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

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?

NCHS data sources used for injury surveillance  Mortality data Underlying cause of death dataUnderlying cause of death data Multiple cause of death dataMultiple cause of death data  Survey data National Hospital Discharge SurveyNational Hospital Discharge Survey National Hospital Ambulatory Medical Care SurveyNational Hospital Ambulatory Medical Care Survey National Health Interview Survey*National Health Interview Survey*

Where are the data used?  Healthy People 2010  Health, United States  Online data: CDC WONDERCDC WONDER Health Data for all AgesHealth Data for all Ages Trends in Health and AgingTrends in Health and Aging WISQARSWISQARS

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

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

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.

Examples of standards setting  Definitions Mortality matrixMortality matrix Morbidity matrixMorbidity matrix  Methodologies Age-adjustmentAge-adjustment Selecting a main injury in multiple cause of death dataSelecting a main injury in multiple cause of death data Severity measurementSeverity measurement

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

wonder.cdc.gov/data2010

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

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 Numerator Number of hospitalizations for nonfatal head injuries (principal diagnosis of ICD-9-CM codes , , , , 925). “Current” 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 ?? Target ?? Numerator Number of hospitalizations for TBIs (principal diagnosis of ICD-9-CM codes: , , , (Barell Matrix definition) “To be revised” Reduce hospitalizations for traumatic brain injuries

TBI (NCIPC surveillance) Age-adjusted hospital discharge rates for different measures of head injury: All head and neck injuries (per Barell Matrix) Current HP 15-1 Objective for nonfatal head injuries per 100,000 population TBI (per Barell Matrix)

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) Target126 Numerator Number of emergency department visits due to injury or poisoning (defined by ICD-9-CM dx codes or E- codes or reason for visit codes). “Current” Reduce hospital ED visits caused by injuries “Current” 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 ?? Target?? Numerator Number of initial emergency department visits due to injury or poisoning (defined by first- listed ICD-9-CM injury codes or E- codes “To be revised” Reduce initial hospital ED visits caused by injuries

ISW3 Revised Initial only (1 st dx or 1 st E-code) Age-adjusted injury visit rates to emergency departments based on alternative definitions: United States, SOURCES: CDC/NCHS, NHAMCS-ED, data files and NEISS-AIP data from WISQARS. Current 15-12:NHAMCS published definition New without initial visit NEISS-AIP (2 denominators) , , , , , , Visits per 10,000 population

Other sources of injury data  Health United States Standard annual tablesStandard annual tables Time trendsTime 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 measuresOnline resource of NCHS mortality and morbidity data with standard definitions for injury measures  NCIPC’s WISQARS and CDC WONDER NCHS mortality dataNCHS mortality data

Health, United States  Trend tables using matrix definitions Homicide ratesHomicide rates Suicide rateSuicide rate Firearm death ratesFirearm death rates  Trend tables using non-matrix definitions Motor vehicle death ratesMotor vehicle death rates ED injury visit rates (to be changed)ED injury visit rates (to be changed) Hospital discharge rates for injury (to be changed)Hospital discharge rates for injury (to be changed) 

Health Data for all Ages & Trends in Health and Aging  Online data retrieval resources based on NCHS data Injury mortalityInjury mortality Injury ED visitsInjury ED visits Injury hospital discharge ratesInjury hospital discharge rates

NCHS and collaborative work  None of the standard setting or definition changes are done without collaborations with our partners: CSTECSTE ICE on Injury StatisticsICE on Injury Statistics ICEHSICEHS NCIPCNCIPC PHDSCPHDSC STIPDASTIPDA

NCHS and collaborative work  CSTE Workgroup on External Cause Coding for Injuries (WECCI)Workgroup on External Cause Coding for Injuries (WECCI)  ICE on Injury Statistics External cause code matricesExternal cause code matrices Diagnoses matricesDiagnoses matrices WHO Technical committee for ICD-11 injury chaptersWHO Technical committee for ICD-11 injury chapters  ICEHS First external cause of injury matrixFirst external cause of injury matrix  NCIPC IndicatorsIndicators MatricesMatrices  PHDSC External cause of injury workgroupExternal cause of injury workgroup  STIPDA Injury Surveillance Workgroups (ISW)Injury Surveillance Workgroups (ISW)

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NCHS Injury resources on the web 

Contact Information Lois A. Fingerhut Special Assistant for Injury Epidemiology CDC/National Center for Health Statistics 3311 Toledo Road Hyattsville, MD