Surveillance Pilot Projects Using Data from Medicaid and Vital Statistics Unit

Death Data Pilot Project aims to identify unreported mortality for known notifiable conditions, obtain death certificate information, and improve understanding of disease severity for better case reporting. Methods involve identifying ICD-10 codes, requesting reports, and collaborating with local health departments to educate on notifiable conditions. Results show investigations and new cases found, with ongoing efforts to enhance death reporting completeness. Future directions include evaluating completed 2012 death data and identifying best correlating ICD-10 codes.

• Surveillance
• Pilot Projects
• Data Analysis
• Public Health
• Disease Surveillance

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1. Surveillance Pilot Projects: Using Data from Medicaid and Vital Statistics Unit RACHEL WISEMAN, MPH ANDY MAUNEY EMERGING AND ACUTE INFECTIOUS DISEASE BRANCH TEXAS DEPARTMENT OF STATE HEALTH SERVICES

2. Death Data Pilot Project Identify previously unreported mortality for known cases of notifiable conditions Identify previously unreported cases of notifiable conditions Obtain death certificate information Improve understanding of severity of disease Ensure that diagnosis at death does not preclude reporting of cases

3. Methods Identified ICD-10 codes that correspond to notifiable conditions Requested quarterly report from VSU of all deaths due to those ICD-10 codes Selection criteria Recently deceased, deceased at a facility Age restrictions by condition Not in NBS for that disease Others by specific condition

4. Methods (contd) Ask LHDs/HSRs to contact facility of death for medical records Determine if patient meets case definition Add patient to NBS Educate facility on notifiable conditions and importance of reporting

5. 2012* Results 448 deaths for 14 conditions 27 deaths investigated 16 deaths did not meet case criteria 6 death investigations pending 3 records not located 2 new cases found *Death reporting for 2012 is incomplete

6. Deaths Identified, 2011-2012* 2011 One new CJD case One new listeriosis case 2012 One new legionellosis case One new tetanus case *Death reporting for 2012 is incomplete

7. Examples of Death Data, 2012* Meningitis 229 deaths 227 excluded from investigation 2 investigated 1 pending, 1 record not located Tetanus 2 deaths, both warranted investigation 1 did not meet case definition 1 new tetanus case found (50% increase in case count) *Death reporting for 2012 is incomplete

8. Future Directions Will evaluate when 2012 death data complete Which ICD-10 codes best correlate with notifiable conditions Which ICD-10 codes identify deaths in previously reported patients Which ICD-10 codes yield deaths that meet case definition Number of investigations required to identify one death

9. Medicaid Data Pilot Project Identify previously unreported cases of select notifiable conditions Determine if Medicaid data can be used as additional surveillance source

10. Methods Request all Medicaid inpatient claims data for six month period Identify patients with ICD-9 codes for selected notifiable conditions Search NBS for patients identified in Medicaid Request medical records for all unreported Medicaid patients Determine if patient meets case definition Add to NBS Educate facility on reporting

11. January-June 2012 Results Patients in Medicaid Found in NBS MR received Met case definition % increase to case count 0.3% Pertussis 83 38 (46%) 39 1 (3%) Tetanus 8 0 7 1 (14%) 100% Salmonellosis 83 51 (61%) 28 6 (21%) 0.2% Varicella <1 yo 28 0 25 23 (92%) 23.2%

12. July-December 2012 Results* Patients in Medicaid 1 5 57 1 22 15 4 5 62 18 Found in NBS MR received to date 1 4 25 -- 13 10 0 5 44 9 Met case definition % increase to case count -- -- -- -- -- -- -- -- 6% -- Botulism CJD Hepatitis A Legionellosis Polio Rubella/CRS Smallpox Tetanus Varicella <19 yo Vibriosis 0 0 7 (12%) 1 (100%) 0 0 0 0 9 (15%) 0 0 0 0 -- 0 0 -- 0 37 (84%) 0 *Project is currently underway

13. Lessons Learned Billing data prone to errors Pertussis case definition is too complex for retrospective surveillance Providers seem to be unaware chickenpox is reportable In Medicaid, inpatient includes clinics, home care and home assistance (non-medical) May be useful for specific conditions

14. Next Steps Create plan for addressing deficiency in chickenpox reporting Clarify with Medicaid the definition of inpatient Request outpatient Medicaid claims data Repeat pilot project Work with NBS office to get specific Medicaid claims fed into documents requiring review queue

15. Tentative Conclusion Medicaid claims data and death data appear to be useful as additional sources of surveillance data for some notifiable conditions

16. Special Thanks To Vital Statistics for providing us with death data (and explaining the system to us) To Medicaid for providing us with Medicaid data To the regional and local staff that have done the follow up to investigate the suspect cases from the death data To the EAIDB staff that review death records To the UT interns, Andy, Katelyn, and Kristen who have done the bulk of the work for the Medicaid project!