link Geof Hileman Program Analysis and Evaluation (M81) Bureau of Medicine and Surgery 571.309.9824 cell 202.762.3543 work timothy.link@med.navy.mil Kennell & Associates 7919-424-7465 ghileman@kennellinc.com FOR OFFICIAL USE ONLY

26. Context • Projects Completed/In Progress: Adverse Outcome Measures GIS Location Analysis

27. BUMED Perinatal Advisory Board Adverse Outcome Report Navy BUMED – Timothy Link Altarum Institute – Christina Ciucci

28. Agenda FOR OFFICIAL USE ONLY

29. What is our goal? • To provide decision makers with metrics which offer: • Prospective view of quality to address issues before they happen • Insight into the private sector • Usable information to make decisions BUMED strives to provide world-class Perinatal Care to its beneficiaries in all care environments. BUMED contracted with Altarum Institute to develop a report which could provide the Perinatal Advisory Board and the individual MTFs with actionable data. FOR OFFICIAL USE ONLY

30. What are the Adverse Outcome Indices? • In the absence of a nationally accepted set of quality indicators for obstetrics, these metrics were developed with input from the following: FOR OFFICIAL USE ONLY

31. What are the Adverse Outcome Indices? The 10 adverse outcome measures and their weighted values are used as input to the AOI metrics: FOR OFFICIAL USE ONLY

32. What are the Adverse Outcome Indices? FOR OFFICIAL USE ONLY

33. Why are these modified? • A modified version of the AOI was defined for reporting after discussions with BUMED, Navy personnel, and Altarum. • Indices are modified due to the following: FOR OFFICIAL USE ONLY

34. How is the data developed? MDR/Service Node No PHI/PII FOR OFFICIAL USE ONLY

35. How is the data reported? *Note: Data shown are not representative of actual scores. Perinatal Advisory Board/BUMED Report Individual MTF Report FOR OFFICIAL USE ONLY

36. How is the data distributed? Perinatal Advisory Board Monthly reports and inquiry responses Specific inquiries FOR OFFICIAL USE ONLY

37. What makes these reports great? FOR OFFICIAL USE ONLY

38. How do the pieces fit together? FOR OFFICIAL USE ONLY

39. What is the road ahead? • The goal is to transform data into information, and information into insight • ~ Carly Fiorina, Former President Hewlett Packard • If you want to know your past, look into your present conditions. If you want to know your future, look into your present actions. • ~ Buddhist Saying FOR OFFICIAL USE ONLY

40. Questions Program Analysis and Evaluation (M81) Bureau of Medicine and Surgery 571.309.9824 cell 202.762.3543 work timothy.link@med.navy.mil FOR OFFICIAL USE ONLY