By Sandy Potter, LCSW, M.B.A.
Vice President and Chief Operations Officer of Behavioral Health
Texas Health Resources
As I sat in the hospital with my mom, I reflected on the long road and all the data points collected up to this moment in time. Health care data analysis is driven by the effort to solve a problem. My mom is a complex, high-need individual who has produced a lot of data points. Many things a payor could have easily seen, have been completely missed. For example, a denied service for physical rehabilitation directly resulted in two falls in the subsequent two weeks. The falls led to two corresponding emergency department visits and the current hospitalization. The reason for denial was “criteria not met…there is no evidence of a need for rehabilitation.” The day the denial letter came in the mail, she did a face plant on the bathroom floor.
After 34 years as a social worker (17 years in managed care), I am struck by the absence of qualitative data in the health care decision making matrix or, at minimum, quantitative data used to understand a person from their view point in a way which makes a difference. However, qualitative data is generated every day on the micro level, face to face with a practitioner. The actual human interaction, service delivery workflow is the oldest and most essential workflow in health care. But, we have missed integrating qualitative data in most of our analysis.
Returning to my mother in the hospital, my contemplations on the complex system of health care data was pleasantly interrupted by a physician who took the time to understand my mother’s experience over the last few months. The conversation produced a shift in the approach to her treatment and very clear data points. The physician integrated qualitative data using the ancient “art” of the clinical interview. We will not be able to “bot” or “algorithm” our way out of the clinical interview. We will need to utilize qualitative data points to make a difference.
Healthcare data points generally revolve around four domains of acute care claims, ambulatory care claims, acute clinical information and ambulatory clinical information with pharmacy and ancillary data points interwoven. Qualitative data, conversely, does not fit nicely into these 4 domains because it is driven by stakeholder interviews. Qualitative data seeks to understand member or consumer experiences in vivo with a person first perspective in much the same way human centered design seeks to address problems from the stakeholder’s view. Denzin & Lincoln describe qualitative research as an interpretive and naturalistic approach (1994, p.2). This means qualitative data does not come in a measure on a claim or from a chart to be loaded into a data warehouse universe and then into your favorite visualization tool. Qualitative data is built from the narrative creating data points of choice which help make sense of changes in health conditions in terms of the meaning and impact on life.
Synthesizing “mixed methods” (qualitative and quantitative) data points into actionable information is the next challenge for big data in health care. Although the method requires more resources and a multidisciplinary team, there are several advantages to integrating qualitative data into our very robust quantitative health care data. In an AHRQ publication, Mixed Methods: Integrating Quantitative and Qualitative Data Collection and Analysis While Studying Patient-Centered Medical Home Models, Wisdom and Creswell outline the advantages of mixed methods study (2013).
The advantages are:
• Generates comparison capability between quantitative and qualitative data
• Integrates the participants’ point of view
• Nurtures scholarly interaction
• Provides methodological flexibility
• Collects rich, comprehensive data
With the advantages of including qualitative information into our overall health care perspective, we should not take the easy route and only work from the neat and clean boxes which come in measurable bites from our EMR’s, Claims, Lab’s and PBM’s. Perhaps the wave of human centered design emerging in health care will provide a tool to integrate qualitative data from the stakeholder’s perspective and improve the overall quality of decision making. So much can be gleaned from taking a step back and collecting the elements from the interpersonal interactions gathered in the discipline of qualitative design.
Denzin, N., & Lincoln. Y. (1994). Handbook of Qualitative Research. Thousand Oaks, CA, US: Sage Publications Inc.
Wisdom J and Creswell JW. (2013). Mixed Methods: Integrating Quantitative and Qualitative Data Collection and Analysis While Studying Patient-Centered Medical Home Models. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ Publication No. 13-0028-EF.
Currently Vice President and Chief Operations Officer of Behavioral Health at Texas Health Resources, Sandy Potter is focused on pursuing the Triple Aim of healthcare: improving the patient experience of care, improving the health of populations and reducing the cost of health care. She works to craft solutions to complex health care problems, directing multiple sites and programs including data analysis, needs analysis and managed care and medical management.
Previously, Sandy was Division Vice President of Government Programs, Clinical Operations, for Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas. In this role, she was part of a solutions team that worked to improve member health outcomes and operational performance for government programs, leading teams to identify inefficiency in products, programs and systems of care.