UNH Grand Rounds Series 20072008 Show Me the Data Everything you always wanted to know about NH publ

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UNH Grand Rounds Series 2007-2008Show Me the
Data!(Everything you always wanted to know about
NH public health data but were afraid to ask!)

• Karla Armenti
• Chief, Health Statistics Data Management
• Division of Public Health Services
• Department of Health and Human Services
• Concord, NH 03110

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Public Health DataWhere can you get it?
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Health Statistics and Data Management Section
(HSDM)
The biostatistics and epidemiology resource for
Public Health.

• Vision
• The vision of the Health Statistics and Data
  Management Section is to be the leading resource
  in New Hampshire for public health information,
  data analysis, and statistical expertise to
  empower, educate, and inform individuals working
  together to improve the health of all New
  Hampshire residents.

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Health Statistics and Data Management Section
(HSDM)

• Mission
• The mission of the Health Statistics and Data
  Management Section is to collect, store, analyze,
  and disseminate public health data in an
  appropriate, ethical and timely manner provide
  relevant education regarding the value and
  utilization of public health data provide tools
  to promote efficiency and build infrastructure
  and capacity for working with data.

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HSDM - Public Health Statistics

• We collect, store, interpret, analyze and
  disseminate data
• Cancer
• Behavioral Risk Factor Surveillance System
  (BRFSS)
• Real-time Automated Hospital Emergency Department
  Data
• Injury
• Birth
• Death
• Hospital (Ambulatory, Inpatient, Specialty)

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HSDM - Public Health Statistics

• As data stewards, we are responsible for
• Ensuring that data is used appropriately
• Individual confidentiality and privacy are
  protected and maintained
• Services provided
• Perform custom data analysis for DHHS and DES and
  community customers
• Produce annual reports 
• Advise programs on appropriate study design and
  analysis
• Develop new surveillance systems for DHHS
  programs to better assess the burden of disease
  and injury in NH

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HSDM - Public Health Statistics

• Staff (603) 271.
• HSDM Section Chief Karla Armenti
• X-8425, karmenti_at_dhhs.state.nh.us
• Cancer Epidemiologist Sai Cherala
• X-7812, Sai.S.Cherala_at_dhhs.state.nh.us
• BRFSS Coordinator/Epidemiologist Susan Knight
• X-4671, sknight_at_dhhs.state.nh.us
• Injury Surveillance Manager/Epidemiologist David
  Reichel
• X-8384, dreichel_at_dhhs.state.nh.us
• Data Analyst JoAnne Miles
• X-0584, jmiles_at_dhhs.state.nh.us
• EPHT Program Manager Matthew Cahillane
• X-4072, mcahilla_at_dhhs.state.nh.us

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Public Health Data Sets Overview

• Cancer Registry
• BRFSS
• Communicable Disease
• Hospital Discharges
• Births
• Deaths

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Cancer Data Sai Cherala, Cancer Epidemiologist

• New Hampshire State Cancer Registry (NHSCR) (in
  partnership with Dartmouth College)
• Cancer became a reportable disease in 1985
• Incidence-based Cancer Registry established
  in1986
• HSDM has overall responsibility for identifying
  all new cases of cancer
• Gathers information about cancer in a community,
  provides the data needed to elucidate the causes
  of the many different cancers, and evaluate the
  programs to control cancers

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Cancer Data

• Data Details
• Data includes
• Cancer patients age, sex, race, ethnicity and
  residence
• Information on a patient's primary tumor and
  treatment (including date of diagnosis, method of
  detection, topography, morphology, behavior,
  clinical extent, staging, metastases, multiple
  primaries, laterality, and first course of
  treatment)
• Available 24 months after the close of a calendar
  year
• Earliest year 1987 through year 2004

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Cancer Data

• HSDM
• Performs ad hoc data requests
• Provides incidence counts down to the town level
  and age-adjusted incidence rates
• Provides annual reports and fact sheets
• Provides limited data sets for scientific
  research through confidential data request forms
• Requires at least 4 weeks of QA, upon receipt of
  a new cancer dataset, prior to use in analysis

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Cancer Data

• Data from the Cancer Registry is used for
  following studies.
• Ovarian Tumor Risk Factors Study
• Colorectal Cancer Family Registry Study
• Toxic Metals in the Northeast
• New England Study of Environment and Health
  (Bladder Cancer)
• New England Lung Cancer Study
• Nurses Health Study, Cohort Cancer Registry
  Follow-up Study
• New Hampshire Mammography Network
• DEMP - Density Equalizing Map Projections for
  Disease Surveillance
• Occupational Health Study
• Sister Study
• Survival Studies in Bladder Cancer

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Publicly Available Cancer Data

• Resources
• http//www.cdc.gov/cancer/npcr/
• http//www.cancer.gov/

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What is BRFSS?Susan Knight, BRFSS Coordinator

• The largest continuous telephone health survey in
  the world (15-20 minutes in length)
• Began in NH in 1987
• Current Sample gt 6,000 NH respondents
• Non-institutionalized adults 18 and over with
  telephones
• Sponsored by the Behavioral Surveillance Branch
  of CDC
• State level estimates prior to 2005
• 2005 and 2006, county level estimates, Manchester
  and Nashua

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2007 Survey CategoriesCore Sections

• Health Status
• Healthy Days
• Health Care Access
• Exercise
• Diabetes
• Hypertension Awareness
• Cholesterol Awareness
• Cardiovascular Disease Prevalence
• Asthma
• HIV/AIDS

• Immunization
• Tobacco Use
• Alcohol Consumption
• Demographics
• Veterans Status
• Disability
• Arthritis Burden
• Fruits and Vegetables
• Physical Activity
• Emotional Support and Life Satisfaction

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2007 Survey CategoriesOptional Modules

• Random Child Selection
• Childhood Asthma Prevalence
• Arthritis Management
• Visual Impairment and Access to Eye Care
• Womens Health
• Cancer Screenings
• Adult Asthma History

• Mental Illness Stigma
• Sexual Violence
• Intimate Partner Violence
• General Preparedness
• Healthy Days (symptoms)
• Heart Attack and Stroke
• Actions to Control Blood Pressure

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2007 SurveyState Added Questions - Examples

• Questions on epilepsy
• Suicide and suicidal thoughts
• Workers Compensation (access to)
• Town of Residence
• Air quality awareness
• Quality of life

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Access to BRFSS Data

• HSDM will perform ad hoc data requests
• Limited data sets are available
• Annual reports and fact sheets published by HSDM
• For more information on BRFSS, reference
  www.cdc.gov/brfss/

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NH Hospital Discharge Data

• Collected via contract by DHHS since 1985
  (through 2005)
• Inpatient (gt24 hours)
• Short Stay Acute Care
• Outpatient (Ambulatory) (lt24 hours)
• Emergency Department
• Observation Stay
• Hospital Ambulatory Surgery
• Specialty
• Long stay rehabilitation (drug, psych, brain
  injury, physical)

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NH Hospital Discharge Data

• Data sets currently available through application
  process
• Multiple file formats provided
• SAS, SPSS, Access, fixed width delimited text,
  etc.
• Data collection rules are under revision to
  modernize and expand data set

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Birth Certificate Data

• Collected by Department of State, Division of
  Vital Records Administration
• Evaluated data through 2003
• 2004 is under evaluation
• File format change in July 2004, numerous changes
• Data sets available under state statute
• Multiple file formats provided

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Death Certificate Data

• Evaluated data through 2004
• Leading Causes of Death Report
• http//www.dhhs.nh.gov/DHHS/HSDM/default.htm

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Bureau of Data and Systems Management Health
Data Sets
Andrew Chalsma 271-4514 achalsma_at_dhhs.state.nh.g
ov
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Bureau of Data and Systems Management

• Mission
• The Bureau of Data and Systems Management
  provides DHHS with information needed to meet
  state and federal statutory and regulatory
  requirements.
• The Bureau supports DHHS, New Hampshires health
  care system, and the public with timely and
  accurate data and statistics for needs
  assessments, program development, program
  evaluation, and policy decisions to improve
  health and health care delivery systems for the
  people of New Hampshire.

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Core Functions

• Collect, manage, develop, and disseminate data
  and statistical information
• Health care needs of New Hampshire
• Health system cost and quality
• Population served by the Department
• Utilization and cost of services and programs of
  the Department

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Core Functions

• Provide stewardship and reporting of social and
  health care data and information
• Development of innovative and effective data
  collection and information dissemination systems
  to address current priorities and future needs
• Standardization of data definitions, data
  cleansing, and data quality measures
• Adherence to state and federal privacy and
  confidentiality standards
• Improving awareness of, and access to, data and
  information
• Collaboration, education, and technical
  assistance on appropriate use and interpretation
  of data

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Hospital Discharge/Vital Records

• Record level data sets available on hospital and
  vital records data with appropriate data use
  agreements.

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Private Insurance Claims and Medicaid

• Collection underway through the Comprehensive
  Health Care Information System (CHIS) project
• Includes medical and pharmacy claims
• Data Available March 2007 paid claims and
  2005-2006 services
• Reports and data sets available through DHHS, see
  www.nhchis.org for more information

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HEDIS and CAHPS Data Sets

• HEDIS Health Plan Employer Data and Information
  Set
• CAHPS Consumer Assessment of Healthcare
  Providers and Systems
• Collected as part of CHIS project
• 2005-2007 submissions for 2004-2006 data from
  three HMOs filing (Anthem, Harvard Pilgrim,
  CIGNA)

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HEDIS

• HEDIS contains a wealth of clinical information
  derived from claims analysis and chart audits
• Childhood immunization and well child visit rates
• Chronic disease screening
• Appropriate care for diabetes, asthma, mental
  health
• See www.nhchis.org for report summarizing 2005
  HEDIS information

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National Public Health Data Resources
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National Public Health Data Resources

• National Center for Health Statistics (NCHS)
• http//www.cdc.gov/nchs/
• NCHS Injury Data
• http//www.cdc.gov/nchs/injury.htm

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National Public Health Data Resources

• National Association of Health Data Organizations
  http//www.nahdo.org/default.aspx
• National Association for Public Health Statistics
  and Information Systems
• http//www.naphsis.org
• Health Resources and Services Administration
• http//datawarehouse.hrsa.gov/pcsa.htm

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Health Care Resources

• http//www.nhhealthcost.org/
• http//www.ahrq.gov/data/hcup/
• http//www.nhqualitycare.org/
• http//www.hospitalcompare.hhs.gov/
• http//www.nhpricepoint.org
• http//www.census.gov/

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Local/Regional Resources

• NH Office of Energy and Planning
• http//www.nh.gov/oep/programs/DataCenter/index.h
  tm
• UNH New Hampshire Health Information Center
• http//www.nhhealthdata.org/

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Other Health Data Sets on the Horizon?
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Environmental Public Health Tracking Program
(EPHT)

• The EPHT is building a web-based tracking
  network, as a component of NH HealthWRQS, that
  will provide single-entry access to standardized
  state environmental and health data, in order to
• Prioritize environmental health concerns, risks,
  and impacts
• Develop a baseline of environmental and public
  health status
• Monitor changes in the environment that affect
  human health
• Evaluate measures and interventions for pollution
  or disease control
• Facilitate decision-making and resource use

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Environmental Public Health Tracking Program

• Initial EPHT data sets
• Air quality and asthma
• Ozone, PM2.5, asthma hospitalizations
• Radon in indoor air and lung cancer
• Contaminants in public drinking water and health
  effects
• Arsenic
• Bladder Cancer
• For more information, go to www.des.state.nh.us/E
  HTP/

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Occupational Injury and Illness Surveillance

• National Institute for Occupational Safety and
  Health (NIOSH) has funding for states to create a
  fundamental occupational health surveillance
  program, measuring 19 health indicators developed
  by NIOSH and CSTE (Council of State and
  Territorial Epidemiologists)
• Indicators
• Workers compensation data, work-related
  hospitalizations (burns, musculoskeletal, carpal
  tunnel, lung disease, blood lead levels, etc.

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Other Potential Data Sets

• TEMSIS (New Hampshire Trauma Emergency Medical
  Services Information System) - Department of
  Safety - Near real time EMS data
• AHEDD (Automated Hospital Emergency Department
  Data) Pilot project
• Poison Control Northern New England Poison
  Center

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Question

• Why do people
• want health data?

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Why do people want health data?

• Program development
• Intervention assessment
• Grant applications
• Community planning
• Research
• Citizen inquiries about their community
• Early event detection (prevention and control)

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Data Limitations

• Can people always get the data they want
• and what they want from the data?
• The most recent year available may be 2004 in
  some data sets
• If the count of cases is 10 or less for a town,
  the rates will be suppressed (not provided) due
  to statistical unreliability (a small numbers
  issue)
• In some data sets, we can provide county level
  data, not town level
• In New Hampshire data on race/ethnicity is
  limited because the state population is
  approximately 96 white (another small numbers
  issue)
• The data sets available are not perfect, parts of
  them may have data quality issues.

HSDM addresses every data request promptly.
Unfortunately, sometimes the answer is, Sorry,
we can not provide the data you are looking for.
If that is the case, we will help you modify
your request so we can meet your need, or provide
you information on alternate sources if available.
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Guidelines for the Release of Public Health Data
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Guidelines Statutes RSA 126 and 141(under
revision)

• Public Information
• Confidential Data
• Sections
• Guidelines for determining the release of
  personal identifying information
• Guideline to Determine the Release of Public
  Information When Constructive Identification is
  at Issue
• Reports and disclaimer

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Confidentiality

• Some people want confidential health data
  limited use data sets, full data sets, individual
  records.
• Protected Health Information (45 CFR 164.501 of
  the Privacy Rule) covered under the Health
  Insurance Portability and Accountability Act of
  1996 (HIPAA)
• NH DHHS data use agreements and data request
  review committees.
• NH DOS, Vital Records Administration IRB
  confidential birth and death data.

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Discussion