Survey of Resources for Health Care Analysts

Veronika BadurovaKennell & Associates, Inc.

Context

The purpose of this session is to provide a toolkit of available resources, such as reference information, data, or grouping software, that can be helpful to healthcare analysts.

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Objectives

After completing this session, the attendee will be able to:

• List key resources that are readily available and helpful to healthcare analysts

• Describe the Navy Analytics Newsletter• Locate the Agency for Healthcare Research and Quality Website• Describe the AHRQ Clinical Classification Software and identify at least

one functional use of the CCS• Describe the HCUP database• Locate the Centers for Disease Control (CDC) Website and identify

databases that may be helpful• Locate the RESDAC website and identify helpful resources• Locate the CMS website and identify helpful resources• Locate the BEA OCFO website and identify ICDs and Functional

Specifications for M2 and MDR• Locate the DMISID table and MEPRS Info Portal websites

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Navy Analytics Newsletter

• Published in M2• Public Folders → M2 → Navy → Analytics

Newsletter

• Outline:• Broad Issue Article • Skills & Methods• Data & Information Systems• New Knowledge• Tips and Tricks• Knowledge Sources

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Navy Analytics Newsletter

• Wide audience – sections pertain to every analyst level

• Variety of Topics• Financial Management• Populations• Data Quality• Mental Health• Medical Home Port• Obstetric Services

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Who is the Agency for Healthcare Research and

Quality (AHRQ)?

• AHRQ is an agency within DHHS.• AHRQ’s mission is “to improve the quality,

safety, efficiency, and effectiveness of health care for all Americans.”

• AHRQ has funded the creation of tools and resources that will help meet the needs of health care researchers/analysts and decision-makers.

AHRQ• AHRQ – Agency for Healthcare Research and Quality • Healthcare Cost and Utilization Project (HCUP, pronounced “H-Cup”) - is a

family of health care databases and related software tools and products developed through a Federal-State-Industry partnership, which brings together data collection efforts to create a national information resource patient-level health care data. http://www.hcup-us.ahrq.gov/overview.jsp

• Databases - Largest collection of longitudinal hospital care data in the U.S.• AHRQ Quality Indicators (QIs) – measures of health care quality, which

consist of 3 modules, that make use of readily available hospital inpatient administrative data.

• Clinical Classification Software (CCS) – developed with HCUP data, CCS is a grouping software that provides a method for classifying ICD-9-CM diagnoses or procedures into clinically meaningful categories. Great for aggregate statistical reporting. http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp

• Note: now also includes categories from the Clinical Classifications Software for Mental Health and Substance Abuse (CCS –MHSA)

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HCUPnet Capabilities

HCUPnet...CAN PRODUCE... CAN NOT PRODUCE

Simple statistics More complicated queries

Sample size calculations Multivariate analysesTrends information Statistics involving

certain variables Rank ordering of diagnoses and procedures

Statistics that may violate confidentiality (patient-, provider-, hospital-level data)

Significance testing

AHRQ

• Databases • Largest collection of longitudinal hospital care data in the

U.S.• Can be utilized for research on a broad range of health

policy issues: cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, state, and local market levels. http://www.hcup-us.ahrq.gov/databases.jsp

• Databases Include:• The National Inpatient Sample (starting in 1988)• The Kid’s Inpatient Database (starting in 1997)• The Nationwide Emergency Department Sample (starting in

2006)• The State Inpatient Databases (starting in 1995)• The State Ambulatory Surgery Databases (starting in 1997)• The State Emergency Department Databases (starting in 1999)

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HCUP Research Publications

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HCUP Databases

Research PublicationsUser Support

Software Tools

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HCUP Provides Many Research Products

Products include:

• Research studies• Statistical Briefs• Fact Books

Products include:

• Research studies• Statistical Briefs• Fact Books

HCUP Research Products

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Research Publications

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Statistical Brief Topics

More than 100 briefs posted – a new brief posted every two weeks:Pregnancy/ChildbirthTraumatic Brain InjuryReadmissions and Re-visitsAmbulatory SurgeriesPotentially Preventable HospitalizationsInjuriesPediatric HospitalizationsEmergency Room UtilizationMost Expensive Hospital Conditions

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Most Recent Report: HCUP Facts and Figures

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Methods Reports

Clinical Classification Software

• How does CCS work?• CCS consists of two related classification

systems – single & multi-level.• Single-level (of 231 mutually exclusive categories) is

most useful for ranking diagnosis/procedures and for direct integration into risk adjustment and other software while multi-level CCS is most useful when evaluating larger aggregations of conditions/procedures or exploring them in greater detail.

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Clinical Classification Software

• Example of Single-level CCS diagnosis categories• 98. Essential hypertension• 99. Hypertension with complications and secondary hypertension• 100. Acute myocardial infarction• 101. Coronary atherosclerosis and other heart disease

• Example of Multi-level CCS diagnosis categories• 7. Diseases of the circulatory system

     7.1. Hypertension         7.1.1. Essential hypertension [98]         7.1.2. Hypertension with complications & secondary hypertension[99]           7.1.2.1. Hypertensive heart and/or renal disease           7.1.2.2. Other hypertensive complications     7.2. Diseases of the heart

• CCS documentation: http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp#download

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Example of single-level CCS diagnosis codes

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DescriptionICD-9-CM diagnosiscodes used to map

CCS category

Essential Hypertension

401.1, 401.9 98

Hypertension with complications and secondary hypertension

401.0, 402.00, 402.01, 402.10, 402.11, 402.90, 402.91, 403.0, 403.00, 403.01, 403.1, 403.10, 403.11, 403.9, 403.90, 403.91, 404.0, 404.00,

404.01, 404.02, 404.03, 404.1, 404.10, 404.11, 404.12, 404.13, 404.9,

404.90, 404.91, 404.92, 404.93, 405.01, 405.09, 405.11, 405.19, 405.91,

405.99, 437.2

99

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Multi-level CCS category Description

ICD-9-CM diagnoses used to map

Single-level CCS used to map

7Diseases of the circulatory system

--

96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121

7.1 Hypertension -- 98 99

7.1.1Essential hypertension

-- 98

7.1.2

Hypertension with complications and secondary hypertension

-- 99

7.1.2.1Hypertensive heart and/or renal disease

40200 40201 40210 40211 40290 40291 4030 40300 40301 4031 40310 40311 4039 40390 40391 4040 40400 40401 40402 40403 4041 40410 40411 40412 40413 4049 40490 40491 40492 40493

--

7.1.2.2Other hypertensive complications

4010 40501 40509 40511 40519 40591 40599 4372

--

Example of multi-level CCS diagnosis codes

Clinical Classification Software

• How/For what can CCS be used?• CCS can be used as “crutch” for analysts who don’t know as

much about coding as they would like.• Serves as a way to crosswalk ICD-9 and CPT Procedure codes

especially useful for those procedures which can be done inpatient and outpatient.

• Managed care plans can use CCS to rank hospitalizations by type of condition (i.e.) specifically examine numbers of cases, length of stay, and total costs to better understand which conditions/procedures were associated with the highest resource use.

• Researchers can use CCS to explore conditions/procedures that are most frequent in their study populations or to compare alternative treatments for similar conditions or to develop risk adjustment models/as a way to predict future health resource utilization.

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HCUP User Support Resources

Download tools and products:

www.hcup-us@ahrq.gov

Active technical assistance:

E-mail: hcup@ahrq.gov

Phone: (866) 290-HCUP

CMS Website

• Regulation and Guidance • Research, Statistics, Data and Systems

• CMS Information Technology• Computer Data & Systems• Provider Type• Statistics, Trends & Reports

• Medicare Program Rates & Statistics• Medicare & Medicaid Trends in Health Care

Sectors

• Research• Monitoring Programs

• Payment Error Rate Measurement (PERM)• http://www.cms.gov/Research-Statistics-Data-and-Systems/Resea

rch-Statistics-Data-and-Systems.html

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RESDAC

• The Research Data Assistance Center (ResDAC) is a CMS contractor that provides free assistance to academic, government and non-profit researchers interested in using Medicare and/or Medicaid data for their research.

• ResDAC is staffed by a consortium of epidemiologists, public health specialists, health services researchers, biostatisticians, and health informatics specialists from the University of Minnesota.

• http://www.resdac.org/FOR OFFICIAL USE ONLY

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Center for Disease Control (CDC)

• Data & Statistics by Topic• http://www.cdc.gov/DataStatistics/

• Health Care Data Interactive• Healthy People 2010 Data

• http://www.cdc.gov/nchs/healthy_people/hp2010/DATA2010.htm

• Available Surveys and Data Collection Systems

• National Health and Nutrition Examination Survey (NHANES)

• National Health Interview Survey (NHIS)• National Immunization Survey (NIS)

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MDR & M2 Functional Specifications

• MDR & M2 Functional Specifications – OCFO BEA• Useful for: all MDR & M2 users• Contains:

• Functional specification of the MHS Data Repository and MHS Mart (M2),

• Data dictionaries for each file/database (MRD & M2)• Interface Control Documents (MDR & M2)• MDR Users Guide

• Includes sample code, background information on available databases, and UNIX commands.

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DMIS ID Table

• DMISID table (www.dmisid.com)• Definition: The Defense Medical Information

System Identifier• Useful for: all MDR & M2 users• Contains: A complete and up-to-date list DMIS

IDs, which are the controlling standard for both medical and military facility identification and cost/workload classification.• Addition elements: zip codes, catchment areas, prisms,

MSMAs, parent and child DMIS IDs, military service, etc.• Downloadable as a dataset • Note: MDR User Guide includes a section on format files

(and code) as there are annual DMIS ID reference tables in the MDR.

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MEPRS Info Portal

• MEPRS Info Portal (www.meprs.info )• Definition: Medical Expense & Performance

Reporting System• Useful for : all MDR & M2 users (esp. finance,

budget)• Contains: Feeds from EAS IV. MEPRS is the

standard cost accounting system for the MHS containing Tri-Service financial, personnel, and workload data from reporting MTFs/DTFs worldwide.• Consolidated Cost Report (CCR)• EAS IV Functional Data Dictionary• Six Sigma MEPRS Management Metrics• MEPRS Newsletter and Questions

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LOINC Codes

• LOINC (Logical Observation Identifiers Names and Codes)

• Definition: A universal code system for identifying laboratory and clinical observations. Much more detailed than normal CPT codes.• Useful for: all MDR users (esp. clinicians)• Structure:

• Website: http://loinc.org/

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ISO 3166 Code Lists

• The government is switching to two character ISO 3166 state and country codes. • http://www.iso.org/iso/country_codes/

iso_3166_code_lists.htm

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