1. Using AHRQ Data at Census RDC’s Health Data Workshop May 6, 2009 Doris Lefkowitz

2. Outline Discuss Key Features of the Medical Expenditure Panel Survey Discuss Key Features of the Medical Expenditure Panel Survey Discuss how to apply to use MEPS data at an RDC Discuss how to apply to use MEPS data at an RDC Discuss How to get additional information on MEPS Discuss How to get additional information on MEPS

3. MEPS Medical Expenditure Panel Survey Medical Expenditure Panel Survey Relatively large, longitudinal study of the US civilian, non-institutionalized population Relatively large, longitudinal study of the US civilian, non-institutionalized population Collects information for all members of the household Collects information for all members of the household Conducted in 1977, 1987 and annually since 1996 Conducted in 1977, 1987 and annually since 1996

4. MEPS Survey Components MEPS-HC -- Household Component MEPS-HC -- Household Component MEPS-MPC -- Medical Provider Component MEPS-MPC -- Medical Provider Component MEPS-IC -- Insurance Component MEPS-IC -- Insurance Component

5. Key Features of MEPS-HC Survey of U.S. civilian noninstitutionalized population Survey of U.S. civilian noninstitutionalized population Sub-sample of respondents to the National Health Interview Survey (NHIS) Sub-sample of respondents to the National Health Interview Survey (NHIS) Oversample of policy relevant target groups Oversample of policy relevant target groups Panel Survey – new panel introduced each year Panel Survey – new panel introduced each year – Continuous data collection over 2 ½ year period – 5 in-person interviews (CAPI) Sample size: about 12K families and 32K persons since 2001 Sample size: about 12K families and 32K persons since 2001

6. Household Participation Verbal consent obtained from household respondent. Each household member is asked to give written consent to allow us to contact their medical providers Verbal consent obtained from household respondent. Each household member is asked to give written consent to allow us to contact their medical providers Informed consent procedure includes a video and written materials mailed to the household Informed consent procedure includes a video and written materials mailed to the household Each household is interviewed 5 times over 2 ½ years Each household is interviewed 5 times over 2 ½ years Interviews typically last 1.5 -2 hours and are conducted in the home on a laptop computer by a trained interviewer Interviews typically last 1.5 -2 hours and are conducted in the home on a laptop computer by a trained interviewer A single respondent provides most of the information for the household A single respondent provides most of the information for the household

7. MEPS Panel Design: Data Reference Periods 200520062007 Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4 Panel 9 Round 3 Round 3 Round 4 Round 4 Round 5 Round 5 Panel 10 Round 1 Round 1 Round 2 Round 2 Round 3 Round 3 Round 4 Round 4 Round 5 Round 5 Panel 11 Round 1 Round 1 Round 2 Round 2 Round 3 Round 3 Round 4 Round 4 Round 5 Round 5 Panel 12 Round 1 Round 1 Round 2 Round 2 Round 3 Round 3 Sample Size Sample Size N = 32,320 N = 32,577 N = 29,370 N is equal to the number of people with a positive person weight on the file.

8. MEPS-HC Core Interview Content Demographics Demographics Charges and Payments Charges and Payments Health Status Health Status Conditions Conditions Utilization Utilization Employment Employment Health Insurance Health Insurance

9. Healthcare Use Hospitalizations Hospitalizations Outpatient and emergency department visits Outpatient and emergency department visits Visits to physicians and other health care providers (nurses, PA, OT/PT, therapists, mental health professionals) Visits to physicians and other health care providers (nurses, PA, OT/PT, therapists, mental health professionals) Prescribed medications Prescribed medications Home health care Home health care Durable medical equipment and supplies Durable medical equipment and supplies Dental care Dental care

10. Detail for each event Date Date Provider name and type Provider name and type Condition associated with the event Condition associated with the event Some details about the event (tests performed, medications prescribed) Some details about the event (tests performed, medications prescribed) Charges, payments Charges, payments

11. MEPS- HC Supplemental CAPI Sections Sections asked in rounds 2 and 4: Access to care Access to care Child preventive health Child preventive health Satisfaction with health plans & providers Satisfaction with health plans & providers Sections asked in rounds 3 and 5: Assets (round 5 only) Assets (round 5 only) Income Income Preventive Care Preventive Care

12. MEPS-HC Supplemental Paper Questionnaires Diabetes Care SAQ Diabetes Care SAQ Adult SAQ Adult SAQ

13. Types of MEPS-HC Files Full-year Files - calendar year data Full-year Files - calendar year data Point-in-time Files - snap shot first part of year Point-in-time Files - snap shot first part of year

14. Levels of MEPS-HC Public Use Files Person Level - detailed person information Person Level - detailed person information Event Level - detailed event level information Event Level - detailed event level information Condition Level - detailed condition information Condition Level - detailed condition information Job Level - detailed job information Job Level - detailed job information

15. All hospitals (and associated doctors), emergency rooms, and out-patient departments used by respondents All hospitals (and associated doctors), emergency rooms, and out-patient departments used by respondents All home health agencies All home health agencies All pharmacies All pharmacies A sample of office-based physicians A sample of office-based physicians MEPS Medical Provider Component (MPC) Sample

16. MEPS Medical Provider Component (MPC) - Purpose Compensate for household item non-response Compensate for household item non-response Accuracy and detail Accuracy and detail Imputation source Imputation source Methodological studies Methodological studies

17. MEPS: Pharmacy Component 8000 pharmacies sampled 8000 pharmacies sampled – data on prescribed medicines purchased by households Data obtained: Data obtained: – Medication Name – National Drug Code (NDC) – Quantity Dispensed – Strength and Form – Sources of Payment – Amount Paid by Each Source

18. MEPS Insurance Component (IC) An independent survey of employers and unions not linked to the household survey An independent survey of employers and unions not linked to the household survey The sample contains information from about 45,000 establishments drawn from a Census Bureau frame and supports national and state- level estimates for all 50 states. The sample contains information from about 45,000 establishments drawn from a Census Bureau frame and supports national and state- level estimates for all 50 states. Data released in tabular form on the MEPS web site Data released in tabular form on the MEPS web site

19. MEPS-IC Purpose Employer-sponsored Health Insurance Employer-sponsored Health Insurance – Availability – Enrollment – Benefit and payment provisions – Cost

20. Data Use Restrictions - MEPS AHRQ makes specific promises to people and establishments who participate in the MEPS AHRQ makes specific promises to people and establishments who participate in the MEPS – Data will only be used for research and statistical purposes – Data that COULD be used to identify them will not be released beyond AHRQ and its contractors – Information about them will only be reported in a summary fashion

21. Data Use Restrictions – IRB Our IRB reviews our data collection and release procedures Our IRB reviews our data collection and release procedures – Affirms the ideas of our authorizing legislation – Requires review by a nosologist and pharmacist for rare conditions and medications to reduce inferential identification – Requires judgments to be made on releases of certain variables

22. AHRQ Data Center History AHRQ has operated a data center at its Rockville headquarters since 2000 AHRQ has operated a data center at its Rockville headquarters since 2000 Provides researchers access to non-public use MEPS data; Provides researchers access to non-public use MEPS data; Partnership with Census RDC’s is an extension of our commitment to have MEPS data used to the fullest extent possible Partnership with Census RDC’s is an extension of our commitment to have MEPS data used to the fullest extent possible

23. AHRQ Data Center (ADC) Mode of data access Mode of data access – on secure LAN at AHRQ - Rockville, Maryland – task order agreement with data contractor – combinations of both

24. AHRQ Data Center Researcher may bring data in, but not out Researcher may bring data in, but not out Researcher has access only to data needed for approved project Researcher has access only to data needed for approved project All tabular data will be reviewed for confidentiality before release from Center All tabular data will be reviewed for confidentiality before release from Center Only approved tables can leave the Center Only approved tables can leave the Center Center will store data files, foreign merge files, and all outputs needed for replication Center will store data files, foreign merge files, and all outputs needed for replication

25. AHRQ Facilities Secure room Secure room Terminal connected to secure LAN Terminal connected to secure LAN SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep, EQS software available, and others upon request SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep, EQS software available, and others upon request Limited staff support by people who know: Limited staff support by people who know: – the data – the confidentiality issues – the software

26. AHRQ Application Process Application procedures are on the MEPS web site Application procedures are on the MEPS web site Submit proposal to data center coordinator Submit proposal to data center coordinator Review within 1 week for feasibility, and data availability Review within 1 week for feasibility, and data availability Institutional Review Board (IRB) review required Institutional Review Board (IRB) review required

27. AHRQ Fees User fee of $150.00 for approved projects to cover technical assistance, simple file construction, and/or up 2 hours of programming support from data contractor User fee of $150.00 for approved projects to cover technical assistance, simple file construction, and/or up 2 hours of programming support from data contractor Additional programming support available from an AHRQ contractor at a cost of $80.00/hr Additional programming support available from an AHRQ contractor at a cost of $80.00/hr User fee waived for full-time students User fee waived for full-time students User fee waived for those intending to move to a Census RDC User fee waived for those intending to move to a Census RDC

28. AHRQ Remote Access Once the researcher has an established data center project, and has worked on site to develop and debug programs, jobs may be submitted to our Data Center Supervisor to run. Once the researcher has an established data center project, and has worked on site to develop and debug programs, jobs may be submitted to our Data Center Supervisor to run. Out-put will be reviewed for confidentiality and mailed to the user Out-put will be reviewed for confidentiality and mailed to the user

29. Confidential Data Available for ADC Projects Geographic data and links based on geographic data Geographic data and links based on geographic data State Identifiers State Identifiers HC-IC linked files for 1996-99 HC-IC linked files for 1996-99 MEPS NHC for 1996 MEPS NHC for 1996 Selected Medical Provider Component Data Selected Medical Provider Component Data

30. Confidential Data Available for ADC Projects Fully specified ICD-9 codes Fully specified ICD-9 codes Continuous measure of poverty status Continuous measure of poverty status Fully specified Industry and Occupation codes Fully specified Industry and Occupation codes Asset data Asset data Imputed NDC codes for prescription drugs Imputed NDC codes for prescription drugs Federal and state marginal tax rates Federal and state marginal tax rates Other variables developed by AHQR researchers Other variables developed by AHQR researchers

31. Partnership with Census Applicants can begin contact with either AHRQ or their local Census RDC Applicants can begin contact with either AHRQ or their local Census RDC AHRQ will request the applicant fill out the AHRQ data center application AHRQ will request the applicant fill out the AHRQ data center application

32. Partnership with Census AHRQ reviews the application AHRQ reviews the application – Does the project conform with AHRQ’s authorizing legislation – Does the data available support the analysis AHRQ sign off is quick, usually completed in less that 2 weeks AHRQ sign off is quick, usually completed in less that 2 weeks

33. Partnership with Census While AHRQ requests an AHRQ data center application for persons wishing to use the Census RDC, the application fee is waived While AHRQ requests an AHRQ data center application for persons wishing to use the Census RDC, the application fee is waived These procedures apply to MEPS household data only. MEPS Insurance Component data follows the customary Census procedures for Title 13 data These procedures apply to MEPS household data only. MEPS Insurance Component data follows the customary Census procedures for Title 13 data

34. Partnership with Census Application process moves to Census for approval Application process moves to Census for approval AHRQ will begin preparing the analytic file for the project AHRQ will begin preparing the analytic file for the project During the Census review and security process, applicant could chose to use the AHRQ data center During the Census review and security process, applicant could chose to use the AHRQ data center

35. Partnership with Census AHRQ staff historically provide extensive support for all data users AHRQ staff historically provide extensive support for all data users We have an active list serve and routinely answer hundreds of user questions each year We have an active list serve and routinely answer hundreds of user questions each year Customers using Census RDCs should not hesitate to continue to interact with AHRQ Customers using Census RDCs should not hesitate to continue to interact with AHRQ

36. Other Resources Information found on the MEPS Web site: www.meps.ahrq.gov Information found on the MEPS Web site: www.meps.ahrq.gov Overview of MEPS, Fact Sheets, and FAQs Overview of MEPS, Fact Sheets, and FAQs Survey instruments Survey instruments Findings/Statistical Briefs/Chart books Findings/Statistical Briefs/Chart books Methods reports Methods reports Data files Data files Bibliography Bibliography MEPS data workshop information and schedule MEPS data workshop information and schedule Mailing list/List server Mailing list/List server Data Center Information Data Center Information