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CVD Surveillance in Texas Texas Cardiovascular Health and Wellness Program. 2010. Weihua Li, MD, MPH Epidemiologist. Goal of Surveillance.

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CVD Surveillance in TexasTexas Cardiovascular Health and Wellness Program

2010

Weihua Li, MD, MPH

Epidemiologist


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Goal of Surveillance

Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health.

Source: Centers for Disease Control and Prevention. Updated guidelines for evaluating public health surveillance systems: recommendations from the guidelines working group. MMWR 2001; 50 (No. RR-13).


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What Data is Collected and Measured? What are the Data Sources? How Do You Tell if a Value is Significant?How Data is Reported to the Public?

  • Surveillance Measures

  • Data Resources

  • Statistics- One Test for Significance

  • Report and Publications


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Surveillance Measure And Resources

  • Morbidity: The occurrence of an illness or illnesses in a population

    • Prevalence

    • Hospitalizations

    • Medicaid reimbursement

    • EMS Response time

    • Quality of care

  • Mortality: The occurrence of death in a population

    • Deaths


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    CVD Surveillance Measures and Resources

    Health Service Region (HSR)

    † Dependent on sample size


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    Prevalence

    • The number of existing cases of a disease or health condition in a population at some designated time

    • How common a disease is in a population

    • An indication of the extent of a health problem


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    Incidence

    • The rate of development of a disease in a group over a certain time period

    • Three important elements to determine incidence rate:

      • The numerator- number of new cases

      • The denominator- population at risk

      • Time- period during which the cases accrue


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    Prevalence - Behavioral Risk Factor Surveillance System (BRFSS)

    • Population-based, random-digit dialed telephone survey

    • Conducted annually by all 50 states, 3 territories, and the District of Columbia

    • For more Information visit:

      • http://www.dshs.state.tx.us/chs/brfss/default.sht

      • http://www.cdc.gov/brfss/index.htm


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    Prevalence -BRFSS (BRFSS)

    • Cardiovascular Disease or Stroke Prevalence included since 1999 (1999, 2001, 2003, 2005, 2006, 2007, 2008, 2009) 

    • Cardiovascular Health included since 1999 (1999, 2001, 2003, 2005, 2007, 2009) 

    • Heart Attack & Stroke signs and symptoms included since 2001 (2001, 2003, 2005, 2009) 

    • Action to control high blood pressure included since 2007 (2007, 2009) 


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    CVD Prevalence - BRFSS (BRFSS)

    • Questions for Prevalence

      • CVD- “Have you ever been told by a doctor, nurse, or other health professional that you had a Heart Attack, Myocardial Infarction, Angina, Coronary Heart Disease, or Stroke ?”

      • Heart Disease- “Have you ever been told by a doctor, nurse, or other health professional that you had a Heart Attack, Myocardial Infarction, Angina, or Coronary Heart Disease ?”

      • Stroke- “Have you ever been told by a doctor, nurse, or other health professional that you had a stroke ?”


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    Prevalence - BRFSS (BRFSS)

    • Available Data

      • All State, HSR, MSA, and some counties

      • Demographics

        • Race/ethnicity

        • Gender

        • Age

        • Education

        • Income

      • Risk Factors


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    Hospitalization-Texas Health Care Information Collections (THCIC)

    • Hospital discharge data have been compiled and tabulated by THCIC since 1999

    • Billing forms used to collected data. Therefore data collected are administrative, not clinical

    • All CVD hospitalization is defined as hospital records listing as the primary diagnosis ICD-9 Code

    • ICD-9 Code for Cardiovascular Disease:390-448

    • For more information visit: http://www.dshs.tx.us/thcic/


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    ICD 9 Codes for CVD (THCIC)

    • Ischemic Heart Disease (ICD-9: 410-414)

    • Heart Attack (ICD-9: 410)

    • Hemorrhagic Stroke (ICD-9: 430-432)

    • Ischemic Stroke (ICD-9: 436-438, 433, and 434)

    • Congestive Heart Failure (ICD-9: 428)

    • Hypertension (ICD-9: 401-405)


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    Hospitalization - THCIC (THCIC)

    • Available Data

      • All State, HSR, MSA, TSA, and counties

      • Charges- $

      • Demographics

        • Race/ethnicity

        • Gender

        • Age

      • Payment Sources

      • Patient Discharge Status

      • Age-adjusted Hospitalization Rates per 10,000


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    Medicaid Reimbursement- (THCIC)Texas Health & Human Services Commission (HHSC)

    • Variables

      • Claim Type- physician, emergency department or in-patient hospital

      • Recipient- having at least one claim (physician, ED, or hospital) with a primary diagnosis of CVD

      • Reimbursement - $


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    Medicaid Reimbursement-HHSC (THCIC)

    • CVD defined as paid or partially paid claims with a primary diagnosis of ICD-9 code:

      • Cardiovascular Disease (ICD-9 CM: 410 - 414, 428, and 430 – 438)

      • Ischemic Heart Disease (ICD-9: 410 - 414)

      • Stroke (ICD-9: 430 - 438)

      • Congestive Heart Failure (ICD-9: 428)

      • Hypertension (ICD-9: 401-405)


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    Medicaid Reimbursement – Health and Human Services Commission (HHSC)

    • Available Data

      • Statewide

      • Claim Type- physician, emergency department or inpatient hospital

      • Reimbursement - $


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    EMS Data- Texas EMS/Trauma Registry Commission (HHSC)

    • Suspected Illness Types CVD defined as cardiac arrest, cardiac rhythm disturbance, and chest pain/discomfort

    • Stroke defined as Stroke/CVA

    • Medical-related calls only (i.e. calls exclusively related to trauma were excluded)

    • 911 calls only (no inter-facility transfers)

    • Texas residents only


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    EMS Data- Texas EMS/Trauma Registry Commission (HHSC)

    • Available Data

      • State, HSR, MSA, TSA, Border and No-borders counties

      • Variables include:

        • Total Number of Transports

        • Response Time

        • Scene Time

        • Transport Time

        • Delivery Time


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    Quality of Care - Health Effectiveness Data and Information Set (HEDIS)

    • HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service.

    • It is a set of standardized performance measures designed to provide purchasers and consumers with the information they need to reliably compare the performance of healthcare plans.

    • For more Information visit:

      http://www.opic.state.tx.us/docs/611_guidetotexashmoquality2009.pdf


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    Quality of Care - HEDIS Set (HEDIS)

    • Available measures

      • State

      • Variables include:

        • Blood Pressure Control

        • Cholesterol Management for Patients with Cardiovascular Condition: LDL-C Screening

        • Cholesterol Management for Patients with Cardiovascular Condition: LDL-C level <130 mg/dL

        • Beta Blocker Treatment after a Heart Attack


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    Mortality-Center for Health Statistics (CHS) Set (HEDIS)

    An CVD death is defined as any death for which CVD is listed as the underlying cause

    • Before 1999, Used ICD -9 code. After 1999 Using ICD 10 code

    • For more Information visit:

      http://www.dshs.state.tx.us/vs/default.shtm


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    Mortality - CHS Set (HEDIS)

    • ICD 10 code:

      • Cardiovascular Disease (ICD-10: I00-I99)

      • Ischemic Heart Disease (ICD-10: I20-I25)

      • Stroke (ICD-10: I60-I69)

      • Congestive Heart Failure (ICD-10: I50)

      • Hypertension (ICD-10: I11-I13)


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    Mortality - CHS Set (HEDIS)

    • Available Data

      • State, HSR, MSA, TSA, and counties

      • Age-adjusted Rates per 100,000

      • Demographics

        • Race/ethnicity

        • Gender

        • Age (age specific)


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    Texas Population Data - CHS Set (HEDIS)

    • Used when preparing demographic information or calculating number of cases when given rate

    • Center for Health Statistics (CHS) provides population estimates and projections

    • Population estimates more reliable than projections

    • http://www.dshs.state.tx.us/chs/popdat/default.shtm


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    Statistics Set (HEDIS)One Test for Significance

    • Confidence Interval (CI) is a statistical measure that is considered by many epidemiologist as meaningful

    • CI is one in a list of several statistical tests to help interpret observed associations

    • CIs are influenced by the variability of the data and the sample size


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    Interpreting CI Set (HEDIS)

    • If the confidence intervals do not overlap, the test is statistically significant.

    Cardiovascular Health and Wellness Program, DSHS


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    Interpreting CI Set (HEDIS)

    • If the confidence intervals overlap, the test is not statistically significant.

    Cardiovascular Health and Wellness Program, DSHS


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    Reports and Publications Set (HEDIS)

    • Chronic Disease Burden Report

      http://www.dshs.state.tx.us/chronic/pdf/CDBR2010.pdf

    • Texas CVD Burden Report

      http://www.dshs.state.tx.us/wellness/default.shtm

      • Fact sheets

      • Posters

      • PowerPoint presentations


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    Data Requests Set (HEDIS)

    • Data requests can be submitted to the CHW epidemiologist via email:

      [email protected]


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