Using the Pediatric Health Information System and Administrative Data for Research David Bertoch, Vice President Matt Hall, Senior Statistician Presentation Objectives • To provide an overview of available administrative data sources, including CHCA’s Pediatric Health Information System • To describe how to use these data sources for research Child Health Corporation of America, All Rights Reserved, 2007 2 Presentation Content • • • • • • • Administrative Data Overview Pediatric Health Information System (PHIS) Other Administrative Data Sources Reliability of ICD-9 Codes Types of Research Analytic Considerations Resources/Contacts Child Health Corporation of America, All Rights Reserved, 2007 3 What is administrative data and where does it come from? Patient arrives at hospital and demographic info is collected and entered into IDX Provider performs assessment and treatment of patient As treatments are provided and ordered, charge codes are captured in IDX Using national required coding guidelines, ICD-9-CM diagnoses and procedure codes are assigned Diagnoses and procedures are entered into patient’s administrative record (IDX) Provider documents some component of their actions and thoughts Trained coders review all of medical record including documentation Data pulled to send bills, quality and outcomes reporting, operations/finance, PHIS/NACHRI Flowchart designed by the Children’s Hospital of Wisconsin Child Health Corporation of America, All Rights Reserved, 2007 4 Common Administrative Data Sources • State Databases • HCUP – KID 2003 – NIS 2006 • CHCA Pediatric Health Information System (PHIS) • Thomson’s National Pediatric Discharge Database (NPDD) Child Health Corporation of America, All Rights Reserved, 2007 5 Pediatric Health Information System (PHIS) Child Health Corporation of America, All Rights Reserved, 2007 6 PHIS Data Overview PHIS Data Repository PHIS By The Numbers* • • • • • • • • INPATIENT Participating Hospitals: 40 Inpatient Cases: 2.2 million Inpatient Days: 13.1 million ED encounters: 6.7 million Total Charges: $90.7 billion Total ICD-9 Codes: 33.6 million Pharmacy Transactions: 116.8 million Physicians: 297,250 Ambulatory Surgery Emergency Department Observation Unit Medical Records Billing System Systems All data submitted electronically (no manual entry) on a quarterly basis 1 * Since 2002, does not include available archived data back to 1992 Child Health Corporation of America, All Rights Reserved, 2007 7 CHCA: North America’s Leading Children’s Hospitals Seattle - Children’s Hospital and Regional Medical Center * Kansas City – The Children’s Mercy * Orange – Children’s Hospital of Orange County * Atlanta – Children’s Healthcare of Atlanta * San Diego – Children’s Hospital and Health Center * Chicago – The Children’s Memorial Hospital * Columbus – Children’s Hospital * Birmingham – The Children’s Hospital of Alabama * Los Angeles – Children’s Hospital Los Angeles * Dallas – Children’s Medical Center of Dallas * Oakland – Children’s Hospital Oakland * New Orleans – Children’s Hospital * Memphis – Le Bonheur Children’s Medical Center * Cincinnati – Children’s Hospital Medical Center * Palo Alto – Lucile Packard Children’s Hospitals * Miami – Miami Children’s Hospital * Dayton – The Children’s Medical Center * Corpus Christi – Driscoll Children’s Hospital * Fresno / Madera – Children’s Hospital Central California * Houston – Texas Children’s Hospital * Milwaukee – Children’s Hospital of Wisconsin* Ft. Worth – Cook Children’s Medical Center * Buffalo – Children’s Hospital of Buffalo* Boston – Children’s Hospital Boston * Denver – The Children’s Hospital * Omaha – Children’s Healthcare Services * Akron – Children’s Hospital Medical Center of Akron* Memphis – St. Jude Children’s Research Hospital Norfolk – Children’s Hospital of The King’s Daughters Health System * Minneapolis – Children’s Hospitals and Clinics * Washington D.C. – Children’s National Medical Center * Phoenix – Phoenix Children’s Hospital * Pittsburgh – Children’s Hospital of Pittsburgh * Detroit – Children’s Hospital of Michigan* Little Rock – Arkansas Children’s Hospital * Nashville - Vanderbilt Children’s Hospital* Philadelphia – The Children’s Hospital of Philadelphia * Hartford – Connecticut Children’s Medical Center* St. Louis – St. Louis Children’s Hospital* Toronto – The Hospital for Sick Children St Petersburg – All Children’s Hospital * New York – Children’s Hospital of New York Presbyterian* Indianapolis – Riley Children’s Hospital/Clarian Health Partners* Listed In Order of Membership * Submit Data into PHIS Child Health Corporation of America, All Rights Reserved, 2007 8 PHIS Hospitals – 41 CHCA Hospitals Submitting Data Minnesota Omaha Kansas City Milwaukee Dayton Chicago Columbus St. Louis Cincinnati Detroit Akron Indianapolis Buffalo Boston Hartford New York Philadelphia Seattle DC Oakland Norfolk Pittsburgh Palo Alto Phoenix Memphis Madera Denver Nashville Los Angeles Dallas Little Rock Atlanta Orange Fort Worth New Orleans St. Petersburg San Diego Corpus Christi Birmingham Miami Child Health Corporation of America, All Rights Reserved, 2007 Houston 9 PHIS Features • Comparable hospitals – Largest children’s hospitals in the US • Unblinded peer selection – Select hospitals with whom you want to compare • Ease of networking – Physicians, clinicians, quality leaders, analysts • Direct access to data – Control over report specifications Child Health Corporation of America, All Rights Reserved, 2007 10 Every hospital uses PHIS in different ways physician Meet JCAHO requirement Credentialing Make better decisions Improve coding Manage utilization Access to database with 6 million pt encounters Increase revenue Child Health Corporation of America, All Rights Reserved, 2007 Reduce manual MR review Develop new service lines 11 Increased Use for Research • 23 articles published with at least 3 pending and many more in development • 25 posters/presentations at Pediatric Academic Societies meeting since 2003 – 9 in 2007 • Wide variety of topics – See handouts Child Health Corporation of America, All Rights Reserved, 2007 12 Typical Data Submission Process Sample for October data load Data Quality Data Pre-Submission Tests Repts to Hosp Submitte d August 15 Review & Correcti ons to Sign Off Solucien t August 29 September 26 October 7 Solucient Database Loaded ~ October 18 Groupers & Derivatio ns ~ October 18 Data Quality Management Audit Database October 21 Child Health Corporation of America, All Rights Reserved, 2007 Data Quality Report Card Annual (2nd Qtr) Ad Hoc Issue Resolutio n As Needed 13 Practical PHIS Data Quality Resources • • • • Data Quality and Completeness Report Card Data Quality Alerts Web Cast: Validating Your Data Significant Issues List Child Health Corporation of America, All Rights Reserved, 2007 14 PHIS for Research Resources • Subset of PHIS main web site • Includes – Standard PHIS methodology text – Existing articles by topic – Data Quality resources – Data content resources • Register at www.chca.com and select PHIS as requested site Child Health Corporation of America, All Rights Reserved, 2007 15 “Level 1” and “Level 2” Breakout LEVEL 1 – Patient Abstract and ICD-9 Coding Patient Abstract Diagnoses Procedures (ICD-9) (ICD-9) LEVEL 2 – Billed Transaction/Utilization Data (all items/services billed to the pt) Pharmacy Imaging/ Lab Clinical Radiology Other: * Room/Nursing Supplies Other * Surgical Svcs * Other misc Child Health Corporation of America, All Rights Reserved, 2007 16 Level 1 – Patient Abstract • • • • • • • • Patient Identification Demographics Episode of Care Physician Profiles Dx/Px Profiles Clinical Classification (Groupers) Payer Source Charge Summaries Child Health Corporation of America, All Rights Reserved, 2007 17 Patient Abstract • Episode of Care – LOS – Admit Date/Month/Year – Discharge Date/Month/Year – Infection Flag – Surgical and Medical Complication Flags • Age in Years – Disposition • Age in Months (if less than 2 yrs) – Pre-Op LOS • Age in Days (if less than 30 – Post-Op LOS days) • Demographics – Gender – Birthweight (gms) – DOB – Pediatric Age Group – AAP Age Code – Age (based on age at admission) – Race/Ethnicity Child Health Corporation of America, All Rights Reserved, 2007 18 Patient Abstract • Physician Profiles – Attending Physician – Attending Physician Subspecialty – Principal Px Physician – Principal Px Physician Subspecialty • Dx/Px Profiles – Principal Dx – Principal Px • Clinical Classification (Groupers) – Major Diagnostic Category (MDC) – CMS (HCFA) DRG – APRDRG • Version 15 • Version 20 • Version 24 Child Health Corporation of America, All Rights Reserved, 2007 19 Patient Abstract • Payer Source (Principal Payer) – Medicare – Medicaid – Title V – Other gov’t – Workers comp – Blue Cross – Other Ins Co – Self Pay – Other Child Health Corporation of America, All Rights Reserved, 2007 • Charge Summaries – Pharmacy Charges – Supply Charges – Lab Charges – Imaging Charges – Clinical Charges – Other Charges – Unmapped Charges 20 Pt Abstract Data (Level 1) Patient Abstract We will follow one patient visit through different sections of PHIS: Discharge ID = 142006763 Child Health Corporation of America, All Rights Reserved, 2007 Value: Compare LOS Readmission Rates Stratify patients based upon your criteria Physician Profiling Severity Adjust 21 Diagnosis Codes (ICD-9) – (Level 1) Diagnoses (ICD-9) Value: Child Health Corporation of America, All Rights Reserved, 2007 Go beyond the principal dx Specific inclusion/ exclusion of patients 22 Procedure Codes (ICD-9) – (Level 1) Procedures (ICD-9) Value: Child Health Corporation of America, All Rights Reserved, 2007 Go beyond the principal px Pre vs Post Op LOS Analysis by surgeon 23 Charge Master Comparability Hospital B Hospital A 35309888 6561447 Vancomycin 125 mg Tablet 125 mg Vancomycin CTC Code 124133.1011552 12 Anti-infectives (Drug Class = 12) 124 Misc antibiotics (Therapeutic Cat = 124) 124133 Vancomycin (Generic Drug=124133) 12413310 oral (Route of Administration=10) 1241331011 tablet (Dosage Form=11) 124133101155 55 (Strength=125) 1241331011552 mg (Unit of Measure=2) Child Health Corporation of America, All Rights Reserved, 2007 24 Pharmacy Data (Level 2) Pharmacy Value: Child Health Corporation of America, All Rights Reserved, 2007 Compare drug utilization by drug, class, and/ or category Compare when drugs were given (by day) Compare route of administration (IV, PO, etc) 25 Lab Data (Level 2) Lab Value: Child Health Corporation of America, All Rights Reserved, 2007 Compare lab tests/pt Revenue Enhancement Opportunity 26 Room/Nursing (Level 2) Room/ Nursing Value: Child Health Corporation of America, All Rights Reserved, 2007 Compare LOS by type of room (med/surg vs ICU) Measure Return to ICU/Direct Admit to ICU Analyze resource utilization by room type (eg. drugs while in NICU 27 Issues/Measures by CTC Area Area Good Measures Limitations Pharmacy •Generic Drug and Route of Administration are commonly used •% of patients received • # of days received • % of patient received by route of admin (digits 7-8) • Units – shouldn’t be used • Can not measure “doses” • Be aware of “Billed” vs “Actual” • Respiratory drugs bundled not billed separately Supplies • Tracking high cost supplies – monitor proper billing of these supplies for specific patient populations • Comparability difficult for low cost supplies – bundling issues Lab • Typically 1 unit = 1 test • Generic lab test fields are commonly used • Watch out for panels vs tests, particularly in Chemistry Child Health Corporation of America, All Rights Reserved, 2007 28 Issues/Measures by CTC Area Area Good Measures Limitations Imaging • Area of imaging focus and exam type used most often •Typically 1 unit=1 exam • Be careful of hosp-hosp mapping consistency on digits1-4; best to include more codes in filter than limit to 1 or 2 codes Clinical • Digits 1-6 are used most often • Non-respiratory use of units is pretty good • Unit of measures involving minutes is better with CTCs but still not exact • Some pharmacy chgs will show up in Respiratory for some hospitals Other • # of days spent in ICU vs non-ICU • Returns to ICU • Products provided while in ICU • Track pts that came through the ED • Use in multi-pass to track products given on day of surgery • Nursing unit severity levels not comparable • Make sure comparing room-room and not just “nursing only” (digit 7-8) • OR and RR time is not exact (minutes) Child Health Corporation of America, All Rights Reserved, 2007 29 PHIS Direct Access User Agreement Key Components of Agreement • PHIS data, other than the PHIS Member Hospital’s own data, cannot be shared verbally, in written form or electronically with any individual or group not acting on the sole behalf of the PHIS Member Hospital without prior consent from the PHIS External Use of Data committee. • The confidentiality statement applies, but is not limited to, the following situations: – – – – the publishing of research results in an external publication using PHIS data in a promotional/advertising campaign giving PHIS data in any format to a managed care organization making an external presentation with PHIS data displayed either verbally or visually in a handout Child Health Corporation of America, All Rights Reserved, 2007 30 HCUP KID / Thomson NPPD Child Health Corporation of America, All Rights Reserved, 2007 31 Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) • • • • Current Data: 2003; updated every three years Short-term, general, non-federal hospitals Stratified systematic sample 2.9 million discharges weighted to 7.4 million – i.e. one row represents multiple discharges • Data elements similar to Level I data in PHIS • Purchase for $200 per year from http://www.hcup-us.ahrq.gov • Free web tool: http://hcupnet.ahrq.gov/ Child Health Corporation of America, All Rights Reserved, 2007 32 Thomson’s National Pediatric Discharge Database (NPDD) • Similar to HCUP KID, but updated twice annually • Uses datasets available to Thomson – – – – State hospital associations Public state data Individual hospitals contracting with Thomson Various hospitals systems • 2.2 million discharges are weighted to 7.1 million • Not as widely published as HCUP KID • Accessible through CHCA Child Health Corporation of America, All Rights Reserved, 2007 33 Reliability of ICD-9 Codes Child Health Corporation of America, All Rights Reserved, 2007 34 Reliability of ICD-9 Codes • Epidemiology, Outcomes, and Costs of Invasive Aspergillosis in Immunocompromised Children in the United States, 2000 • Zaoutis, Heydon, Chu, Walsh, Steinbach • Pediatrics. 2006 Apr; 117(4): e711-e716 – “In general, health services researchers believe that the use of ICD-9-CM codes to identify cases in administrative databases has high specificity (eg, few instances in which patients did not in fact receive a diagnosis of the condition) but may be lower in sensitivity (ie, the administrative diagnosis may fail to detect all true cases).” Child Health Corporation of America, All Rights Reserved, 2007 35 Reliability of ICD-9 Codes • Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments • Johnson, Adair, Brant, Holmwood, Mitchell • Pediatrics. 2002 Oct; 110(4):e49 • Spec: Of 3,091 charts coded as having a discharge diagnosis of bronchiolitis (ICD-9 code 466.1), 3,054 cases (99%) met clinical definition • Sen: Additional 43/377 (11%) should have been coded as bronchiolitis Child Health Corporation of America, All Rights Reserved, 2007 36 Reliability of ICD-9 Codes • Use of Active Surveillance to Validate International Classification of Diseases Code Estimates of Rotavirus Hospitalizations in Children • Hsu, Staat, Roberts et al. • Pediatrics. 2005 Jan; 115(1):78-82 • Spec: Discharge coded as rotavirus very specific marker for true rotavirus disease: 98% of discharge records coded specifically as rotavirus had a laboratoryconfirmed diagnosis. • Sen: Discharge records were coded as rotavirus in less than half of the confirmed rotavirus infections Child Health Corporation of America, All Rights Reserved, 2007 37 Types of Research Using Administrative Data Child Health Corporation of America, All Rights Reserved, 2007 38 1. Epidemiology / Population Estimates • Population estimates difficult with PHIS – Convenience sample, lacks “denominator” – Possible with specific quaternary diagnoses or procedures • HCUP KID & Thomson’s NPDD – Weighted for national estimates • Potential research topics… – What is the prevalence of a disease in the population – How frequent is a px done in a population Child Health Corporation of America, All Rights Reserved, 2007 39 1. Epidemiology / Population Estimates (Example 1) • National hospitalization impact of pediatric all-terrain vehicle injuries. • Killingsworth JB, Tilford JM, Parker JG, Graham JJ, Dick RM, Aitken ME • Pediatrics. 2005 Mar;115(3):e316-21 – – – – HCUP KID 1997 and 2000 5,292 children hospitalized with ATV-related injuries Hospitalizations increased 79.1% between 1997 and 2000 Rates of ATV-related hospitalization were highest among adolescent white male – Total hospital charges: $74,367,677 for the 2-year study period Child Health Corporation of America, All Rights Reserved, 2007 40 1. Epidemiology / Population Estimates (Example 2) • Off-label drug use in hospitalized children • Shah SS, Hall M, Goodman DM, Feuer P, Sharma V, Fargason C Jr, Hyman D, Jenkins K, White ML, Levy FH, Levin JE, Bertoch D, Slonim AD • Arch Pediatr Adolesc Med. 2007 Mar;161(3):282-90 – At least 1 drug was used off-label in 297,592 (78.7%) of 355,409 discharges – Off-label use accounted for $270m (40.5%) of the total dollars spent on these medications – Factors associated with off-label use: undergoing a surgical procedure, age older than 28 days, greater severity of illness, and all-cause in-hospital mortality. Child Health Corporation of America, All Rights Reserved, 2007 41 2. Cost & Charge Estimation • Most data sources do not capture costs, but charges • Typically use ratio of cost-to-charges – In KID, each hospital has one ratio – In PHIS, each hospital has 31 ratios categorized into drug, radiology, etc. • Potential research topics… – – – – Public vs. private expenditures Incremental charges associated with comorbidities Compare costs of treating with drug x versus drug y Identify factors associated with increased charges Child Health Corporation of America, All Rights Reserved, 2007 42 2. Cost & Charge Estimation (Example 1) • Direct medical cost of influenza-related hospitalizations in children. • Keren R, Zaoutis TE, Saddlemire S, Luan XQ, Coffin SE. • Pediatrics. 2006 Nov;118(5):e1321-7 – 727 patients hospitalized for community-acquired laboratory-confirmed influenza – The mean total cost of hospitalization: $13,159 • $39,792 pts admitted to an ICU • $7,030 pts cared for exclusively on the wards – Cardiac, metabolic, and neurologic/neuromuscular diseases and age of 18-21 were independently associated with the highest hospitalization costs Child Health Corporation of America, All Rights Reserved, 2007 43 2. Cost & Charge Estimation (Example 2) • Factors associated with increased resource utilization for congenital heart disease • Connor JA, Gauvreau K, Jenkins KJ. • Pediatrics. 2005 Sep;116(3):689-95 – Identify patient, institutional, and regional factors that are associated with high resource utilization for congenital heart surgery – Some states were more likely to have high resource use cases – Independent predictors of a higher odds of high cost • • • • • • Risk Adjustment for Congenital Heart Surgery risk category Age Prematurity Presence of other major noncardiac structural anomalies Medicaid insurance Admission during a weekend Child Health Corporation of America, All Rights Reserved, 2007 44 3. Longitudinal Data Analysis • KID and NPDD do not have unique pt identifiers • PHIS has MRNs that can be tracked across time within institution (some hospitals have data back to 1992) • Useful for classifying certain pts underlying disease • Potential research topics… – Utilization of chronic populations – Readmissions, if the case can be made that most patients don’t go somewhere else – Time-to-event analysis – Trends in admissions or seasonality Child Health Corporation of America, All Rights Reserved, 2007 45 3. Longitudinal Data Analysis (Example) • A multi-center study of factors influencing cerebrospinal fluid shunt survival in infants and children – Shah SS, Hall M,Slonim A, Hornig GW, Berry JG, Sharma V. – J Neurosurg (In Press) • 7,399 had shunt placement and at least one-year of follow-up • 20.2%, 7.5%, and 6.9% of patients required 1, 2, or 3 or more shunt revisions, respectively • In multivariable analyses, children undergoing shunt placement in the Northeast census region had a longer duration of shunt survival between initial placement and both the first and second revisions. • Young age and a pdx of obstructive hydrocephalus were associated with a higher risk of failure Child Health Corporation of America, All Rights Reserved, 2007 46 4. Utilization / Standards of Care • Line item utilization is not available in KID or NPDD • PHIS is the most robust data source • Look for frequency of utilization (drugs, imaging, labs, etc.) in a population – Common (e.g. asthma) or rare (e.g. HLHS) • Potential research topics… – Disparities in care – Impact of specific diagnoses on resources (throughput, supplies, pharmacy, etc.) – Adherence to evidence-based guidelines – Evaluate the effect of clinical care guidelines (pre vs. post) – Impact of case volume on outcomes Child Health Corporation of America, All Rights Reserved, 2007 47 4. Utilization / Standards of Care (Example 1) • Racial and economic disparity and the treatment of pediatric fractures • Slover J, Gibson J, Tosteson T, Smith B, Koval • J Pediatr Orthop. 2005 Nov-Dec;25(6):717-21 – Supracondylar humerus (n = 2,957), femoral shaft (n = 1,726) or radius and ulna forearm fracture (n = 828) as their primary diagnosis – Hispanic (78%) and black (82%) patients were more likely to receive closed reduction with internal fixation of supracondylar humerus fractures than whites (73%, P = 0.02) – No other differences noted Child Health Corporation of America, All Rights Reserved, 2007 48 4. Utilization / Standards of Care (Example 2) • The effect of surgical case volume on outcome after the Norwood procedure • Checchia PA, McCollegan J, Daher N, Kolovos N, Levy F, Markovitz B • J Thorac Cardiovasc Surg. 2005 Apr;129(4):754-9 – Twenty-nine hospitals and 87 surgeons performed 801 Norwood procedures during the study period – Survival after the Norwood procedure is associated with institutional Norwood procedure volume but not with individual surgeon case volume Child Health Corporation of America, All Rights Reserved, 2007 49 4. Utilization / Standards of Care (Example 3) • Institutional variation in ordering complete blood counts for children hospitalized with bronchiolitis • Tarini BA, Garrison MM, Christakis DA. • J Hosp Med. 2007 Mar;2(2):69-73 – Little evidence to support the use of diagnostic testing, particularly complete blood counts (CBCs) – 17,397 children were included in the analysis, and 48.2% had at least 1 CBC, whereas 7.8% had more than 1 CBC – The proportion of admissions with initial (23.2%-70.2%) and repeat (0%-18.6%) CBCs varied significantly across hospitals Child Health Corporation of America, All Rights Reserved, 2007 50 Analytic Considerations Child Health Corporation of America, All Rights Reserved, 2007 51 Risk Adjustment • Necessary given heterogeneity of hospitals / patient populations across time • APR-DRG severity-of-illness or case mix index may or may not be adequate • Charge and los weights in PHIS – Assigned to every discharge based on APR-DRG and severity level assignment – Assume resource utilization is correlated with severity Child Health Corporation of America, All Rights Reserved, 2007 52 Risk Adjustment (Continued) • Weights compare the average charge (LOS) for each APR-DRG / severity level combination to the overall average using a national dataset • Example: – APR-DRG=1 (liver transplant), Severity=3 (Major) – Charge weight is 21.2. – This means that the average charge for patients in this group were 21.2 times the average charge for ALL pediatric discharges, regardless of their APR-DRG or severity level. Child Health Corporation of America, All Rights Reserved, 2007 53 Risk Adjustment (Continued) • Ad hoc risk adjustment may be necessary – Create list of factors that might impact outcome • Patient and hospital level – Model for parsimony (remove insignificant predictors) – Clearly articulate gaps in factors unavailable in administrative data Child Health Corporation of America, All Rights Reserved, 2007 54 Modeling Considerations • Data is clustered by hospital – All models should be hierarchical • Varying reliability of estimates across hospitals – Consider Bayesian shrinkage estimators, also useful when doing risk adjustment • Data is retrospective and observational – Consider matching or propensity scoring to mimic randomized trials, be sure to verify methods effect on balancing covariates Child Health Corporation of America, All Rights Reserved, 2007 55 Modeling Considerations (Continued) • Overwhelming power – Reduce significance – P-values can be ineffectual, consider alternate presentations • KID and NPDD is survey data – Use software (e.g. SAS, SUDANN) to account for sampling frame Child Health Corporation of America, All Rights Reserved, 2007 56 Strengths of Administrative Data in Research • • • • • • • Patient level data Line item utilization (PHIS) Population size = Power Multiple institutions for rare conditions National estimates Hospital-to-hospital variation Useful for designing Phase I trials Child Health Corporation of America, All Rights Reserved, 2007 57 Limitations of Administrative Data in Research • Retrospective and observational • Substantial factors for risk adjustment might be missing • Outcomes are limited • Unknown Sen / Spec for many ICD-9 codes; dxs and pxs rely on proper documentation and coding • Charges are billed resource, not necessarily administered Child Health Corporation of America, All Rights Reserved, 2007 58 PHIS for Research Resources • Subset of PHIS main web site • Includes – Standard PHIS methodology text – Existing articles by topic – Data Quality resources – Data content resources • Register at www.chca.com and select PHIS as requested site Child Health Corporation of America, All Rights Reserved, 2007 59 PHIS Contacts • CHCA – David Bertoch (david.bertoch@chca.com) – Matt Hall (matt.hall@chca.com) • CHOP – Quality Improvement: • Finnah Escritor – PHIS-related Research: • The Center for Pediatric Clinical Effectiveness Theo Zaoutis or Ron Keren Child Health Corporation of America, All Rights Reserved, 2007 60