Transcript Secondary Data Analysis:

Secondary Data
Analysis I
Opportunities and Pitfalls
VERDICT Health Services
Research Center
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Laurel A. Copeland, MPH PhD
VA Health Services Research &
Development
UTHSCSA Department of Psychiatry
[email protected]
http://czresearch.com/dropbox
What Can Secondary Data
Analysis Do for You?
• Provide preliminary data for grant proposals
• Facilitate publication while you apply for
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grants
Explore new areas
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My CV
Shope JT, Copeland LA, Maharg R, Dielman TE, Butchart AT (1993). Health Education Quarterly 20: 373-390.
Shope JT, Copeland LA, Dielman TE (1994). Alcoholism: Clin Exper Res 18: 726-733.
Shope JT, Copeland LA, Marcoux BC, Kamp ME (1996). J Drug Educ, 26: 323-337.
Shope JT, Copeland LA, Maharg R, Dielman TE (1996). Alcoholism: Clin Exper Res 20: 791-798.
Copeland LA, Shope JT, Waller PF (1996). J School Health 66: 254-260.
Barry KL, Fleming MF, Manwell L, Copeland LA (1997). J Fam Prac 45: 151-158.
Zimmerman MA, Copeland LA, Shope JT, Dielman, TE (1997). J Youth Adolescence 26: 117-141.
Barry KL, Fleming MF, Manwell L, Copeland LA, Appel, Scott (1998). Fam Med 30:366-371.
Blow FC, Barry KL, BootsMiller BJ, Copeland LA, McCormick R, Visnic S (1998). J Psychiatric Research 32: 311-319.
Valenstein M, Barry KL, Blow FC, Copeland LA, Ullman E (1998). Psychiatric Services 49: 1043-1048.
Shope JT, Copeland LA, Kamp ME, Lang SW (1998). J Drug Educ 28: 185-197.
Kales HC, Blow FC, Copeland LA, Bingham RC, Kammerer EE, Mellow AF (1999). Am J Psychiatry 156: 550-556.
Blow FC, Barry KL, Copeland LA, McCormick R, Lehmann L, Ullman E (1999). Psychiatric Services 50: 390-394.
Maio RF, Shope JT, Blow FC, Copeland LA, Gregor MA, Brockmann LM, Weber JE, Metrou ME (2000). Annals Emerg Med 35:252-7.
Kales HC, Blow FC, Bingham RC, Copeland LA, Mellow AM (2000). Psychiatric Services 51: 795-800.
Roberts JS, Blow FC, Copeland LA, Barry KL, Van Stone W (2000). J Ger Psychiatry Neurology 13: 78-86.
Blow FC, Walton MA, Barry KL, Coyne JC, Mudd SA, Copeland LA (2000). JAGS 48: 769-774.
Kales HC, Blow FC, Bingham RC, Roberts JS, Copeland LA, Mellow AM (2000). Am J Geriatric Psychiatry 8:301-309.
Blow FC, Ullman E, Barry KL, Bingham CR, Copeland LA, McCormick R, Van Stone W (2000). Am J Orthopsychiatry 70: 389-400.
Valenstein M, Copeland LA, Owen R, Blow FC, Visnic S (2001). J Clin Psychiatry 62: 545-551.
Valenstein M, Copeland LA, Owen R, Blow FC, Visnic S (2001). Psychiatric Services 52: 1242-4.
Duffy SA, Terrell, Jeff, Valenstein M, Ronis, David, Copeland LA, Connors, Mary (2002). Gen Hosp Psychiatry 24: 140-7.
Valenstein M, Copeland LA, Blow FC, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T (2002). Med Care 40: 630-9.
Hegedus, Andrea M, Copeland LA, Barry KL, Blow FC. (2002). American Journal of Orthopsychiatry 72: 331-340.
Copeland LA, Blow FC, Barry KL (2003). Health Education & Behavior 30:305-21.
Copeland LA, Zeber JE, Valenstein M, Blow FC (2003). Am J Psychiatry 160:1817-1822.
Valenstein M, Blow FC, Copeland LA, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T (2004). Schizophr Bull 30: 255-64.
Janz NK, Wren PA, Copeland LA, Lowery JC, Goldfarb SL, Wilkins EG. (2004). J Clin Oncology 22:3091-3098.
Lambert MT, Terrell JE, Copeland LA, Ronis DL, Duffy SA. (2005). Nicotine & Tobacco Research 7:233-241.
Copeland LA, Fletcher CE, Patterson J(2005). Military Medicine 170:602-606.
Copeland LA, Elshaikh MA, Jackson J, Penner LA, Underwood III W (2005). Cancer 104:1372-1380.
O'Neill JL, Flanagan PS, Zaleon CR, Copeland LA (2005). Pharmacotherapy 25:1560-1565.
Pugh MJV, Copeland LA, Zeber JE, Cramer JA, Amuan MT, Cavazos JE, Kazis LE (2005). Epilepsia 46:1820-7.
Copeland LA, Zeber JE, Rosenheck RA, Miller AL (2006). Med Care 44:110-116.
Lambert MT, Copeland LA, Sampson N, Duffy SA (2006). Progress Neuropsychopharm Biol Psychiatry 30:919-23.
Hopp FP, Woodbridge P, Subramanian U, Copeland LA, Smith D, Lowery JC (2006). Telemedicine and eHealth 12:297-307.
Silveira MJ, Copeland LA, Feudtner C (2006). Am J Public Health 96:1243-1248.
Zeber JE, Copeland LA, Grazier KL (2006). Military Medicine 171:619-26.
Wilkins EG, Lowery JC, Copeland LA, Goldfarb SL, Wren PA, Janz NA (2006). Medical Decision Making 26:589-598.
Copeland LA, Mortensen EM, Zeber JE, Pugh MJ, Restrepo MI, Dalack GW (2007). Progress Neuro-Psychopharm Biol Psychiatry 31:720-6
Alexander JA, Copeland LA, Metzger ME (2007). Clinical Toxicology 45(5):440-50.
Kilbourne AM, Copeland LA, Zeber JE, Bauer MS, Lasky EC, Good CB (2007). Psychopharmacology Bulletin 40:104-15
Fletcher CE, Baker SJ, Copeland LA, Reeves PJ, Lowery JC (2007). Journal of Nursing Scholarship 39:358-62
Duffy SA, Copeland LA, Hopp FP, Zalenski RJ (2007). Journal of Palliative Medicine 10:1137-45
Mortensen EM, Restrepo MI, Copeland LA, Pugh JA, Anzueto AR, Cornell JE, Pugh MJ (2007). Pharmacotherapy 27: 1619-26
Kilbourne AM, Post EP, Bauer MS, Zeber JE, Copeland LA, Good CB, Pincus HA (2007). J Affective Disorders 102:145-51.
Zeber JE, Copeland LA, Amuan ME, Cramer JA, Pugh MJ (2007). Epilepsy & Behavior 10:539-46.
Mortensen EM, Pugh MJ, Copeland LA, Restrepo MI, Cornell JE, Anzueto A, Pugh JA (2008). Eur Respir J 31(3):611-7.
Copeland LA, Zeber JE, Salloum IM, Pincus HA, Fine MJ, Kilbourne AM (2008). J Nerv Ment Disease 196:16-21.
Leibowitz RQ, Jeffreys MD, Copeland LA, Noel PH (2008). Gen Hosp Psychiatry 30:100-3.
Pugh MJ, Van Cott AC, Cramer JA, Knoefel JE, Amuan ME, Tabares J, Ramsay RE, Berlowitz DR; TIGER Team (2008). Neurology 70:2171-8.
Zeber JE, Copeland LA, Good CB, Fine MJ, Bauer MS, Kilbourne AM (2008). J Affect Disord 107:53-62.
Copeland LA, Zeber JE, Pugh MJ, Mortensen EM, Restrepo MI, Lawrence VA (2008). Annals Surg 248:31-8.
Pugh MJ, Zeber JE, Copeland LA, Tabares JV, Cramer JA (2008). Psychiatric Services 59:925-8.
Zeber JE, Copeland LA, Hosek BJ, Karnad AB, Lawrence VA, Sanchez-Reilly SE (2008). Crit Rev Oncology/Hematology 67:237-42.
Mortensen EM, Restrepo MI, Copeland LA, Pugh JA, Anzueto AR (2008). Am J Med Sci
Zeber JE, Copeland LA, McCarthy JF, Bauer MS, Kilbourne AM (2009). Am J Public Health
Copeland LA, Miller AL, Welsh DE, McCarthy JF, Zeber JE, Kilbourne AM (2009). Am J Public Health
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My CV without 2° Data
Shope JT, Copeland LA, Maharg R, Dielman TE, Butchart AT (1993). Health Education Quarterly 20: 373-390.
Shope JT, Copeland LA, Dielman TE (1994). Alcoholism: Clin Exper Res 18: 726-733.
Shope JT, Copeland LA, Marcoux BC, Kamp ME (1996). J Drug Educ, 26: 323-337.
Shope JT, Copeland LA, Maharg R, Dielman TE (1996). Alcoholism: Clin Exper Res 20: 791-798.
Copeland LA, Shope JT, Waller PF (1996). J School Health 66: 254-260.
Barry KL, Fleming MF, Manwell L, Copeland LA (1997). J Fam Prac 45: 151-158.
Zimmerman MA, Copeland LA, Shope JT, Dielman, TE (1997). J Youth Adolescence 26: 117-141.
Barry KL, Fleming MF, Manwell L, Copeland LA, Appel, Scott (1998). Fam Med 30:366-371.
Blow FC, Barry KL, BootsMiller BJ, Copeland LA, McCormick R, Visnic S (1998). J Psychiatric Research 32: 311-319.
Valenstein M, Barry KL, Blow FC, Copeland LA, Ullman E (1998). Psychiatric Services 49: 1043-1048.
Shope JT, Copeland LA, Kamp ME, Lang SW (1998). J Drug Educ 28: 185-197.
Kales HC, Blow FC, Copeland LA, Bingham RC, Kammerer EE, Mellow AF (1999). Am J Psychiatry 156: 550-556.
Blow FC, Barry KL, Copeland LA, McCormick R, Lehmann L, Ullman E (1999). Psychiatric Services 50: 390-394.
Maio RF, Shope JT, Blow FC, Copeland LA, Gregor MA, Brockmann LM, Weber JE, Metrou ME (2000). Annals Emerg Med 35:252-7.
Kales HC, Blow FC, Bingham RC, Copeland LA, Mellow AM (2000). Psychiatric Services 51: 795-800.
Roberts JS, Blow FC, Copeland LA, Barry KL, Van Stone W (2000). J Ger Psychiatry Neurology 13: 78-86.
Blow FC, Walton MA, Barry KL, Coyne JC, Mudd SA, Copeland LA (2000). JAGS 48: 769-774.
Kales HC, Blow FC, Bingham RC, Roberts JS, Copeland LA, Mellow AM (2000). Am J Geriatric Psychiatry 8:301-309.
Blow FC, Ullman E, Barry KL, Bingham CR, Copeland LA, McCormick R, Van Stone W (2000). Am J Orthopsychiatry 70: 389-400.
Valenstein M, Copeland LA, Owen R, Blow FC, Visnic S (2001). J Clin Psychiatry 62: 545-551.
Valenstein M, Copeland LA, Owen R, Blow FC, Visnic S (2001). Psychiatric Services 52: 1242-4.
Duffy SA, Terrell, Jeff, Valenstein M, Ronis, David, Copeland LA, Connors, Mary (2002). Gen Hosp Psychiatry 24: 140-7.
Valenstein M, Copeland LA, Blow FC, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T (2002). Med Care 40: 630-9.
Hegedus, Andrea M, Copeland LA, Barry KL, Blow FC. (2002). American Journal of Orthopsychiatry 72: 331-340.
Copeland LA, Blow FC, Barry KL (2003). Health Education & Behavior 30:305-21.
Copeland LA, Zeber JE, Valenstein M, Blow FC (2003). Am J Psychiatry 160:1817-1822.
Valenstein M, Blow FC, Copeland LA, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T (2004). Schizophr Bull 30: 255-64.
Janz NK, Wren PA, Copeland LA, Lowery JC, Goldfarb SL, Wilkins EG. (2004). J Clin Oncology 22:3091-3098.
Lambert MT, Terrell JE, Copeland LA, Ronis DL, Duffy SA. (2005). Nicotine & Tobacco Research 7:233-241.
Copeland LA, Fletcher CE, Patterson J(2005). Military Medicine 170:602-606.
Copeland LA, Elshaikh MA, Jackson J, Penner LA, Underwood III W (2005). Cancer 104:1372-1380.
O'Neill JL, Flanagan PS, Zaleon CR, Copeland LA (2005). Pharmacotherapy 25:1560-1565.
Pugh MJV, Copeland LA, Zeber JE, Cramer JA, Amuan MT, Cavazos JE, Kazis LE (2005). Epilepsia 46:1820-7.
Copeland LA, Zeber JE, Rosenheck RA, Miller AL (2006). Med Care 44:110-116.
Lambert MT, Copeland LA, Sampson N, Duffy SA (2006). Progress Neuropsychopharm Biol Psychiatry 30:919-23.
Hopp FP, Woodbridge P, Subramanian U, Copeland LA, Smith D, Lowery JC (2006). Telemedicine and eHealth 12:297-307.
Silveira MJ, Copeland LA, Feudtner C (2006). Am J Public Health 96:1243-1248.
Zeber JE, Copeland LA, Grazier KL (2006). Military Medicine 171:619-26.
Wilkins EG, Lowery JC, Copeland LA, Goldfarb SL, Wren PA, Janz NA (2006). Medical Decision Making 26:589-598.
Copeland LA, Mortensen EM, Zeber JE, Pugh MJ, Restrepo MI, Dalack GW (2007). Progress Neuro-Psychopharm Biol Psychiatry 31:720-6
Alexander JA, Copeland LA, Metzger ME (2007). Clinical Toxicology 45(5):440-50.
Kilbourne AM, Copeland LA, Zeber JE, Bauer MS, Lasky EC, Good CB (2007). Psychopharmacology Bulletin 40:104-15
Fletcher CE, Baker SJ, Copeland LA, Reeves PJ, Lowery JC (2007). Journal of Nursing Scholarship 39:358-62
Duffy SA, Copeland LA, Hopp FP, Zalenski RJ (2007). Journal of Palliative Medicine 10:1137-45
Mortensen EM, Restrepo MI, Copeland LA, Pugh JA, Anzueto AR, Cornell JE, Pugh MJ (2007). Pharmacotherapy 27: 1619-26
Kilbourne AM, Post EP, Bauer MS, Zeber JE, Copeland LA, Good CB, Pincus HA (2007). J Affective Disorders 102:145-51.
Zeber JE, Copeland LA, Amuan ME, Cramer JA, Pugh MJ (2007). Epilepsy & Behavior 10:539-46.
Mortensen EM, Pugh MJ, Copeland LA, Restrepo MI, Cornell JE, Anzueto A, Pugh JA (2008). Eur Respir J 31(3):611-7.
Copeland LA, Zeber JE, Salloum IM, Pincus HA, Fine MJ, Kilbourne AM (2008). J Nerv Ment Disease 196:16-21.
Leibowitz RQ, Jeffreys MD, Copeland LA, Noel PH (2008). Gen Hosp Psychiatry 30:100-3.
Pugh MJ, Van Cott AC, Cramer JA, Knoefel JE, Amuan ME, Tabares J, Ramsay RE, Berlowitz DR; TIGER Team (2008). Neurology 70:2171-8.
Zeber JE, Copeland LA, Good CB, Fine MJ, Bauer MS, Kilbourne AM (2008). J Affect Disord 107:53-62.
Copeland LA, Zeber JE, Pugh MJ, Mortensen EM, Restrepo MI, Lawrence VA (2008). Annals Surg 248:31-8.
Pugh MJ, Zeber JE, Copeland LA, Tabares JV, Cramer JA (2008). Psychiatric Services 59:925-8.
Zeber JE, Copeland LA, Hosek BJ, Karnad AB, Lawrence VA, Sanchez-Reilly SE (2008). Crit Rev Oncology/Hematology 67:237-42.
Mortensen EM, Restrepo MI, Copeland LA, Pugh JA, Anzueto AR (2008). Am J Med Sci
Zeber JE, Copeland LA, McCarthy JF, Bauer MS, Kilbourne AM (2009). Am J Public Health
Copeland LA, Miller AL, Welsh DE, McCarthy JF, Zeber JE, Kilbourne AM (2009). Am J Public Health
Is it scientifically valid to use data
for purposes for which they were
not originally collected?
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How comfortable are you with this idea?
What is the alternative?
Today and next week
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Learn some uses of secondary data
Learn about sources of secondary data
Understand possible effects of HIPAA on this type of research
Describe biases commonly encountered in secondary data
Describe frequently used research designs in health services
research.
Define risk adjustment and why it is important in HSR; give
examples of methods
Discuss rationale for methods to account for nesting or clustering
of data
Methods of Learning
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Lecture & discussion
In-class epidemiologic exercise
Journal article evaluation – readings are
online (http://czresearch.com/dropbox/)
Optional proposal abstract for your own
secondary data analysis
Different Uses
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Health Care Delivery
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Natural history
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Quality assessment
Geographic variation; under- or over-utilization
Adverse events
Outcomes of a particular treatment
Cost
incidence, prevalence
prognosis
Association not causation
Other
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Regulatory
Some Examples
To show you the range of uses
To show you the work is publishable
Regulatory enforcement
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TENET HEALTHCARE – 2002
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Medicare Report Jan-Oct 2004 included these findings:
– At Alvarado Hospital, prosecutors accused Tenet of running covert
kickback arrangements
– Document requests were received from federal prosecutors in L.A.
– False claims were uncovered and the company agreed to pay
$22.5M to settle allegations
– Redding Medical Center was determined to be performing
unnecessary cardiac surgery
– Tenet sold some holdings to Hospital Partners of America to
satisfy part of the 2003 settlement with federal officials
– Whistleblowers were to receive over $8M
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Whose data set is it
anyway? Sharing raw data
from randomized trials
Andrew J Vickers
Trials. 2006 May 16;7:15
http://www.trialsjournal.com/content/pdf/1745-6215-7-15.pdf
Risk of death in elderly users
of conventional vs. atypical
antipsychotic medications
Wang PS, Schneeweiss S, Avorn J,
Fischer MA, Mogun H, Solomon DH,
Brookhart MA. N Engl J Med. 2005
Dec 1;353(22):2335-41
http://content.nejm.org/cgi/reprint/353/22/2335.pdf
Cancer incidence in Kentucky,
Pennsylvania, and West
Virginia: disparities in
Appalachia
Lengerich EJ, Tucker TC, Powell RK,
Colsher P, Lehman E, Ward AJ,
Siedlecki JC, Wyatt SW (2005). J Rural
Health 21(1):39-47.
http://www.blackwell-synergy.com/toc/jrh/21/1
Does Medicare coverage of
colonoscopy reduce racial/ethnic
disparities in cancer screening
among the elderly?
Shih YC, Zhao L, Elting LS (2006).
Health Aff (Millwood). Jul-Aug;
25(4):1153-62.
http://content.healthaffairs.org/cgi/content/full/25/4/1153
Can you think of examples of
secondary data analysis that
you have read in the medical
literature?
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Any that have influenced your practice
or your research direction?
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Anything you would like to see
investigated but have not yet found in
the literature?
Exercise #1
Policy Decision on
Funding
Of Regional Trauma
Center (handout)
Secondary Data Exercise #1
A Regional Trauma Center (which encourages the surrounding hospitals
to refer patients with serious injuries to it for expert care) is seeking
additional funds from next year’s health budget for more equipment
and staff. A local politician (who would rather spend such money on
a new hospital named after his father) criticizes this request for
additional resources by claming that Regional Trauma Centers do
not, in fact, save lives, and he submits the following data to back up
his claim.
You are asked for your opinion on these data. How should you respond?
surrounding hospitals
# of cases
Total
7,266
Case-fatality rate 458/7,266
# of
deaths
458
= 6.3%
regional trauma
center
# of cases
3,354
212/3,354
# of
deaths
212
= 6.3%
Secondary Data Exercise #1
You, being expert in possible sources of confounding in secondary
data, say the data are incomplete as presented. You propose reanalysis, taking into account the severity of the trauma in all treated
cases.
By examining the data stratified by severity, the value of the regional
trauma center becomes clear.
Severity of Trauma
Surrounding Hospitals
Regional Trauma Center
# cases
# deaths
# cases
#
deaths
Mild
3,734
37
1.0%
687
3
0.4%
Moderate
1,887
94
5.0%
1,238
37
3.0%
Severe
1,645
327
19.9%
1,429
172
12.0%
Total
7,266
458
6.3%
3,354
212
6.3%
fatality
rate
fatality
rate
Interpret data carefully
Data Quality
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If no reliable (accurate and adequate) data are
available, questions about risk adjustment are
moot
Inconsistent practices in assigning standard
ICD9 codes & names to diseases exist—but this
has improved over time (Do you know who
assigns the codes?) http://www.eicd.com/
Lack of specificity of ICD9 system in some
diagnostic areas, especially with regard to
severity
Administrative Data
Limitations
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Need patient-specific identifiers to link episodes
Need multi-year data when outcomes are infrequent
Limited generalizability if restricted by type of
institution or hospital, by type of payor, or by
location/region
May lack important clinical variables known to be
related to outcomes (especially clinical tests or
qualitative evaluations of severity)
Secondary Database
Analysis Ia
Sources of Data
Data Sources
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Financial or Claims Files
Electronic Medical Records
Survey Data
Trial Data
NHLBI Clinical Trials
http://www.nhlbi.nih.gov/resources/deca/default.htm - National Heart Lung
& Blood Institute
Study Name
Prepared/Updated ↓
Asymptomatic Cardiac Ischemia Pilot (ACIP)
01/2000
Lung Health Study (LHS)
08/2001
Thrombolysis in Myocardial Infarction Study (TIMI II)
08/2001
Intermittent Positive Pressure Breathing (IPPB)
05/2001
Post Coronary Artery Bypass Graft Study (CABG)
05/2001
Antiarrhythmics Versus Implantable Defibrillators(AVID)
02/2002
Asthma Clinical Research Network: Beta Agonist in Mild Asthma (ACRN: BAGS)
02/2002
Digitalis Investigation Group (DIG)
02/2002
Asthma Clinical Research Network: Colchicine in Moderate Asthma (ACRN: CIMA)
02/2002
Psychophysiological Investigation of Myocardial Ischemia (PIMI)
07/2002
Coronary Artery Surgery Study (CASS)
07/2003
High Frequency Ventilation in Premature Infants Study (HIFI)
07/2003
Multiple Risk Factor Intervention Trial (MRFIT)
07/2003
Raynaud's Treatment Study (RTS)
05/2003
Acute Respiratory Distress Syndrome Clinical Network (ARDSNet 01/03): Lower versus
higher tidal volume, lisofylline treatment and ketoconazole treatment (3 study
factorial)
07/2003
… etc.
NHLBI Clinical Trials - most recent
Study Name
Prepared/Updated
↓
Public Access Defibrillation (PAD) Community Trial
08/2007
Bypass Angioplasty Revascularization Investigation (BARI)
11/2007
Women's Health Initiative: Clinical Trials (WHI-CT)
02/2008
Prevention of Events with Angiotensin Converting Enzyme
Inhibition (PEACE) Trial
03/2008
Acute Respiratory Distress Syndrome Clinical Network
(ARDSNet02): Efficacy of Corticosteroids as Rescue
Therapy for the Late Phase of Acute Respiratory Distress
Syndrome (LaSRS)
05/2008
Acute Respiratory Distress Syndrome Clinical Network
(ARDSNet05): Fluid and Catheter Treatment Trial (FACTT)
05/2008
Viral Activation Transfusion Study (VATS)
05/2008
National Emphysema Treatment Trial (NETT)
08/2008
NHLBI Epidemiology Studies
(selected)
http://www.nhlbi.nih.gov/resources/deca/directry.htm
Study Name
Prepared/Updated
A Case-Control Etiologic Study of Sarcoidosis (ACCESS)
04/2004
Atherosclerosis Risk in Communities Study (ARIC)
01/2008
Bogalusa Heart Study (BHS)
12/2006
Cardiovascular Health Study (CHS)
07/2008
Coronary Artery Risk Development in Young Adults (CARDIA)
11/2007
Cord Blood Transplant Study (COBLT)
01/2007
Framingham Heart Study-Cohort
03/2007
Framingham Heart Study-Offspring
05/2007
Honolulu Heart Program (HHP)
01/2004
Lipid Research Clinics- Prevalence Study (LRCPS)
02/2005
NHLBI Growth and Health Study (NGHS)
09/2005
National Longitudinal Mortality Study (NLMS)
01/2000
Puerto Rico Heart Health Program (PRHHP)
12/2002
Cooperative Study of Sickle Cell Disease (CSSCD)
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 - 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 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)
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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/surveyd
ata.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
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
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)

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
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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.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/pafiles/PA-08-168.html
 Secondary Analysis of Existing Alcohol Epidemiology Data
(R03): PA-08-169 http://grants.nih.gov/grants/guide/pafiles/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

UTHSCSA Career Development

Delgado, McManus & Lichtenstein offer a
series on Career Development including this
set of presentations on K-Awards (NIH
Career Development Awards)
http://iims.uthscsa.edu/ed_kpaseo_workshop.
html
Your Assignment


Read; think
If you want extra feedback, e-mail me a 1page proposal abstract for a database
analysis related to your area of interest any
time in next few years
[email protected]