South Carolina Data Systems
Improvement Plan Project

Funded Proposal

The state of South Carolina will be implementing a Robert Wood Johnson Foundation Phase II Information for State Health Policy Program Grant during the next four years (1993-1997). The state has been awarded this funding to assist with health statistics systems improvements in support of health policy making and program management. The grant will be administered by the State Budget and Control Board's Division of Research and Statistical Services.

Following a comprehensive review of the State's health information needs, the State developed a data systems improvement plan (known as the South Carolina Data Plan) that focuses on providing the necessary changes o permit the linkage of general patient-level data systems and program-specific data systems into a full patient-centered data base extending across all health care settings over an extended period of time. This linkage of patient data within the health care system will permit a full range of research related to utilization, treatment patterns, outcomes, and charges. The objective of creating these systems is a reorientation of thinking about health care delivery from setting- specific to holistic treatment by assisting policy makers in answering the difficult questions about what works, what does not work, and how do cost and reimbursement affect the ability to deliver care? The specific data systems recommendations include:

• enhance the existing inpatient hospital data base to include specialty hospitals (psychiatric, substance abuse, and rehabilitation), to collect patient identifiers on each record, and to collect external cause of injury codes (E-codes) on all injury records; collection of patient identifiers will assist in the ability to link inpatient hospital records with other patient-level data bases for disease registries, reducing the requests for duplicative reporting by hospitals;

• design and perform sample surveys of employers and unemployed individuals to estimate the levels of and types of insurance coverage of South Carolina's residents;

• develop a data system for collection of outpatient, patient- level data (including treatment and costs) with patient identifiers to enable appropriate linkages to other patient- level data bases; and

• extract patient-level data bases from state agency data systems including vital records, birth and death data, nursing home claims data, community long term care services, home health services and claims data, state mental health services data, state substance abuse services, ambulance run data and trauma registry data; develop methodologies to link various data bases which will provide patient-level utilization and cost data system for maternal and child health, elderly, mental illness, substance abuse, and outcomes analysis enabling assessment of effectiveness and efficiency of health services delivery.

During Phase I of the Program, Governor Campbell created of two-tiered organizational structure, consisting of a Steering Committee and an Interagency Work Group composed of both public and private sector representatives whose goal was to effectively integrate health policy development and quality data. As a result of these efforts, the South Carolina passed legislation during the 1993 session creating a Data Oversight Council composed of representatives from both the public and private sectors. The Council's purpose is to make periodic recommendations to the Joint Legislative Health Care Planning and Oversight Committee concerning what data systems should be built in the state, what analyses should be performed, and what information can be best disseminated for public use.

This Council will be provided with a Data Analysis Task Force of technical experts who will review the current South Carolina Data Plan, make additional recommendations for system changes, recommend analysis and dissemination techniques to meet the needs of policy makers in various settings, and recommend policy questions needing extended research.

Structure and Size of the IWG:

Executive Ordered Interagency Work Group
2 Elected; 14 Executive Agencies; 3 Providers
10 Consumer/lnterest Organizations

Issues:

Long-Term Support
Maternal Child Health

Effected Data Systems:

Household Population (New)
Birth (Linkage)
Medicaid Data (Linkage)
School Associations (Linkage)

Dissemination:

Reports
Newsletter
Briefings
User Conference
Public Use Tapes

Electronic Products:

Public Use Tapes
E-Mail
User-Friendly Software
Executive Information System
Linkage Projects

Project Title: "South Carolina: Linking Data Systems, Coming Together, Affecting Policy"

Project Director: Walter P. ("Pete") Bailey, MPH ,Chief of Health and Demographic Statistics

The Interagency Work Group for Phase II will be the Data Oversight Council, a 17- member committee composed of five state government ex-officio representatives, five non health care-related business representatives, five provider representatives, one insurance company representative and one managed care representative.

The Data Oversight Council, created in legislation, is required to make periodic recommendations to the Joint Legislative Health Care Planning and Oversight Committee concerning what data systems should be built in the state as well as what analysis should be performed and what information should be released for public use. This provides a direct linkage for project activities with the members of the General Assembly.

Serving as staff to the Council, the Division will convene nine Functional Workgroups composed of technical experts in the areas of Outcomes, Access/Cost, Maternal and Child Health, Certificate of Need Planning, Mental Health, Substance Abuse, Elderly, Injury/Trauma, and Manpower. These groups will review the Data Plan, make additional recommendations for systems changes, recommend analysis and dissemination techniques to meet the needs of policymakers in various settings, and recommend policy questions needing extended research. Recommendations of these groups will flow to the Data Oversight Council for prioritization and directions to the Division for overseeing implementation.

Phase I activities resulted in the selection of the following priority issues (short term priorities are designated with an (S) following them):

• Improving access to health care services through (a) improved insurance coverage (S) and b) appropriate types and distribution of health care services;
• Maintaining and/or improving existing quality of care in a cost effective manner (S);
• Determining the effect of lifestyle, social, and other factors on the health of the population, particularly In (a) maternal/infant health (S), (b) immunization status for children, (c) cancer and (d) injury/trauma;
• Health care cost containment;
• Enhancing informed decisions by purchasers in the selection of health care services;
• Determining the most efficient and effective means of care for the growing elderly population; and
• Evaluating and improving types of treatment for mental Illness and substance abuse across the spectrum of care settings.

Data systems improvements have been recommended which will enable the state to provide critical information for each of the priority issues. Priorities have thus been set by a realistic timetable of data availability with those improvements accomplished first for which political problems have been resolved and/or which are technically more expedient to accomplish.

The Division proposes to undertake the following data system improvements during the Phase II period:

• Enhance the existing inpatient hospital discharge system (UB-82) to include psychiatric, substance abuse and rehabilitation hospitals; and to collect patient identifiers on all records and E-codes on injury records;
• Extract patient-level data sets with patient identifiers from existing state agency data bases for nursing home services, community long term care services, home health care services, mental health services, substance abuse services, emergency medical services and vital records birth and death records and link at the patient level with the inpatient hospital data to create a patient-level longitudinal data base across all settings of care; implement an outpatient data system, beginning with outpatient surgery; perform sample surveys of employers and unemployed individuals to estimate the number of insured persons and the types and levels of coverage that they have.

Return to State Grantee Information Page