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The role of NCHS in providing guidance for defining injuries in administrative data sets. Lois A. Fingerhut, MA Office of Analysis and Epidemiology National Center for Health Statistics CSTE, June 2007. Presentation Overview. What are the sources of national data for injury surveillance?

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the role of nchs in providing guidance for defining injuries in administrative data sets

The role of NCHS in providing guidance for defining injuries in administrative data sets

Lois A. Fingerhut, MA

Office of Analysis and Epidemiology

National Center for Health Statistics

CSTE, June 2007

presentation overview
Presentation Overview
  • What are the sources of national data for injury surveillance?
  • Where are the national data used?
  • What are the data issues for states?
  • What is the role for a national agency?
  • What is the role of collaborative efforts?
nchs data sources used for injury surveillance
NCHS data sources used for injury surveillance
  • Mortality data
      • Underlying cause of death data
      • Multiple cause of death data
  • Survey data
      • National Hospital Discharge Survey
      • National Hospital Ambulatory Medical Care Survey
      • National Health Interview Survey*
where are the data used
Where are the data used?
  • Healthy People 2010
  • Health, United States
  • Online data:
    • CDC WONDER
    • Health Data for all Ages
    • Trends in Health and Aging
    • WISQARS
what can states do with national data
What can States do with national data?
  • Benchmark to national data
  • Modify data according to standard operational definitions
  • Conduct cross-state comparisons
benchmarking
Benchmarking
  • All States can replicate definitions from:
    • National Vital Statistics System - Mortality
  • Most States can replicate definitions from:
    • National Hospital Discharge Survey (diagnoses)
  • States may or may not be able to replicate definitions tracked by:
    • National Hospital Ambulatory Care Survey
    • National Ambulatory Care Survey
need for standards and operational definitions
Need for standards and operational definitions
  • Standard definitions for injury definitions from health care survey data and from vital statistics are necessary for national benchmarks.
  • Currently several standards exist, but are often not consistently applied.
examples of standards setting
Examples of standards setting
  • Definitions
    • Mortality matrix
    • Morbidity matrix
  • Methodologies
    • Age-adjustment
    • Selecting a main injury in multiple cause of death data
    • Severity measurement
examples of benchmarking tools
Examples of benchmarking tools
  • Objective specifications for HP2010 Injury and Violence objectives provide information on:
    • National data sources
    • Target populations
    • ICD-9 CM and ICD-10 codes
    • Age groups/standard populations used for age adjustment
    • Inclusion/exclusion criteria
  • Updated specifications accessible in DATA2010
hp2010 objectives with soon to be updated definitions
HP2010 Objectives with soon-to-be updated definitions

Injury Prevention

15-1 Nonfatal head injury hospitalizations (NHDS)

15-12 Emergency department visits (NHAMCS)

slide14

“Current” 15-1. Reduce hospitalizations for nonfatal head injuries

National Data Source National Hospital Discharge Survey (NHDS), CDC, NCHS.

State Data Source State hospital discharge systems.

Healthy People 2000 Objective 9.9 (Unintentional Injuries).

Changes since the 2000 None.

Publication

Measure Rate per 100,000 population (age adjusted).

Baseline 60.6 (1998)

Target 45.0

NumeratorNumber of hospitalizations for nonfatal head injuries (principal diagnosis of ICD-9-CM codes 800- 801, 803-804, 850-854, 870-873, 925).

slide15

“To be revised” 15-1. Reduce hospitalizations for traumatic brain injuries

National Data Source National Hospital Discharge Survey (NHDS), CDC, NCHS.

State Data Source State hospital discharge systems.

Healthy People 2000 Objective 9.9 (Unintentional Injuries).

Changes since the 2000 None.

Publication

Measure Rate per 100,000 population (age adjusted).

Baseline ??

Target ??

NumeratorNumber of hospitalizations for TBIs (principal diagnosis of ICD-9-CM codes: 800.0-801.9,

803.0-804.9,850.0-854.1,950.1-950.3 995.55(Barell Matrix definition)

age adjusted hospital discharge rates for different measures of head injury 1997 2005

All head and neck injuries

(per Barell Matrix)

TBI (NCIPC surveillance)

TBI (per Barell Matrix)

Current HP 15-1 Objective

for nonfatal head injuries

Age-adjusted hospital discharge rates for different measures of head injury: 1997-2005

250

200

150

per 100,000 population

100

50

0

1997

1998

1999

2000

2001

2002

2003

2004

2005

slide17

“Current” 15-12. Reduce hospital ED visits caused by injuries

National Data Source National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC,NCHS.

State Data Source Not identified.

Healthy People 2000 Objective Not applicable.

Changes since the 2000 Publication None.

Measure Rate per 1,000 population (age adjusted)

Baseline 131 (1997)

Target 126

NumeratorNumber of emergency department visits due to injury or poisoning (defined by ICD-9-CM dx codes or E- codes or reason for visit codes).

slide18

“To be revised” 15-12. Reduce initial hospital ED visits caused by injuries

National Data Source National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC,NCHS.

State Data Source Not identified.

Healthy People 2000 Objective Not applicable.

Changes since the 2000 Publication None.

Measure Rate per 1,000 population (age adjusted)

Baseline ??

Target ??

NumeratorNumber of initial emergency department visits due to injury or poisoning (defined by first- listed ICD-9-CM injury codes or E- codes

slide19

Current 15-12:NHAMCS published definition

New without initial visit

Revised 15-12 Initial only (1st dx or 1st E-code)

NEISS-AIP

(2 denominators)

ISW3

Age-adjusted injury visit rates to emergency departments based on alternative definitions: United States, 1995-2005

1,500.0

1,400.0

1,300.0

Visits per 10,000 population

1,200.0

1,100.0

1,000.0

900.0

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

SOURCES: CDC/NCHS, NHAMCS-ED, 1995-2005 data files and NEISS-AIP data from WISQARS.

other sources of injury data
Other sources of injury data
  • Health United States
    • Standard annual tables
    • Time trends
  • Health Data for all Ages and Trends in Health and Aging
    • Online resource of NCHS mortality and morbidity data with standard definitions for injury measures
  • NCIPC’s WISQARS and CDC WONDER
    • NCHS mortality data
health united states
Health, United States
  • Trend tables using matrix definitions
    • Homicide rates
    • Suicide rate
    • Firearm death rates
  • Trend tables using non-matrix definitions
    • Motor vehicle death rates
    • ED injury visit rates (to be changed)
    • Hospital discharge rates for injury (to be changed)
  • www.cdc.gov/nchs/hus.htm
health data for all ages trends in health and aging
Health Data for all Ages & Trends in Health and Aging
  • Online data retrieval resources based on NCHS data
    • Injury mortality
    • Injury ED visits
    • Injury hospital discharge rates
  • www.cdc.gov/nchs/health_data_for_all_ages.htm
  • www.cdc.gov/nchs/agingact.htm
nchs and collaborative work
NCHS and collaborative work
  • None of the standard setting or definition changes are done without collaborations with our partners:
    • CSTE
    • ICE on Injury Statistics
    • ICEHS
    • NCIPC
    • PHDSC
    • STIPDA
nchs and collaborative work24
NCHS and collaborative work
  • CSTE
    • Workgroup on External Cause Coding for Injuries (WECCI)
  • ICE on Injury Statistics
    • External cause code matrices
    • Diagnoses matrices
    • WHO Technical committee for ICD-11 injury chapters
  • ICEHS
    • First external cause of injury matrix
  • NCIPC
    • Indicators
    • Matrices
  • PHDSC
    • External cause of injury workgroup
  • STIPDA
    • Injury Surveillance Workgroups (ISW)
nchs injury resources on the web
NCHS Injury resources on the web
  • http://www.cdc.gov/nchs/injury.htm
contact information
Contact Information

Lois A. Fingerhut

Special Assistant for Injury Epidemiology

CDC/National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

laf4@cdc.gov