VA Health Care Data at the Austin Automation Center

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VA Health Care Data at the Austin Automation
Center

• Paul G. Barnett, PhD
• April 4, 2003

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Overview of presentation

• Origin of data- Where do data come from?
• Organization of data
• What data are available?
• Which file do I use?
• Source of documentation- Where can I learn more?

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

• Computer system at each medical center
• Formerly called Decentralized Hospital Care
  Program (DHCP)
• Also called CPRS
• Data are periodically extracted and transmitted
  to Austin

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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

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Which file do I use?

• SAS Extracts of NPCD
• Hospital Discharge
• Patient Treatment Files (PTF)
• Outpatient Visits
• Outpatient Care Files (OPC)

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PTF files

• Four sets of files in PTF based on type of care
• Each set has multiple files with different data

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Sets of files

• 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

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NON-EXTENDED CARE

• Most VA stays
• Acute medical and surgical stays
• Psychiatry
• Rehabilitation
• Excludes most extended care and observation stays
• Patient may be transferred, so some extended care
  and observation stays are in these files!

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EXTENDED CARE

• Predominantly extended care unit stays
• Patient may be transferred to other parts of
  hospital
• thus some acute care is in these files!
• Includes community nursing home care
• thus some non-VA care is in these files!
• STATYP42 indicates community nursing home care
  in this file

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OBSERVATION

• Observation unit stays visits
• Are treated as hospital stays by VISTA
• Are not considered hospital stays for VA
  performance measures
• Vast majority of files consist of observation
  visits of 1 day or less
• Patient may be transferred to other parts of
  hospital
• Thus some acute and even extended care
  occasionally appear in these files!

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NON-VA files

• Stays at non-VA hospitals under contract with VA
• Community nursing home stays in extended care file

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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 and non-VA care is in extended
  care file
• Some acute care is in observation file
• Search all files!

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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

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Types of files

• Each hospital stay is characterized in different
  files
• A set of files is made up of the following types
• MAIN
• BEDSECTION
• SURGERY
• PROCEDURES

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PTF File NamesType of care file vs. type of file
Non-Extended Care Extended Care Observation
Main PM XM PMO
Bedsection PB XB PBO
Surgery PS XS --
Procedure PP XP --
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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

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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

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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

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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)

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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

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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!

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Outpatient NPCD SAS extract files

• Outpatient Care Files (OPC)
• EVENTS
• PROCEDURES
• DIAGNOSIS
• VISITS
• These different files contain overlapping
  information
• A single outpatient visit may appear in every
  file!

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EVENTS (SE)

• Comprehensive file
• All outpatient visits in NPCD
• Doesnt include non-VA care
• May exclude some outpatient care
• Characteristics of patient
• Characteristics of visit

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Events File- characteristics of patient

• Scrambled Social Security No. (SCRSSN)
• Age (but not birth date)
• Gender (SEX)
• Eligibility category (ELIG)
• Zip code of residence (ZIP)

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Event File- characteristics of visit

• Station (STA3N, STA5A)
• Clinic stop visited (CL)
• Date of visit (VIZDAY)
• Provider (up to 10)
• Provider Type
• Provider ID (cant be decoded)
• ICD-9 diagnosis codes (up to 10)
• CPT procedure codes (up to 15)

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Stop Code

• 3 digit code for location of care
• Now called DSS identifier
• Policy defines stop codes
• http//www.herc.research.med.va.gov/
• CostData_Files/dss-identifiers_3-00.doc
• 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

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Using the SE file

• Job Control Language (JCL) specification
• DD name may require trailing zero (0) most
  recent file
• E.g., for FY00
• //IN1 DD DSNMDPPRD.MDP.SAS.SE00(0),DISPSHR

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Using the SE file- example

• Trailing zero used in DD statement but not in SAS
  statement
• //S640XXX6 JOB TSO01C19,S640PGB,
• // NOTIFYSYSUID,MSGCLASSI
• //STEP1 EXEC SAS,REGION5000K,SOUTR,WORK'500,100
  '
• //IN1 DD DSNMDPPRD.MDP.SAS.SE00(0),DISPSHR
• //LIBRARY DD DSNMDPPRD.MDP.FMTLIB6,DISPSHR
• //SYSIN DD
• OPTIONS NOCENTER LS78 PS266
• PROC MEANS DATAIN1.SE00 N MEAN MIN MAX SUM

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PROCEDURES (SC)

• Has CPT procedure codes
• Up to 12 procedure codes reported
• Compared to 15 codes in events (SE) file
• Was discontinued in FY2002

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DIAGNOSIS (SG)

• Has ICD-9 diagnosis codes
• Limited to visits in which a diagnosis was
  assigned
• Was discontinued in FY2002

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VISITS (SF)

• Has demographics, list of up to 15 stops visited
  on a single day by that patient
• No diagnosis or procedure
• Visits prior to 1997 have secondary stop code
  not comparable to visits file for subsequent years

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Regional outpatient files

• Some files are divided into segments by
  geographic region
• Use regional files if your analysis is limited to
  a single region, as jobs will run much more
  quickly

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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

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Information on NPCD SAS extracts

• Manuals on PTF and OPC available from VA
  Information Resource Center (VIREC)
• http//www.virec.research.med.va.gov
• FY2000 version just released
• Tabulation of key variables

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Other important at Austin files

• Long-term care files
• Patient Assessment File indicates patient
  severity
• Replaced by Minimum Data Set (MDS)
• See long-term care guidebooks
• http//www.va.gov/resdev/ps/pshsrd/ltcrguid/expage
  .htm

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Financial Files at Austin (text files)

• Financial Management System (FMS)
• Cost by service (e.g. nursing, medicine)
• Cost Distribution Report (CDR)
• Cost by patient care department (e.g., inpatient
  surgery, psychiatry)

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VA Fee Basis Files

• Information on care provided to veterans by
  providers under contract to VA
• Fee basis files
• Acute hospital stays
• Ancillary services provided to inpatients
• Outpatient services
• Payments to pharmacies
• Travel expenses

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Decision Support System

• Combines clinical and financial data from VISTA
• Cost of
• VA health care products
• VA health care stays and visits
• Clinical data including
• Results of 49 lab tests

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Where do DSS data come from?
VISTA Workload and patient data
Time allocation Relative costs
DSS VISN Level Production Databases (at Austin
but limited access)
Extracts of DSS- SAS Files at Austin
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DSS national extracts

• Cost files
• Clinical files

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DSS national cost extracts--Inpatient cost files

• Discharge- One record per hospital stay
• (like PTF main files)
• Treating specialty- One record for each month in
  a bed section, includes census patients
• (like PTF bed section files, but one record per
  month, and includes census)
• These files overlap

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DSS national cost extracts--Outpatient cost files

• Outpatient visits
• Designed to have records not in SE file
• Some visits in SE file not present in FY2000
  extract
• Pharmacy
• These files are mutually exclusive

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DSS national cost extracts

• First created in 1998
• FY2000 data may be reliable at some sites
• User must beware!

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DSS Department cost file (ALBCC)

• Cost of each Account Level Budget Cost Center at
  each medical center

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DSS clinical extracts

• Laboratory tests done (inpatient and outpatient)
• Laboratory results (49 tests)
• Planned extracts
• Pharmacy
• Radiology

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Other VA files at Austin

• BIRLS
• Gives dates death for veterans
• Compensation and Pension files
• Identifies veterans with service connected
  disabilities
• Enrollment files

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Other files at Austin

• Medicare Reports
• Medicare Cost Reports
• HCFA DRG Weights
• HCFA Wage Index
• American Hospital Association Survey
• Area Resource File
• ZIP Code Files
• State hospital discharge reports

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Where can I learn more?

• VA Information Resource Center
• http//www.virec.research.med.va.gov
• virec_at_research.hines.med.va.gov
• [phone] (Central Time)
• Health Economics Resource Center
• http//www.herc.research.med.va.gov
• herc_at_med.va.gov
• [phone] (Pacific Time)

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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

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HSRData e-mail group

• E-mail discussion group of VA data users
• See VIREC web site on how to join