Urgent Care and Mini Clinics – the Donut Hole in Syndromic Surveillance

doughnut-1023028-mIn recent years the range and availability of ambulatory care service providers has continued to grow. These include urgent care centers, mini clinics, and so-called “Doc in a box” providers. While the emergence of these services benefits consumers on many levels, it also creates a potentially serious “donut hole” in regional syndromic surveillance. A proliferation of these facilities can lead to diminished accuracy and efficacy of the population health data that’s made available, which can result in potentially serious negative consequences…for both public health officials and the communities they serve.
Read more

In Development: Hospital Readmissions Tracking Tool

In light of the recent Medicaid changes regarding hospital readmissions within a 30 large_readmitday time period, HMS is working to create a tool which will allow facilities to track readmissions.

Beginning on October 1, 2012, section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program (HRRP). The HRRP has imposed a financial penalty on hospitals with many readmissions during a certain timeframe. The HRRP defines readmission as a patient who is readmitted to the same or another hospital within a 30-day time period. It excludes certain readmissions, such as transfers to another hospital. The goal of this penalty is to encourage improvements to patient care and reduce Medicare costs.
Read more

Population Health and the Polar Vortex

This winter’s “polar vortex” has led to discussions about everything from the devastating effects sub-zero temperatures can have on homeless populations, to the difficulties it’s caused marathon runners in training, and the dangers extreme cold can pose to pets.

Here at HMS, we saw several state public health departments use EpiCenter to implement a cold weather classifier that would enable them to track the number of injuries related to the extreme cold. This tool allowed for the tracking and analysis of emergency department registrations with chief complaints containing phrases like “out in the cold,” “no heat,” “hypothermia,” “frostbite,” and “exposure.” Observing event-specific data in situations like these allows public health to track the overall health of the population, and also to monitor the effectiveness of public outreach efforts and public health warnings.

New Jersey used EpiCenter to create a cold-related injury classifier with input from HMS, which they utilized in conjunction with their Super Bowl surveillance. Ohio created their own, separate cold-related injury classifier in EpiCenter and then shared the SAS code for that classifier with the International Society for Disease Surveillance (ISDS). Several other regions, including Indiana, New Hampshire, Washington, and Boston, then implemented the same code in their own cold weather surveillance.

During the first round of severely cold temperatures on January 6th, 7th, and 8th, temperatures in Ohio dropped well below zero degrees Fahrenheit. As could be expected, they observed a surge in ED visits due to cold-related injuries, with visit numbers peaking on the 8th. After that initial cold snap, Ohio initiated public health messages warning the population about taking precautions to seek shelter and stay out of the cold. The second cold snap on January 28th and 29th, during which temperatures dropped even lower, yielded dramatically fewer emergency department visits, a trend that Ohio’s public health officials believe can be attributed in part to the warnings they issued following the initial burst of below-freezing temperatures.


Cold-Related Injury ED visits in Ohio

The availability of this sort of data is opening doors for research on the relationships between public policy measures and emergency department utilization. For example, January’s cold-related injury data could be leveraged in conjunction with information about the capacity of homeless shelters and auxiliary facilities to assess the effects of public policy on the numbers of emergency department visits. Several state public health departments have also created heat-related injury classifiers in preparation for summer; as this sort of data becomes more widely available via tools like EpiCenter, we look forward to seeing the new ways public health discovers to more effectively monitor and improve population health.