The role of NCHS in providing guidance for defining injuries in administrative data sets

1. The role of NCHS in providing guidance for defining injuries in administrative data sets Lois A. Fingerhut, MA Office of Analysis and Epidemiology National Center for Health Statistics CSTE, June 2007

2. Presentation Overview • What are the sources of national data for injury surveillance? • Where are the national data used? • What are the data issues for states? • What is the role for a national agency? • What is the role of collaborative efforts?

3. NCHS data sources used for injury surveillance • Mortality data • Underlying cause of death data • Multiple cause of death data • Survey data • National Hospital Discharge Survey • National Hospital Ambulatory Medical Care Survey • National Health Interview Survey*

4. Where are the data used? • Healthy People 2010 • Health, United States • Online data: • CDC WONDER • Health Data for all Ages • Trends in Health and Aging • WISQARS

5. What can States do with national data? • Benchmark to national data • Modify data according to standard operational definitions • Conduct cross-state comparisons

6. Benchmarking • All States can replicate definitions from: • National Vital Statistics System - Mortality • Most States can replicate definitions from: • National Hospital Discharge Survey (diagnoses) • States may or may not be able to replicate definitions tracked by: • National Hospital Ambulatory Care Survey • National Ambulatory Care Survey

7. Need for standards and operational definitions • Standard definitions for injury definitions from health care survey data and from vital statistics are necessary for national benchmarks. • Currently several standards exist, but are often not consistently applied.

8. Examples of standards setting • Definitions • Mortality matrix • Morbidity matrix • Methodologies • Age-adjustment • Selecting a main injury in multiple cause of death data • Severity measurement

9. Examples of benchmarking tools • Objective specifications for HP2010 Injury and Violence objectives provide information on: • National data sources • Target populations • ICD-9 CM and ICD-10 codes • Age groups/standard populations used for age adjustment • Inclusion/exclusion criteria • Updated specifications accessible in DATA2010

10. wonder.cdc.gov/data2010

13. HP2010 Objectives with soon-to-be updated definitions Injury Prevention 15-1 Nonfatal head injury hospitalizations (NHDS) 15-12 Emergency department visits (NHAMCS)

14. “Current” 15-1. Reduce hospitalizations for nonfatal head injuries National Data Source National Hospital Discharge Survey (NHDS), CDC, NCHS. State Data Source State hospital discharge systems. Healthy People 2000 Objective 9.9 (Unintentional Injuries). Changes since the 2000 None. Publication Measure Rate per 100,000 population (age adjusted). Baseline 60.6 (1998) Target 45.0 NumeratorNumber of hospitalizations for nonfatal head injuries (principal diagnosis of ICD-9-CM codes 800- 801, 803-804, 850-854, 870-873, 925).

15. “To be revised” 15-1. Reduce hospitalizations for traumatic brain injuries National Data Source National Hospital Discharge Survey (NHDS), CDC, NCHS. State Data Source State hospital discharge systems. Healthy People 2000 Objective 9.9 (Unintentional Injuries). Changes since the 2000 None. Publication Measure Rate per 100,000 population (age adjusted). Baseline ?? Target ?? NumeratorNumber of hospitalizations for TBIs (principal diagnosis of ICD-9-CM codes: 800.0-801.9, 803.0-804.9,850.0-854.1,950.1-950.3 995.55(Barell Matrix definition)

16. All head and neck injuries (per Barell Matrix) TBI (NCIPC surveillance) TBI (per Barell Matrix) Current HP 15-1 Objective for nonfatal head injuries Age-adjusted hospital discharge rates for different measures of head injury: 1997-2005 250 200 150 per 100,000 population 100 50 0 1997 1998 1999 2000 2001 2002 2003 2004 2005

17. “Current” 15-12. Reduce hospital ED visits caused by injuries National Data Source National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC,NCHS. State Data Source Not identified. Healthy People 2000 Objective Not applicable. Changes since the 2000 Publication None. Measure Rate per 1,000 population (age adjusted) Baseline 131 (1997) Target 126 NumeratorNumber of emergency department visits due to injury or poisoning (defined by ICD-9-CM dx codes or E- codes or reason for visit codes).

18. “To be revised” 15-12. Reduce initial hospital ED visits caused by injuries National Data Source National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC,NCHS. State Data Source Not identified. Healthy People 2000 Objective Not applicable. Changes since the 2000 Publication None. Measure Rate per 1,000 population (age adjusted) Baseline ?? Target ?? NumeratorNumber of initial emergency department visits due to injury or poisoning (defined by first- listed ICD-9-CM injury codes or E- codes

19. Current 15-12:NHAMCS published definition New without initial visit Revised 15-12 Initial only (1st dx or 1st E-code) NEISS-AIP (2 denominators) ISW3 Age-adjusted injury visit rates to emergency departments based on alternative definitions: United States, 1995-2005 1,500.0 1,400.0 1,300.0 Visits per 10,000 population 1,200.0 1,100.0 1,000.0 900.0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 SOURCES: CDC/NCHS, NHAMCS-ED, 1995-2005 data files and NEISS-AIP data from WISQARS.

20. Other sources of injury data • Health United States • Standard annual tables • Time trends • Health Data for all Ages and Trends in Health and Aging • Online resource of NCHS mortality and morbidity data with standard definitions for injury measures • NCIPC’s WISQARS and CDC WONDER • NCHS mortality data

21. Health, United States • Trend tables using matrix definitions • Homicide rates • Suicide rate • Firearm death rates • Trend tables using non-matrix definitions • Motor vehicle death rates • ED injury visit rates (to be changed) • Hospital discharge rates for injury (to be changed) • www.cdc.gov/nchs/hus.htm

22. Health Data for all Ages & Trends in Health and Aging • Online data retrieval resources based on NCHS data • Injury mortality • Injury ED visits • Injury hospital discharge rates • www.cdc.gov/nchs/health_data_for_all_ages.htm • www.cdc.gov/nchs/agingact.htm

23. NCHS and collaborative work • None of the standard setting or definition changes are done without collaborations with our partners: • CSTE • ICE on Injury Statistics • ICEHS • NCIPC • PHDSC • STIPDA

24. NCHS and collaborative work • CSTE • Workgroup on External Cause Coding for Injuries (WECCI) • ICE on Injury Statistics • External cause code matrices • Diagnoses matrices • WHO Technical committee for ICD-11 injury chapters • ICEHS • First external cause of injury matrix • NCIPC • Indicators • Matrices • PHDSC • External cause of injury workgroup • STIPDA • Injury Surveillance Workgroups (ISW)

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26. NCHS Injury resources on the web • http://www.cdc.gov/nchs/injury.htm

28. Contact Information Lois A. Fingerhut Special Assistant for Injury Epidemiology CDC/National Center for Health Statistics 3311 Toledo Road Hyattsville, MD 20782 laf4@cdc.gov