Secondary Database Analysis II

1. Secondary Database Analysis II Sources and Uses of Extant Databases

2. 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

3. 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)

4. Data Sources • Financial or Claims Files • Electronic Medical Records • Survey Data • Trial Data

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

6. NHLBI Clinical Trials - most recent

7. NHLBI Epidemiology Studies (selected) http://www.nhlbi.nih.gov/resources/deca/directry.htm

8. National Center for Health Statistics (NCHS) • http://www.cdc.gov/nchs/

9. 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 andOperations http://www.cdc.gov/nchs/data/nhanes/nhanes3/cdrom/main.pdf Analytic 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

10. National Center for Health Statistics (NCHS) 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

11. 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), 1994-1996http://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

12. 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

13. 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

14. 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

15. Healthcare Cost & Utilization Project (HCUP) http://www.hcup-us.ahrq.gov/home.jsp What's New – right-hand inset What is HCUP HCUP Products (data are not free) HCUP Services FACT SHEET – very informative Note 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)

16. 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 Site Surveys 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)

17. 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: 1-888-741-7242Local: (734) 615-9524Fax: (734) 647-8200e-mail: samhda-support@icpsr.umich.edu

18. Health Medical & Care Archive (HMCA) - Health System Change (HSC) – The Robert Wood Johnson Foundation – ICPSR Archives CTS Surveys: from HSC, funded by RWJF, stored at ICPSR - Household Survey, Employer Survey, Physician Survey To 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/

19. SEER: Surveillance Epidemiology & End Results • http://seer.cancer.gov/registries/ • SEER*Stat software: http://seer.cancer.gov/seerstat/

20. 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/

21. 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 • And 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