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

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Financial or Claims Files

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Electronic Medical Records

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Survey Data

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Trial Data

NHLBI Clinical Trials

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

Lung & Blood Institute - National Heart ↓ Prepared/Updated Study Name Asymptomatic Cardiac Ischemia Pilot (ACIP) 01/2000 Lung Health Study (LHS) Thrombolysis in Myocardial Infarction Study (TIMI II) Intermittent Positive Pressure Breathing (IPPB) Post Coronary Artery Bypass Graft Study (CABG) Antiarrhythmics Versus Implantable Defibrillators(AVID) Asthma Clinical Research Network: Beta Agonist in Mild Asthma (ACRN: BAGS) Digitalis Investigation Group (DIG) Asthma Clinical Research Network: Colchicine in Moderate Asthma (ACRN: CIMA) Psychophysiological Investigation of Myocardial Ischemia (PIMI) Coronary Artery Surgery Study (CASS) High Frequency Ventilation in Premature Infants Study (HIFI) Multiple Risk Factor Intervention Trial (MRFIT) Raynaud's Treatment Study (RTS) Acute Respiratory Distress Syndrome Clinical Network (ARDSNet 01/03): Lower versus higher tidal volume, lisofylline treatment and ketoconazole treatment (3 study factorial) … etc.

08/2001 08/2001 05/2001 05/2001 02/2002 02/2002 02/2002 02/2002 07/2002 07/2003 07/2003 07/2003 05/2003 07/2003

Study Name

NHLBI Clinical Trials recent most

Public Access Defibrillation (PAD) Community Trial Bypass Angioplasty Revascularization Investigation (BARI) Women's Health Initiative: Clinical Trials (WHI-CT) Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial Acute Respiratory Distress Syndrome Clinical Network (ARDSNet02): Efficacy of Corticosteroids as Rescue Therapy for the Late Phase of Acute Respiratory Distress Syndrome (LaSRS) Acute Respiratory Distress Syndrome Clinical Network (ARDSNet05): Fluid and Catheter Treatment Trial (FACTT) Viral Activation Transfusion Study (VATS) National Emphysema Treatment Trial (NETT) Prepared/Updated ↓ 08/2007 11/2007 02/2008 03/2008 05/2008 05/2008 05/2008 08/2008

NHLBI Epidemiology Studies (selected)

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

Study Name A Case-Control Etiologic Study of Sarcoidosis (ACCESS) Atherosclerosis Risk in Communities Study (ARIC) Bogalusa Heart Study (BHS) Cardiovascular Health Study (CHS) Coronary Artery Risk Development in Young Adults (CARDIA) Cord Blood Transplant Study (COBLT) Framingham Heart Study-Cohort Framingham Heart Study-Offspring Honolulu Heart Program (HHP) Lipid Research Clinics- Prevalence Study (LRCPS) NHLBI Growth and Health Study (NGHS) National Longitudinal Mortality Study (NLMS) Puerto Rico Heart Health Program (PRHHP) Cooperative Study of Sickle Cell Disease (CSSCD) Prepared/Updated 04/2004 01/2008 12/2006 07/2008 11/2007 01/2007 03/2007 05/2007 01/2004 02/2005 09/2005 01/2000 12/2002 07/2008

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 NHANES III Errata -

http://www.cdc.gov/nchs/datawh/dur.htm

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 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

available on CD 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)

  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

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

Healthcare Cost and Utilization Project (HCUP)

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Largest collection of all-payer longitudinal hospital data in US available for release to researchers

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Family of administrative databases and tools maintained by AHRQ

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As of 2002 data, 35 state-level data organizations contribute data on hospital stays including Texas

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 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

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) 615-9524 Fax: (734) 647-8200 e-mail: [email protected]

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/

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/

Who Will Fund Your Analyses?

 Your institution has a listserv: [email protected]

 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