CiMH hollywood 2010

Combining Data Warehousing and Predictive

Modeling to Open New Possibilities for Guiding

Clinical And Management Decision Making

Nathaniel Israel

San Francisco Department of Public Health

[email protected]

Stephen Guerin

Redfish Group / Santa Fe Complex

[email protected]

San Francisco

Department of

Public Health

Goals:

• Briefly describe common frameworks for utilizing behavioral health data for decision support

• Describe a particular implementation of a decision support framework in SF County

• Describe a particular visualization strategy, Agent Based Modeling (ABM)

• Demonstrate potential uses of ABM in decision support

Basic Frameworks

• Billing data give us the “What” of client

flow

– Access, Engagement, Services, Linkages

• Clinical data give us a “Why” re: client flow

– Allow us to answer the question, “Was

movement clinically appropriate?”

• Example: time in hospital / residential care

Billing Data

A E S L

Hospital X Addt’l X X

Residential X Addt’l X X

Intensive OP X X X X

Outpatient X X X X /

Addt’l

Clinical Data

• CANS Data:

– System Snapshot of Needs and Functioning

– Agency -Level Trajectories re: sub-population

needs and outcomes

– Client –Level Outcomes

System-Level Profile

System-Level Profile

Agency Trajectories

Population Trajectory: HSA

0

5

10

15

20

25

1 2 3

Assessment Number (6-month intervals)

Avera

ge N

um

ber

of

Acti

on

ab

le

Item

s P

er

Cli

en

t

A Better Way, Inc. Alternative Family Services, Inc. CASARC

Foster Care Mental Health IPP HSA - AVERAGE

Client –Level Outcomes

• Theory: Complex Systems Research

– Agent-Based Modeling

– Data Visualization

• Applied Examples:

– Emergency Response Planning

– Pharmaceutical R&D Portfolio

• Florida Case Study

• Ongoing San Francisco Project




• Applied Examples





Complex Adaptive Systems

How Systems Organize

Why Systems Organize

Josh Thorp, stigmergic.net

Flocking and Schooling

Josh Thorp, stigmergic.net

A simple agent’s behavior

Attract

Repel

Ants and Pheromones









Zozobra Crowd Dynamics

Roberto Clemente Bridge

Open to pedestrian traffic only

Fans use bridge to downtown and to closest “T” stations

MANAGING CASE FLOWS

Eli Lilly’s R&D Portfolio Planning

Eli Lilly R&D Portfolio Scheduling

time

$

cost

revenue

Eli Lilly R&D Workflow Simulation and Portfolio Scheduling









Input is simple spreadsheet

Client Trajectories

Number of Days in a Placement

Client Trajectories


Client Trajectories

Distance Metric

Dendrogram

Capturing Direction of Flow




Number of Transitions between Placements

Agent-based Clustering

(Frey and Dueck, 2007) Science Magazine

Agent-based Clustering









Visualization Project Scope

1) clients’ movement between levels of care

over time.

2) agencies client movement over time.

3) service use by demographic and clinical

characteristics, including gender, age,

ethnicity, and diagnosis.

Nate’s “What” client flows from Billing DataWill be integrating the “Why” from Clinical Data

0

100

200

300

400

500

600

700

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Co

un

t

Age (as of 6/30/2008)

Patient Ages

0 2000 4000 6000 8000 10000 12000

Family Mosaic ProjectWestside Integrated CYF Svc

RAMS CYF OPTEDGEWOOD CHILDRENS RI EPSDT

OMI Family Ctr Children SvcInstituto Fam DeLaRaza

Seneca Concord CTF OP (closed)SF BOYS & GIRLS HOME #1 (St. Vincents)

Craig CumminsInstituto Fam DeLaRaza SED

Kevin D HardingMICHAEL SCOTT

Infant Parent Prg-IPP ChildcarRAMS Employee Development Prgm

SFCFTC UC CAF Program OPInfant Parent Prg-IPP NPA (Neuropsych Assmt)

WESTSIDE CALWORKS COUNSELINGJack Travis

CMHDA NON MD TIER1 (Value Options PPN)LANGLEY PORTER CLINIC MD

Transition-Age Youth ProgramHUGH MOLESWORTH

Norman ZukowskyRAMS Fu-Yau EPSDT

WESTSIDE CALWORKS COUNS(RAMS)WARREN TAYLOR

Peter BrowningAlexandre V Zinchenco

THE ANCHOR PROGRAMCONARD-JACKSON STREET HOUSEGROVE ST CRISIS RES BAKER PLCS

Judith L SpeedGregory BrownLouis J Roussel

Tim S HuiCynthia S Yang

RAMS PAES Counseling Ser OPFRED R STODDARD

#N/ABaker Places Grove Street OPT

# of Services by Reporting Unit

No

t al

l RU

s ar

e d

isp

laye

d

0 2000 4000 6000 8000 10000 12000

Family Mosaic Project

Seneca Res Out Patient (CTF-Community Tx Facility)

YGC - Youth Guidance Center

Chinatown Child Dev Center

Seneca Center WRAP

MISSION FAMILY CENTER

EDGEWOOD CHILDREN'S OUT PATIEN

Southeast Child/Family

SOUTHEAST CHILD & FAMILY CTR 2

Westside Integrated CYF Svc

Edgewood Day Treatment ("Day Day Treatment")

Seneca Residential Day TX

Oakes Children's Center DT

McAuley Day Treatment

URBAN SERVICES YMCA

walden adolescent Intensive DT

EDGEWOOD CTR CHIL & FAM EPSDT

Edgewood Child EPSDT DAY TX (Residential Day Treatment)

RAMS CYF OPT

FSA Tender Lion EPSDT

# of Services by Reporting Unit (top 20)

0 5000 10000 15000 20000 25000 30000

Individual Therapy

Indiv Psych 90806 45-74 min

CASE CONF,NON MD,15MIN H2015 5

INDIVIDUAL PSYCH AB3632 45-74M

Pharmacolgcl mgmt w/brief psy

Assessment Non MediCal

GROUP THERAPY AB3632

I E P - AB3632

FAMILY THERAPY W/PT AB3632

Hospital Visit Subsqnt 35 min

Brief Medication Visit

Individual 45-50 min 90806 (4)



INT IND PSY AB3632 45-74 MINS

CASE MGMNT PLACEMENT SFGH/SD

Init Psychiatric Exam 90801(6)

FAMILY THERAPY W PT 90847 (4)

Init Psychiatric Exam 90801(5)

COMM PSY SUP SRV 90MIN H0036 9

GRP THERAPY PER PERS 90853 (1)

Hospital Visit Init 50 min

CLIENT REPORT PREP AB3632


EMERGENCY DEPT VISIT EVAL 5150

FAMILY THER W/O PT 90846 (8)

Interact Psych Diag AB3632

# of Procedure Codes

No

t al

l RU

s ar

e d

isp

laye

d

0 5000 10000 15000 20000 25000 30000

Individual Therapy

Case Management Brokerage

Collateral

Day Trx Inten Full Child

Assessment & Evaluation

Medication Support/Monitoring

Indiv Psych 90806 45-74 min

Day Trx Intensive Full AB3632

Crisis Intervention No MediCal

Individual AB3632

Family Therapy with patient

Day Trx Rehab Full Day


Collateral AB3632

Day Trx Rehab Full Day AB3632



Assessment AB3632

INDIVIDUAL PSYCH AB3632 45-74M

Group Therapy

# of procedure codes (top 20)

Opensource or Free Toolsfor visualization and agent-based modeling

• Netlogohttp://ccl.northwestern.edu/netlogo/

• Processinghttp://www.processing.org

• Nodeboxhttp://www.nodebox.net

• Open Frameworkshttp://www.openframeworks.cc/

• HTML5 with Javascript

http://ccl.northwestern.edu/netlogo/

Combining Data Warehousing and Predictive

Modeling to Open New Possibilities for Guiding

Clinical And Management Decision Making

Nathaniel Israel

San Francisco Department of Public Health

[email protected]

Stephen Guerin

Redfish Group / Santa Fe Complex

[email protected]

San Francisco

Department of

Public Health

Eli Lilly R&D Portfolio Scheduling

time

$

cost

revenue

Eli Lilly R&D Workflow Simulation and Portfolio Scheduling

Project Scope

Visualize client flow through the public mental health service system based on Medicaid billing data:

1) Visualize clients’ movement (service use) between levels of care over time.

2) Visualize each agency’s clients’ movement (service use) over time.

3) Visualize clients’ service use by demographic and clinical characteristics, including

gender, age, ethnicity, and diagnosis.

This visualization will allow system stakeholders to understand a) how clients are moving through the system (using services at different levels of care)b) whether / how this flow varies by provider within and across levels of care and c) whether / how this flow varies by client demographic characteristics.

The delivered program will also allow for the upload of new data to inform the visualizations, and for the comparison of clients’ service utilization across two distinct periods of time.

A procedure document will be included with the program and this document will provide step-by-step instructions that enable users to upload new data to the program. The program will be available to users wherever it is installed and service data is uploaded.

Project FlowData

• Verify initial data

• Additional sources

Model

• Data Model

• Agent-based Model

Visualizations

• Case flow Animations

• Network Navigation

Deployment

• Analyst

• Web

• Table

Project FlowData



Model

• Data Model


Visualizations



Deployment

• Analyst

• Web

• Table

Project Timeline

Project Timeline

Project FlowData



Model

• Data Model


Visualizations



Deployment

• Analyst

• Web

• Table

Project FlowData



Model

• Data Model


Visualizations



Deployment

• Analyst

• Web

• Table

Source: Juice Analytics

Data Issues

• Client Primary RUs with no mapping in provider table

• RUs in services with no mapping in provider table:

Project FlowData



Model

• Data Model


Visualizations



Deployment

• Analyst

• Web

• Table

Health & Medicine

CiMH hollywood 2010