Janet Coffman, PhD Associate Adjunct Professor Philip R. Lee Institute for Health Policy Studies

1. The Comparative Effectiveness Large Dataset Analysis Core: A Resource for Accelerating Research with Large, Public Datasets Janet Coffman, PhD Associate Adjunct Professor Philip R. Lee Institute for Health Policy Studies University of California, San Francisco October 5, 2012

2. Outline • Examples of major types of large, public datasets • Overview of Comparative Effectiveness Large Dataset Analysis Core (CELDAC) • CELDAC datasets • CELDAC accomplishments • K Scholar success story • Discussion

3. Major Types of Large Datasets Used in Health Services Research

4. Major Sources of Data

5. Major Units of Observation

6. Major Types of Survey Designs

7. National Health and Nutrition Examination Survey • Nationally representative sample of 5,000 persons per year • Data collected in 15 counties per year • Two major components • Interviews: demographic characteristics, socioeconomic status, diet, health behaviors • Physical examinations: medical, dental, physiological, lab tests http://www.cdc.gov/nchs/nhanes.htm 7

8. Examples of UCSF Faculty Publications Using NHANES • Seligman H.K. Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002. Journal of General Internal Medicine. 2007 Jul;22(7):1018-23. • Woodruff T, Zota A, Schwartz J. Environmental chemicals in pregnant women in the United States: NHANES 2003-2004. Environmental Health Perspectives. 2011 Jun;119(6):878-85. 2007 Jul;22(7):1018-23. 8

9. Medical Expenditure Panel Survey • Nationally representative sample of 22,000 to 37,000 persons • Overlapping panel design • 2 years of data collected through 5 rounds of interviews • Three major components • Household survey • Data on cost and utilization from providers caring for household survey participants • Survey of employers regarding employer-sponsored health insurance benefits http://www.meps.ahrq.gov/mepsweb/ 9

10. Examples of UCSF Faculty Publications Using MEPS • Newacheck P, Kim S. A national profile of health care utilization and expenditures for children with special health care need. Archives of Pediatric and Adolescent Medicine. 2005 Jan;159(1):10-7. • Yelin E., et al. Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons with 1997. Arthritis and Rheumatism. 2007 May;56(5):1397-407. 10

11. Overview of CELDAC

12. CELDAC Partners CELDAC is a partnership at UCSF among the • Philip R Lee Institute for Health Policy Studies • Clinical and Translational Science Institute • Academic Research Systems Funding • Administrative supplement to the NCRR grant for UCSF’s Clinical & Translational Science Institute • California HealthCare Foundation

13. CELDAC Mission The mission of CELDAC is to enhance UCSF's capacity for analysis of large local, state, and national health datasets to conduct comparative effectiveness research and other types of health services and health policy research.

14. CELDAC Goals • Accelerate access to and use of local, state, and national health datasets, as a model for other CTSAs and health research organizations. • Enhance UCSF researchers’ ability to compete for funding to use large data sets to conduct research. • Develop procedures and infrastructure by conducting pilot studies. • Support additional studies using large, public datasets. • Provide consultation to researchers currently working with or interested in working with large datasets.

15. CELDAC’S Main Components, 2013 • Online, searchable inventory of datasets • Consultation • Repository of select datasets available through MyResearch

16. Find Large Datasetshttp://ctsi.ucsf.edu/research/celdac A guided search tool to find the best datasets for a project. Builds on previous efforts by Nancy Adler, Andy Bindman, Claire Brindis, Charlie Irwin and others.

17. Search Results –Search for administrative data on infants’ use of health care serviceshttp://ctsi.ucsf.edu/research/celdac

18. Dataset Description and Links

19. Provide Consultation • Study design/conceptualization • Identification of relevant datasets • Assistance with dataset acquisition • Cohort selection • Data cleaning • Linking datasets • Strategies to deal with common methodological issues in analysis of observational data • Programming support for preliminary analyses

20. Provide Consultation • CELDAC provides some services on its own • Links researchers with other CTSI Consultation Service units as needed • Data management • Biostatistics • Other

21. CELDAC Datasets

22. Analyze Large Datasets • CELDAC has created a repository of select large, public datasets that are available to UCSF faculty at no cost. • These data sets include • American Hospital Association Annual Survey • Area Resource File • HCUP Kids Inpatient Database • HCUP National Emergency Department Sample • HCUP National Inpatient Sample • HCUP State Emergency Department and Inpatient Databases (select states)

23. National Inpatient Sample • Largest publicly available all-payer inpatient database • 20% stratified sample of admissions to community hospitals • 8 million discharges • Data available from 1988 to 2010 • Number of participating states has increased over time from 8 to 45 23

24. Kid’s Inpatient Sample • Only all-payer inpatient care database on children • 3 million discharges of children and adolescents ≤ 20 years old • Data available for 1997, 2000, 2003, 2006, and 2009 • Number of participating states has increased over time from 22 to 44 24

25. State Inpatient Databases • Universe of inpatient discharge abstracts from community hospitals • 46 states currently participate: > 90% of community hospital discharges • Some states provide variables for tracking readmissions • Data available from 1990 onward • UCSF has data from 2006 to 2010 for states with readmissions variables 25

26. National Emergency Department Sample • 20% stratified sample of visits to community hospital EDs • 25 to 30 million unweighted records • Data available from 2006 to 2009 • 29 states currently participate • Includes ED visits that resulted in • Treat-and-release • Transfer to another hospital • Admission to the same hospital 26

27. State Emergency Department Databases • Universe of ED visits that did not result in a hospital admission from community hospitals in participating states • 27 states currently participate • Some states provide variables for tracking revisits • Data available from 1999 onward • UCSF has data from 2006 to 2010 for states with revisits variables

28. CELDAC Accomplishments

29. CELDAC Clients • CELDAC has assisted over 70 faculty, staff, and trainees at UCSF • 22 using datasets in CELDAC’s repository • 18 consultations • 11 linkages with other UCSF resources • 9 presentations to faculty, staff, and trainees

30. CELDAC Clients • School of Medicine • Anesthesia • Dermatology • Emergency Medicine • Family & Community Medicine • Medicine • Neurological Surgery • Neurology • Obstetrics & Gynecology • Orthopedic Surgery • Psychiatry • Pediatrics • Radiology • Surgery • Urology • CELDAC serves a wide range of departments • School of Nursing • Community Health Systems Nursing • Family Health Care Nursing • School of Dentistry • Preventive and Restorative Dentistry • School of Pharmacy • Clinical Pharmacy

31. CELDAC Extensions • UCSF Library • Cross reference available datasets • UCSF CTSI • Assist Community Engagement with consultations that concern data analysis • Collaborate with Data Management consultation unit on project to identify UCSF staff with data management expertise

32. CELDAC Extensions • California HealthCare Foundation • Assessment of state policymakers’ needs for health care data

33. K Scholar Success Story

34. Naomi Bardach, MD, MAS Assistant Professor of Pediatrics Former KL2 Scholar Current K23 Scholar (NICHD)

35. Initial Study • Objective • To describe variation in hospital-level pediatric asthma readmission rates in community hospitals and hospital and patient characteristics associated with readmissions

36. Initial Study • Design/Methods • HCUP State Inpatient Databases for states with revisit linkages (AZ, CA, FL, NC, UT) • Readmissions of patients age 2-21 years to non-federal hospitals within 30-days of asthma related admission • Outliers = hospitals with readmission rates that did not overlap with estimate of group mean • Random effects logistic model to assess hospital and patient characteristics associated with readmissions

37. Initial Study • Results • 1.9% of admissions were readmissions within 30 days (391 of 20,323) • Readmissions ranged from 0% to 7.3% • Only 2 hospitals had readmission higher rates the group mean and none had lower rates • Patient age, race, payor, and immunological complex chronic condition associated with odds of readmission

38. Subsequent Studies • Used HCUP State Inpatient and Emergency Department databases to assess readmission and revisit rates across diseases and conditions • Used the HCUP Kids Inpatient Database and a database from freestanding children’s hospitals to analyze pediatric ED visits and hospitalizations for mental health conditions

39. How CELDAC Helped • Initial K23 proposal not funded in part due to concerns about data sources • Revised proposal to incorporate analysis of HCUP state databases • Revised proposal funded • Platform presentation at Pediatric Academic Societies Annual Meeting • Manuscript revised and resubmitted to Pediatrics

40. Questions for Discussion • How could CELDAC better serve K Scholars? • What are the biggest barriers to research with large, public datasets at UCSF? • What services relating to analysis of large, public datasets would be most helpful?

41. Contact CELDAC • Janet Coffman, PhD, Principal Investigator: Janet.Coffman@ucsf.edu/415-476-2435 • Claire Will, PhD, Project Coordinator: Claire.Will@ucsf.edu/415-476-6009 • http://ctsi.ucsf.edu/research/large-datasets