ICEHS ‘Data Wonks’ Roundtable Lois A. Fingerhut November 2004 Centers for Disease Control and...
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Transcript of ICEHS ‘Data Wonks’ Roundtable Lois A. Fingerhut November 2004 Centers for Disease Control and...
![Page 1: ICEHS ‘Data Wonks’ Roundtable Lois A. Fingerhut November 2004 Centers for Disease Control and Prevention National Center for Health Statistics.](https://reader030.fdocuments.us/reader030/viewer/2022032604/56649e615503460f94b5c803/html5/thumbnails/1.jpg)
ICEHS ‘Data Wonks’ Roundtable
Lois A. Fingerhut
November 2004
Centers for Disease Control and PreventionNational Center for Health Statistics
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What’s New from NCHS• International Collaborative Effort (ICE)
on Injury Statistics: 10 year review
• Injury Severity
• Multiple cause of death analyses– Barell Matrix for main injury death– Poisoning examples
• New Death Certificates
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Injury ICE- 10 year review
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• Injury Prevention, 10/04 • Injury Control and Safety Promotion
12/04 (to be published)
• History• Mission• Participants• Current projects• Other ICE related projects
Article Published
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Current Projects
• Injury indicators ……… injury severity
• Selecting a main injury from among multiple diagnoses on death certificates
• Poisoning- how to define it?• Household survey comparisons of injury
questions (to be published by Injury Prevention)
• Occupational injuries• Multiple injury profiles
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Other projects
• Frameworks for presenting injury mortality data
• Barell Injury Diagnosis Matrix
• ICECI technical assistance
• Definition of injury (ongoing??)
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Injury Severity
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Injury Severity• Outgrowth of:
– Injury Indicators work in the ICE activities– Desire for “public domain” severity measure
• Meeting held early September at NCHS to discuss with the “experts” how we can incorporate measure(s) of injury severity into administrative datasets
• Focus was on AIS related measures and ICISS (based on ICD codes) measures
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What we know • National trends in injury-related
hospital discharges and emergency dept. visits reflects utilization, but not differences in injury severity
• ICD codes alone cannot distinguish severity among injuries
• ICD-10 has provided no real guidance on how to select a main injury among multiple cause of injury mortality data
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The “practical problems”• ICD-9 CM is still being used for coding morbidity
data; annual updates to CM continue
• Most recent version of ‘ICDMAP’ [translates ICD-9 CM codes to AIS scores] doesn’t recognize new codes
• ICD-10 CM doesn’t yet have an implementation date and there is no new ICDMAP based on ICD-10
• ICD codes used for mortality data often lack specificity
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What we discussed
• Strengths and weaknesses of different severity scales
• Solutions for administrative data acknowledging the limitations of the source data (e.g., non-specific coding, changes in admission practices)
• Can we measure threat to function as well as threat to life?
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Severity scales
AIS• Based on anatomical
descriptors
• Used in trauma data
• Post-dot score ranges from 0-6
• Subjective
• Time consuming
• Proprietary
ICISS
• Based strictly on ICD codes
• ICISS score for a given patient =
Product of survival risk ratios (survivors with a given code/ all patients with that code) associated with each ICD dx
• Easy to apply to admin. data sets- free
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What was accomplished
• Consensus paper is being drafted
• Recommend a standard measure to users of administrative databases (e.g., Statewide hospital discharge data sets)
• Incorporate a method to identify the “main injury” in mortality and add it to the mortality file– Multiple cause analyses
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Optimism….
• Incorporate ICISS into administrative data
• Retain AIS for trauma and for measuring threat to function
• Add ?? to mortality file
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Multiple cause mortality data from NCHS
National Vital Statistics System
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• ICD-10: uses all digits; up to 20 listed diagnoses
• For 2001, range (0-15 injuries listed)– 1 injury listed 65% of deaths– 2 injuries 22%– 3 injuries 8%– 4 -15 injuries 4%
• Can we select the most severe injury?– Do we need to include underlying
cause of death?
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Specificity in ICD-10 mortality coding: (1)Frequently occurring
pairs
Most frequent pair – occurs 3,327 times• S06.9 (Intracranial injury, unspecified) and
S09.9 (Unspecified injury of the head)
Second most frequent – occurs 2,671 times• S09.9 (Open wound of head, part
unspecified) and S29.9 (Unspecified injury of the thorax)
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Specificity in mortality coding: (2) accounts for significant
numbers of deaths
• S09.9 Unspecified injury of head– Any mention 21,343
• S01.9 Open wound of head, part unspecified– Any mention 17,677
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Analyzing multiple cause of death data
• Detailed explanations and SAS codes are provided in:Anderson RN, Miniño AM, Fingerhut LA, Warner M, Heinen MA. Deaths: Injuries, 2001. National vital statistics reports; vol 52 no 21. Hyattsville, Maryland: National Center for Health Statistics. 2004
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Near final version of ICD -10 Barell Matrix (APHA Poster)
• I hope you got to see it!
• Lead authors are Paul Jones and Bruce Lawrence who work for Ted Miller
• Lois Fingerhut contributed draft ICD codes for matrix based on work done earlier in Australia by Richard Hockey
• Hope to finalize this in the next two months. NCHS 2002 Injury Mortality report will incorporate it!
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Poisoning deaths• Must analyze multiple cause data to get
any substance-specific counts
• From the mc data, for example, in 2002 cocaine was the single leading substance mentioned followed by other opioids (includes, for example hydrocodone, oxycodone, morphine)
• Poster handouts available
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New Death CertificatesTransportation questions
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Injury Checkbox items on Revised Death Certificates
• 2 Standard certificate questions to be implemented by 1/1/05- not mandatory
43. DESCRIBE HOW INJURY OCCURRED [more space on certificate than before]
44. IF TRANSPORTATION INJURY, SPECIFY
□ Driver/Operator □ Passenger □ Pedestrian □ Other (Specify)
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Idaho 200337. DESCRIBE HOW INJURY OCCURRED. IF TRANSPORTATION INJURY, STATE THE TYPE(S) OF VEHICLE(S) INVOLVED (Automobile, pickup, motorcycle, ATV, bicycle, etc),
SPECIFY WHICH VEHICLE DECEDENT OCCUPIED, if applicable
TRANSPORTATION INJURY ONLY38a. WAS DECEDENT: □ Driver/Operator □ Passenger □ Pedestrian □
Other (Specify)38b. WHAT SAFETY DEVICE(S) DID THE DECEDENT
USE/EMPLOY?□ Seat Belt □ Child Safety Seat □ Helmet □ Air bag□ None □ Unknown
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South Dakota & Florida
• IF TRANSPORTATION INJURY, (Check all that apply)
• □ Driver/Operator □ Car/Minivan
• □ Passenger □ Pickup/Van• □ Pedestrian □ Heavy
transport• □ Other (Specify)□ Bus
□ Other (Specify)
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Coming soon…
National Trendsin Injury Hospitalizations,1979-2001
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www.cdc.gov/nchs/injury.htm