Title: VA and NonVA Databases and Their Uses Part 1
1VA and Non-VA Databases and Their UsesPart 1
- Nancy Petersen, PhD
- Michael Johnson, PhD
2- VA databases
- National Patient Care Databases
- BIRLS Death File
- Veteran Population
- Pharmacy Benefits Management Files
- Data warehouses
- Non-VA database
- National Death Index
3- Additional VA databases
- Decision Support System
- External Peer Review Program
- National Surgical Quality Improvement Program
- Some non-VA databases
- Medicare and Medicaid
- Surveillance, Epidemiology, and End-Results
Program (SEER) Files
4Why databases?
- HSR and HCQCUS have a long history of using
large, administrative databases - Health care system studies
- Large regional or national populations
- Data already collected
- Data not originally intended for research
5VISTA Veterans Information System Technology
Architecture
- Local VAMC Computer system aka Decentralized
Hospital Computer Program (DHCP) - Patient and hospital operations info
- Computerized Patient Record System (CPRS)
- Source of data for regional and national databases
6Local, Regional, National VA Databases
7Patient Treatment Files (1)
- PTF
- Discharge databases
- Fiscal year (e.g., FY00 discharge dates of
10/1/99 to 9/30/00) - Austin mainframe
- FY70 forward
- HCQCUS UNIX version
- FY88 - FY03
- FY82 - FY87 subsets
8Patient Treatment Files (2)
- 4 types of files on Austin mainframe
- Main (hospital stay info)
- Surgery file (surgical suite)
- Procedure file (non-surgical suite procedures)
- Partial information FY84 - FY87
- Full information FY88 - present
- Bed section (each bed section within a patients
hospital stay) - Availability same as for procedure file
9Patient Treatment Files (3)
- Basic information
- VA Station Number
- Veterans Integrated Service Network (VISN)
- Dates of admission and discharge
- Dates of surgeries and procedures
10Patient Treatment Files (4)
- Demographic information
- Scrambled SSNs
- Age
- Race
- Gender
- Marital status
- Income
- County of residence
11Patient Treatment Files (5)
- Clinical information
- First-listed diagnosis
- Principal diagnosis (admitting diagnosis)
- FY95 forward
- Primary diagnosis (longest length of stay)
- Pre - FY95
- 9 associated diagnoses
12Patient Treatment Files (6)
- Clinical information
- Surgical Procedure Files
- 5 surgical procedures (ICD-9) per visit to the
operating room - Multiple procedures (ICD-9) performed in areas
other than surgical suite
13Patient Treatment Files (7)
- Limitations
- No lifestyle information such as smoking, alcohol
abuse unless coded by MD/coder - No functional status
- No lab, X-ray results
- Care outside VA that is not paid for by VA is not
captured - outside care paid by VA is in Contract Files
- lack same level of detail as PTF files
14Patient Treatment Files (8)
- Advantages
- Unique patient identifier (scrambled SSN)
- Longitudinal follow-up
- Merge with other VA databases
- Unscrambled SSN is available
- Over 15 years inpatient data
- Cohort studies
- Risk-adjustment (demographic variables, 1st
listed diagnosis, comorbidities)
15Patient Treatment Files (9)
- Uses
- 14-day readmission for specific cohorts
- Patterns of use of inpatient care
- bed days of care, lengths of stay
- discharge rate
- multi-stay ratio
- Geographic variation among VISNs, Census Bureau
regions/divisions - Case-mix differences
16Extended Care Files
- Discharge databases
- VA long-term care facilities
- VA nursing homes
- VA domiciliaries
- Contract nursing home care
- State nursing homes
- Same structure as PTF files
- Austin mainframe
17VA Census Files
- Patients not yet discharged at end of FY
- Similar format to PTF, excluding discharge info
- Count of patients treated in FY
- Austin mainframe
18Outpatient Clinic Files (1)
- OPC
- Visits to staff at VA outpatient clinics
- VA medical centers
- Free-standing VA community clinics
- FY80-FY85, 20 sample
- Since then, 100 of patient visits
- Over 65 million records in FY03
19Outpatient Clinic Files (2)
- Basic information
- VA Station Number
- Veterans Integrated Service Network (VISN)
- Dates of clinic visit
- Type of clinic (clinic stop)
20Outpatient Clinic Files (3)
- Demographic information
- Scrambled SSN
- Age
- Eligibility
- Means Test
- County of residence
- Race (not always coded)
21Outpatient Clinic Files (4)
- Clinical information
- 11 ICD-9 diagnosis codes
- FY97 - present
- 15 CPT codes for outpatient procedures
- Partial procedure files FY90 - FY96
- Full procedure files FY97 - present
22Outpatient Clinic Files (5)
- Limitations
- No lab, X-ray results
- Outpatient care received outside VA that is not
paid for by VA is not captured - Diagnoses only available since 1997
23Outpatient Clinic Files (6)
- Advantages
- Unique patient identifier (scrambled SSN)
- Longitudinal follow-up
- Merge with other databases
- Uses
- Volume and patterns of utilization
- visits to primary care clinics
- visits to ER and urgent care (may indicate lack
of continuity of care)
24Outpatient Clinic Files (7)
- Uses (continued)
- visits to specialists
- use of lab and X-rays
- use of procedures
- Examples
- and type of cardiac tests and procedures
- association between pneumonia vaccination and
subsequent hospitalization for pneumonia
25Contract Files
- Care by non-VA providers paid for by VA
- Inpatient
- Extended care
- Outpatient care (fee-basis)
- Less detailed than information from VA settings
- Provides a more complete picture of utilization
26BIRLS Death Files (1)
- Beneficiary Identification and Records Locator
Subsystem - Collected by Veterans Benefits Administration
- Deaths reported to VBA by VAMC, families, funeral
directors - Supplemented by information from Social Security
Administration
27BIRLS Death Files (2)
- Basic information
- SSN
- Name
- Gender
- Dates of military service
- Date of birth
- Date of death
- Cause of death is NOT useful
- only coded as natural or unnatural
28BIRLS Death Files (3)
- Updated quarterly
- Created in 1972
- High degree of accuracy has been reported in
literature - 1980s
- Our experience has shown that BIRLS and PTF (PTF
date of death and disposition type dead, with
or without autopsy) should both be used to
identify deaths
29National Death Index (1)
- Death record information submitted by State vital
statistics offices to National Center for Health
Statistics - Use to determine if persons in studies have died
- Name of state where death occurred
- Date of death
- Death certificate number
- Cause of death available from NDI Plus
30National Death Index (2)
- Includes deaths from 1979 forward
- Deaths are added to NDI annually, approximately 1
year after a particular calendar year - In Spring 2004, deaths from 2002 are available
31National Death Index (3)
- Matching criteria
- SSN
- First name
- Last name
- Fathers surname
- Date of birth
32National Death Index (4)
- Use of NDI and NDI Plus requires application
process for approval - Fees are involved
- 350 initial submission of user records, 100
subsequent submissions - For each year of death searched, 1st 2500 user
records 0.30 NDI, 0.36 NDI Plus - Each additional record, 0.15 (NDI), 0.21 (NDI
Plus)
33Veteran Population Files (1)
- Estimates
- 1990 to 2004
- Projections
- 2005 forward to 2030
- No listing by name or SSN
- Deaths and separations from military service
34Veteran Population Files (2)
- Age
- Gender
- Period of service
- State
- County
35Veteran Population Files (3)
- EXCEL
- CD-ROM
- Full documentation
36Pharmacy Benefits Management (PBM)
- National pharmacy dispensing records beginning
FY1999 - IV and unit dose (inpatient) prescription orders
filled in a VA facility - Outpatient prescription orders filled at a VA
pharmacy or Consolidated Mail Outpatient Pharmacy
(CMOP) - Extracted monthly from VISTA
37PBM
- Located in Hines, Ill.
- Not directly accessible for researchers
- Available by request
- IRB approved study
- Summary of study protocol
- Completed PBM request form online
- Can search records for you to identify patients
or link a finder file to pull records
38PBM
- Documentation from VIREC
- Bibliography of research using VA pharmacy data
- Contact Francesca Cunningham, PharmD
(708-786-7862) - PBM website vaww.pbm.med.va.gov
39PBM
- Example uses
- Source of information to identify patients with
disease conditions - Case ascertainment
- Diabetes (Selby, 2001)
- Comorbidity definitions, risk-adjustment
- Chronic Disease Score/Rx Risk (Von Korff, 1992
Johnson RE 1994 Clark 1995) - Rx-Risk-V (CDS for VA system Sloan, 2003)
40PBM
- Study patterns of use of drugs for a given
condition - Adherence to prescribed regimen or guidelines
- Anti-hypertensives (Christensen 1997)
- Schizophrenia, depression (Chen 2000, 2001 - VA)
- Costs of pharmaceutical care
- Pharmacoeconomics
41Data warehouses
- Another source of clinical data
- Some VISNs (regional network level) aggregate the
VISTAs from their VAMCs - Inpatient and outpatient diagnoses and procedures
(PTF, OPC) - Pharmacy, laboratory, vital signs
- Access is limited
42Data warehouses
- VISN 16 (ours) Gulf Coast network
- VISN 20 Pacific Northwest
- VISN 22 West Coast
- VISN 7 Atlantic Southeast
- VISN 2 Upstate New York
- Others?
43Data warehouse architecture
44DSS National Data ExtractLab Test Results
- Results on 56 laboratory tests
- National
- Began this year, retroed to FY01 FY03
- File has demographics, admitdate, dischdate,
visitdate - Inpatient and outpatient labs
- Millions of test records per year
45Veterans Information Resource Center (VIREC)
- HSRD Center (Hines) provides information to
researchers about database access, validity,
reliability - Data access and training
- Resource Guides for NPCD, PTF, OPC, DSS, PBM,
others - Data Issues Briefs
- List server for HSR Data mailing list
- LISTSERV_at_VIREC.RESEARCH.MED.VA.GOV
46Websites
- VIREC - www.virec.research.med.va.gov
- Austin AC - vaww.aac.va.gov
- PBM - vaww.pbm.med.va.gov
- DSS - vaww.dss.med.va.gov
- HERC www.herc.research.med.va.gov
- KLFmenu klfmenu.med.va.gov
- METRIC www.measurementexperts.org