Using AHRQ Data at Census RDC’s
Health Data Workshop
May 6, 2009
Doris Lefkowitz
Outline
 Discuss Key Features of the Medical
Expenditure Panel Survey
 Discuss how to apply to use MEPS data
at an RDC
 Discuss How to get additional
information on MEPS
MEPS
 Medical Expenditure Panel Survey
 Relatively large, longitudinal study of the US
civilian, non-institutionalized population
 Collects information for all members of the
household
 Conducted in 1977, 1987 and annually since
1996
MEPS Survey
Components
 MEPS-HC -- Household Component
 MEPS-MPC -- Medical Provider Component
 MEPS-IC -- Insurance Component
Key Features of MEPS-HC
 Survey of U.S. civilian noninstitutionalized population
 Sub-sample of respondents to the National Health
Interview Survey (NHIS)
 Oversample of policy relevant target groups
 Panel Survey – new panel introduced each year
– Continuous data collection over 2 ½ year period
– 5 in-person interviews (CAPI)
 Sample size: about 12K families and 32K persons
since 2001
Household Participation
 Verbal consent obtained from household respondent.
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Each household member is asked to give written
consent to allow us to contact their medical providers
Informed consent procedure includes a video and
written materials mailed to the household
Each household is interviewed 5 times over 2 ½ years
Interviews typically last 1.5 -2 hours and are
conducted in the home on a laptop computer by a
trained interviewer
A single respondent provides most of the information
for the household
MEPS Panel Design: Data Reference Periods
2005
Q1
Q2
2006
Q3
Q4
Q1
Q2
Q3
2007
Q4
Q1
Q2
Q3
Panel 9
Round 3
Round 4
Round 5
Panel 10
Round 1
Round 2
Round 3
Round 4
Round 5
Panel 11
Round 1
Round 2
Round 3
Round 4
Round 5
Panel 12
Round 1
Round 2
Round 3
Sample Size
N = 32,320
N is equal to the number of people with a positive person weight on the file.
N = 32,577
N = 29,370
Q4
MEPS-HC
Core Interview Content
 Demographics
 Charges and Payments
 Health Status
 Conditions
 Utilization
 Employment
 Health Insurance
Healthcare Use
 Hospitalizations
 Outpatient and emergency department visits
 Visits to physicians and other health care providers
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(nurses, PA, OT/PT, therapists, mental health
professionals)
Prescribed medications
Home health care
Durable medical equipment and supplies
Dental care
Detail for each event
 Date
 Provider name and type
 Condition associated with the event
 Some details about the event (tests performed,
medications prescribed)
 Charges, payments
MEPS- HC Supplemental CAPI
Sections
Sections asked in rounds 2 and 4:
 Access to care
 Child preventive health
 Satisfaction with health plans &
providers
Sections asked in rounds 3 and 5:
 Assets (round 5 only)
 Income
 Preventive Care
MEPS-HC Supplemental Paper
Questionnaires
 Diabetes Care SAQ
 Adult SAQ
Types of MEPS-HC Files
 Full-year Files - calendar year data
 Point-in-time Files - snap shot first
part of year
Levels of MEPS-HC Public
Use Files
 Person Level - detailed person
information
 Event Level - detailed event level
information
 Condition Level - detailed condition
information
 Job Level - detailed job information
MEPS Medical Provider
Component (MPC) Sample
 All hospitals (and associated doctors),
emergency rooms, and out-patient
departments used by respondents
 All home health agencies
 All pharmacies
 A sample of office-based physicians
MEPS Medical Provider
Component (MPC) - Purpose
 Compensate for household item
non-response
 Accuracy and detail
 Imputation source
 Methodological studies
MEPS: Pharmacy Component
 8000 pharmacies sampled
– data on prescribed medicines purchased
by households
 Data obtained:
– Medication Name
– National Drug Code (NDC)
– Quantity Dispensed
– Strength and Form
– Sources of Payment
– Amount Paid by Each Source
MEPS Insurance Component (IC)
 An independent survey of employers and unions
not linked to the household survey
 The sample contains information from about
45,000 establishments drawn from a Census
Bureau frame and supports national and statelevel estimates for all 50 states.
 Data released in tabular form on the MEPS web
site
MEPS-IC Purpose
 Employer-sponsored Health Insurance
– Availability
– Enrollment
– Benefit and payment provisions
– Cost
Data Use Restrictions - MEPS
 AHRQ makes specific promises to people
and establishments who participate in the
MEPS
– Data will only be used for research and
statistical purposes
– Data that COULD be used to identify them will
not be released beyond AHRQ and its
contractors
– Information about them will only be reported in
a summary fashion
Data Use Restrictions – IRB
 Our IRB reviews our data collection and
release procedures
– Affirms the ideas of our authorizing legislation
– Requires review by a nosologist and
pharmacist for rare conditions and
medications to reduce inferential identification
– Requires judgments to be made on releases of
certain variables
AHRQ Data Center History
 AHRQ has operated a data center at its
Rockville headquarters since 2000
 Provides researchers access to non-public
use MEPS data;
 Partnership with Census RDC’s is an
extension of our commitment to have
MEPS data used to the fullest extent
possible
AHRQ Data Center (ADC)
 Mode of data access
– on secure LAN at AHRQ -
Rockville, Maryland
– task order agreement with data
contractor
– combinations of both
AHRQ Data Center
 Researcher may bring data in, but not out
 Researcher has access only to data
needed for approved project
 All tabular data will be reviewed for
confidentiality before release from Center
 Only approved tables can leave the
Center
 Center will store data files, foreign merge
files, and all outputs needed for
replication
AHRQ Facilities
 Secure room
 Terminal connected to secure LAN
 SAS, STATA, GAUSS, Stat Transfer,
SUDAAN, Limdep, EQS software
available, and others upon request
 Limited staff support by people who
know:
– the data
– the confidentiality issues
– the software
AHRQ Application
Process
 Application procedures are on the
MEPS web site
 Submit proposal to data center
coordinator
 Review within 1 week for feasibility,
and data availability
 Institutional Review Board (IRB)
review required
AHRQ Fees
 User fee of $150.00 for approved projects to
cover technical assistance, simple file
construction, and/or up 2 hours of
programming support from data contractor
 Additional programming support available
from an AHRQ contractor at a cost of
$80.00/hr
 User fee waived for full-time students
 User fee waived for those intending to move
to a Census RDC
AHRQ Remote Access
 Once the researcher has an
established data center project, and
has worked on site to develop and
debug programs, jobs may be
submitted to our Data Center
Supervisor to run.
 Out-put will be reviewed for
confidentiality and mailed to the user
Confidential Data Available
for ADC Projects
 Geographic data and links based on
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geographic data
State Identifiers
HC-IC linked files for 1996-99
MEPS NHC for 1996
Selected Medical Provider Component
Data
Confidential Data Available
for ADC Projects
 Fully specified ICD-9 codes
 Continuous measure of poverty status
 Fully specified Industry and Occupation
codes
 Asset data
 Imputed NDC codes for prescription drugs
 Federal and state marginal tax rates
 Other variables developed by AHQR
researchers
Partnership with Census
 Applicants can begin contact with
either AHRQ or their local Census
RDC
 AHRQ will request the applicant fill
out the AHRQ data center application
Partnership with Census
 AHRQ reviews the application
– Does the project conform with AHRQ’s
authorizing legislation
– Does the data available support the
analysis
 AHRQ sign off is quick, usually
completed in less that 2 weeks
Partnership with Census
 While AHRQ requests an AHRQ data
center application for persons
wishing to use the Census RDC, the
application fee is waived
 These procedures apply to MEPS
household data only. MEPS
Insurance Component data follows
the customary Census procedures for
Title 13 data
Partnership with Census
 Application process moves to
Census for approval
 AHRQ will begin preparing the
analytic file for the project
 During the Census review and
security process, applicant could
chose to use the AHRQ data center
Partnership with Census
 AHRQ staff historically provide
extensive support for all data users
 We have an active list serve and
routinely answer hundreds of user
questions each year
 Customers using Census RDCs
should not hesitate to continue to
interact with AHRQ
Other Resources
 Information found on the MEPS Web
site: www.meps.ahrq.gov
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Overview of MEPS, Fact Sheets, and FAQs
Survey instruments
Findings/Statistical Briefs/Chart books
Methods reports
Data files
Bibliography
MEPS data workshop information and schedule
Mailing list/List server
Data Center Information