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1. Kentucky Injury Prevention and Research Center Issues and Methods in Using Kentucky’s Hospital Discharge Data Set for Injury Surveillance November 19, 2003

2. Overview Background on hospital discharge data (HDD) collection in KY What to count as an injury-related discharge? Some results for 2001 Limitations of the HDD dataset for injury surveillance

3. A little bit of KY HD history

4. KY Statues and Regulations Related to Hospital Discharge Data Collection

5. The UB-92 Form Stands for Uniform Bill – 1992 Developed by the National Uniform Billing Committee (which was formed by the American Hospital Association in 1975) in 1992 Includes a uniform data set definition and a hard copy billing form Originally created to provide a standard system for the billing and payment of health care claims

7. HD Data Processing CompData is the vendor that handles collection and processing of UB92 claim forms Performs extensive edits, returns forms with errors to be corrected and resubmitted Replaced original vendor (Unisys) in 1999. As a result, case capture and data quality improved dramatically beginning in 2000.

8. Years of Reliable HD Data

10. Defining Injury in HDD

11. STIPDA Recommendations State and Territorial Injury Prevention Directors Association “Consensus Recommendations for Using Hospital Discharge Data in Injury Surveillance,” 2003

12. STIPDA Recommendations

13. STIPDA Recommendations ICD-9: diagnosis 800-999 = injury and poisoning STIPDA injury case definition: principal diagnosis 800-999, excluding 909.3, 909.5 995.0 – 995.4, 995.6 – 995.7, 995.86, 995,89 996 - 999

14. KIPRC HD Injury Dataset We obtain all discharges having ANY ICD-9 diagnosis code 800-999 OR having an E-code. In 2001, there were 85,588 cases meeting these criteria

15. Principal injury discharges - 2001

16. Secondary injury discharges - 2001 There were 12,016 discharges (14%) that were NOT primary discharges, but have a secondary diagnosis meeting the STIPDA definition for injury/poisoning Of these secondary injury discharges, 5,301 (44%) had a primary diagnosis of mental disorder, circulatory disease, or respiratory disease 4,996 (42%) of the SID’s had an E-code. The mechanism in 60% of cases was a fall or a poisoning. 2/3 were unintentional, and 825 (17%) were self-inflicted.

17. Secondary injury discharges – 2001 (continued) Many of the SID’s appear to be unintentional falls secondary to a medical condition, or self-inflicted injuries secondary to a mental disorder diagnosis However, this statement is based on only 42% e-coded SID’s Implications for injury surveillance: report both primary and secondary injuries?

18. E-coded discharges with no injury diagnosis - 2001 There were also thousands of discharges having an E-code but no STIPDA injury diagnosis, principal or secondary 70% of these E-codes indicate “adverse effects of drugs, medicaments, or other biologicals when used therapeutically” (E870 – E879) 21% indicate “adverse effects of medical care.” (E930.0 – E949.9) Adverse effects may be worth studying, but are usually not strictly considered injuries in injury research The other 9% indicated mostly unintentional injuries and a few self-inflicted injuries. Again, how to deal with these cases?

19. 2001 Results

20. CDC Recommended Framework Apply CDC’s Recommended Framework for Presenting Injury Mortality Data to principal injury discharges

21. Leading Causes of Hospitalization Due to Injury, by Mechanism and Manner (KY Residents, 2001)

22. Leading Causes of Hospitalization Due to Injury by Age Group (KY Residents, 2001) DRAFT Do not circulate

23.

24. Limitations Out-of-state hospitalizations Non-reporting hospitals Incomplete e-coding Remember, UB-92 was created for processing health care claims, not for surveillance purposes. As as result there may be biases in the way diagnoses and other information are coded which reflect payment, rather than surveillance, concerns.

25. Other issues Duplicate records Injury severity Barrel Matrix Other stuff I don’t know about yet or forgot

26. ?’s?

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