actionable transparency for healthcare data

Assistance with customization of this powerpoint template, with your unique pdf files, snapshots and hyperlinks, can be provided by contacting www.emPoweredDecisions.us Additionally, powerpoints and pivots can be easily published to organizational websites.

* Copyright www.emPoweredDecisions.us

Example StateExample Hospital

Example County

Next

Resources

Corral all your data in one place

http://www.empowereddecisions.us/


Actionable Transparency for emPowered Decisions *To advance the objectives of IHI”s Triple Aim it is imperative to organize the many healthcare-related indicators in an accessible format to facilitate stakeholder collaboration and effective decision-making.

- For Accountable Health Communities, the context:- A ‘Social Progress Index’- County Health Rankings (a Health Equity Index)- BRFSS (Behavior-Related Factors Surveillance Survey)

- IHI ‘Measures of Triple Aim Objectives’- Community Health (Populations)- Quality Patient-Centric Healthcare- Affordable and Universal Healthcare Access

- Framework of Data for “Community Health Assessment” (ACHI)- Local Community Stakeholder Collaboration- Comprehensive and Strategic Assessment- Priorities and Integrated Action, Accountability- Relevant, Timely and Open Monitoring for Improvement

Our County Our State - Public Health CMS/Medicare Education/ESH

Hospitals CDC/ NCHS/HP 2020 HCPF/Medicaid Economics/BEA

Other Facilities CHI/Other NGO APCD/CIVHC International

Example Hospital

Example County

Example State

Organization

BackHome

Next

Every organization has its own unique set of data requirements and ‘most important metrics’. While corralling those unique data sets, and making them transparent to key stakeholders, high-performing organizations keep their finger on the pulse of their community and their industry, engaging with their colleagues in a holistic effort to promote a larger cause, the health of their communities and country.

Categories of Data

http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx

https://innovation.cms.gov/initiatives/AHCM

http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/MeasuresResults.aspx

http://www.assesstoolkit.org/

Next Corral all your data in

one place

County Health

Rankings

Social Progress

Index

Behavior-Related Factors

Core Measures, or Indicators, are needed reliably – timely, accurate and comprehensive - for tracking community health and economic status.

Data Warehouses are a critical resource for accessing needed information if Local Public Health Officials (LPHOs) are doing their most important work.

Collecting the data in a timely and accurate manner is first.

Open doors to stakeholders, as understandable and quickly accessible data, is the true substance of value.

Pivot tables are one key to unlock the value and benefits of this treasure trove.

- For “Accountable Health Communities”, Macro Views:- The ‘Social Progress Imperative’- County Health Rankings (Social Determinants of

Health)- BRFSS (Behavior-Related Factors, Surveillance

Survey)

ActionableTransparency

Home

Next

Our CountyOur State - Public Health

Consumer/Employee/Patient – Access to Quality/Cost-Effective Services:

Hospital Compare (CMS)

Health Grades

Healthcare Bluebook

Guroo (HCCI – Commercial Health Care Cost Institute

ZocDocs (patient-reviewed physicians, credentials and appointments)

Connect-for-Health (Colorado) – Select Health Insurance Plan

DORA – Physician, other professional and provider/facility licensure

AHD – American Hospital Directory Example

Data sets and pivot tables are not available

G. Swan, Pivot Table Repository of Healthcare Data, July 2016 Fishbone Overview * Copyright www.emPoweredDecisions.us

Home

Hospital Pricing - IP 100 DRGs

Hospital Pricing – OP 30 APCs

Relevant hyperlinks

in one place




https://www.medicare.gov/hospitalcompare/search.html

https://www.healthgrades.com/

https://healthcarebluebook.com/

http://www.healthcostinstitute.org/about-guroo

https://www.zocdoc.com/

http://planfinder.connectforhealthco.com/plan-details

https://www.ahd.com/data_sources.html

https://www.ahd.com/free_profile.php?hcfa_id=9b5efb07bbc75eb53f475ff5d351adc5&ek=0cfa5b113d80214f236ec8ac3660ac79

https://www.colorado.gov/pacific/sites/default/files/Example%20-%20Pivot%20Table%20Repository%20of%20Healthcare%20Data.pdf


https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient2014.html

https://www.colorado.gov/pacific/sites/default/files/CMS%20Hospital%20Metrics%20-%2030%20APCs%20Hospital%20OP%20Medicare%202013%202015r.xlsx

State of Colorado Dept of Public Health and Environment (CDPHE):

Social Progress Index

County Health Rankings

BRFSS – Behavior Related

Birth Certificates Data Set

Death Certificates Data Set

Communicable Diseases

Info pdf Snapshot m-power Pivot xls



Info pdf Snapshot m-power Pivot N/A



Colorado SIM: State Innovation ModelColorado Health Foundation Report CardColorado Business Group for HealthCoHID: Colorado Health Indicator WarehouseCCAHC – Colorado Commission on Affordable HC

State Health Assessment and PrioritiesSHIP – State Health Improvement PlanPerformance and Strategy Tools CoRHIO Regional Health Information Org.


Home

Corral all your data in

one place




https://www.colorado.gov/cdphe

http://www.socialprogressimperative.org/global-index/

http://www.countyhealthrankings.org/

http://www.chd.dphe.state.co.us/topics.aspx?q=Adult_Health_Data

http://www.crazybikes.com/mrc/CRAZYBIKES.R00180s

https://www.colorado.gov/pacific/sites/default/files/Pivot%20-%20SPI%20Social%20Progress%20Index%20Data%202015r%20v2.xlsx


https://www.colorado.gov/pacific/sites/default/files/2015R%20Annual%20Trend%20CountyHealthRankings%20ALL%20Data%20v3%20PivotsOnly.xlsx


https://www.colorado.gov/pacific/sites/default/files/01%20CO%20CDPHE%20Data%20County%20ALL%20BRFSS%20v2%20Pivot.xlsx




https://www.colorado.gov/healthinnovation

http://www.coloradohealth.org/yellow.aspx?id=8388

http://www.cbghealth.org/

http://www.chd.dphe.state.co.us/cohid/Default.aspx

https://www.colorado.gov/pacific/cocostcommission/record-input-received

https://www.cohealthinfo.com/state-of-health/

https://www.colorado.gov/pacific/cdphe-lpha/healthy-colorado

https://www.colorado.gov/pacific/cdphe-lpha/performance-and-strategy-tools

http://www.corhio.org/



Pivot xls









County Health Rankings (Health Equity Index)- Excellent resource for Local Public Health Officials- Basic Snapshot for “Community Health Assessment”- Compare to peer counties and National Quintiles

Our County State - Public Health CMS/Medicare Education/ESH




Colorado Health Foundation: Colorado Health Report Card





Denver County:


County Health Rankings


Birth Certificates

Death Certificates

Communicable Diseases







CALPHO – Colorado Assoc of Public Health OfficialsNACCHO – Natl Assoc of County & City Health OfficialsCoHID (Colorado Health Indicator Database)Denver School-Based Health Centers

Community Health AssessmentCounty Strategic PlanCHIP – Community Health Improvement PlanCounty’s Public Health Accreditation Report


CoHID

Home


one place





http://www.countyhealthrankings.org/











http://www.calpho.org/




http://www.naccho.org/




http://www.denverhealth.org/medical-services/primary-care/our-services/school-based-health-centers



CoHID Example: Extracted from “Injury Hospitalizations”of the Colorado Trauma Registry

Data in pivot table format allows users to quickly see different perspectives:- Annual Trends- Compare Peers- Filter on Metadata- PivotGraphs- Conditional

Formatting- Excel Features- Publish Dynamic Web

Pages- Easily Update as new

Data is acquired

Home Our County Our State - Public Health CMS/Medicare Education/ESH




CoHID (Colorado Health Indicator Database):

Birth Data

Death Data


PRAMS - Pregnancy-related

Trauma Registry

Cancer Registry







CALPHONACCHOColorado Cancer RegistrySchool-based Primary Health Clinics

Community Health AssessmentCounty Strategic PlanCHIP – Community Health Improvement PlanCounty’s Public Health Accreditation Report







https://www.colorado.gov/pacific/cdphe/cancerregistry










Real-time Access to Birth Data:

Data from Birth Certificates are filed at the time of birth. Why is data available only after two to three years?

Using the selection filters at CoHID, data can only be selected one thin slice at a time. Whereas, a pivot table can hold the entire data set to allow users/stakeholders to see macro trends, disparities (by race, age, education, etc), and filtered views (with ‘slicers’).

A pivot table can have granularity and multiple metadata (filters).

Tools within Excel can facilitate calculations (eg per capita, ratios, etc), conditioned formatting and dynamic graphics (pivotgraph).

Pivots, with an icon option to download, would be an additional, highly valuable icon for downloading and flexible exploration of the available data.

Our County State - Public Health CMS/Medicare Education/ESH



http://www.chd.dphe.state.co.us/cohid/topics.aspx?q=Birth_Data


Real-time Access to Mortality Data:

Data from Death Certificates are filed at the time of death. Why is data available only after two to three years?

Using the selection filters at CoHID, data can only be selected one thin slice at a time. Whereas, a pivot table can hold the entire data set to allow users/stakeholders to see macro trends, disparities (by race, age, education, etc), and filtered views (with ‘slicers’).

A pivot table can have granularity and multiple metadata (filters).

Tools within Excel can facilitate calculations (eg per capita, ratios, etc), conditioned formatting and dynamic graphics (pivotgraph).

Pivots, with an icon option to download, would be an additional, highly valuable icon for downloading and flexible exploration of the available data.






Hospital Benchmarking Metrics:

Medicare Cost Reports

CMS Hospital Patient Satisfaction

CMS Time and Effectiveness

CMS Hospital Infection Rates

CMS Pricing IP 100 DRGs

CMS Pricing OP 30 Procedures






Info pdf Snapshot m-power Pivot xlsCHA – Colorado Hospital AssociationAHA – American Hospital AssociationDartmouth AtlasJCAHO – The Joint CommissionAHD – American Hospital Directory Example

G. Swan, Pivot Table Repository of Healthcare Data, July 2016

Snapshot: List Hospitals

Fishbone Overview

Snapshot: TPS, 2016


Hospital: Denver Health Medical Center





one place

https://www.cms.gov/research-statistics-data-and-systems/downloadable-public-use-files/cost-reports/

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-instruments/HospitalQualityInits/HospitalHCAHPS.html

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-instruments/NursingHomeQualityInits/NHQIQualityMeasures.html

https://www.medicare.gov/hospitalcompare/Data/Healthcare-Associated-Infections.html


https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Outpatient.html


https://www.colorado.gov/pacific/sites/default/files/CMS%20Hospital%20Cost%20Reports%202008-2012.xlsx


https://www.colorado.gov/pacific/sites/default/files/2014.06%2012M%20CMS%20HCAHPS%20Scores%20Stars%20v3%20PivotOnly.xlsx


https://www.colorado.gov/pacific/sites/default/files/CMS%20Hospital%20Metrics%20-%20Timely%20and%20Effective%20Care%202014.xlsx



https://www.colorado.gov/pacific/sites/default/files/Copy%20of%20CMS%20100%20DRGs%20-%20Hospitals%20IP%20Price%20Index%202012%20v5.xlsx



http://www.cha.com/Resources/Colorado-Hospital-Utilization-Data.aspx

http://www.aha.org/research/rc/stat-studies/data-and-directories.shtml

http://www.dartmouthatlas.org/

https://www.colorado.gov/pacific/sites/default/files/joint%20commission%20quality%20check%20indicators%202015.xlsx





Our Hospital: Denver Health Medical Center:

Medicare Cost Reports


CMS Time and Effectiveness

CMS Hospital Infection Rates

CMS Pricing IP 100 DRGs

CMS Pricing OP 30 Procedures







CHA – Colorado Hospital AssociationColorado Quality Report by HospitalAHA – American Hospital AssociationJCAHO – The Joint CommissionAHD – American Hospital Directory Example

G. Swan, Pivot Table Repository of Healthcare Data, July 2016 Fishbone Overview

CMS – Hospital CompareCMS/Total Performance ScoreLeapFrog – Hospital SafetyCIVHC/APCD – Not AvailableCORHIO – Not Available




Other Facilities CHI/Other NGO APCD/CIVHC InternationalCorral

all your data in

one place

http://www.denverhealth.org/

https://www.cms.gov/research-statistics-data-and-systems/downloadable-public-use-files/cost-reports/


https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-instruments/NursingHomeQualityInits/NHQIQualityMeasures.html

https://www.medicare.gov/hospitalcompare/Data/Healthcare-Associated-Infections.html


https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Outpatient.html





https://www.colorado.gov/pacific/sites/default/files/CMS%20Hospital%20Metrics%20-%20Timely%20and%20Effective%20Care%202014.xlsx






http://www.cha.com/

snapshot:%20%20List%20Hospitals





https://www.medicare.gov/hospitalcompare/profile.html#profTab=0&ID=060011&Distn=1.0&dist=25&loc=DENVER%2C%20CO&lat=39.737567&lng=-104.9847179

http://www.hospitalsafetyscore.org/h/denver-health-medical-center?findBy=city&city=Denver&state_prov=CO&agree=undefined&rPos=1115&rSort=distance


State - Public Health

Our County

Hospitals

Other Facilities

CDC/ NCHS/HP 2020

CHI/Other NGO

CMS/Medicare

HCPF/Medicaid

APCD/CIVHC

Education/ESH

Economics/BEA

International

Other Facilities

CMS – Skilled Nursing Homes

CMS – Ambulatory Surgery Centers

CMS – Dialysis Centers

ACO Accountable Care Organizations

US Kidney Transplant Centers






CHA – Colorado Hospital AssociationAHA – American Hospital AssociationDartmouth AtlasJCAHO – The Joint CommissionAHD – American Hospital Directory Example





https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/SNF.html

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/ASCs.html

https://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/ESRD.html

https://innovation.cms.gov/initiatives/aco/





http://www.kidneytransplantcenters.org/Center/Index?Adp=false&Desens=false&Incompat=false&NonSteroid=false&State=&filter=1


http://www.cha.com/Resources/Colorado-Hospital-Utilization-Data.aspx

http://www.aha.org/research/rc/stat-studies/data-and-directories.shtml

http://www.dartmouthatlas.org/






CDC – Center for Disease Control

National Center for Health Stats

National Survey of Child Health

Healthy People 2020

Health Indicators Warehouse

NSCH - Natl Survey of Child Health

BRFSS - Behavior Related Factors

National Program of Cancer Registries







Info pdf Snapshot m-power Pivot N/AAPHA American Public Health AssociationUSCDC Data and StatisticsHealth System Transformation and Improvement






https://www.cdc.gov/nchs/

http://childhealthdata.org/learn/NSCH

http://www.cdc.gov/nchs/healthy_people/hp2020.htm

http://www.healthindicators.gov/

http://www.cdc.gov/nchs/slaits/nsch.htm

http://www.cdc.gov/brfss/

http://www.cdc.gov/cancer/npcr/



https://www.colorado.gov/pacific/sites/default/files/Copy%20of%20CDC%20NSCH%20Natl%20Survey%20Child%20Health%202012%20v4%202015R.xlsx






https://www.apha.org/

https://www.apha.org/

http://www.cdc.gov/cancer/npcr/

http://www.cdc.gov/DataStatistics/

http://www.cdc.gov/stltpublichealth/program/transformation/index.html



CMS – Centers for Medicare and Medicaid Services

NHE – National Health Expenditures


AHRQ HCUP – Discharges by Payer

Hospital Infection Rates

CMS Hospital Pricing IP 100 DRGs

Hospitals TPS – Total Performance







Gallup Poll: Health and Well-BeingNAHQACOs – Shared Savings Program






https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountsprojected.html


http://hcupnet.ahrq.gov/


https://data.medicare.gov/Hospital-Compare/Hospital-Value-Based-Purchasing-HVBP-Total-Perform/ypbt-wvdk


https://www.colorado.gov/pacific/sites/default/files/02%20NHE%20Natl%20Health%20Expense%20Hist%20to%202013%20Proj%20to%202024%20v3%20DataPivots.xlsx




https://www.colorado.gov/pacific/sites/default/files/Pivot%20AHRQ%20HCUP%202015r%20-%20Hospitalization%20by%20Payer%20Type.xlsx





http://file/C:/Users/Lorez%20Meinhold/Downloads/Gallup%20Survey%20Data%202015%20-%20State%20x%20State%20v2.xlsx



HCPF (HealthFirst Medicaid): Health Care & Public Financing


HCPF Expenditure Reports

HCPF Caseload Trends

Quality and Health Improvement

CHI – Medicaid Enrollment

CIVHC/APCD – Medicaid Utilization







Gallup Poll: Health and Well-BeingACOs – Shared Savings Program


See CIVHC/APCD





https://www.colorado.gov/hcpf/research-data-and-grants




https://www.colorado.gov/pacific/hcpf/premiums-expenditures-and-caseload-reports

https://www.colorado.gov/pacific/hcpf/premiums-expenditures-and-caseload-reports

https://www.colorado.gov/pacific/hcpf/quality-and-health-improvement-reports

http://www.coloradohealthinstitute.org/data-repository/results

https://www.comedprice.org/#/reports


https://www.colorado.gov/pacific/sites/default/files/02%20NHE%20Natl%20Health%20Expense%20Hist%20to%202013%20Proj%20to%202024%20v3%20DataPivots.xlsx







https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/SharedSavingsProgram/



CHI – Colorado Health Institute

CHAS Colorado Health Access Survey

County Data Workbooks

Workforce Prevalence

Colorado Health Report Card

County Health Profiles


Info Page SnapshotsPivots Pivot xls

Info Page SnapshotsPivots Pivot xls




Colorado Health FoundationGallup Poll: Health and Well-Being





http://www.coloradohealthinstitute.org/

http://www.coloradohealthinstitute.org/key-issues/detail/new-models-of-health-care/colorado-health-access-survey-1

http://www.coloradohealthinstitute.org/key-issues/detail/health-care-workforce/county-data-workbooks

http://www.coloradohealthinstitute.org/key-issues/category/health-care-workforce


http://www.coloradohealthinstitute.org/data-repository/county



https://www.colorado.gov/pacific/sites/default/files/CHI%20-%20Local%20County%20Data%20Workbook%20v4%20DataPivots%202015.xlsx


https://www.colorado.gov/pacific/sites/default/files/Pivot%20Table%20-%20WorkForce%20Prevalence%20CHI%202015%20Data.xlsx





http://www.coloradohealth.org/


CIVHC – All Payer Claims Database (APCD):

Quality and Burden of Illness

Utilization and Chronic Conditions

Total Cost of Care (TCC)

ED (Emergency Dept) Utilization

Pricing Hospital IP Discharges

Pricing Hospital OP Procedures


pdf Medicaid pdf Private Pivot xls



Info pdfX Snapshot m-power Pivot N/A


APCD National Council





http://civhc.org/


https://www.colorado.gov/pacific/sites/default/files/02%20CIVHC%20Quality%20and%20Illness%20Burden%20v3%20DataALL%202014%202016r.xlsx

https://www.colorado.gov/pacific/sites/default/files/04%20CIVHC%20Utilization%20and%20Chronic%20v2%20DataALL.xlsx


https://www.colorado.gov/pacific/sites/default/files/Pivot%20Table%20-%20Cost%20of%20Care%20-%20CIVHC%20APCD.xlsx


https://www.colorado.gov/pacific/sites/default/files/Pivot%20CIVHC%20APCD%20ED%20Utilization%20%25%20by%20Payer%20v3.xlsx



https://www.apcdcouncil.org/



Education - Colorado:

CDE – Colorado Dept of Education

CDE – Data and Accountability

Colorado - SchoolView Data Center

National Survey of Child Health

ESH - Education Super Highway

SBHA - School-Based Health Alliance







Colorado Children's Campaign - Kids Count National EducationX






http://www.cde.state.co.us/

http://www.cde.state.co.us/schoolview

https://edx.cde.state.co.us/SchoolView/DataCenter/reports.jspx?_adf_ctrl-state=pac20phbp_4&_afrWindowMode=0&_afrLoop=5323920506560372&_adf.ctrl-state=hd2dblxfp_4



http://childhealthdata.org/learn/NSCH

http://www.educationsuperhighway.org/

http://www.sbh4all.org/





https://www.colorado.gov/pacific/sites/default/files/Copy%20of%20CDC%20NSCH%20Natl%20Survey%20Child%20Health%202012%20v4%202015R.xlsx



http://www.coloradokids.org/



Return to Education Our County Our State - Public Health CMS/Medicare Education/ESH



Economic Metrics:


US Census.gov DOLA Colorado

American Community Survey

BEA Bureau of Economic Analysis

BLS Bureau of Labor and Statistics

FRED – Federal Reserve Economic Data







XX







https://www.census.gov/

https://demography.dola.colorado.gov/population/

https://www.census.gov/programs-surveys/acs/

http://www.bea.gov/

http://www.bls.gov/

https://fred.stlouisfed.org/









International Metrics


OECD – Health Metrics

Global Burden of Illness

Our World in Data

Guidelines Intl Network (GIN)

Cochrane Disease Registers






WHO – World Health OrganizationWorld Bank – Country StatisticsJCIA – The Joint Commission InternationalJCIA – International Library of MeasuresCIA – Country Statistics







http://www.oecd.org/els/health-systems/health-data.htm

http://www.healthdata.org/gbd

https://ourworldindata.org/

http://www.g-i-n.net/




https://www.colorado.gov/pacific/sites/default/files/Pivot%20Table%20-%20Healthcare%20Measures-%20Intl%20Comparison%20OECD%202014.xlsx




http://www.who.int/healthinfo/statistics/en/

http://data.worldbank.org/

http://www.jointcommissioninternational.org/

http://www.jointcommissioninternational.org/news/international-library-of-measures/

https://www.cia.gov/library/publications/the-world-factbook/



TPS – Quintiles of Colorado Hospitals, 2016




CoHID

Example Pivot: Colorado Population

Home

State - Public Health

Our County

Hospitals

Other Facilities

CDC/ NCHS/HP 2020

CHI/Other NGO

CMS/Medicare

HCPF/Medicaid

APCD/CIVHC

Education/ESH

Economics/BEA

International

CoHID can easily continue their current analytic tool, AND provide access to data in pivot table format.


CoHID Example:Colorado Trauma Registry

Currently, can only extract one location at a time, one year at a time.

The result is a pdf snapshot.

Instead of stakeholders having to transcribe or untangle the data into their own individual data register, CoHID should add an icon as an additional option for users to download the data in pivot format.

Once created, new data can easily be added as it is acquired.

Pivot allows for users to use features of Excel ie, calculations, graphs, conditional formatting and variance analysis.

Finally, pivot can publish to a web page for simple access to data.

Our County State - Public Health

CMS/Medicare Education/ESH

Hospitals CDC/ NCHS/HP 2020

HCPF/Medicaid Economics/BEA

Other Facilities

CHI/Other NGO APCD/CIVHC International

Internet Website

Tableau Video:Getting Started

https://public.tableau.com/en-us/s/gallery/50-years-crime-us

http://www.tableau.com/learn/tutorials/on-demand/getting-started

http://www.tableau.com/learn/tutorials/on-demand/getting-started

Tableau:- Corral the Data Sets- Normalize (Clean) the Data- Validate Data x Accountability- Prepare/Disseminate Reports

Additional Considerations:- Access/Use Source Data Sets- Dashboards/Visualizations- MetaData/Filtered Views- Public-Facing Data Capability

http://www.tableau.com/

Health Grades:

- Three tiers, only- No trends- No numerators

https://www.healthgrades.com/

actionable transparency for healthcare data

Health & Medicine