1. VA Economic Data Sets I: Utilization Paul G. Barnett, PhD June 15, 2005 VA Health Economics Course

2. Overview of this lecture Access to VA Data VA Utilization Databases Inpatient Files Outpatient Files Other VA Databases

3. Access to VA Data

4. How to access VA data System set up for VA Employees Austin Automation Center –Best for patient level observations VISN Support Service Center –Easiest for observations about groups of patients, stays, or encounters

5. Austin Automation Center Requires timesharing account –Must be a VA employee, have approvals Facility incurs charges for jobs you run Must be able to program in SAS Only way to create and follow cohorts

6. Austin Automation Center (cont.) Information on how to obtain an account available from VA Information Resource Center (VIREC) link (Note that you “right click” to go to a Power Point link) link –See “Toolkit for new users of VA data” –Guide for first time users of Austin data- linklink Information also available from Austin help desk and web site- –See links page for VA web site URL –(512) 326-6780 or (800) 883-4100

7. VISN Support Service Center (VSSC) Web Site See links pages for VA web site URL No account required –Requires access to private VA network –Requires VA email user name and password No programming skills needed –Reports generator For most reports, no charge is incurred

8. VSSC Web Site (cont.) In general, provides data at level of facility or groups of patients Many useful reports  Click on: –“DSS” –“Financial” –“Workload” Some patient-level data –If you have an Austin account –Generates SAS code and runs job –Charge is incurred

9. VSSC Web Site (cont.) Financial and Clinical Data Mart (FCDM) –Proclarity-- Web based report generator –Has great flexibility, content expanding –Proclarity Desktop– PC software that allows great flexibility

10. VA Utilization Databases

11. Where do the data come from? Veterans Information Systems & Technology Architecture (VISTA) National Patient Care Database (NPCD) Extracts of NPCD- SAS Files at Austin

12. Veterans Information Systems & Technology Architecture (VISTA) Computer system at each medical center Formerly called Decentralized Hospital Care Program (DHCP) Also called Computerized Patient Record System (CPRS) Data are periodically extracted and transmitted to Austin

13. National Patient Care Database (NPCD) Located at the Austin Automation center A large data base that cannot be accessed by researchers Used by Austin to generate user accessible files, the “SAS extracts”

14. Which utilization files can I use? SAS Extracts of NPCD –Inpatient Files Patient Treatment Files (PTF) –Outpatient Files Outpatient Care Files (OPC)

15. Inpatient Files

16. PTF files Four sets of files in PTF based on type of care Each set has multiple files with different data Sets are mutually exclusive A given hospital stay appears in only one set of files Stays are assigned to one of the following: –NON-EXTENDED CARE –EXTENDED CARE –OBSERVATION –NON-VA

17. Which set of files to use? Unexpected types of care may be found in files –Some extended and observation care is in non-extended file –Some acute care is in extended care file –Some non-VA care is in extended care file (Community Nursing Homes stays designated by STATYP=42) –Some acute care is in observation file Search all files!

18. CENSUS files Patients still in hospital on September 30 These stays are incomplete; when the stay is finished, it is reported in other files. Census file may be needed –if analyst wants to know about stays that are not yet over –for some studies of long-term care, as some stays last many years

19. Types of files Each hospital stay is characterized in different files A set of files is made up of the following types –MAIN- one record per stay –BEDSECTION- one record per ward –SURGERY –PROCEDURES

20. PTF File Names Type of care file vs. type of file Non-Extended Care Extended Care Observation MainPMXMPMO BedsectionPBXBPBO SurgeryPSXS-- ProcedurePPXP--

21. MAIN file One record per hospital stay Variables pertain to entire stay Characteristics of patient –Scrambled Social Security number (SCRSSN) –Age, gender, zip code of residence Characteristics of stay –Medical center number (STA3N), admission date, discharge date, diagnoses

22. BEDSECTION file Bedsection (BEDSECN) is 2 digit code that indicates the location of care Bedsection file has one record for each bedsection visited by patient –One to several records per hospital stay –e.g. stay that involved days in Medical Intensive Care (12) and General Acute Medicine (15) has two records in this file

23. BEDSECTON file (cont.) BEDSECN is actually “treating specialty”- the service of the treating physician PLBED is the location of care, but this variable does not always have a value

24. MAIN vs. BEDSECTION Some variables are in both Files may be merged on the variables that define a stay: –SCRSSN, ADMITDAY, ADTIME, DISDAY, STA3N, SRTKEY –Rare duplicate records distinguished only by difference in STA6A (6 digit station code)

25. PTF Surgery File Reports ICD-9 codes for surgical procedures Each record has up to 5 surgical procedures At least one record for every day that a surgery is performed –A second record if more than 5 surgeries in a day –Zero to several records for a hospital stay Merge with other files using stay defining variables

26. PTF Procedures File Like surgery file, but reports medical procedures A given ICD-9 procedure code may appear in either the surgery or procedure file— –Analyst should look in both files!

27. What is a VA hospital stay? A single stay may include days in: –Acute medical unit –Long term care –Psychiatric care –Rehabilitation unit

28. Can VA stays be compared to non-VA care? Are stays in VA hospitals longer than stays in community hospitals for the same diagnosis (or Diagnosis Related Group)? Is the cost of a stay in VA hospitals longer than stays in community hospitals for the same diagnosis (or Diagnosis Related Group)? What should be done to make VA care comparable?

29. Outpatient Files

30. Outpatient NPCD SAS extract files– the events file (SE) Comprehensive file –All outpatient visits in NPCD –Doesn’t include non-VA care –May exclude some outpatient care Characteristics of patient Characteristics of visit

31. Event File- characteristics of visit Station (STA3N, STA5A) Clinic stop visited (CL) Date of visit (VIZDAY) Provider (up to 10) –Provider Type –Provider ID (can’t be decoded) ICD-9 diagnosis codes (up to 10) CPT procedure codes (up to 15) –New version will include duplicates, up to 20 codes per record

32. Stop Code 3 digit code for location of care Now called “DSS identifier” Policy defines stop codes: linklink Primary stop code– This is what matters Secondary “credit” stop code– Should be ignored –Policy limits its use to specific modifiers –Many sites still use old rules, inappropriately

33. What is a “visit”? There may be more than one record per clinic stop per day per person Consider outpatient care for two patients –One patient has a single record with two procedures and two providers –One patient has two records with one procedure and one provider in each record How should we count the number of “visits”?

34. Unscrambling Social Security Numbers (SSNs) Each true SSN has exactly one scrambled SSN Special permission is required to unscramble (or scramble) –Approval at national level –Research use requires IRB approval –With approval, Information Security Officer adds special “Functional Task Codes” to your Austin profile For each data base, a file links true and scrambled SSNs

35. Information on NPCD SAS extracts VIREC manuals on Medical SAS Datasets (PTF and OPC) linklink Tabulation of key variables

36. Other VA Databases

37. VA Data to be Described in Upcoming Lectures Pharmacy, Labor DSS National Data Extracts Prosthetics, Fee Basic Department Level Costs Person Level Costs HERC Average Costs

38. Other Types of VA Data 1. Long-term care files 2.Patient-level files 3.Provider-level files 4.Allocation Resource Center files

39. 1. Long-term care files Patient Assessment File indicates patient severity Replaced by Minimum Data Set (MDS) See long-term care guidebooks- linklink

40. 2. Patient-Level Files BIRLS –Gives dates death for veterans –See VIREC documentation- linklink

41. 2. Patient-Level Files (cont.) Compensation and Pension files –Identifies veterans with service connected disabilities Enrollment Extract File 2001 Survey of Veterans- linklink

42. 3. Provider-Level Files Facility file Provider files Malpractice Costs data

43. Database of VA facilities Veteran Administration Site Tracking system (VAST) Location and characteristics of VA facilities and contract providers –Data base on web site –Brief database at Austin: RMTPRD.S573CET.VAST.JAN2005.SAS Created by VA Planning Systems Support Group (PSSG) (See links page for VA web site URL) –(352) 374-6080

44. Provider identification file Includes provider identification number IN NPCD and provider name –MDPPRD.PRO.SAS.NAT.FY05.PROVNAME –MDPPRD.PRO.SAS.NAT.FY05.PROVNAME.PCMM –May require true social security number access

45. 4. Allocation Resource Center files VERA files –Measure workload for VA budget process (RPM/VERA) –DSS based cost estimates Used to allocate count of patients who receive care at more than one facility –Does not report individual encounters –Greatest detail: group of encounters of an individual patient Available at VSSC web site

46. Allocation Resource Center files (cont.) Data in support of VERA model –Research funding at each VA medical center –Count of residents at each VA medical center Created by VA Allocation Resource Center (See links page for VA web site URL) –(781) 849-1837

47. Other useful web sites with VA data Veteran Data & Information Page – linklink Check VSSC web site –Reports can be used to identify underlying dataset VA Corporate Database Monograph –Brief descriptions of VA databases linklink –Comprehensive, out of date

48. Where can I learn more? VA Information Resource Center- linklink –virec@research.hines.med.va.govvirec@research.hines.med.va.gov –(708) 202-2413 (Central Time) Health Economics Resource Center- linklink –herc@med.va.govherc@med.va.gov –(650) 617-2630 (Pacific Time)

49. VIREC vs. HERC VIREC: Questions about clinical and utilization files; –PTF, OPC, long-term care files, DSS clinical data HERC: Questions about financial datasets –FMS, CDR, DSS cost data

50. HSRData e-mail group E-mail discussion group of VA data users See VIREC web site on how to join