Wendy Brunner Minnesota Department of Health June 13, 2011

1. Using Data from the Indian Health Service General Data Mart to Describe the Burden of American in Minnesota’s American Indian Population Wendy Brunner Minnesota Department of Health June 13, 2011

2. Background MDH Asthma Program working on three projects with American Indian tribes in Minnesota • Sought data on asthma to assist in developing programs and for program evaluation Few sources of data are available to describe burden of asthma • Hospital discharge data does not include claims from Indian Health Service (IHS) hospitals • Hospital discharge data does not include race/ethnicity • Statewide surveys (e.g., BRFSS) do not sample sufficient numbers to produce reliable estimates for this population

3. American Indians in Minnesota • 11 tribes • 3 IHS facilities: Cass Lake hospital, Red Lake hospital, White Earth health center • >39,000 American Indians residing in Minnesota received health services at an IHS or Tribal facility in 2007-2009 (Bemidji Area IHS Headquarters User Population report) Source: Bemidji Area IHS Office

5. Data Source: IHS General Data Mart • Covers users of tribal health care • Contains registration (demographics) and encounter data including office visits, hospitalizations, ED visits, and medication dispensing events • Data exported from facilities via RPMS or commercial software to IHS National Data Warehouse • Unique identifier links the registration and encounter tables • Authorized users include some Area Statistical Officers

6. Asthma Query options • Asthma prevalence criteria : “Any asthma” vs. “Persistent asthma” • Time window: 1 yr vs. 2 yr vs. 3 yr • Denominator: population of active users vs. IHS census-based estimate of service population

7. Asthma Prevalence Criteria “Any Asthma” “Persistent Asthma” Meeting anyof the following: • ≥1 emergency department visit with a primary diagnosis of asthma • ≥1 acute inpatient discharge with a primary diagnosis of asthma • ≥1 outpatient visit with a primary or secondary diagnosis of asthma • ≥2 asthma medication dispensing events Meeting any of the following: • ≥1 emergency department visit with a primary diagnosis of asthma • ≥1 acute inpatient discharge with a primary diagnosis of asthma • ≥4 outpatient visits with a primary or secondary diagnosis of asthma AND ≥2 asthma medication dispensing events • ≥4 asthma medication dispensing events

8. Asthma Queries • Any asthma, 2009 • Any asthma, 2008-2009 • Any asthma, 2007-2009 • Persistent asthma, 2009 • Persistent asthma, 2008-2009 • Persistent asthma, 2007-2009

9. Results: Denominators - I Active Users of Tribal Health Care

10. Results: Denominators - II Active Users of Tribal Health Care

11. Demographics of active users of tribal health care vs. Minnesota

12. Results: Asthma definition comparison

13. Results: Time window comparison - I

14. Results: Time window comparison - II

15. “Any Asthma” definition, 2008-2009

16. Tribal Asthma Data Profile – page 1

17. Tribal Asthma Data Profile – page 2

18. Strengths and Limitations of Data Source Strengths • Breadth of information available • Timeliness • Skilled and knowledgeable statistician to run queries Limitations • Lack of direct access to the data • Dependent on IHS staff availability • Does not cover all American Indians living in Minnesota; only users of tribal health care • Consistently picking up contract care? • Administrative prevalence comparability with survey data?

19. Next Steps • Regional data profiles • Tribal-level data profiles • Tribal-level queries (IHS area office needs written permission from tribal council to run queries of tribal-level data) • Asthma control measures: e.g., average # of quick reliever dispensing events per year, ratio of ED visits/clinic visits for asthma

20. Conclusion • IHS General Data Mart is a rich source of health information for American Indians living in Minnesota • Opportunity to collaborate with IHS staff and benefit from their knowledge of the data