Analytical Report: Identifying Providers with Potentially Higher Adverse Events

1. Problem Description:

Administrators at Acme Healthcare aim to identify providers or groups of providers that

might have more adverse events while accounting for patient-level risk factors. Adverse
events can range from medical errors to complications during procedures, and identifying
patterns in provider behavior is crucial for improving patient safety and quality of care.

2. Utilizing Groupers for Analysis:

Groupers play a pivotal role in dissecting and categorizing data to uncover meaningful
insights. For this analysis, we can group diagnoses, procedures, and medication codes into
analytical categories based on their clinical relevance and potential impact on adverse
events. By aggregating data at these analytical levels, we can identify patterns and outliers
associated with specific providers or provider groups.

For example, diagnoses related to post-operative complications can be grouped together,

enabling us to assess if certain providers have higher rates of such complications
compared to their peers. Similarly, procedures prone to adverse events, such as surgical
interventions, can be grouped to pinpoint providers exhibiting unusual trends.

3. Analytical Plan:

Our approach involves the following steps:

- Data Preparation: Gather comprehensive patient-level data, including demographics,

diagnoses, procedures, medications, and provider identifiers.

- Risk Adjustment: Utilize advanced statistical methods to adjust for patient-level risk
factors, such as age, comorbidities, and severity of illness.

- Grouping and Aggregation: Employ groupers to categorize diagnoses, procedures, and

medications into analytical clusters.

- Provider Profiling: Analyze provider-level data to identify patterns of adverse events,

comparing observed outcomes against expected rates after risk adjustment.
- Outcome Reporting: Present findings in a clear and actionable format, highlighting
providers or groups warranting further investigation or intervention.

4. ETL Processes for Analytical File Creation:

To create the analytical file, several Extract, Transform, and Load (ETL) processes are
required:

- Data Extraction: Retrieve relevant data from disparate sources, including electronic
health records (EHR), billing systems, and clinical databases.

- Data Cleaning: Standardize data formats, address missing values, and remove duplicates
to ensure data integrity.

- Variable Transformation: Transform raw data into analytically meaningful variables, such
as grouping diagnoses and procedures, and calculating risk scores.

- Data Integration: Merge datasets while preserving the integrity of patient-provider

relationships and maintaining patient privacy.

- Data Loading: Load processed data into a secure analytical environment, ready for further
analysis and reporting.

5. Appendix:

- Data Dictionary Enhancements: Expand the data dictionary to include detailed

descriptions of analytical variables, groupers, and risk adjustment methods.

- Analytical Output Summary: Provide examples of potential analytical outputs, such as

provider performance dashboards and risk-adjusted outcome reports, to guide decision-
making and quality improvement efforts.