Project Title

Clinically enhanced multi-purpose administrative dataset for comparative effectiveness research in the State of Florida

Shortened Title

Clinically enhanced multi-purpose dataset for CER in Florida

Publication Date

2013

Abstract

Comparative effectiveness research is increasingly becoming an essential tool in health care research, and decision-making, and quality improvement process. The newly enacted health care reform establishes a new perspective of health care services with emphasis and incentives for cost-containment and efficient utilization of resources. The paucity of critical comparative cost-effectiveness information to assess intervention options that will enable care providers, consumers, decision-making parties as well as other stakeholders to make informed decisions and choices on available alternatives could hamper the realization of the potentially accruable benefits of the new health care reform. The state of Florida suffers from a very costly health care system with global annual health care expenditure growth, personal health care and per capita health care expenditures that exceed the national average. The virtual absence of reliable and rigorously validated large, clinically enhanced administrative databases statewide hinders the ability of public health and other researchers to offer evidence-based data that could inform decision-making and improve efficient utilization of health care resources in the state. It is for this reason that the project in this grant proposal is capital for the state because it envisages filling this gap, which is a necessary step if Florida is to succeed in achieving a cost-effective and efficient health care delivery system in the future under the newly enacted national health care reform. The choice of maternal and child health as a focus is timely and well-informed because despite huge spending, Florida is performing below average compared to the rest of the nation in preventing maternal deaths and preterm births. It is for these reasons that we propose this study with the following specific aims: Specific Aim 1: To create an expanded clinically enhanced maternal-infant dataset for the State of Florida by augmenting the current statewide hospitalization data files through linkages to other data sources; Specific Aim 2: To validate the created dataset in Specific Aim 1 through a rigorous process that will establish confidence in the use of the dataset by the public; Specific Aim 3: To demonstrate the utility of the newly created enriched dataset in conducting comparative effectiveness analysis using early term elective delivery as a case study. The dataset from the project will encompass information from the following data sources: the birth certificate, in-patient hospital discharge data, ambulatory and emergency department data, financial data, and Florida maternal mortality data. The success of the project is assured because the undertaking is based on an existing firm statewide partnership that has already completed an earlier data linkage activity that resulted in a refined dataset which will serve as the main template for the activities proposed for this grant. The project is important for Florida because it could lead to research that will provide critical information required to enable health care stakeholders effectively promote best clinical practices and to monitor quality improvement with the overall objective of enhancing maternal-infant health in the state.

Data Types

Diagnostic data

Geographic scope type

State

Locations of Focus

Florida

Population Network Size

The current project has collected inpatient, outpatient, emergency department, and vital statistics data for approximately 2.4 million infants, born 1998-2009, and their mothers.

Major Partners

Principal partners include: University of South Florida, Florida Department of Health, Agency for Health Care Administration

CER/PCOR Study Priority Populations

Minority groups, Women, Children, Pregnancy, including preterm birth (Pregnancy and childbirth)

Treatment Comparators

The primary project associated with this grant is a comparative effectiveness study on early term elective delivery (EED).

EED is defined as induction of term delivery at less than 39 weeks without medical or obstetric indication. The procedure is rising in the US in tandem with a concomitant increase in the rates of induction of labor. Currently, early term deliveries in the US account for about 17.5% of all live births with a significant proportion of these occurring as elective interventions. The concern regarding elective term deliveries is because of the heightened morbidity risk for the baby as well as morbidity incurred as a result of frequent cesarean sections associated with these pregnancies. Infants born as a result of EED show morbidity patterns similar to those associated with preterm birth and include: elevated risk for adverse respiratory outcomes in general, and specifically, RDS (respiratory distress syndrome), TTN (transient tachypnea of the newborn), greater admission to the neonatal intensive care unit, neonatal sepsis, increased hospital length of stay, increased ventilator support, feeding problems and other transition issues. Although the American College of Obstetricians and Gynecologists has stated that elective delivery should not be performed before 39 weeks of gestation to minimize prematurity-related neonatal complications, the practice still persists and is rising. So far, most of the information on the adverse effects of EED relates to the infant and there is very little information to assess the morbidity sustained by the mother or the risk of maternal death as a result of operative interventions associated with EED (e.g., for failed induction of vaginal delivery, etc.). One obvious reason is that the studies on EED are based on data from a few hospitals which are under-powered to assess a rare outcome such as maternal morbidity in a very low risk population.115 This is important because the full impact of EED will be incomplete without taking into account effects on the mother as well, and quality improvement measures need to take this into consideration to have a greater impact on the quality of care provided to mothers during pregnancy. To fill this gap in knowledge and to illustrate the utility of the expanded dataset created under this grant we propose to conduct a comparative effectiveness study of early elective delivery guided by the following hypotheses:

Hypothesis 01: Early elective delivery is associated with subsequent infant morbidity and mortality

Hypothesis 02: Early elective delivery is associated with subsequent maternal morbidity and mortality

Hypothesis 03: Early elective delivery is associated with increased utilization of health care resources leading to elevated healthcare costs

Outcome(s) of Interest

In addition to our primary study, the data infrastructure being developed through this project's funding will be used to investigate a myriad of topics in public health, medicine, health services research, cost-effectiveness analyses, and other CER projects, all with a focus on maternal and child health.

Share

COinS