Providing clinical detail within administrative data records will enhance the ability to report publicly on quality and costs of care, as well as improve the accuracy, transparency, research capacity, and value of administrative data. Adding clinical data, especially present on admission coding and laboratory results, to existing administrative datasets is seen as a practical, effective, and cost-effective method to produce more accurate and expanded quality assessments of hospitals; it will also provide the evidence base for quality improvement efforts.

In September 2007, four HCUP Partners were awarded Adding Clinical Data Pilot or Planning contracts to work in collaboration with hospitals in their States to explore feasible, practical solutions to adding clinical data to administrative discharge records. These projects built on work sponsored by AHRQ that assessed the incremental value of adding particular clinical data elements. In the first type of project, three HCUP Partner States conducted a two-year, in-depth pilot to add or link hospital clinical information to administrative (discharge abstract or claims) data. In the second type of project, a smaller planning award was provided to one HCUP Partner that sought to enhance its administrative datasets with more clinical data, but was not yet prepared to conduct the actual linkage. The findings from these projects were accumulated in a guidance document that will allow other data organizations to share lessons learned in creating enhanced administrative databases.

The pilot projects were conducted in: Florida (Center for Health Information and Policy Analysis, Agency for Health Care Administration), Minnesota (Minnesota Hospital Association); and Virginia (Virginia Health Information). The planning project was conducted in Washington (Washington State Department of Health). Thomson Reuters and the National Academy for State Health Policy (NASHP) developed the guidance document based on the lessons learned in these four projects and provided assistance for these projects to share their experiences.

Overview Presentation
This presentation (PDF File, 3,750 KB), given at the 13th HCUP Partners Meeting (November 2009), provides information on outcomes from the Adding Clinical Data Pilot project and Peer-to-Peer Learning Network.

Contract Final Report

• This report (PDF file, 248 KB) summarizes the completed activities for one planning and three pilot sites in adding clinical data to discharge records.

Pilot Sites

• Florida - coming soon
• Minnesota (PDF File, 208 KB)
• Virginia (PDF File, 2,118 KB)

Implementation Plans

Pilot Sites

• Florida (PDF File, 169 KB)
• Minnesota (PDF File, 393 KB)
• Virginia (PDF File, 281 KB)

Planning Site

• Washington (PDF File, 29 KB)

Project Websites

• Florida
• Minnesota
• Virgina
• Washington

State Summary Document
This document (PDF file, 34 KB) summarizes activities and plans for each site, including team members, project status as of April 2008, and site-specific web sites.

Contract Scope of Work

• Adding Clinical Data to Statewide Administrative Data: Pilot Projects

Other State and National Activities

• California Office of Statewide Health Planning and Development (PDF file, 15 KB)

AHRQ-Sponsored Study on Adding Clinical Data Elements to Administrative Data for Hospital-level Reporting

• Enhancement of claims data to improve risk adjustment of hospital mortality (Pine et al, 2007 JAMA article)
• Combining administrative and clinical data to stratify surgical risk (Fry et al, 2007 Ann Surg. article)
• Cost-Effective Enhancement of Claims Data to Improve Comparisons of Patient Safety (Harmon et al, 2007 J Patient Saf article)

Reference Materials and Web Links

• The Case for the Present-on-Admission (POA) Indicator (PDF file, 246 KB)
• An Introduction to LOINC (W. Ed Hammond) (PDF file 141 KB)
• AHRQ National Resource Center for Health Information Technology