Minnesota Atlas of Childrens Health Care, 2014 - 2015 Pamela Mink, - - PowerPoint PPT Presentation

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Minnesota Atlas of Childrens Health Care, 2014 - 2015 Pamela Mink, - - PowerPoint PPT Presentation

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Minnesota Atlas of Childrens Health Care, 2014 - 2015 Pamela Mink, PhD, MPH NAHDO Annual Meeting, Little Rock, Arkansas November, 2019 Acknowledgements The Atlas was developed by the Minnesota Department of Health. We would like to

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Minnesota Atlas of Children’s Health Care, 2014 - 2015

Pamela Mink, PhD, MPH NAHDO Annual Meeting, Little Rock, Arkansas November, 2019

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Acknowledgements

  • The Atlas was developed by the Minnesota Department of Health. We would like

to acknowledge the following individuals for their contributions:

  • David Goodman, MD, MS, The Dartmouth Institute
  • Karl Finison, MA, Director of Analytic Development, Onpoint Health Data
  • Joanna Duncan, PhD, CPC, Director of Data Analytics and Operations, Onpoint Health Data
  • Melanie Pinette, MS, Health Data Analyst, Onpoint Health Data
  • Amy Kinner, MS, Health Services Researcher, Onpoint Health Data
  • MDH staff contributors:
  • Benjamin Nicla, BA
  • Astrid Knott, PhD
  • Stefan Gildemeister, MA

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Minnesota Atlas of Children’s Health Care

  • The Minnesota Atlas of Children’s Health

Care reports on county-level geographic variation in children’s health care.

  • 1,329,357 Children (1,114,941 Child-Years)
  • Study Period: July 2014 - June 2015
  • Utilizes data from the MN APCD
  • Shows patterns of care received by nearly

the entire Minnesota population of infants and children for 15 measures:

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  • Health care

service use

  • Office visits
  • ED visits
  • Hospitalizations
  • Chest X-rays
  • Head CT scans
  • Prescription

drug use/fill rates

  • Antibiotics
  • Gastric acid

suppressants

  • ADHD
  • Antipsychotics
  • Appropriate

treatment

  • Pharyngitis
  • URIs
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SLIDE 4

Some Questions to Consider

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  • What have we learned?
  • How can we best interpret variation?
  • To whom might these data be useful?
  • What are the policy implications?
  • How would additional data enhance

the Atlas?

  • How do we approach engaging

stakeholders and communicating the Atlas?

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SLIDE 5

Pediatric Health Care Measurement

Question:

  • What do we know about pediatric

health care use?

Answer:

  • Some, but not as much as we do about

the 18 – 64 or 65+ populations

  • Patchwork of data from different
  • rganizations, measuring different

things at different levels

  • Vital Records (States/CDC)
  • Fetal/Infant Deaths
  • CHIP/Medicaid (States/CMS)
  • Rich data and research literature
  • However, population limited, not fully

representative population

  • Vaccination Registry
  • Hospital Compare
  • Only one measure (out of dozens)

pertains specifically to children (asthma admissions)

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Why Variation?

  • Offers a lens through which to view

health care and to think about how to improve it

  • Of particular interest is unwarranted

variation

  • Variation not explained by health needs
  • r care preferences.
  • Represents health system performance

and opportunity to improve care.

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Measurement of variation can…

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Offer information on health care markets Raise important questions about the reasonableness

  • f practice patterns

Show what is attainable in quality and efficiency Generate hypotheses regarding the causes of variation Help to develop public reporting of performance measures

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Location of Minnesota Children

  • The 10 most populous counties

(shaded) are home to more than 65% of the children in our study population

  • Hennepin/Ramsey home to >31%

Atlas allows examination of variation across the Twin-Cities, the metro, and greater Minnesota

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Coverage of Minnesota Children

  • Commercial insurance: 61.9 percent
  • Minnesota Health Care Programs (includes

Minnesota’s Medicaid program): 38.1 percent

  • County rates of Medicaid coverage vary

Atlas shows measures by payer, and across counties

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Counties with Highest Rates Counties with Lowest Rates Mahnomen – 79% Carver – 17% Beltrami – 66% Washington – 21% Koochiching – 64% Roseau – 22%

Percentage of MN children covered by MHCP

Source: Onpoint Health Data analysis of data from the MN APCD

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SLIDE 10

Atlas Layout

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Map of county rates County rates for 10 most populous counties

  • The atlas includes ‘two-

pagers’ for each of the 15 measures studied.

“Turnip plot”

  • f county rates

Description of measure and summary of findings Statewide rates by payer

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Office & Clinic Visits

(Visits per insured child)

11 Source: Onpoint Health Data analysis of data from the MN APCD Results adjusted for age, gender and Medicaid proportion (payer specific rates adjusted for age and gender)

County Visit Rate Washington 3.14 Dakota 3.12 Anoka 3.05 Hennepin 2.96 Wright 2.95 Scott 2.91 Stearns 2.90

  • St. Louis

2.69 Ramsey 2.59 Olmsted 2.27

By County

2.84 2.87 2.79 1 2 3 4 Overall Commercial Medicaid

By County, Most Populous Counties By Payer By County, Geographic Distribution

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Emergency Room Visits

(Visits per 1,000 insured children)

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County Visit Rate Olmsted 373.3 Hennepin 340.0

  • St. Louis

316.7 Scott 296.0 Wright 287.8 Ramsey 285.7 Anoka 283.6 Dakota 266.1 Washington 249.3 Stearns 238.8

By County By County, Most Populous Counties By Payer By County, Geographic Distribution

305.1 172.9 505.7

200 400 600

Overall Commercial Medicaid

Source: Onpoint Health Data analysis of data from the MN APCD Results adjusted for age, gender and Medicaid proportion (payer specific rates adjusted for age and gender)

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Head CT Scans

(Visits per 1,000 insured children)

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County Visit Rate

  • St. Louis

12.3 Wright 11.2 Stearns 10.2 Scott 9.7 Dakota 9.5 Anoka 8.7 Washington 8.5 Olmsted 8.4 Hennepin 7.8 Ramsey 6.4

By County By County, Most Populous Counties By Payer By County, Geographic Distribution

9.4 7.8 12.2

5 10 15

Overall Commercial Medicaid

Source: Onpoint Health Data analysis of data from the MN APCD Results adjusted for age, gender and Medicaid proportion (payer specific rates adjusted for age and gender)

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Antipsychotic Medication Use

(Percentage of children with medication fill)

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County Visit Rate

  • St. Louis

1.0% Olmsted 0.7% Anoka 0.7% Wright 0.7% Dakota 0.7% Scott 0.7% Washington 0.7% Stearns 0.6% Hennepin 0.6% Ramsey 0.5%

By County By County, Most Populous Counties By Payer By County, Geographic Distribution

0.7% 0.4% 1.2%

0.0% 0.5% 1.0% 1.5%

Overall Commercial Medicaid

Source: Onpoint Health Data analysis of data from the MN APCD Results adjusted for age, gender and Medicaid proportion (payer specific rates adjusted for age and gender)

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Standardized Ratios

Medical Services Utilization

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Office Visits ER Visits Hospital Stays Chest X- rays Head CT Scans

Source: Onpoint Health Data analysis of data from the MN APCD

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Standardized Ratios

Prescription Use

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Antibiotics Acid Suppressants ADHD Medications Antipsychotic Medications

Source: Onpoint Health Data analysis of data from the MN APCD

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Some Caveats

  • What are the causes and consequences of variation?
  • What is the “right” rate?
  • For some measures (e.g., appropriate care for pharyngitis and

upper respiratory infections), it would be the highest rate

  • For most measures, the highest rate is likely not the right rate
  • Overuse, potential harm
  • Results were controlled for age, gender and payer
  • But, information on race, ethnicity, language or origin not available in MN APCD

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What does it all mean?

  • What do these data tell us?
  • What don’t/can’t they tell us?
  • To whom might these data be

useful?

  • In what ways?
  • What are the policy implications
  • f this work?

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Stakeholder Engagement

Internal (MDH) stakeholders

Family/child health Rural health Leadership

External stakeholders

Pediatricians, family physicians Patient/child advocates Health equity/access

Other MN Agencies

MN Children’s Cabinet

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  • What are the key messages?
  • What are the opportunities for

improvement?

  • Deeper dive on some measures to

learn more about potential causes of variation?

  • Consider other measures?
  • Further research?
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Thank You!

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Health Economics Program: www.health.state.mn.us/healtheconomics MN All Payer Claims Data: www.health.state.mn.us/data/apcd/publications.html Contact: Pam.Mink@state.mn.us/ 651.201.3551

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Measures in the Atlas

  • Common Services
  • ED visits, office visits, & hospital stays
  • Diagnostic Imaging
  • Head CT & chest X-rays
  • Prescription Drug Use
  • Antibiotics, ADHD medications, acid suppressants and antipsychotic medications
  • Appropriate Treatment
  • Sore throats & common cold

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