VA Economic Data Sets I: Utilization

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VA Economic Data Sets I Utilization

• Paul G. Barnett, PhD
• June 15, 2005
• VA Health Economics Course

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Overview of this lecture

• Access to VA Data
• VA Utilization Databases
• Inpatient Files
• Outpatient Files
• Other VA Databases

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Access to VA Data
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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

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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

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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)
• See Toolkit for new users of VA data
• Guide for first time users of Austin data- link
• Information also available from Austin help desk
  and web site-
• See links page for VA web site URL
• [phone] or [phone]

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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

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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

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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

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VA Utilization Databases
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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 Computerized Patient Record System
  (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 utilization files can I use?

• SAS Extracts of NPCD
• Inpatient Files
• Patient Treatment Files (PTF)
• Outpatient Files
• Outpatient Care Files (OPC)

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Inpatient Files
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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
• 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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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
  STATYP42)
• 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- one record per stay
• BEDSECTION- one record per ward
• SURGERY
• PROCEDURES

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PTF File NamesType of care file vs. type of file
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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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What is a VA hospital stay?

• A single stay may include days in
• Acute medical unit
• Long term care
• Psychiatric care
• Rehabilitation unit

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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?

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Outpatient Files
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Outpatient NPCD SAS extract files the events
file (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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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)
• New version will include duplicates, up to 20
  codes per record

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Stop Code

• 3 digit code for location of care
• Now called DSS identifier
• Policy defines stop codes link
• 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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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?

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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

• VIREC manuals on Medical SAS Datasets (PTF and
  OPC) link
• Tabulation of key variables

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Other VA Databases
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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

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Other Types of VA Data

• 1. Long-term care files
• Patient-level files
• Provider-level files
• Allocation Resource Center files

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1. Long-term care files

• Patient Assessment File indicates patient
  severity
• Replaced by Minimum Data Set (MDS)
• See long-term care guidebooks- link

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2. Patient-Level Files

• BIRLS
• Gives dates death for veterans
• See VIREC documentation- link

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2. Patient-Level Files (cont.)

• Compensation and Pension files
• Identifies veterans with service connected
  disabilities
• Enrollment Extract File
• 2001 Survey of Veterans- link

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3. Provider-Level Files

• Facility file
• Provider files
• Malpractice Costs data

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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.JAN2
  005.SAS
• Created by VA Planning Systems Support Group
  (PSSG) (See links page for VA web site URL)
• [phone]

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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

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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

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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)
• [phone]

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Other useful web sites with VA data

• Veteran Data Information Page link
• Check VSSC web site
• Reports can be used to identify underlying
  dataset
• VA Corporate Database Monograph
• Brief descriptions of VA databases link
• Comprehensive, out of date

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Where can I learn more?

• VA Information Resource Center- link
• virec_at_research.hines.med.va.gov
• [phone] (Central Time)
• Health Economics Resource Center- link
• 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