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CVD Surveillance in Texas Texas Cardiovascular Health and Wellness Program

CVD Surveillance in Texas Texas Cardiovascular Health and Wellness Program. 2010. Weihua Li, MD, MPH Epidemiologist. Goal of Surveillance.

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CVD Surveillance in Texas Texas Cardiovascular Health and Wellness Program

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  1. CVD Surveillance in TexasTexas Cardiovascular Health and Wellness Program 2010 Weihua Li, MD, MPH Epidemiologist

  2. Goal of Surveillance Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health. Source: Centers for Disease Control and Prevention. Updated guidelines for evaluating public health surveillance systems: recommendations from the guidelines working group. MMWR 2001; 50 (No. RR-13).

  3. What Data is Collected and Measured? What are the Data Sources? How Do You Tell if a Value is Significant?How Data is Reported to the Public? • Surveillance Measures • Data Resources • Statistics- One Test for Significance • Report and Publications

  4. Surveillance Measure And Resources • Morbidity: The occurrence of an illness or illnesses in a population • Prevalence • Hospitalizations • Medicaid reimbursement • EMS Response time • Quality of care • Mortality: The occurrence of death in a population • Deaths

  5. CVD Surveillance Measures and Resources Health Service Region (HSR) † Dependent on sample size

  6. Prevalence • The number of existing cases of a disease or health condition in a population at some designated time • How common a disease is in a population • An indication of the extent of a health problem

  7. Incidence • The rate of development of a disease in a group over a certain time period • Three important elements to determine incidence rate: • The numerator- number of new cases • The denominator- population at risk • Time- period during which the cases accrue

  8. Prevalence - Behavioral Risk Factor Surveillance System (BRFSS) • Population-based, random-digit dialed telephone survey • Conducted annually by all 50 states, 3 territories, and the District of Columbia • For more Information visit: • http://www.dshs.state.tx.us/chs/brfss/default.sht • http://www.cdc.gov/brfss/index.htm

  9. Prevalence -BRFSS • Cardiovascular Disease or Stroke Prevalence included since 1999 (1999, 2001, 2003, 2005, 2006, 2007, 2008, 2009)  • Cardiovascular Health included since 1999 (1999, 2001, 2003, 2005, 2007, 2009)  • Heart Attack & Stroke signs and symptoms included since 2001 (2001, 2003, 2005, 2009)  • Action to control high blood pressure included since 2007 (2007, 2009) 

  10. CVD Prevalence - BRFSS • Questions for Prevalence • CVD- “Have you ever been told by a doctor, nurse, or other health professional that you had a Heart Attack, Myocardial Infarction, Angina, Coronary Heart Disease, or Stroke ?” • Heart Disease- “Have you ever been told by a doctor, nurse, or other health professional that you had a Heart Attack, Myocardial Infarction, Angina, or Coronary Heart Disease ?” • Stroke- “Have you ever been told by a doctor, nurse, or other health professional that you had a stroke ?”

  11. Prevalence - BRFSS • Available Data • All State, HSR, MSA, and some counties • Demographics • Race/ethnicity • Gender • Age • Education • Income • Risk Factors

  12. Hospitalization-Texas Health Care Information Collections (THCIC) • Hospital discharge data have been compiled and tabulated by THCIC since 1999 • Billing forms used to collected data. Therefore data collected are administrative, not clinical • All CVD hospitalization is defined as hospital records listing as the primary diagnosis ICD-9 Code • ICD-9 Code for Cardiovascular Disease:390-448 • For more information visit: http://www.dshs.tx.us/thcic/

  13. ICD 9 Codes for CVD • Ischemic Heart Disease (ICD-9: 410-414) • Heart Attack (ICD-9: 410) • Hemorrhagic Stroke (ICD-9: 430-432) • Ischemic Stroke (ICD-9: 436-438, 433, and 434) • Congestive Heart Failure (ICD-9: 428) • Hypertension (ICD-9: 401-405)

  14. Hospitalization - THCIC • Available Data • All State, HSR, MSA, TSA, and counties • Charges- $ • Demographics • Race/ethnicity • Gender • Age • Payment Sources • Patient Discharge Status • Age-adjusted Hospitalization Rates per 10,000

  15. Medicaid Reimbursement-Texas Health & Human Services Commission (HHSC) • Variables • Claim Type- physician, emergency department or in-patient hospital • Recipient- having at least one claim (physician, ED, or hospital) with a primary diagnosis of CVD • Reimbursement - $

  16. Medicaid Reimbursement-HHSC • CVD defined as paid or partially paid claims with a primary diagnosis of ICD-9 code: • Cardiovascular Disease (ICD-9 CM: 410 - 414, 428, and 430 – 438) • Ischemic Heart Disease (ICD-9: 410 - 414) • Stroke (ICD-9: 430 - 438) • Congestive Heart Failure (ICD-9: 428) • Hypertension (ICD-9: 401-405)

  17. Medicaid Reimbursement – Health and Human Services Commission (HHSC) • Available Data • Statewide • Claim Type- physician, emergency department or inpatient hospital • Reimbursement - $

  18. EMS Data- Texas EMS/Trauma Registry • Suspected Illness Types CVD defined as cardiac arrest, cardiac rhythm disturbance, and chest pain/discomfort • Stroke defined as Stroke/CVA • Medical-related calls only (i.e. calls exclusively related to trauma were excluded) • 911 calls only (no inter-facility transfers) • Texas residents only

  19. EMS Data- Texas EMS/Trauma Registry • Available Data • State, HSR, MSA, TSA, Border and No-borders counties • Variables include: • Total Number of Transports • Response Time • Scene Time • Transport Time • Delivery Time

  20. Quality of Care - Health Effectiveness Data and Information Set (HEDIS) • HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. • It is a set of standardized performance measures designed to provide purchasers and consumers with the information they need to reliably compare the performance of healthcare plans. • For more Information visit: http://www.opic.state.tx.us/docs/611_guidetotexashmoquality2009.pdf

  21. Quality of Care - HEDIS • Available measures • State • Variables include: • Blood Pressure Control • Cholesterol Management for Patients with Cardiovascular Condition: LDL-C Screening • Cholesterol Management for Patients with Cardiovascular Condition: LDL-C level <130 mg/dL • Beta Blocker Treatment after a Heart Attack

  22. Mortality-Center for Health Statistics (CHS) An CVD death is defined as any death for which CVD is listed as the underlying cause • Before 1999, Used ICD -9 code. After 1999 Using ICD 10 code • For more Information visit: http://www.dshs.state.tx.us/vs/default.shtm

  23. Mortality - CHS • ICD 10 code: • Cardiovascular Disease (ICD-10: I00-I99) • Ischemic Heart Disease (ICD-10: I20-I25) • Stroke (ICD-10: I60-I69) • Congestive Heart Failure (ICD-10: I50) • Hypertension (ICD-10: I11-I13)

  24. Mortality - CHS • Available Data • State, HSR, MSA, TSA, and counties • Age-adjusted Rates per 100,000 • Demographics • Race/ethnicity • Gender • Age (age specific)

  25. Texas Population Data - CHS • Used when preparing demographic information or calculating number of cases when given rate • Center for Health Statistics (CHS) provides population estimates and projections • Population estimates more reliable than projections • http://www.dshs.state.tx.us/chs/popdat/default.shtm

  26. StatisticsOne Test for Significance • Confidence Interval (CI) is a statistical measure that is considered by many epidemiologist as meaningful • CI is one in a list of several statistical tests to help interpret observed associations • CIs are influenced by the variability of the data and the sample size

  27. Interpreting CI • If the confidence intervals do not overlap, the test is statistically significant. Cardiovascular Health and Wellness Program, DSHS

  28. Interpreting CI • If the confidence intervals overlap, the test is not statistically significant. Cardiovascular Health and Wellness Program, DSHS

  29. Reports and Publications • Chronic Disease Burden Report http://www.dshs.state.tx.us/chronic/pdf/CDBR2010.pdf • Texas CVD Burden Report http://www.dshs.state.tx.us/wellness/default.shtm • Fact sheets • Posters • PowerPoint presentations

  30. Data Requests • Data requests can be submitted to the CHW epidemiologist via email: Weihua.Li@dshs.state.tx.us

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