Secondary Database Analysis II

Sources and Uses of Extant Databases

Last Time – Uses

Secondary Data: Can provide new information on health care delivery (quality;

geographic variation; post-marketing adverse events; cost), on natural the history of disease, and on regulatory matters.

Can save data-collection resources: time, money, personnel, participant burden

Can save researcher resources: your time, your money May permit you to build your CV without anyone’s help or

funds – just your time (but co-authors are a good thing) Can provide preliminary data for a grant proposal May enable research on rare events or difficult populations

Last Time – Precautions Take note of the study design; is it suitable? What are inclusion & exclusion criteria? Why? How does that

affect the sample and generalizability? What bias may be inherent in the database – perhaps from the

population or from the method of measurement? Selection bias: who got included; migration: who was lost/gained and why; other sources of systematic error (bias)

Control for bias – restrict (lose generalizability); match (limited # factors); stratify; adjust with covariates; then discuss potential impact of uncorrected bias on your results; could conduct sensitivity analyses on multivariable models

Risk adjustment – outcome-specific; an index incorporates many predictors – do you need to study some separately?; comorbidity index for case-mix adjustment (e.g., Charlson); other predictors based on your reading of the literature; propensity scores (for treatment choice; good for small datasets, for non-randomized studies of treatment effect)

Data Sources

Financial or Claims Files Electronic Medical Records Survey Data Trial Data

NHLBI Clinical Trials

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

oAsymptomatic Cardiac Ischemia Pilot (ACIP) (Prepared May, 1996) oIntermittent Positive Pressure Breathing (IPPB) (Prepared May, 2001) oPost Coronary Artery Bypass Graft Study (CABG) (Prepared May, 2001) oThe Thrombolysis in Myocardial Infarction Study (TIMI II) (Prepared August, 2001) oThe Lung Health Study (LHS) (Prepared August, 2001) oDigitalis Investigation Group (DIG) (Prepared February, 2002) oBeta Agonist in Mild Asthma (BAGS) (Prepared February, 2002

NHLBI Epidemiology Studieshttp://www.nhlbi.nih.gov/resources/deca/directry.htm

Cord Blood Transplantation Study Framingham Heart Study-Cohort (Updated January, 2005) Framingham Heart Study-Offspring (Updated November, 2005) Honolulu Heart Program (HHP) (Updated January, 2004) Atherosclerosis Risk in Communities Study (ARIC) (Updated

August, 2004) Coronary Artery Risk Development in Young Adults (CARDIA)

(Updated September, 2005) Cardiovascular Health Study (CHS) (Updated August, 2004) National Longitudinal Mortality Study (NLMS) (Prepared

October, 1995) Puerto Rico Heart Health Program (PRHHP) (Prepared

December, 2002)

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) 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.pdf

NHANES 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

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 – smallest version

(ASCII) is 26Mb Documentation is online with data 23 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 have been moved to the intranet (http://vaww.virec.research.med.va.gov) No public use files Data: administrative, hospital/facility level data, medical record information, patient-level medical care data including procedures, surgeries, radiography, laboratory (some), pharmacy, and diagnoses 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.med.va.gov/home/default.asp NIH http://www.nih.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 RFAs, e.g., Prescription Opioid Use and Abuse in the Treatment of Pain (R01, R03, R21, R25) - (RFA-DA-06-005) – jointly from National Institute on Drug Abuse, National Institute on Aging, National Institute of Dental and Craniofacial Research Application Receipt Date(s): February 23, 2006 http://grants.nih.gov/grants/guide/rfa-files/RFA-DA-06-005.htmlAnd there are Program Announcements that are pertinent, e.g., these from NIAAA:

Secondary Analysis of Existing Alcohol Epidemiology Data (R21): PA-06-557 http://www.dshs.state.tx.us/fic/AL17-10-1.SHTM#L <http://www.dshs.state.tx.us/fic/AL17-10-1.SHTM#L>

Secondary Analysis of Existing Alcohol Epidemiology Data (R03): PA-06-558 http://www.dshs.state.tx.us/fic/AL17-10-1.SHTM#M <http://www.dshs.state.tx.us/fic/AL17-10-1.SHTM#M>

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