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04/24/02 1
Cross-system Utilization using
Three Years of Data
Paul Stiles, J.D., Ph.D. Diane Haynes, M.A.
813) 974-9349 [voice] (813) 974-8209 [voice]
stiles@fmhi.usf.edu haynes@fmhi.usf.edu
Policy & Services Research Data Center
Department of Mental Health Law & Policy
Louis de la Parte Florida Mental Health Institute
University of South Florida
13301 Bruce B. Downs Blvd.
Tampa, FL 33612
Pinellas Data Collaborative
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PDC Background
Established under F.S. 163 Several organizations in county
participating including:– BOCC -- DJJ– DSS -- JWB– Courts/Sheriff -- DCF– EMS --FMHI (repository)
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Data Sets
Criminal Justice [CJIS]
Dept of Social Services [DSS]
DCF/ADM [IDS]
Medicaid [AHCA]
Juvenile Welfare Board [JWB]
Child Welfare [CW]
Emergency Medical Services [EMS]
Baker Act [BA]
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On-going Questions/Analyses Use and cost of Acute Care (Baker Act) services in the county
Use of Acute Care (Baker Act) by children
Overlap of identified population (PEMHS) in JWB that are in Medicaid
Network Analysis on Individuals Dealing with Substance Abuse
Continuity of Care Study (GPW Closing)
How many kids being served by JWB are also involved in the Child Welfare system?
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Cross Systems Utilization:Initial Questions
What is the measure/degree to which adults and children in the 8 systems have caseload overlap for over a three year period (1998-2001)?
What is the measure/degree to which high users in the systems have caseload overlap over a three year period (1998-2001)?
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Overview
The Eight Systems
The Statistical Method used in this study
Findings
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Eight Systems Included in this Study
Criminal Justice [CJIS]
Dept of Social Services [DSS]
DCF/ADM [IDS]
Medicaid [AHCA]
Juvenile Welfare Board [JWB]
Child Welfare [CW]
Emergency Medical Services [EMS]
Baker Act [BA]
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• CJIS 35%
• DSS 34%
• EMS 24%
• IDS 58%
• MMH 77%
• JWB 19%
• CW 24%
• BA 21%
• CJIS35%
• DSS36%
• EMS24%
• IDS51%
• MMH 79%
• JWB15%
• CW15%
• BA15%
Between 1998 and 1999 Between 1999 and 2000 Between 1998 and 2000
• CJIS 25 %
• DSS 21 %
• EMS 19 %
• IDS44%
• MMH 64%
• JWB34%
• CW13%
• BA 13 %
Overlap within each system across years - All
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• CJIS 28%
• DSS 33%
• EMS 18%
• IDS 55%
• MMH 56%
• JWB 8%
• CW 65%
• BA 38%
• CJIS26%
• DSS29%
• EMS19%
• IDS41%
• MMH 57%
• JWB3%
• CW58%
• BA18%
Between 1998 and 1999 Between 1999 and 2000 Between 1998 and 2000
• CJIS14%
• DSS13%
• EMS11%
• IDS21%
• MMH 40%
• JWB0%
• CW53%
• BA13%
Overlap within each system across years - HH
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Statistical Method
Probabilistic Population Estimation (PPE)
Caseload Segregation/Integration Ratio (C-SIR)
This process relies on information in existing databases and the agencies do not have to share unique person identifiers. It avoids the expense of case-by-case matching and sensitive issues of client-patient confidentiality.
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Probabilistic Population Estimation (PPE) A statistical method for determining the number of people
represented in a data set that does not contain a unique identifier. The estimation is based on a comparison of information on the distribution of Date of Birth and Gender in the general population with the distribution of Date of Birth and Gender observed in the data sets.
The number of distinct birthday/gender combinations that occurred in each data subset are counted. The number of people necessary to produce the observed number of birthday/gender combinations are then calculated.
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Caseload Segregation/Integration Ratio (C-SIR)
C-SIR =
C-SIR is a rating between 0 and 100 which indicates the amount of overlap of clients between agencies.
Zero being no overlap at all and 100 being total overlap.
Duplicated Count
Unduplicated Count
- 1
Duplicated Count
Largest Undup. Count- 1 * 100
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One year Overlap/C-Sir (44)
IDS
MMH
7,447
3,996
3,131
Unique ID Count PPE Count Population Cross
MMH 7,104 7,127 56.06%
IDS 11,640 11,443 34.92%
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Findings from last year’s analysis There is very little overlap in users between the
systems that were looked at.
The caseload integration/segregation rating in this study varied from 5 to 44 on a scale of 0 to 100. The greatest overlap is between IDS and MMH, the mental health systems
It is the non-high users that are more likely to cross multiple systems, not the high users. If an individual is a high user in one system, they probably are not in the other systems.
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Three Year Overlap/C-Sir-AdultsTotal Population
Rate
# of IndWho
OverlapMMH & IDS 40 6,548
MMH & DSS 28 9,514
MMH & CJIS 26 32,154
IDS & DSS 16 3,317
IDS & CJIS 40 6,563
DSS & CJIS 43 13,973
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Three Year Overlap/C-Sir-KidsTotal Population
Rate# of Ind
Who OverlapMMH & IDS 69 3,062
MMH & DSS 100 626
MMH & CJIS 95 135
IDS & DSS 4 26
IDS & CJIS 67 97
DSS & CJIS 1 2
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Three Year Overlap/C-Sir-Adults“Heavy Hitters”
Rate
# of IndWho
OverlapMMH & IDS 52 517
MMH & DSS 3 97
MMH & CJIS 2 124
IDS & DSS <1 6
IDS & CJIS 7 64
DSS & CJIS 3 86
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Three Year Overlap/C-Sir-Kids“Heavy Hitters”
Rate
# of IndWho
OverlapMMH & IDS 76 349
MMH & DSS * *
MMH & CJIS 3 2
IDS & DSS * *
IDS & CJIS <1 0
DSS & CJIS * *
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Overlap/C-Sir JWB & CW
JWB Child Welfare
48,639 23,720
17,563
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Overlap/C-Sir EMS & IDS/MMH/BA (All Age Groups)
Rate# of IndWho Overlap
EMS & IDS 7 105EMS & MMH 14 29,948EMS & BA 62 5,146
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We need your help!!
Help with what systems to cross Help with predicted pathways (so that
we can look at service use patterns over time)
Help selecting other systems to include (e.g., Education?)
Help with interpretation
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Demographics (ALL-Adults)
0
20
40
60
80
100
CW
BA
DS
SJW
BID
SM
MH
EM
SC
JISFemale
Male
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Demographics (ALL-Kids)
0
20
40
60
80
100
CW
BA
DS
SJW
BID
SM
MH
EM
SC
JIS
Female
Male
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Reference
Banks, S. & Pandiani, J. (1998). The use of state and general hospitals for inpatient psychiatric care. American Journal of Public Health, 99(3), 448-451.
Banks, S., Pandiani, Gauvin, L, Readon, M.E., Schacht, L., & Zovistoski, A. (1998). Practice patterns and hospitalization rates. Administration and Policy in Mental Health, 26(1), 33-44.
Banks, S, Pandiani, J. & James, B (1999). Caseload segregation/integration: A measure of shared responsibility for children & adolescents. Journal of Emotional & Behavioral Disorders, 7(2), p 66-17.
Banks, S, Pandiani, J., Bagdon, W., & Schacht, L. (1999). Causes and Consequences of Caseload Segregation/Integration. 12th Annual Research Conference (1999) Proceedings, Research and Training Center for Children’s Mental Health.
Pandiani, J., Banks, S., & Gauvin, L. (1997). A global measure of access to mental health services for a managed care environment. The Journal of Mental Health Administration, 24(3), 268-277.
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