PROVIDENCE, R.I. [Brown University] — From the machine learning that allows Alexa to understand users who ask “What’s the weather today?” to the systems that predict the paths and impacts of hurricanes, big data is being used to accomplish remarkable tasks across a wide range of sectors.
The field of health care is no exception — physicians are using artificial intelligence tools to better identify breast cancer, scholars are analyzing patient data to identify inefficiencies within the health care system, and the possibilities for using data to solve problems in health care are nearly boundless.
Through a new partnership between the Rhode Island Department of Health and Brown-based, federally funded Advance Clinical and Translational Research (Advance-CTR), five health care researchers affiliated with Brown University, Lifespan and the University of Rhode Island now have access to the state’s All-Payer Claims Database (APCD). APCDs are mandated, state-run archives that contain information from medical and pharmacy bills for the state’s residents, whether they’re insured by Medicaid, Medicare or private insurance companies.
“This project is all about making a link between a state asset, the APCD, and a university-based scientific collaboration, Advance-CTR, to ensure that our health care system works to benefit the residents of Rhode Island,” said Dr. Ira Wilson, the partnership’s co-leader and a professor at Brown’s School of Public Health and Warren Alpert Medical School. “Rhode Island spends $8 to $9 billion on health care each year. If we can figure out how to cut just a fraction of a percent, it will more than pay for the necessary infrastructure.”
The five research teams have had access to the database for more than a year, and Advance-CTR’s partnership license will remain active until at least April 2020.
The primary goals of the APCD partnership? To use big data to benefit residents of Rhode Island, and the nation, by figuring out how to minimize waste, improve health care and train the next generation of health care scholars to be proficient in a data-driven world — all while properly safeguarding every patient’s personal information.
Minimizing waste, improving care
While a half dozen states have made APCDs accessible to researchers to date, Rhode Island’s database is ideal for researchers for several reasons, said Neil Sarkar, director of the Brown Center for Biomedical Informatics, an associate professor of medical science and co-leader of the partnership.
First, because Rhode Island has a population just over 1 million, it is possible to track nearly all instances of heart attacks or shoulder surgeries, as two examples, instead of selecting a sample of patients with the hope that the sample is statistically representative, Sarkar said. Because the APCD includes residents with government-sponsored health insurance and private insurance, it’s a nearly complete dataset for studying the rates of certain conditions among Rhode Islanders.
In addition, because approximately 70 percent of the state’s residents remain in Rhode Island, it’s possible to track patients over the long term even if they switch from private insurance to Medicaid and back, Sarkar said. Switching between private and government-sponsored health insurance can make tracking long-term health outcomes particularly challenging, but is an area where APCDs are critical.
“One of the things that is really exciting about conducting research in Rhode Island, if you work at the population level, is that you can actually get full longitudinal histories of individuals and track health care trajectories over time in a much more controlled environment,” Sarkar said. “It is an excellent test-bed for research.”
Currently, Rhode Island’s APCD includes medical bills, or claims, from 2011 through 2018, with more data being added on a quarterly basis as it becomes available, Wilson said. The program’s leaders aim to continue the partnership for many more years and to expand the number of seats to support additional researchers.
To date, five projects enabled by the partnership are now underway.
Dr. Brett Owens, chief of sports medicine at Miriam Hospital and a professor of orthopedics at Brown, is studying the long-term outcomes of orthopedic procedures for shoulder injuries. Shoulder instability can occur if the shoulder ligaments are stretched or torn when the shoulder is dislocated; some cases can be treated with physical therapy while other cases require surgery. Unlike primary care physicians, specialists often don’t get the chance to track patients over time, unless there are severe aftereffects.
Dr. Orestis Panagiotou, an assistant professor (research) in the Department of Health Services, Policy and Practice at Brown, is investigating health care services that provide no or minimal value at high cost, such as diagnostic imaging for low-risk conditions without medical warning signs, or services that may in fact be harmful to patients such as unnecessary laboratory tests. The team is looking at the rates at which various treatments are used so that health care providers can improve the care they provide.
Sarkar is leading a team to determine what health conditions are amenable to being modeled using a claims database and which are not. For example, diabetics with high blood pressure also have a high risk for heart attacks and cardiovascular conditions. This pattern and others — such as risk factors for blindness among premature babies — should be apparent from analyzing the data. Determining what conditions can be studied using APCD will lead to new studies and further insights that could result in medical care improvements. Sarkar is also leading the analysis of APCD to provide data-driven insights for a Rhode Island General Assembly special commission studying the impacts of insurer payments on access to health care.
Wilson has been studying the sources of health care cost increases in Rhode Island (and the rest of the nation) for the past 30 years. With access to the APCD, his team is comparing costs between hospitals or provider groups for different procedures, determining conditions that require more preventive interventions to reduce costly and distressing emergency department visits, and assessing the use of low-value, high-cost treatments for various conditions. The goal is to help the state reduce health care cost increases in a responsible manner.
Steven Cohen, an assistant professor at the University of Rhode Island, is using the APCD to study the socioeconomic factors that impact health care use and medical outcomes in Rhode Island. His team is examining the database by ZIP code to see if certain areas have particularly high or low usage of emergency services and medical tests such as MRI or CT scans. This information could inform policymakers and health care practitioners in order to increase health equity and decrease costs.