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Navy Medicine Chartbook

Navy Medicine Chartbook. Tying illness and treatment to the population at risk Thomas A. Bickett 6 June 2012. Introduction. 1)Context: This is an introduction to a new Chartbook of Navy Medicine. Included is an example case of the diagnosis and treatment of spine disorders.

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Navy Medicine Chartbook

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  1. Navy Medicine Chartbook Tying illness and treatment to the population at risk Thomas A. Bickett 6 June 2012

  2. Introduction • 1)Context: This is an introduction to a new Chartbook of Navy Medicine. Included is an example case of the diagnosis and treatment of spine disorders. • 2)Purpose: The Chartbook ties together all components of beneficiary health care to enable policy makers to make informed decisions about the MHS system. The components include beneficiary demographics, illness rates, intermediate resources, and costs. • 3)Outcome: The Chartbook will allow decision makers to make informed policy changes. Projected changes in the population will in turn lead to changes in the number of conditions treated and the number of procedures performed. FOR OFFICIAL USE ONLY

  3. Components of Chartbook • The Chartbook can be divided into several components: • Population • What is the demographic distribution beneficiaries in a geographic area? • How does the distribution differ across areas and how has it changed over the past several years? • Illness • What is the rate of chronic illness in the population? • How does that rate vary across geographic areas? • Episodes and Intermediate Resources • What is the utilization of these chronically ill patients? • How does that utilization vary across geographic areas? • What major procedures are provided to these patients? • How does the rate of treatment (or non-treatment) differ across areas? FOR OFFICIAL USE ONLY

  4. Lee and Jones Model Population Illness Episode Intermediate Products Resources Operating Costs Population demographics. How do populations differ? What is the illness rate in the population? How can the illness rate be reduced? How long is the episode of care? For chronic conditions, episodes may not have a defined duration. What are the treatments provided to the patient? Are these treatments in line with clinical practice guidelines? • This year’s chartbook focuses on illness within the population and the amount of services used and required to serve this population.

  5. Population • Current focus within the MHS is on enrolled beneficiaries • The Chartbook expands the scope to include non-enrolled beneficiaries, beneficiaries enrolled to Managed Care Support contracts, and Medicare beneficiaries • Geographic concepts include: • MSMAs (groups of catchment areas) • Catchment Areas (40 miles around hospitals) • PRISM Areas (20 miles around hospitals and clinics) • User interface • User selects year, geographic area, and demographics • Output includes: • Tables and figures displaying demographic characteristics within the population • Trends over the past 6 years FOR OFFICIAL USE ONLY

  6. Population demographic output based on a user-selected input • This is the output if user selects FY 11, Jacksonville Catchment area, and Enrollment group and Gender demographics • Allows for comparison of specific Catchment area to Navy average • User can choose to display counts or percentages Source: DEERS FY2006-FY2011 FOR OFFICIAL USE ONLY

  7. Illness Section • Chronic illnesses of interest: • Diabetes, Asthma, Cardiovascular disease, Hypertension, Back disorders, mental health disorders • Pregnancies, although not an illness, will also be identified. • For each condition we will calculate the following: • Number of beneficiaries • Rate of diagnosis • Amount and type of utilization • Procedure rates, if applicable FOR OFFICIAL USE ONLY

  8. Case Study: Spinal disorders • What are the common conditions that lead to major spinal procedures: • Spinal Stenosis – Narrowing of the spinal canal • Spondylosis and Spondylolisthesis – Degenerative osteoarthritis of joints between discs or displacement of a vertebrae • Intervertebral disc disorders – Disc degeneration and other disc disorders • What are the common surgical treatments performed on MHS beneficiaries? • Spinal Fusion – Fusing two or more vertebrae together • Decompression – Removal of part of a vertebrae to relieve pressure • Disc Replacement – Replacement of a vertebrae FOR OFFICIAL USE ONLY

  9. Spinal Conditions Primary Diagnosis for Major Spinal Surgery Procedures – FY 2010: All Navy catchment areas and MSMAs Source: M2 FY10 - SIDR,TED-I, SADR, TED-NI tables FOR OFFICIAL USE ONLY

  10. Spinal Disorders in Navy Catchment Areas – FY10 Source: M2 FY10 -SIDR,TED-I, SADR, TED-NI FOR OFFICIAL USE ONLY

  11. Adjusted spinal disorder diagnosis rates – FY10 Source: M2 FY10 - SIDR,TED-I, SADR, TED-NI, DEERS FOR OFFICIAL USE ONLY

  12. Methods for identifying spinal procedures • Inpatient—45 different 4-digit ICD-9-CM procedure codes: • Exploration / decompression (0302 , 0309) • Excision/destruction/repair of intervertebral disc (8050, 8051, 8059) • Spinal fusion (810x - 9 different codes) and re-fusion (813x -10 codes) • 8162, 8163, 8164: Indicate number of vertebrae to which an 810x or 813x code applies • Device implantation, revision, or repair • 8451, 8459 – Insertion of a spinal or spinal fusion device • 848x (6 codes): Insertion, revision, or replacement of a device • Disc replacement (846x - 10 codes) • Ambulatory—94 different CPT codes • Core set derived from ACGME resident caseload reporting standards • Arthrodesis (fusion/re-fusion): 22 CPT codes • Decompression: 68 CPT codes • In addition, 4 CPT codes for disc replacement FOR OFFICIAL USE ONLY

  13. Spinal surgery volume – FY10 • Total procedures—5,094 • 4,160 Inpatient • 934 Ambulatory Source: M2 FY10 - SIDR,TED-I, SADR, TED-NI FOR OFFICIAL USE ONLY

  14. Age-Risk of spinal surgery – FY10 Source: M2 FY10 - SIDR,TED-I, SADR, TED-NI, DEERS FOR OFFICIAL USE ONLY

  15. Adjusted spinal surgery rates – FY10 Source: M2 FY10 - SIDR,TED-I, SADR, TED-NI, DEERS FOR OFFICIAL USE ONLY

  16. Adjusted spinal surgery rates by procedure type – FY10 Source: M2 FY10 - SIDR,TED-I, SADR, TED-NI, DEERS FOR OFFICIAL USE ONLY

  17. Adjusted spinal surgery rates by condition – FY10 Source: M2 FY10 - SIDR,TED-I, SADR, TED-NI, DEERS FOR OFFICIAL USE ONLY

  18. What to do about variation • Step 1: Establish Clinical Practice Guidelines for treating spinal disorders • Step 2: Determine which areas are over (or under) the recommended rate of spinal surgery • Step 3: Identify whether the variation originates in the direct or purchased care sector FOR OFFICIAL USE ONLY

  19. Still to come • Sharepoint Interface for the Chartbook • Currently active in its most simplistic form (beneficiary demographics only) • Illness and procedures will be added throughout the rest of this year. • The interface will allow the user to directly link the incidence of disease with the population that lives there, regardless of enrollment. • CAC enabled Sharepoint link TBA FOR OFFICIAL USE ONLY

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