the comparative effectiveness large dataset analysis core: a resource for accelerating research with...
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The Comparative Effectiveness Large Dataset Analysis Core: A Resource for Accelerating Research with Large, Public
Datasets
Janet Coffman, PhD
Associate Adjunct Professor
Philip R. Lee Institute for Health Policy Studies
University of California, San Francisco
October 5, 2012
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Outline
• Examples of major types of large, public datasets
• Overview of Comparative Effectiveness Large Dataset Analysis Core (CELDAC)
• CELDAC datasets• CELDAC accomplishments • K Scholar success story• Discussion
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Major Types of Large Datasets Used in
Health Services Research
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Major Sources of Data
Type of Data Set Description Examples
Survey Collects information from individuals, families, or organizations
• Medical Expenditure Panel Survey• National Health and Nutrition
Examination Survey
Administrative claims
Information from records of health professionals and health care facilities, usually from billing records
• HCUP National Inpatient Sample• Medicare Research Identifiable
Files
Registries Information from datasets that incorporate all persons with a particular condition(s)
• California Cancer Registry• San Francisco Mammography
Registry
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Major Units of Observation
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Unit of Observation ExamplesIndividual • National Health and Nutrition Examination Survey
• National Survey of Children’s HealthHousehold • Medical Expenditure Panel Survey
• National Health Interview SurveyVisit or discharge • HCUP Kid’s Inpatient Databases
• National Ambulatory Medical Care SurveyPhysician • American Medical Association Masterfile
• HSC Health Tracking Physician SurveyFacility (e.g., hospital, clinic) •American Hospital Association Annual Survey
•California OSHPD Hospital Annual Financial DataGeographic area (e.g., county, state)
•US Census•Area Resource File
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Major Types of Survey DesignsType of Survey
Description Examples
Cross-sectional
Data collected from a single sample at a single point in time
•National Health Interview Survey
•National Survey of Children’s Health
•California Health Interview Survey
Panel Data collected from a single sample at multiple points in time
•Medical Expenditure Panel Survey
•Health and Retirement Survey•National Longitudinal Study of
Adolescent Health
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National Health and Nutrition Examination Survey
• Nationally representative sample of 5,000 persons per year
• Data collected in 15 counties per year• Two major components
– Interviews: demographic characteristics, socioeconomic status, diet, health behaviors
– Physical examinations: medical, dental, physiological, lab tests
http://www.cdc.gov/nchs/nhanes.htm7
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Examples of UCSF Faculty Publications Using NHANES
• Seligman H.K. Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002. Journal of General Internal Medicine. 2007 Jul;22(7):1018-23.
• Woodruff T, Zota A, Schwartz J. Environmental chemicals in pregnant women in the United States: NHANES 2003-2004. Environmental Health Perspectives. 2011 Jun;119(6):878-85. 2007 Jul;22(7):1018-23.
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Medical Expenditure Panel Survey• Nationally representative sample of 22,000 to
37,000 persons• Overlapping panel design• 2 years of data collected through 5 rounds of
interviews• Three major components
• Household survey• Data on cost and utilization from providers caring for
household survey participants• Survey of employers regarding employer-sponsored
health insurance benefits
http://www.meps.ahrq.gov/mepsweb/9
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Examples of UCSF Faculty Publications Using MEPS
• Newacheck P, Kim S. A national profile of health care utilization and expenditures for children with special health care need. Archives of Pediatric and Adolescent Medicine. 2005 Jan;159(1):10-7.
• Yelin E., et al. Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons with 1997. Arthritis and Rheumatism. 2007 May;56(5):1397-407.
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Overview of CELDAC
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CELDAC Partners
CELDAC is a partnership at UCSF among the – Philip R Lee Institute for Health Policy Studies– Clinical and Translational Science Institute– Academic Research Systems
Funding– Administrative supplement to the NCRR grant for
UCSF’s Clinical & Translational Science Institute– California HealthCare Foundation
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CELDAC Mission
The mission of CELDAC is to enhance UCSF's capacity for analysis of large local, state, and national health datasets to conduct comparative effectiveness research and other types of health services and health policy research.
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CELDAC Goals• Accelerate access to and use of local, state, and national
health datasets, as a model for other CTSAs and health research organizations.
• Enhance UCSF researchers’ ability to compete for funding to use large data sets to conduct research.
• Develop procedures and infrastructure by conducting pilot studies.
• Support additional studies using large, public datasets.
• Provide consultation to researchers currently working with or interested in working with large datasets.
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CELDAC’S Main Components, 2013
• Online, searchable inventory of datasets
• Consultation
• Repository of select datasets available through MyResearch
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Find Large Datasetshttp://ctsi.ucsf.edu/research/celdac
A guided search tool to find the best datasets for a project. Builds on previous efforts by Nancy Adler, Andy Bindman, Claire Brindis, Charlie Irwin and others.
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Search Results –Search for administrative data on infants’ use of health care services
http://ctsi.ucsf.edu/research/celdac
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Dataset Description and Links
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Provide Consultation
• Study design/conceptualization • Identification of relevant datasets• Assistance with dataset acquisition• Cohort selection• Data cleaning• Linking datasets• Strategies to deal with common methodological
issues in analysis of observational data• Programming support for preliminary analyses
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Provide Consultation
• CELDAC provides some services on its own
• Links researchers with other CTSI Consultation Service units as needed– Data management– Biostatistics– Other
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CELDAC Datasets
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Analyze Large Datasets• CELDAC has created a repository of select large,
public datasets that are available to UCSF faculty at no cost.
• These data sets include– American Hospital Association Annual Survey– Area Resource File– HCUP Kids Inpatient Database – HCUP National Emergency Department Sample– HCUP National Inpatient Sample– HCUP State Emergency Department and Inpatient
Databases (select states)
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National Inpatient Sample
• Largest publicly available all-payer inpatient database
• 20% stratified sample of admissions to community hospitals
• 8 million discharges• Data available from 1988 to 2010• Number of participating states has
increased over time from 8 to 45
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Kid’s Inpatient Sample
• Only all-payer inpatient care database on children
• 3 million discharges of children and adolescents ≤ 20 years old
• Data available for 1997, 2000, 2003, 2006, and 2009
• Number of participating states has increased over time from 22 to 44
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State Inpatient Databases
• Universe of inpatient discharge abstracts from community hospitals
• 46 states currently participate: > 90% of community hospital discharges
• Some states provide variables for tracking readmissions
• Data available from 1990 onward• UCSF has data from 2006 to 2010 for
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National Emergency Department Sample
• 20% stratified sample of visits to community hospital EDs
• 25 to 30 million unweighted records• Data available from 2006 to 2009• 29 states currently participate• Includes ED visits that resulted in
– Treat-and-release– Transfer to another hospital– Admission to the same hospital
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State Emergency Department Databases
• Universe of ED visits that did not result in a hospital admission from community hospitals in participating states
• 27 states currently participate• Some states provide variables for tracking
revisits• Data available from 1999 onward• UCSF has data from 2006 to 2010 for
states with revisits variables
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CELDAC Accomplishments
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CELDAC Clients
• CELDAC has assisted over 70 faculty, staff, and trainees at UCSF– 22 using datasets in CELDAC’s repository– 18 consultations– 11 linkages with other UCSF resources– 9 presentations to faculty, staff, and trainees
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CELDAC Clients• CELDAC serves a wide range of departments
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School of Medicine• Anesthesia• Dermatology• Emergency Medicine• Family & Community
Medicine• Medicine• Neurological Surgery• Neurology• Obstetrics & Gynecology• Orthopedic Surgery• Psychiatry• Pediatrics• Radiology• Surgery• Urology
School of Nursing• Community Health
Systems Nursing• Family Health Care
Nursing
School of Dentistry• Preventive and
Restorative Dentistry
School of Pharmacy• Clinical Pharmacy
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CELDAC Extensions• UCSF Library
– Cross reference available datasets
• UCSF CTSI– Assist Community Engagement with
consultations that concern data analysis– Collaborate with Data Management
consultation unit on project to identify UCSF staff with data management expertise
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CELDAC Extensions
• California HealthCare Foundation– Assessment of state policymakers’ needs
for health care data
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K Scholar Success Story
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Naomi Bardach, MD, MAS
• Assistant Professor of Pediatrics
• Former KL2 Scholar
• Current K23 Scholar (NICHD)
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Initial Study
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• Objective– To describe variation in hospital-level
pediatric asthma readmission rates in community hospitals and hospital and patient characteristics associated with readmissions
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Initial Study
• Design/Methods– HCUP State Inpatient Databases for states with revisit
linkages (AZ, CA, FL, NC, UT)– Readmissions of patients age 2-21 years to non-
federal hospitals within 30-days of asthma related admission
– Outliers = hospitals with readmission rates that did not overlap with estimate of group mean
– Random effects logistic model to assess hospital and patient characteristics associated with readmissions
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Initial Study
• Results– 1.9% of admissions were readmissions within
30 days (391 of 20,323)– Readmissions ranged from 0% to 7.3%– Only 2 hospitals had readmission higher rates
the group mean and none had lower rates– Patient age, race, payor, and immunological
complex chronic condition associated with odds of readmission
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Subsequent Studies• Used HCUP State Inpatient and
Emergency Department databases to assess readmission and revisit rates across diseases and conditions
• Used the HCUP Kids Inpatient Database and a database from freestanding children’s hospitals to analyze pediatric ED visits and hospitalizations for mental health conditions
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How CELDAC Helped• Initial K23 proposal not funded in part
due to concerns about data sources• Revised proposal to incorporate analysis
of HCUP state databases• Revised proposal funded• Platform presentation at Pediatric
Academic Societies Annual Meeting• Manuscript revised and resubmitted to Pediatrics
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Questions for Discussion
• How could CELDAC better serve K Scholars?• What are the biggest barriers to
research with large, public datasets at UCSF?
• What services relating to analysis of large, public datasets would be most helpful?
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Contact CELDAC
• Janet Coffman, PhD, Principal Investigator: [email protected]/415-476-2435
• Claire Will, PhD, Project Coordinator: [email protected]/415-476-6009
• http://ctsi.ucsf.edu/research/large-datasets
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