Transcript Secondary Database Analysis II

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
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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
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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
Studies
http://www.nhlbi.nih.gov/resources/deca/directry.htm
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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)
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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.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
National Center for Health
Statistics (NCHS)
Longitudinal Studies of Aging (LSOA )
http://www.cdc.gov/nchs/lsoa.htm
National Health Interview Survey (NHIS)
http://www.cdc.gov/nchs/nhis.htm
NCHS
National Ambulatory Medical Care Survey (NAMCS), 1993-2000
http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm
National Ambulatory Medical Care Survey (NAMCS), 1973-1992
http://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), 1996
http://www.cdc.gov/nchs/nhhcs.htm
National Nursing Home Survey (NNHS), 1995 and 1997
http://www.cdc.gov/nchs/nnhs.htm
Behavioral Risk Factor
Surveillance System (BRFSS)
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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
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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
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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 Databases
State Inpatient Databases (SID)
State Ambulatory Surgery Databases (SASD)
State Emergency Department Databases (SEDD)
Nationwide Inpatient Sample (NIS)
Kids' Inpatient Database (KID)
Medical Expenditure Panel
Survey (MEPS)
Another AHRQ product - http://www.meps.ahrq.gov/
Overview: MEPS Web Site
The Medical Expenditure Panel Survey (MEPS) is a set of largescale 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
DATA from Substance Abuse and
Mental Health Data Archives
(SAMHDA)
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http://www.icpsr.umich.edu/SAMHDA/
"A national resource providing public data
access and online analysis"
 SAMHDA Helpline: 1-888-741-7242
Local: (734) 615-9524
Fax: (734) 647-8200
e-mail: [email protected]
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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/
SEER: Surveillance
Epidemiology & End Results
http://seer.cancer.gov/registries/
 SEER*Stat software:
http://seer.cancer.gov/seerstat/
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Websites with Database
Lists
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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: [email protected]
 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.html
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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
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