For fiscal year: _____/____/____ to _____/____/____
Month
Date Year Month Date Year
NOTE: Project summary and introduction.
A. General
Questions
I’d like to start by asking you some
general questions about the encounter/claims data system at [MCO name].
A1._ Does your MIS consist of a single data
system, or multiple data systems? Are
you familiar with all data systems comprising your MIS? _____________________________________
_______________________________________________________________
A2._ What software do you use to maintain
your encounter database (e.g., MS Access, DBase, SAS, MS Excel, custom
software)? _________________________________________
_______________________________________________________________
A3._ Do providers enter data directly, or are
they entered by data entry personnel from hard copy forms? _______________________________________________________________
_______________________________________________________________
A4._ Do you have experience creating data
files or data extracts from your MIS?
By a data extract, we mean writing all records for a given individual to
an electronic file, not creating a report summarizing activity for a group of
patients. ______________________________________________
_______________________________________________________________
A5._ If you were to provide us with a data
file, what type of file could you provide us (e.g., block ASCII, MS Excel,
DBase)? _________________________________________________
A6._ Because we are following the patients in
[MCO name] over time, it is
important that we understand how many current [MCO name] patients we can expect to have in our study several
years from now. Based on your
experience and as of the beginning of this month, approximately what percent of
patients who were with [MCO name] 1
year ago are still with [MCO name]:
a)__ 1 year ago? _________________________________________________________
b)__ 3 years ago? ________________________________________________________
c)__ 5 years ago? ________________________________________________________
B.
Integration with Outside Providers
A key aspect of evaluating workplace
interventions is understanding how they affect total health care
utilization. To understand this, we
would like to track all health care
services received by [MCO name]
patients. So now I’d like to ask you a
few questions to find out how much information from various providers you have,
and how that data may differ from the other data you might provide us.
B1._ Can you provide us with information on
services rendered by providers who are not affiliated with [MCO name] but who provide health care services to your patients
under your cap? By not affiliated, we
mean that the providers are not member providers of [MCO name] but may provide services to [MCO name] patients through special contracts or point-of-service
plans that patients may have. An
example of such a provider might be an alcohol or drug abuse treatment
facility, an out-of-town emergency room, or a specialist outside of [MCO name] to whom the patient was
referred. ______
_______________________________________________________________
B2._ Does
your MIS contain a provider or place of service code that identifies both
providers who are and who are not affiliated with [MCO name]? Specifically,
do you have a code that identifies:
_______________________________________________________________ the
home clinic
_______________________________________________________________ other
clinics or facilities within [MCO name]______________________________________________
_______________________________________________________________ hospitals
_______________________________________________________________ alcohol/drug
treatment facilities________________________________________________________
_______________________________________________________________ out-of-network
emergency room visits____________________________________________
What is the name of that code? ____________________________________
B3._ Is the data entry process different for
specialty clinics such as alcohol/drug treatment facilities? If so, how?
_________________________________________________________
_______________________________________________________________
B4._ What data do you require from outside
contractors in order for them to receive payment? Where is that data stored?
Is it stored with other encounter data?
Do you track the number of visits or the amount of services rendered by
that contractor, or is the contractor paid a fixed fee? __
_______________________________________________________________
_______________________________________________________________
B5._ Do you have an industrial medicine
department that covers worker's compensation and/or disability claims, or do
you refer these claims to a specialist? ____________________
_______________________________________________________________
_______________________________________________________________
B6._ What obstacles are there that might
prevent us from assessing the total health care utilization of your patients,
and what might we do to capture as much of this utilization as possible?
_______________________________________________________________
_______________________________________________________________
C.
Confidentiality—Patient Identifying Information
Because of the sensitive nature of
our data request, we want to be sure that we protect the confidentiality of the
involved patients. So now I’d like to
ask you some questions about patient identifying information and
confidentiality concerns.
C1. Part of our research requires that we
receive patient-level data from you and merge that with patient-level data from
other sources. In order to do this, we
need to use a patient identifier that uniquely distinguishes one patient from
another. A subscriber ID number might
be an example of such an identifier.
Can you provide us with such an identifier? What do you call that identifier?
_______________________________________________________________
C2. What assurances of confidentiality do you
require to release this identifier to us?
_______________________________________________________________
_______________________________________________________________
D. Data
Availability
Next, we’d like to ask you some
questions about the availability of certain types of health care utilization
data. By availability, we mean that you
would be able to provide us with the data in an electronic file. Because we want to track individual services
received by a patient, we would prefer that each record in the electronic file
reflect information for one and only one procedure provided for one and only
one diagnosis.
D1. Can you provide us data on specific services provided to
patients? That is, could you generate
an electronic file that has one record per service provided by [MCO name] to one of its patients? By a service, we mean a single procedure as
captured by one and only one CPT code.
Yes. __________________________________________________________
No. At what level can you provide us data?
a)_ One
record per patient per visit. _____________________________
b)_ One
record per patient per day. ______________________________
c)_ Other. Specify (i.e. monthly utilization for a
specific population): ____
________________________________________________________
________________________________________________________
D2. Although we want to examine individual
services, it is important that we understand how these services combine to form
a treatment visit and how treatment visits combine to form a treatment episode. An example of a treatment episode is an
initial outpatient visit with several follow-up visits all for the same health
problem. For outpatient records, can
you provide us with information that
a) links multiple services to a single
visit? (if Q1 = Yes)_________________
gives
the number of services per visit? (if Q1 = a)____________________
gives
the number of number of visits and services per day? (if Q1 = b)___
b) links multiple visits to a single
treatment episode, or identifies initial and follow-up visits for a common
diagnosis? ___________________________________________________
D3. For inpatient records, can you provide us
with information that
a)
links multiple
services to a specific day? __________________________
b)
links multiple
days to a single hospital stay? _______________________
c)
identifies
distinct hospital stays and gives the length of stay? __________
E.
Available Data Fields
Now I’d like to ask you about the
availability of specific data fields.
Which of the following data elements do you have?
Patient Demographic Data
Data
Variables:
|
Available Electronically?
|
Unit of Observation*
|
Available for
Off-Site Services?**
|
Notes
|
|
Date of
birth
|
|
|
|
|
|
Sex
|
|
|
|
|
|
Race/ethnicity
|
|
|
|
Distinguish white Hispanic from white?
|
|
Education
|
|
|
|
|
|
Marital
status
|
|
|
|
|
|
Relation
to subscriber
|
|
|
|
|
|
Patient
enrollment and dis-enrollment dates
|
|
|
|
Ask about reasons why these dates get changed. Ask for a complete enrollment
history.
|
|
Patients’
primary clinic
|
|
|
|
|
|
Benefit
limitations or health plan information
|
|
|
|
Pay special attention to limitations on
ADM services
|
*S = service, V =
visit, P = patient
**e.g., alcohol or
drug abuse treatment facility, out-of-town emergency room, or specialist
Utilization Data
Data
Variables:
|
Available Electronically?
|
Unit of Observation*
|
Available for
Off-Site Services?**
|
Notes
|
|
Identity
of physician seen at visit
|
|
|
|
|
|
Date of
service
|
|
|
|
|
|
Place of
service
|
|
|
|
Home clinic, specialty clinic, ER, etc.
|
|
Cost of service
|
|
|
|
Amount charged, amount paid, amount
allowed, or patient’s out-of-pocket
|
|
Diagnosis
codes (including primary, secondary, etc.)
|
|
|
|
ICD-9 preferred
|
|
Procedure
codes (including primary, secondary, etc.)
|
|
|
|
|
|
Length
of stay for inpatient visit
|
|
|
|
|
|
Pharmacy
|
|
|
|
|
*S = service, V =
visit, P = patient
**e.g., alcohol or
drug abuse treatment facility, out-of-town emergency room, or specialist
So that we can better understand the
information you’ve just given me, please send me a test file with the data
items we’ve just discussed for approximately 300 records. This test file is the best way for me to
verify my understanding of your data system.
Could you please send this test file to me at:
Grantee contact
address line 1
address line 2
address line 3
Do you have any questions regarding
this test file?
__________________________________________________________________
__________________________________________________________________
F.
Historical Records
An important part of understanding
individuals’ health care utilization is knowing their health care history. Thus, we’d like to collect historical data
on individuals’ health care utilization going back at least 5 years.
F1._ Does your current data system include
historical information for the last 5 years?
a) Yes.
Does your data go back even farther?
How far back? ____________
b) No. How far back does your data go? _____________________________
F2._ Is there any reason why some historical
data may be lost between now and the start of any data collection, because of
routine or periodic data purges, for example?
_______
_______________________________________________________________
G.
Transferring Data
Finally, we’d like to ask some
questions about transferring the data from [MCO
name] to us. Because the data files
we are requesting will be very large, we would prefer to receive compressed
data files on a large electronic medium such as tape or CD ROM.
G1. Could you write the data files to tape or
diskette? If so, please list all
formats for both tape and diskette (e.g., 8 mm tape or 3.5” diskette). Please include CD ROM if you can write data
to that medium.
_______________________________________________________________
_______________________________________________________________
G2. Are you familiar with file compression
utilities such as PKZip? Please list
all utilities you have used. _______________________________________________________________
_______________________________________________________________
_______________________________________________________________
G3. Are you familiar with any backup
utilities such as Microsoft backup?
Please list all utilities you have used. _________________________________________________________
_______________________________________________________________
_______________________________________________________________
Thank you for your time. This interview has been very helpful.
To facilitate our understanding of
your data system, we’d like to see a printed list of all data fields available
on your MIS (including definitions of those fields and definitions of any codes
used). Could you please include this
list with the test file we discussed above?
Thank you. Do you have any
questions concerning this interview, the test file, or the list of available
data fields that I’ve requested?
__________________________________________________________________
__________________________________________________________________
Notes
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
