Secondary Data Analysis I

Opportunities and Pitfalls

VERDICT Health Services Research Center

Laurel A. Copeland, MPH PhD VA Health Services Research &

Development UTHSCSA Department of Psychiatry copelandl@uthscsa.edu http://czresearch.com/dropbox

What Can Secondary Data Analysis Do for You?

• Provide preliminary data for grant proposals• Facilitate publication while you apply for

grants• Explore new areas

My CV Shope JT, Copeland LA, Maharg R, Dielman TE, Butchart AT (1993). Health Education Quarterly 20: 373-390. Shope JT, Copeland LA, Dielman TE (1994). Alcoholism: Clin Exper Res 18: 726-733. Shope JT, Copeland LA, Marcoux BC, Kamp ME (1996). J Drug Educ, 26: 323-337. Shope JT, Copeland LA, Maharg R, Dielman TE (1996). Alcoholism: Clin Exper Res 20: 791-798. Copeland LA, Shope JT, Waller PF (1996). J School Health 66: 254-260. Barry KL, Fleming MF, Manwell L, Copeland LA (1997). J Fam Prac 45: 151-158. Zimmerman MA, Copeland LA, Shope JT, Dielman, TE (1997). J Youth Adolescence 26: 117-141. Barry KL, Fleming MF, Manwell L, Copeland LA, Appel, Scott (1998). Fam Med 30:366-371. Blow FC, Barry KL, BootsMiller BJ, Copeland LA, McCormick R, Visnic S (1998). J Psychiatric Research 32: 311-319. Valenstein M, Barry KL, Blow FC, Copeland LA, Ullman E (1998). Psychiatric Services 49: 1043-1048. Shope JT, Copeland LA, Kamp ME, Lang SW (1998). J Drug Educ 28: 185-197. Kales HC, Blow FC, Copeland LA, Bingham RC, Kammerer EE, Mellow AF (1999). Am J Psychiatry 156: 550-556. Blow FC, Barry KL, Copeland LA, McCormick R, Lehmann L, Ullman E (1999). Psychiatric Services 50: 390-394. Maio RF, Shope JT, Blow FC, Copeland LA, Gregor MA, Brockmann LM, Weber JE, Metrou ME (2000). Annals Emerg Med 35:252-7. Kales HC, Blow FC, Bingham RC, Copeland LA, Mellow AM (2000). Psychiatric Services 51: 795-800. Roberts JS, Blow FC, Copeland LA, Barry KL, Van Stone W (2000). J Ger Psychiatry Neurology 13: 78-86. Blow FC, Walton MA, Barry KL, Coyne JC, Mudd SA, Copeland LA (2000). JAGS 48: 769-774. Kales HC, Blow FC, Bingham RC, Roberts JS, Copeland LA, Mellow AM (2000). Am J Geriatric Psychiatry 8:301-309. Blow FC, Ullman E, Barry KL, Bingham CR, Copeland LA, McCormick R, Van Stone W (2000). Am J Orthopsychiatry 70: 389-400. Valenstein M, Copeland LA, Owen R, Blow FC, Visnic S (2001). J Clin Psychiatry 62: 545-551. Valenstein M, Copeland LA, Owen R, Blow FC, Visnic S (2001). Psychiatric Services 52: 1242-4. Duffy SA, Terrell, Jeff, Valenstein M, Ronis, David, Copeland LA, Connors, Mary (2002). Gen Hosp Psychiatry 24: 140-7. Valenstein M, Copeland LA, Blow FC, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T (2002). Med Care 40: 630-9. Hegedus, Andrea M, Copeland LA, Barry KL, Blow FC. (2002). American Journal of Orthopsychiatry 72: 331-340. Copeland LA, Blow FC, Barry KL (2003). Health Education & Behavior 30:305-21. Copeland LA, Zeber JE, Valenstein M, Blow FC (2003). Am J Psychiatry 160:1817-1822. Valenstein M, Blow FC, Copeland LA, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T (2004). Schizophr Bull 30: 255-64. Janz NK, Wren PA, Copeland LA, Lowery JC, Goldfarb SL, Wilkins EG. (2004). J Clin Oncology 22:3091-3098. Lambert MT, Terrell JE, Copeland LA, Ronis DL, Duffy SA. (2005). Nicotine & Tobacco Research 7:233-241. Copeland LA, Fletcher CE, Patterson J(2005). Military Medicine 170:602-606. Copeland LA, Elshaikh MA, Jackson J, Penner LA, Underwood III W (2005). Cancer 104:1372-1380. O'Neill JL, Flanagan PS, Zaleon CR, Copeland LA (2005). Pharmacotherapy 25:1560-1565. Pugh MJV, Copeland LA, Zeber JE, Cramer JA, Amuan MT, Cavazos JE, Kazis LE (2005). Epilepsia 46:1820-7. Copeland LA, Zeber JE, Rosenheck RA, Miller AL (2006). Med Care 44:110-116. Lambert MT, Copeland LA, Sampson N, Duffy SA (2006). Progress Neuropsychopharm Biol Psychiatry 30:919-23. Hopp FP, Woodbridge P, Subramanian U, Copeland LA, Smith D, Lowery JC (2006). Telemedicine and eHealth 12:297-307. Silveira MJ, Copeland LA, Feudtner C (2006). Am J Public Health 96:1243-1248. Zeber JE, Copeland LA, Grazier KL (2006). Military Medicine 171:619-26. Wilkins EG, Lowery JC, Copeland LA, Goldfarb SL, Wren PA, Janz NA (2006). Medical Decision Making 26:589-598. Copeland LA, Mortensen EM, Zeber JE, Pugh MJ, Restrepo MI, Dalack GW (2007). Progress Neuro-Psychopharm Biol Psychiatry 31:720-6 Alexander JA, Copeland LA, Metzger ME (2007). Clinical Toxicology 45(5):440-50. Kilbourne AM, Copeland LA, Zeber JE, Bauer MS, Lasky EC, Good CB (2007). Psychopharmacology Bulletin 40:104-15 Fletcher CE, Baker SJ, Copeland LA, Reeves PJ, Lowery JC (2007). Journal of Nursing Scholarship 39:358-62 Duffy SA, Copeland LA, Hopp FP, Zalenski RJ (2007). Journal of Palliative Medicine 10:1137-45 Mortensen EM, Restrepo MI, Copeland LA, Pugh JA, Anzueto AR, Cornell JE, Pugh MJ (2007). Pharmacotherapy 27: 1619-26 Kilbourne AM, Post EP, Bauer MS, Zeber JE, Copeland LA, Good CB, Pincus HA (2007). J Affective Disorders 102:145-51. Zeber JE, Copeland LA, Amuan ME, Cramer JA, Pugh MJ (2007). Epilepsy & Behavior 10:539-46. Mortensen EM, Pugh MJ, Copeland LA, Restrepo MI, Cornell JE, Anzueto A, Pugh JA (2008). Eur Respir J 31(3):611-7. Copeland LA, Zeber JE, Salloum IM, Pincus HA, Fine MJ, Kilbourne AM (2008). J Nerv Ment Disease 196:16-21. Leibowitz RQ, Jeffreys MD, Copeland LA, Noel PH (2008). Gen Hosp Psychiatry 30:100-3. Pugh MJ, Van Cott AC, Cramer JA, Knoefel JE, Amuan ME, Tabares J, Ramsay RE, Berlowitz DR; TIGER Team (2008). Neurology 70:2171-8. Zeber JE, Copeland LA, Good CB, Fine MJ, Bauer MS, Kilbourne AM (2008). J Affect Disord 107:53-62. Copeland LA, Zeber JE, Pugh MJ, Mortensen EM, Restrepo MI, Lawrence VA (2008). Annals Surg 248:31-8. Pugh MJ, Zeber JE, Copeland LA, Tabares JV, Cramer JA (2008). Psychiatric Services 59:925-8. Zeber JE, Copeland LA, Hosek BJ, Karnad AB, Lawrence VA, Sanchez-Reilly SE (2008). Crit Rev Oncology/Hematology 67:237-42. Mortensen EM, Restrepo MI, Copeland LA, Pugh JA, Anzueto AR (2008). Am J Med Sci Zeber JE, Copeland LA, McCarthy JF, Bauer MS, Kilbourne AM (2009). Am J Public Health Copeland LA, Miller AL, Welsh DE, McCarthy JF, Zeber JE, Kilbourne AM (2009). Am J Public Health

My CV without 2° Data Shope JT, Copeland LA, Maharg R, Dielman TE, Butchart AT (1993). Health Education Quarterly 20: 373-390. Shope JT, Copeland LA, Dielman TE (1994). Alcoholism: Clin Exper Res 18: 726-733. Shope JT, Copeland LA, Marcoux BC, Kamp ME (1996). J Drug Educ, 26: 323-337. Shope JT, Copeland LA, Maharg R, Dielman TE (1996). Alcoholism: Clin Exper Res 20: 791-798. Copeland LA, Shope JT, Waller PF (1996). J School Health 66: 254-260. Barry KL, Fleming MF, Manwell L, Copeland LA (1997). J Fam Prac 45: 151-158. Zimmerman MA, Copeland LA, Shope JT, Dielman, TE (1997). J Youth Adolescence 26: 117-141. Barry KL, Fleming MF, Manwell L, Copeland LA, Appel, Scott (1998). Fam Med 30:366-371. Blow FC, Barry KL, BootsMiller BJ, Copeland LA, McCormick R, Visnic S (1998). J Psychiatric Research 32: 311-319. Valenstein M, Barry KL, Blow FC, Copeland LA, Ullman E (1998). Psychiatric Services 49: 1043-1048. Shope JT, Copeland LA, Kamp ME, Lang SW (1998). J Drug Educ 28: 185-197. Kales HC, Blow FC, Copeland LA, Bingham RC, Kammerer EE, Mellow AF (1999). Am J Psychiatry 156: 550-556. Blow FC, Barry KL, Copeland LA, McCormick R, Lehmann L, Ullman E (1999). Psychiatric Services 50: 390-394. Maio RF, Shope JT, Blow FC, Copeland LA, Gregor MA, Brockmann LM, Weber JE, Metrou ME (2000). Annals Emerg Med 35:252-7. Kales HC, Blow FC, Bingham RC, Copeland LA, Mellow AM (2000). Psychiatric Services 51: 795-800. Roberts JS, Blow FC, Copeland LA, Barry KL, Van Stone W (2000). J Ger Psychiatry Neurology 13: 78-86. Blow FC, Walton MA, Barry KL, Coyne JC, Mudd SA, Copeland LA (2000). JAGS 48: 769-774. Kales HC, Blow FC, Bingham RC, Roberts JS, Copeland LA, Mellow AM (2000). Am J Geriatric Psychiatry 8:301-309. Blow FC, Ullman E, Barry KL, Bingham CR, Copeland LA, McCormick R, Van Stone W (2000). Am J Orthopsychiatry 70: 389-400. Valenstein M, Copeland LA, Owen R, Blow FC, Visnic S (2001). J Clin Psychiatry 62: 545-551. Valenstein M, Copeland LA, Owen R, Blow FC, Visnic S (2001). Psychiatric Services 52: 1242-4. Duffy SA, Terrell, Jeff, Valenstein M, Ronis, David, Copeland LA, Connors, Mary (2002). Gen Hosp Psychiatry 24: 140-7. Valenstein M, Copeland LA, Blow FC, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T (2002). Med Care 40: 630-9. Hegedus, Andrea M, Copeland LA, Barry KL, Blow FC. (2002). American Journal of Orthopsychiatry 72: 331-340. Copeland LA, Blow FC, Barry KL (2003). Health Education & Behavior 30:305-21. Copeland LA, Zeber JE, Valenstein M, Blow FC (2003). Am J Psychiatry 160:1817-1822. Valenstein M, Blow FC, Copeland LA, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T (2004). Schizophr Bull 30: 255-64. Janz NK, Wren PA, Copeland LA, Lowery JC, Goldfarb SL, Wilkins EG. (2004). J Clin Oncology 22:3091-3098. Lambert MT, Terrell JE, Copeland LA, Ronis DL, Duffy SA. (2005). Nicotine & Tobacco Research 7:233-241. Copeland LA, Fletcher CE, Patterson J(2005). Military Medicine 170:602-606. Copeland LA, Elshaikh MA, Jackson J, Penner LA, Underwood III W (2005). Cancer 104:1372-1380. O'Neill JL, Flanagan PS, Zaleon CR, Copeland LA (2005). Pharmacotherapy 25:1560-1565. Pugh MJV, Copeland LA, Zeber JE, Cramer JA, Amuan MT, Cavazos JE, Kazis LE (2005). Epilepsia 46:1820-7. Copeland LA, Zeber JE, Rosenheck RA, Miller AL (2006). Med Care 44:110-116. Lambert MT, Copeland LA, Sampson N, Duffy SA (2006). Progress Neuropsychopharm Biol Psychiatry 30:919-23. Hopp FP, Woodbridge P, Subramanian U, Copeland LA, Smith D, Lowery JC (2006). Telemedicine and eHealth 12:297-307. Silveira MJ, Copeland LA, Feudtner C (2006). Am J Public Health 96:1243-1248. Zeber JE, Copeland LA, Grazier KL (2006). Military Medicine 171:619-26. Wilkins EG, Lowery JC, Copeland LA, Goldfarb SL, Wren PA, Janz NA (2006). Medical Decision Making 26:589-598. Copeland LA, Mortensen EM, Zeber JE, Pugh MJ, Restrepo MI, Dalack GW (2007). Progress Neuro-Psychopharm Biol Psychiatry 31:720-6 Alexander JA, Copeland LA, Metzger ME (2007). Clinical Toxicology 45(5):440-50. Kilbourne AM, Copeland LA, Zeber JE, Bauer MS, Lasky EC, Good CB (2007). Psychopharmacology Bulletin 40:104-15 Fletcher CE, Baker SJ, Copeland LA, Reeves PJ, Lowery JC (2007). Journal of Nursing Scholarship 39:358-62 Duffy SA, Copeland LA, Hopp FP, Zalenski RJ (2007). Journal of Palliative Medicine 10:1137-45 Mortensen EM, Restrepo MI, Copeland LA, Pugh JA, Anzueto AR, Cornell JE, Pugh MJ (2007). Pharmacotherapy 27: 1619-26 Kilbourne AM, Post EP, Bauer MS, Zeber JE, Copeland LA, Good CB, Pincus HA (2007). J Affective Disorders 102:145-51. Zeber JE, Copeland LA, Amuan ME, Cramer JA, Pugh MJ (2007). Epilepsy & Behavior 10:539-46. Mortensen EM, Pugh MJ, Copeland LA, Restrepo MI, Cornell JE, Anzueto A, Pugh JA (2008). Eur Respir J 31(3):611-7. Copeland LA, Zeber JE, Salloum IM, Pincus HA, Fine MJ, Kilbourne AM (2008). J Nerv Ment Disease 196:16-21. Leibowitz RQ, Jeffreys MD, Copeland LA, Noel PH (2008). Gen Hosp Psychiatry 30:100-3. Pugh MJ, Van Cott AC, Cramer JA, Knoefel JE, Amuan ME, Tabares J, Ramsay RE, Berlowitz DR; TIGER Team (2008). Neurology 70:2171-8. Zeber JE, Copeland LA, Good CB, Fine MJ, Bauer MS, Kilbourne AM (2008). J Affect Disord 107:53-62. Copeland LA, Zeber JE, Pugh MJ, Mortensen EM, Restrepo MI, Lawrence VA (2008). Annals Surg 248:31-8. Pugh MJ, Zeber JE, Copeland LA, Tabares JV, Cramer JA (2008). Psychiatric Services 59:925-8. Zeber JE, Copeland LA, Hosek BJ, Karnad AB, Lawrence VA, Sanchez-Reilly SE (2008). Crit Rev Oncology/Hematology 67:237-42. Mortensen EM, Restrepo MI, Copeland LA, Pugh JA, Anzueto AR (2008). Am J Med Sci Zeber JE, Copeland LA, McCarthy JF, Bauer MS, Kilbourne AM (2009). Am J Public Health Copeland LA, Miller AL, Welsh DE, McCarthy JF, Zeber JE, Kilbourne AM (2009). Am J Public Health

Is it scientifically valid to use data for purposes for which they were not originally collected?

How comfortable are you with this idea? What is the alternative?

Today and next week

Learn some uses of secondary data Learn about sources of secondary data Understand possible effects of HIPAA on this type of research Describe biases commonly encountered in secondary data Describe frequently used research designs in health services

research. Define risk adjustment and why it is important in HSR; give

examples of methods Discuss rationale for methods to account for nesting or clustering

of data

Methods of Learning

Lecture & discussion In-class epidemiologic exercise Journal article evaluation – readings are

online (http://czresearch.com/dropbox/) Optional proposal abstract for your own

secondary data analysis

Different Uses

Health Care Delivery Quality assessment Geographic variation; under- or over-utilization Adverse events Outcomes of a particular treatment Cost

Natural history incidence, prevalence prognosis Association not causation

Other Regulatory

Some Examples

To show you the range of usesTo show you the work is publishable

Regulatory enforcement

TENET HEALTHCARE – 2002

Medicare Report Jan-Oct 2004 included these findings: – At Alvarado Hospital, prosecutors accused Tenet of running covert

kickback arrangements – Document requests were received from federal prosecutors in L.A. – False claims were uncovered and the company agreed to pay

$22.5M to settle allegations – Redding Medical Center was determined to be performing

unnecessary cardiac surgery – Tenet sold some holdings to Hospital Partners of America to

satisfy part of the 2003 settlement with federal officials – Whistleblowers were to receive over $8M

Whose data set is it anyway? Sharing raw data

from randomized trials

Andrew J VickersTrials. 2006 May 16;7:15

http://www.trialsjournal.com/content/pdf/1745-6215-7-15.pdf

Risk of death in elderly users of conventional vs. atypical antipsychotic medications

Wang PS, Schneeweiss S, Avorn J, Fischer MA, Mogun H, Solomon DH,

Brookhart MA. N Engl J Med. 2005 Dec 1;353(22):2335-41

http://content.nejm.org/cgi/reprint/353/22/2335.pdf

Cancer incidence in Kentucky, Pennsylvania, and West

Virginia: disparities in Appalachia

Lengerich EJ, Tucker TC, Powell RK, Colsher P, Lehman E, Ward AJ,

Siedlecki JC, Wyatt SW (2005). J Rural Health 21(1):39-47.

http://www.blackwell-synergy.com/toc/jrh/21/1

Does Medicare coverage of colonoscopy reduce racial/ethnic

disparities in cancer screening among the elderly?

Shih YC, Zhao L, Elting LS (2006). Health Aff (Millwood). Jul-Aug;

25(4):1153-62. http://content.healthaffairs.org/cgi/content/full/25/4/1153

Can you think of examples of secondary data analysis that you have read in the medical literature?

Any that have influenced your practice or your research direction?

Anything you would like to see investigated but have not yet found in the literature?

Exercise #1 Policy Decision on

FundingOf Regional Trauma

Center (handout)

Secondary Data Exercise #1A Regional Trauma Center (which encourages the surrounding

hospitals to refer patients with serious injuries to it for expert care) is seeking additional funds from next year’s health budget for more equipment and staff. A local politician (who would rather spend such money on a new hospital named after his father) criticizes this request for additional resources by claming that Regional Trauma Centers do not, in fact, save lives, and he submits the following data to back up his claim.

You are asked for your opinion on these data. How should you respond?

surrounding hospitals regional trauma center

# of cases # of deaths

# of cases # of deaths

Total 7,266 458 3,354 212

Case-fatality rate 458/7,266 = 6.3% 212/3,354 = 6.3%

Secondary Data Exercise #1

You, being expert in possible sources of confounding in secondary data, say the data are incomplete as presented. You propose re-analysis, taking into account the severity of the trauma in all treated cases.

By examining the data stratified by severity, the value of the regional trauma center becomes clear.

Severity of Trauma Surrounding Hospitals Regional Trauma Center

# cases # deaths fatality rate

# cases # deaths

fatality rate

Mild 3,734 37 1.0% 687 3 0.4%

Moderate 1,887 94 5.0% 1,238 37 3.0%

Severe 1,645 327 19.9% 1,429 172 12.0%

Total 7,266 458 6.3% 3,354 212 6.3%

Interpret data carefully

Data Quality

• If no reliable (accurate and adequate) data are available, questions about risk adjustment are moot

• Inconsistent practices in assigning standard ICD9 codes & names to diseases exist—but this has improved over time (Do you know who assigns the codes?) http://www.eicd.com/

• Lack of specificity of ICD9 system in some diagnostic areas, especially with regard to severity

Administrative Data Limitations

Need patient-specific identifiers to link episodes Need multi-year data when outcomes are infrequent Limited generalizability if restricted by type of

institution or hospital, by type of payor, or by location/region

May lack important clinical variables known to be related to outcomes (especially clinical tests or qualitative evaluations of severity)

Secondary Database Analysis Ia

Sources of Data

Data Sources

Financial or Claims Files Electronic Medical Records Survey Data Trial Data

NHLBI Clinical Trialshttp://www.nhlbi.nih.gov/resources/deca/default.htm - National Heart Lung & Blood Institute

Study Name    Prepared/Updated  ↓

Asymptomatic Cardiac Ischemia Pilot (ACIP) 01/2000

Lung Health Study (LHS) 08/2001

Thrombolysis in Myocardial Infarction Study (TIMI II) 08/2001

Intermittent Positive Pressure Breathing (IPPB) 05/2001

Post Coronary Artery Bypass Graft Study (CABG) 05/2001

Antiarrhythmics Versus Implantable Defibrillators(AVID) 02/2002

Asthma Clinical Research Network: Beta Agonist in Mild Asthma (ACRN: BAGS) 02/2002

Digitalis Investigation Group (DIG) 02/2002

Asthma Clinical Research Network: Colchicine in Moderate Asthma (ACRN: CIMA) 02/2002

Psychophysiological Investigation of Myocardial Ischemia (PIMI) 07/2002

Coronary Artery Surgery Study (CASS) 07/2003

High Frequency Ventilation in Premature Infants Study (HIFI) 07/2003

Multiple Risk Factor Intervention Trial (MRFIT) 07/2003

Raynaud's Treatment Study (RTS) 05/2003

Acute Respiratory Distress Syndrome Clinical Network (ARDSNet 01/03): Lower versus higher tidal volume, lisofylline treatment and ketoconazole treatment (3 study factorial)

07/2003

… etc.

NHLBI Clinical Trials - most recent

Study Name    Prepared/Updated  ↓

Public Access Defibrillation (PAD) Community Trial 08/2007

Bypass Angioplasty Revascularization Investigation (BARI) 11/2007

Women's Health Initiative: Clinical Trials (WHI-CT) 02/2008

Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial

03/2008

Acute Respiratory Distress Syndrome Clinical Network (ARDSNet02): Efficacy of Corticosteroids as Rescue Therapy for the Late Phase of Acute Respiratory Distress Syndrome (

LaSRS)

05/2008

Acute Respiratory Distress Syndrome Clinical Network (ARDSNet05): Fluid and Catheter Treatment Trial (FACTT)

05/2008

Viral Activation Transfusion Study (VATS) 05/2008

National Emphysema Treatment Trial (NETT) 08/2008

NHLBI Epidemiology Studies (selected)

http://www.nhlbi.nih.gov/resources/deca/directry.htm

Study Name    Prepared/Updated   

A Case-Control Etiologic Study of Sarcoidosis (ACCESS) 04/2004

Atherosclerosis Risk in Communities Study (ARIC) 01/2008

Bogalusa Heart Study (BHS) 12/2006

Cardiovascular Health Study (CHS) 07/2008

Coronary Artery Risk Development in Young Adults (CARDIA) 11/2007

Cord Blood Transplant Study (COBLT) 01/2007

Framingham Heart Study-Cohort 03/2007

Framingham Heart Study-Offspring 05/2007

Honolulu Heart Program (HHP) 01/2004

Lipid Research Clinics- Prevalence Study (LRCPS) 02/2005

NHLBI Growth and Health Study (NGHS) 09/2005

National Longitudinal Mortality Study (NLMS) 01/2000

Puerto Rico Heart Health Program (PRHHP) 12/2002

Cooperative Study of Sickle Cell Disease (CSSCD) 07/2008

National Center for Health Statistics (NCHS)

http://www.cdc.gov/nchs/

NCHS Public-use Data Files & Documentation

About Public-use data files - http://www.cdc.gov/nchs/datawh/ftpserv/ftpdata/aboutpud.htm Data Release Policy - http://www.cdc.gov/nchs/about/policy/reldata.htm Data Use Restrictions - http://www.cdc.gov/nchs/datawh/dur.htm NHANES III Errata

Data from the National Health and Nutrition Examination Survey (NHANES) What’s New http://www.cdc.gov/nchs/about/major/nhanes/whatsnew.htm Third National Health and Nutrition Examination

http://www.cdc.gov/nchs/about/major/nhanes/nh3data.htm Reference Manuals and Reports/Plan and Operations http://www.cdc.gov/nchs/data/nhanes/nhanes3/cdrom/main.pdfAnalytic Guidelines http://www.cdc.gov/nchs/data/nhanes/nhanes3/nh3gui.pdfNHANES I Epidemiologic Followup Study (NHEFS)

http://www.cdc.gov/nchs/products/elec_prods/subject/nhefs.htm

Longitudinal Studies of Aging (LSOA ) http://www.cdc.gov/nchs/lsoa.htm - available on CD

National Health Interview Survey (NHIS)http://www.cdc.gov/nchs/nhis.htm

National Center for Health Statistics (NCHS)

National Ambulatory Medical Care Survey (NAMCS), 1993-2000http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm

National Ambulatory Medical Care Survey (NAMCS), 1973-1992http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm

National Hospital Ambulatory Medical Care Survey (NHAMCS), 1992-2000 http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm

National Hospital Discharge Survey (NHDS), 1996-2000& National Survey of Ambulatory Surgery (NSAS), 1994-1996

http://www.cdc.gov/nchs/about/major/hdasd/nhds.htm

National Home and Hospice Care Survey (NHHCS), 1996http://www.cdc.gov/nchs/nhhcs.htm

National Nursing Home Survey (NNHS), 1995 and 1997http://www.cdc.gov/nchs/nnhs.htm

NCHS

Behavioral Risk Factor Surveillance System (BRFSS)

http://www.cdc.gov/brfss/ Datasets are large – ASCII version may be 15Mb for

a single year Documentation is online with data 24 years of data available at

http://www.cdc.gov/brfss/technical_infodata/surveydata.htm

Don’t forget the citation! http://www.cdc.gov/brfss/suggestedcitation.htm

VA Data

Data descriptions and access details are documented (http://www.virec.research.va.gov) No public use files; must be VA employee/WOC Data: administrative, hospital/facility level data, medical record information, patient-level medical care data including procedures, surgeries, radiography, laboratory (some), pharmacy, and diagnoses, all in SAS datafiles 5.5 million patients with incentive to stay in the system

Healthcare Cost and Utilization Project (HCUP)

Largest collection of all-payer longitudinal hospital data in US available for release to researchers

Family of administrative databases and tools maintained by AHRQ

As of 2002 data, 35 state-level data organizations contribute data on hospital stays including Texas

http://www.hcup-us.ahrq.gov/home.jsp What's New – right-hand insetWhat is HCUPHCUP Products (data are not free)HCUP Services

FACT SHEET – very informativeNote the Clinical Classifications Software (CCS) & Comorbidity Software (this is free)

HCUP DatabasesState Inpatient Databases (SID)State Ambulatory Surgery Databases (SASD)State Emergency Department Databases (SEDD)Nationwide Inpatient Sample (NIS)Kids' Inpatient Database (KID)

Healthcare Cost & Utilization Project (HCUP)

Another AHRQ product - http://www.meps.ahrq.gov/

Overview: MEPS Web SiteThe Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States.

MEPS Web SiteSurveys used, data available, canned reports, data FAQ’s, MEPSnet query tools, etc.

http://www.meps.ahrq.gov/mepsweb/data_stats/data_overview.jsp

Medical Expenditure Panel Survey (MEPS)

DATA from Substance Abuse and Mental Health Data Archives (SAMHDA)

http://www.icpsr.umich.edu/SAMHDA/ "A national resource providing public data

access and online analysis" SAMHDA Helpline: 1-888-741-7242

Local: (734) 615-9524Fax: (734) 647-8200e-mail: samhda-support@icpsr.umich.edu

CTS Surveys: from HSC, funded by RWJF, stored at ICPSR

- Household Survey, Employer Survey, Physician SurveyTo provide an in-depth look at the issues and challenges physicians face in the rapidly changing health care system, HSC's Community Tracking Study includes a Physician Survey.

http://www.hschange.org/index.cgi?data=04 Get data from ICPSR http://www.icpsr.umich.edu/HMCA/

Health Medical & Care Archive (HMCA) - Health System Change (HSC) – The Robert Wood Johnson Foundation – ICPSR Archives

SEER: Surveillance Epidemiology & End Results

http://seer.cancer.gov/registries/ SEER*Stat software:

http://seer.cancer.gov/seerstat/

Websites with Database Lists

AHRQ http://www.ahrq.gov/ NLM http://www.nlm.nih.gov/ CDC http://www.cdc.gov/ VIREC http://www.virec.research.va.gov/ HERC http://www.herc.research.va.gov/ ICPSR http://www.icpsr.umich.edu/ Census & CDC: http://dataferrett.census.gov/

Who Will Fund Your Analyses?

Your institution has a listserv: FUNDINGINFO2@LISTS.UTHSCSA.EDU NIH has career development awards : http://grants1.nih.gov/training/ -- and RFAsAnd there are Program Announcements that are pertinent, e.g., these from NIAAA:

Secondary Analysis of Existing Alcohol Epidemiology Data (R21): PA-08-168 http://grants.nih.gov/grants/guide/pa-files/PA-08-168.html

Secondary Analysis of Existing Alcohol Epidemiology Data (R03): PA-08-169 http://grants.nih.gov/grants/guide/pa-files/PA-08-169.html

VA HSR&D has grants (PI must be or become 5/8+ VA) http://www.hsrd.research.va.gov/for_researchers/ Foundations have grants (ADA, AHRQ, Hogg, NARSAD, etc.) Local pots of money

UTHSCSA Career Development

Delgado, McManus & Lichtenstein offer a series on Career Development including this set of presentations on K-Awards (NIH Career Development Awards) http://iims.uthscsa.edu/ed_kpaseo_workshop.html

Your Assignment

Read; think If you want extra feedback, e-mail me a 1-

page proposal abstract for a database analysis related to your area of interest any time in next few yearscopelandl@uthscsa.edu