Medical Research with Military Healthcare System Databases

1. Medical Researchwith Military Healthcare SystemDatabases 25 October 2006 LTC John S Scott

2. Military Healthcare System Databases • What’s out there: M2, SIDR, SADR, etc. • Examples • Who Owns It: Agencies • How can you get it: Contacts • Privacy: Dos and Don’ts

3. Data Sources • M2: “The MHS Management Analysis and Reporting Tool” • Individual Patient Data System (Jan 1980-Dec 1988) • Standard Inpatient Data Record (1989 to present) • Standard Ambulatory Data Record (2000 to present) • Health Care Service Record-Institutional (2000 -) • Health Care Service Record-Noninstitutional (2000-) • Defense Eligibility Enrollment Reporting System (DEERS) • Defense Manpower Data Center – surveys et al • Military Homefront QOL Library – stats and surveys • Defense Technical Information Center

4. The Population • Over 2.3 million Pediatric beneficiaries • 70,000 births/year (50,000 at MHS hospitals) • 1.1 million outpatient visits/year • Stats such as # patients, # visits, by year of birth available from DMDC, PASBA, et al

5. Data Sources – data fields • Demographic information: name, age, gender, race, ethnicity, dates, status, location • Management information Average length of stay, bed days, etc. • Diagnosis and procedure codes – ICD-9, ICD-9-CM) • Source system is CHCS and TRICARE • A detailed listing of fields is in S:\M2 Data Fields

6. Examples • How often is breech birth complicated by a septic hip? Cieslak TJ, Rajnik M. Fetal breech presentation predisposes to subsequent development of septic arthritis of the hip. Pediatr Infect Dis J 2005;24(7):650-2. • What is the trend in GER diagnoses in hospitalized infants?Callahan CW. The diagnosis of gastroesophageal reflux in hospitalized infants: 1971-1995. J Am Osteopath Assoc 1998;98(1):32-4. • What is the prevalence of HLHS in the MHS? Scott JS, Niebuhr DW. HLHS in military family members: trends in intervention, survival, and prevalence. Congenitla Heart Disease (in press).

7. Example - HLHS • Uncommon disease, 1/5000 births, survival only recently possible • All encounter records for children with the HLHS code: 6500 outpatient visits, 600 military inpatient, 600 civilian inpatient • Crude survival, prevalence, and rates of intervention calculated and trended over time

8. Agencies • M2 data mining: most institutions have personnel with access. Here contact Dr. Carolyn Hamm • Patient Administration Systems and Biostatistics Activity, Data Analysis Section: contact Mr. Ron L. James • M2 data, service to extract and send • Protocol driven DUA needed for PHI • DMDC – access to public information • DTIC – permission to access, run searches, public information • TRICARE Management Activity – extensive DUA process

13. Research Privacy Regulations • Regulations are based on paper records, but must be followed to do research • Patient databases, even without identifying information, are HUMAN USE research • Have an approved protocol before requesting data • You can usually get an expedited review • You may do some preliminary work, “in preparation for research” – but talk to IRB first • For PHI, you will need a Data Use Agreement • IRB approval is usually a first step