In this installment of DataMatters CHIA is pleased to announce the release of an interactive dashboard on selected clinical quality measures for 2018 and 2020, featured under “News You Can Use.” New to this issue is a quarterly update to the Hospital Inpatient Discharge Data (HIDD) series, showing trends revealed by this data from October 2018 – March 2022. The “Data User Profile” highlights a recent study on outpatient GI endoscopies that leveraged the MA APCD.
It’s been a busy few months for CHIA, with the results announced for both the 2021 Massachusetts Employer Survey (MES) as well as the 2021 Massachusetts Health Insurance Survey (MHIS). These statewide surveys provide stakeholders and policymakers with a valuable lens into the employer and resident experience and are an important tool in understanding the challenges Commonwealth faced in navigating the health care delivery system.
Finally, CHIA held its June 2022 meeting of its Oversight Council which is available for viewing on the agency YouTube channel. Here, the Council received updates on CHIA’s operations, as well as presentations from CHIA staff on the results from the MES as well as findings from the April publication of a health care equity report by geographic region.
We hope you enjoy this month’s newsletter and the chance to learn something new. If there’s something you enjoyed or if you have suggestions for improvement, we welcome your feedback at firstname.lastname@example.org.
News You Can Use
Figure includes a subset of clinical quality performance measure scores. See interactive report for full results.
CHIA today released an interactive dashboard on selected clinical quality measures for 2018 and 2020. As part of CHIA's ongoing work to monitor health care quality in the Commonwealth, A Focus on Provider Quality: Selected Clinical Measures, 2018 and 2020 examines performance across a subset of metrics from the NCQA Healthcare Effectiveness Data and Information Set (HEDIS®). This analysis explores the clinical performance of care delivered to Massachusetts commercial HMO/POS members during 2020, both at the statewide and primary care medical group levels.
Data User Profile
Each edition of DataMatters features an interview with a CHIA data user, focusing on their experience obtaining and using our data and how they used it. We deeply appreciate Dr. Meng-Yun Lin, Assistant Professor of Social Sciences and Health Policy from Wake Forest University School of Medicine for speaking with us on her recent study on outpatient GI endoscopies.
Differences in Patient Outcomes after Outpatient GI Endoscopy across Settings: a Statewide Matched Cohort Study was produced using CHIA’s Massachusetts All-Payer Claims Database (MA APCD) data in conjunction with Medicare Fee-for-Service data. This article was also developed with Julia Prentice and Godwin Osei-Poku, staff of CHIA’s sister agency, the Betsy Lehman Center for Patient Safety.
Our study examined whether patient outcomes following outpatient gastrointestinal (GI) endoscopy are comparable between hospital outpatient departments (HOPD) and ambulatory surgery centers (ASCs) at the population level.
During the past decade, outpatient procedures have increasingly been performed in nonhospital settings, specifically ASCs. ASCs are facilities that specialize in surgical and diagnostic procedures that do not require an overnight stay. Unlike hospitals, ASCs are loosely regulated. For example, ASCs are not required to report cost and quality data to the Centers for Medicare & Medicaid Services. GI endoscopies are the most common procedures performed in ASCs, accounting for roughly 25% of total surgical procedures. However, evidence on whether patient outcomes are comparable across settings is scarce. Most prior studies were limited to experiences at a single facility or focused on provider self-reporting data. Therefore, we felt an urgent need for a comprehensive evaluation of patient outcomes at the population level.
Our study used the Massachusetts All-Payer Claims Database (MA APCD) from CHIA and Medicare fee-for-service data.
We found the MA APCD a valuable data source for comparative effectiveness studies like ours. The MA APCD tracks individuals over time and across providers/settings, allowing linkage of postprocedure adverse outcomes to index procedures performed in a different facility. In addition, the MA APCD and Medicare data collectively cover a majority of Massachusetts residents, enabling population-based estimation of patient outcomes following GI endoscopies.
We examined unplanned hospital visits following outpatient GI endoscopy performed in Massachusetts from 2014 to 2017. We identified screening colonoscopy, non-screening colonoscopy, and esophagogastroduodenoscopy (EGD) performed in ASCs or HOPDs and assessed unplanned hospital visit rates within 7 and 30 days following these procedures. To compare rates between ASCs and HOPDs, we constructed procedure-specific, propensity score-matched samples and adjusted for patient, procedure, and facility characteristics.
Our key findings include:
We hypothesized that postprocedure unplanned hospital visits are less common among ASC patients than their HOPD counterparts because of the selection of healthier, less complicated patients. However, we noted that ASC patients fared better than HOPD patients across procedures and follow-up periods among patients with similar demographic and clinical characteristics and after adjusting for a set of procedure and facility characteristics. We dove deeper into the finding and concluded that the favorable outcome in ASCs might be driven by unmeasured lower clinical and/or technical complexity. For example, fewer patients were chosen to receive complex procedures involving biopsies or removal of tumor polyps in ASCs. Collectively, our findings suggest physicians seemed to be prudent in selecting low-risk patients for receiving procedures in ASCs in Massachusetts during the study period.
Two takeaways from our study:
In addition, we wanted to emphasize the value of MA APCD data for efforts to monitor patient safety at the population level. Though medical record abstraction may be the gold standard to determine procedure-related adverse events, it is not feasible, both economically and technically, to perform chart reviews at the population level. Federal efforts have so far been unsuccessful in designing an effective system of monitoring patient safety in ASCs. Although claims-based studies might not tell the whole story, population-level estimates provide valuable information to regulatory agencies to refine and redesign surveillance programs to safeguard patient safety.
Publications and Data Releases
Massachusetts Health Insurance Survey (MHIS) Summary of Results
CHIA recently published summary results from the 2021 Massachusetts Health Insurance Survey (MHIS). The MHIS is a biennial population-based survey that provides valuable information on health insurance coverage, health care access and use, and health care affordability for Massachusetts residents. The MHIS survey results provide a detailed look at the issues impacting Massachusetts residents. The MHIS was last released in spring 2020.
Upcoming Events and Resources
Events and announcements of interest to our community, organized by CHIA, our data partners, and others
Department of Public Health
Public Health Council Meeting
Wednesday, August 10, 2022, 9:00 AM
The Public Health Council of the Department of Public Health promulgates regulations, advises the Department on certain major policy decisions and actions and is responsible for voting Determination of Need applications submitted by health facilities. It meets once per month at DPH’s Boston office.
CHIA Data User Workgroups
Tuesday, August 23, 2022 – 3 p.m.
CHIA hosts monthly, public workgroups as opportunities for users of the MA APCD and Case Mix databases to meet with CHIA’s in-house data experts to discuss analytical techniques and data questions. Meetings alternate between APCD and Case Mix; the next workgroup will be hosted on Zoom. For more information or to register, visit the information page.
Massachusetts Health Policy Commission
Wednesday, September 14, 2022, 12:00 PM
The HPC’s 11-member Board meets approximately every six weeks throughout the year to review staff- or guest- presented overviews of the agency’s major workstreams, and other topics related to health care cost containment and reform. Major reports, statutory regulations, and publications are authorized by a majority vote at these meetings.
CHIA Oversight Council
Tuesday, September 20, 2022, 12:00 PM
CHIA’s appointed Oversight Council meets quarterly to discuss agency priorities and agenda-setting. The next meeting is scheduled for Tuesday, September 20, at 12:00 p.m. and will stream live on CHIA’s YouTube channel.
National Association of Health Data Organizations (NAHDO) Summer Spotlight Series, events through September 21, 2022 (Virtual)
NAHDO will host an all-virtual Summer Spotlight Series, focusing on Health Equity and Disparities. Events in August and September will include breakout groups on specific health data disparity topics, a “Data Solution Showcase,” and “Lessons Learned from COVID.” Free to members.
Massachusetts Association of Health Plans (MAHP) Annual Conference Health Care 2022 – Challenges and Opportunities in the Years Ahead
Thursday, November 17, 2022, 7:30 a.m. – 2:00 PM
Attendees will hear health care experts discuss the future of public health during the COVID-19 pandemic, provider prices in the Massachusetts health care market, as well as talks on health equity, among other topics.
Michael Osterholm, PhD, MPH, epidemiologist and COVID-19 Expert and Director of the Center for Infectious Disease Research and Policy will offer keynote remarks. Dr. Mallika Marshall, MD, Medical Reporter for WBZ 4, CBS News Boston, will serve as Master of Ceremonies.
Visit MAHP’s conference webpage to view the Annual Conference agenda and register to attend. Sponsorship and exhibitor opportunities are available!
Join Our Team
A selection of open positions at CHIA. Please feel free to share broadly with your network. Follow CHIA on LinkedIn for more regular updates.
Senior Health Informatics and Reporting Analyst
Health Informatics and Reporting