AHRQ has initiated a research program that awarded eight grants in September 2010 to improve statewide all-payer, hospital-based encounter-level data (inpatient, emergency department, and ambulatory surgery) for the purpose of both producing the evidence base for comparative effectiveness and evaluating efforts to implement comparative effectiveness where the evidence already exists. Two types of grants have been implemented under this research program to improve state data by:

• Enhancing the clinical content of the state databases in Hawaii, Florida, New Jersey, New York, and Minnesota
• Improving the race/ethnicity data in state databases in California, New Mexico, and the Northwest region (Idaho, Oregon, and Washington)

The grant projects will be conducted over a 3-year period. During that time, AHRQ (with assistance from contractor Social & Scientific Systems) will disseminate information about the projects as they progress. Upon completion of the projects, AHRQ will disseminate information about lessons learned and tools for other state data organizations to adopt the improvements.

Five grantees will broaden and supplement their existing population-based data with hospital-based electronic pharmacy data, clinical laboratory data, prehospital emergency care data, clinical registries, and vital record birth and death certificates.

Florida

Investigators at the University of South Florida are leveraging a strong collaborative partnership among many of Florida's key health care entities to create a statewide enhanced maternal–infant database of clinical and nonclinical information derived from birth and death vital records, as well as inpatient, ambulatory, and emergency department data. The end product will be tested by conducting a comparative effectiveness research study using early-term elective delivery as a case study. The database will serve as a sustainable tool for research, quality improvement, and enhancement of overall health, and as a model for other states with similar objectives. To date, the Florida project has:

• Expanded existing partnerships and forged new local, state, and national partnerships to foster collaboration around innovative research ideas and to improve infrastructure
• Improved data quality with a standardized protocol to process various types of health records, identified errors/ inconsistencies in datasets and developed remedies, and identified previously undocumented data decisions
• Implemented unique strategies for linking maternal and child health records from disparate data sources, created a hierarchical linking algorithm, implemented innovative procedures to automate post-linkage processing rules, and improved the ability to link multiple births as well as health records with missing Social Security numbers and names.

The Florida team has published timely manuscripts in peer-reviewed journals, including "The Missing Link in Preconceptional Care: The Role of Comparative Effectiveness Research" and "Cutting Edge Technology for Public Health Workforce Training in Comparative Effectiveness Research," and has participated in numerous panels and presentations based on the work and products of the grant. Grant abstract: PDF file, 18 KB; HTML

Hawaii

Collaborators from The Queen's Medical Center and Hawaii Health Information Consortium are enhancing the clinical content of Hawaii's statewide hospital discharge database by adding laboratory results and have furthered development of a master patient identifier to link and track patients across hospitals throughout the state. The researchers will demonstrate the viability of the enhanced database by performing a comparative effectiveness research study to examine the outcomes of care for patients treated by hospitalists compared with patients treated by nonhospitalists. The end result will be an enduring infrastructure that will improve research and quality. The Hawaii grant has begun to achieve many of its goals; it has:

• Forged relationships with and secured participation of Hawaii's hospitals and laboratories
• Installed a Health Level Seven interface engine and designed protocols to accept data from disparate hospitalsystems; the team is now receiving production data feeds from most of the hospitals in the state
• Successfully linked laboratory data to hospital discharge data.

The Hawaii team continues to assess and improve data quality, and is validating its Physician Master Database and working to improve linkages between mothers and infants in anticipation of the comparative effectiveness research phase of the project. Grant abstract: PDF file, 16 KB; HTML

Minnesota

The Minnesota Hospital Association (MHA), in collaboration with Michael Pine Associates and the Mayo Clinic Division of Health Care Policy and Research, is augmenting the current MHA clinically enhanced administrative hospital discharge database with laboratory data from additional hospitals, and is introducing hospital pharmacy data and Minnesota death certificate data to the database. The end goal of the project is to use these data to facilitate rich comparative effectiveness analysis and to enhance the scope and quality of the Minnesota hospital discharge database. To date, the project has:

• Increased hospital enrollment in the project with 6 hospitals currently submitting data, with a total of 22 hospitals enrolled, and recruitment efforts ongoing
• Designed specifications, database edits, and layouts; and begun testing of hospital data files
• Installed a Health Level Seven health care integration engine to facilitate compilation of study data
• Developed ongoing reports on data quality, including present-on-admission and congestive heart failure cases.

Going forward, the research team intends to finalize data standards and edits, maintain hospital engagement, and continue recruitment efforts. Grant abstract: PDF file, 10 KB; HTML Website: Minnesota AHRQ Lab Project

New Jersey

An innovative partnership between academic researchers at Rutgers Center for State Health Policy an the New Jersey Department of Health and Senior Services is creating a data infrastructure that bridges prehospital and hospital care using electronic patient care records for emergency medical services transports in New Jersey. These data are being linked to all-payer hospital discharge data and death certificates to support a wide range of studies on interventions that involve prehospital and hospital services. A comparative effectiveness study of outcomes after provision of therapeutic hypothermia for initial survivors of out-of-hospital cardiac arrest will illustrate the value of the data. The project has:

• Achieved linkage between the data sources for years 2009–2010; a strategy for enhanced linkage is well under way; and the team is working with local emergency medical services to better understand the varied procedural issues that affect the data
• Completed a survey of therapeutic hypothermia availability and delivery protocols at all New Jersey hospitals; a manuscript based on the survey findings has been published in the journal Therapeutic Hypothermia and Temperature Management.

The grant work has afforded the New Jersey team the opportunity to participate in several panels and presentations. Grant abstract: PDF file, 16 KB; HTML

New York

The New York State (NYS) Department of Health; School of Public Health, SUNY–Albany; and Michael Pine Associates are working together to link administrative data from NYS' Statewide Planning and Research Cooperative System (SPARCS) acute care hospital discharge database to laboratory test results from facilities that perform coronary artery bypass graft (CABG) surgery or elective percutaneous coronary interventions (PCI). To assess the value of the resulting clinically enhanced database, the research team will compare comparative riskadjusted outcomes and analyses of the appropriateness of alternative revascularization procedures using the clinically enhanced administrative database with analyses performed using specialized CABG and PCI registries. Another goal of the project is to determine whether laboratory test results will enhance the ability of the cardiac registry data to riskadjust patient outcomes. The project has reached a number of milestones:

• Data Use Agreements have been approved for all major data sources used in the study.
• The New York State Health Commissioner has designated the project a research study governed by NYS Public Law 206 (1) (j), an important distinction that protects hospital participants' confidentiality.
• Successful record matching has been accomplished on 3 years of SPARCS, cardiac, PCI, and vital records data.
• Twenty (20) of 56 eligible New York hospitals have been recruited to participate in the study and have supplied required laboratory data. Laboratory data have been reviewed for completeness and validity.
• Data from 4 hospitals have been judged satisfactory for analysis; clarifications and/or additional data have been requested from the other 16 hospitals. Test matches of laboratory data to SPARCS data are being conducted after laboratory data pass quality reviews.
• The merged datasets are expected to be available for analysis by October 1, 2012.

If addition of the laboratory data to the cardiac registry improves the ability to risk-adjust patient outcomes, efforts will be explored to include selected laboratory data in the NYS cardiac care registries. Grant abstract: PDF file, 16 KB; HTML

Three grantees are improving the validity, reliability, and detail of patient race and ethnicity data which will generate better data for comparative effectiveness research to improve health care outcomes, including less disparate outcomes for different racial and ethnic groups.

California

Investigators from the University of California, Los Angeles, in collaboration with the California Office of Statewide Health Planning and Development (OSHPD), are improving the reliability, validity, and completeness of self-reported race, ethnicity, and primary language (R/E/L) provided by hospitals in three OSHPD databases. The project has assessed data collection, reporting, and accuracy in California hospitals; is benchmarking the data against six comparison states; and will improve hospital race, ethnicity, and primary language data via development of standardized materials, educational intervention, auditing, and followup. The researchers will link OSHPD databases to other state agency data and use statistical approaches to authenticate their efforts. The project will make substantial, sustainable improvements to the reporting of R/E/L among patients in California's hospitals. The project has:

• Performed a baseline assessment of R/E/L data collection, reporting, and accuracy among acute care hospitals in California; and is sharing hospital survey results at professional conferences
• Created and disseminated tools to improve quality and consistency of collection of R/E/L data targeted to hospitals
• Conducted 3 webinars to more than 350 hospital representatives throughout California
• Performed data linkages with OSHPD's inpatient, emergency department, and ambulatory surgery data to data from cancer registries and cancer clinical trials (considered the "gold standard" for R/E/L accuracy).

Going forward, the California team will compile gold standard data; create revised audit rules for identifying outlier hospitals; apply supplemental data and statistical methods to improve data completeness; and perform a followup of California hospital practices, attitudes, and performance. Grant abstract: PDF file, 16 KB; HTML Website: Improving Race, Ethnicity, and Language Collection in California

New Mexico

The New Mexico Department of Health is improving the quality of race and ethnicity data in hospital discharge and emergency department databases by revising the New Mexico administrative code to mandate race, ethnicity, and tribal identifier data reporting. Specific goals include: improving patient race and ethnicity data in the New Mexico Hospital Inpatient Discharge Data; collecting tribal identifier data; evaluating the quality of race and ethnicity data; and sharing methods, tools, and procedures with other states. The project has:

• Changed state regulations to align with 1997 U.S. Office of Management and Budget standards
• Developed a systematic method to identify and target institutional factors influencing data collection
• Increased awareness of the need to improve data quality at the hospital level through presentations and webinars.

The New Mexico team has begun to realize an increase in data quality across all targeted fields. The work related to this grant has afforded New Mexico the opportunity to disseminate findings at various venues, including national conferences and meetings. Grant abstract: PDF file, 10 KB; HTML

Oregon/Washington/Idaho

Using the most complete roster of Northwest American Indian/Alaska Native (AI/AN) people available, the Improving Data & Enhancing Access-Northwest (IDEA-NW) Project of the Northwest Portland Area Indian Health Board is conducting record linkages with an array of health-related data systems in a three state region to identify and, in some cases, augment racial misclassification and improve disease/mortality estimates. Thus far, the project has:

• Identified racial misclassification in hospital discharge systems (Oregon and Washington), cancer registries (three states), death certificates (three states), Medicaid (Oregon), STD/HIV/CD (Oregon and Idaho), childhood blood lead registry (Oregon), and trauma registries (Washington and Idaho)
• Engaged in meaningful discussion with state data managers about race data quality and usefulness of their surveillance systems for minority health assessment; several partners have implemented rules to correct race classification of AI/AN people based on linkage findings. Completed a first series of local-level data reports for Northwest tribes
• Completed assessment of the Northwest Tribal Registry linkage dataset
• Greatly improved collaboration between the Tribal Epidemiology Center and the Departments of Health in Idaho, Oregon, and Washington.

Moving forward, the team intends to increase its focus on the generation of tribal-level health profile reports and to continue to work toward disseminating results and developing concrete methods by which other states and Tribal Epidemiology Centers can implement similar programs. Grant abstract: PDF file, 17 KB; HTML Website: NPAIHB IDEA-NW