Population and administrative
datasets for research &
evaluation
Rahul Chhokar – Health Promotion & Prevention
Amin Jivanni – Decision Support Services
Waqar Mughal – Workplace Health
Catherine Barnardo – Decision Support Services
1
Objectives
1. Have some knowledge of the types of
population and administrative data available
in and outside of Fraser Health
2. Have a basic understanding of the use of
population and administrative data in
planning, evaluation, and research
3. Have knowledge of the policy and
procedures for research related data
requests in Fraser Health
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Outline
 Overview of administrative databases
 Sources of data
 External
 Internal
 Examples using administrative/population data
for research and evaluation
 Case Study
 Role of Decision Support Services
 Policy and procedures related to data requests in
Fraser Health
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Background
What are administrative databases?
 Information routinely collected from compensation
agencies, medical services plans, and hospitals for the
purposes of billing and accounting
Commonly used in research settings to:
1. Understand population health trends
2. Monitor patient outcomes
3. Determine the efficacy of various treatments and
medical interventions
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Characteristics of administrative data
 Population-based
- Majority of British Columbians are covered by
Medical Services Plan
 Unique identifiers
- Personal identifiers (e.g. PHN, name, date of birth)
to link records/files
 Longitudinal/follow-up
- Track groups of individuals over time
 Secondary data
- Primary use is for billing and accounting purposes
 Reliability and validity
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Benefits of using administrative data
 Readiness for use
 Wide geographic coverage
- Currently over 4 million are enrolled in MSP
 Cost/time efficient
 Records contacts with health care system
 Large number of records allow study of rare
events
 Long term follow-up
- Loss to follow-up less of a problem than traditional
methods
- Biases such as recall and response bias less likely
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Limitations of using administrative data
 Primary purpose is not to study health/disease
outcomes
- Lack of clinically relevant data
 Issues surrounding validity or accuracy
- Quality is highest for items directly associated with
payment
 Issues surrounding privacy/security
 May exclude certain types of information
- (e.g. services not covered under provincial health
plan)
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Linking across datasets
 Allows you to study the trajectory of care and
compensation
 Linkage across files
- Using personal identifiers
• Name, Date of Birth, Personal Health Number,
etc.
- Linkages to an established cohort (e.g. occupational
cohort)
- Linkage to geographic and census variables
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British Columbia Linked Health
Database (BCLHD)
 Constructed in 1996 by the Centre for Health Services
and Policy Research
 Resource for population health research
 In addition to health service use, information from Vital
Statistics, WorkSafeBC, and the BC Cancer Agency
 Links files to study health utilization and compensation
trends over time for a given individual in BC
 Provide datasets stripped of personally identifiable
information
 Requires a data access request
 www.chspr.ubc.ca
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Data for population health research BCLHD
 Hospital separations
- 1985/86 onward
- Hospital code, level of care, ICD-9 code,
procedures, separation date, responsibility of
payment
 Medical Services Plan
- 1985/86 onward
- Date of service, practitioner number, speciality code,
ICD-9 code, claim type
 Pharmacare
- 1986 onward
- Plan type, drug number, date of prescription, days
supply dispensed
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Data for population health research BCLHD
 Workers’ Compensation
- 1987 onwards
- Injury date, short-term disability date, body part
injured, nature of injury
 BC Cancer Agency
1986 onwards
Diagnosis date, site location, histology, method of
confirmation
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Databases for population health
research
 BC Vital Statistics
- Registry of all births and deaths in BC
- VISTA - an environment through which medical,
social, and demographic information from vital event
data can be derived
- http://www.vs.gov.bc.ca/
 BC Statistics
 1971-2006 population estimates and 2007-2036
population projections
- By health regions, regional districts and developmental
regions, school districts and college regions
- By age and gender
- http://www.bcstats.gov.bc.ca/
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Databases for population health
research
 Statistics Canada
- 2006 census
- Demographic information – age, race, income,
marital status, education, immigration
- Aggregate data - tabulations
- http://www.statcan.ca/
 BC Perinatal database
- 2000/2001 onwards
- Standardized information on antenatal, intrapartum,
immediate post-partum, and newborn data on all
births in BC
- To evaluate perinatal outcomes, care processes and
resources
- http://www.rcp.gov.bc.ca/
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Survey data for population health
research
 National Longitudinal Survey of Children and
Youth
- Last release - December 2006
- Started in 1994 and conducted every two years
- Long-term study of Canadian children that follows development and
well-being from birth to early childhood
- Approximately 26,000 children and youth
 National Population Health Survey
- Last release - November 2006
- Started in 1994/1995 and conducted every two years for 18 years
- NPHS longitudinal sample includes over 17,000 persons from all ages
in 1994/1995
- Provide health and disease information on a panel of people that are
followed over time
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Survey data for population health
research
 Canadian Community Health Survey
- Last release - June 2006
- Cross-sectional estimates of health determinants, health status,
and health system utilization
- Primary use is for health surveillance – prevalence of disease
- Allows for analyses at the regional level
 Adolescent Health Survey
- McCreary Centre Society
- Provincial survey to examine youth physical, mental, and
emotional health
- Administered in 1992, 1998, 2003, and 2008
- 31,000 students participated in 2003
- http://www.mcs.bc.ca/
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Other external sources for population
health research
 Human Early Learning Partnership (UBC)
- BC Atlas of Child Development
- http://www.earlylearning.ubc.ca/
 Health Canada
- http://www.hc-sc.gc.ca/
 Public Health Agency of Canada
- http://www.phac-aspc.gc.ca/
 BC Drug and Poison Information Centre
 BC Trauma Registry
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External Datasets
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Provincial Discharge Abstract
CIHI Portal Services
CIHI indicator reports and data holdings
CIHI-HayGroup Benchmarking
Health Ideas
Population projection P.E.O.P.L.E. series
BC Ambulance Services
BC Bedline
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External Datasets
 Provincial Discharge Abstract
- Contains inpatient and day procedure
abstracts for all health authorities
- All required abstract data elements are
present
- Useful for service utilization by place of
residence and comparative studies
- For more information contact DSS
DSS@fraserhealth.ca
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External Datasets
 Canadian Institute for Health Information
(CIHI) Portal Service
- Based on inpatient and day procedure data
for all provinces and territories
- Most abstract data elements are present
- Allows on-line reporting and multidimensional analysis on available data
elements
- For more information contact
amin.jivanni@fraserhealth.ca
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External Datasets
 CIHI indicator reports
- provide comparative information on
• the overall health of the population served
• the major non-medical determinants of health in
the region
• the health services received by the region's
residents
• characteristics of the community or the health
system that provide useful contextual information
- More information at secure.cihi.ca
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External Datasets
 CIHI data holdings
- CIHI provides data to researchers in
accordance with its privacy policies
- Data holdings include
• health services
• health expenditures
• health human resources
- More information at secure.cihi.ca
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External Datasets
 CIHI-HayGroup Benchmarking Comparison of
Canadian Hospitals
- Reports and tools to compare clinical efficiency,
operational efficiency and quality of care
- Based on acute and day procedure abstracts and
financial and statistical data from participating
hospitals
- For more information contact
amin.jivanni@fraserhealth.ca
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External Datasets
 Healthideas
- contains information about health services to
British Columbians including hospital
services, physician services, and population
and other reference data
- healthideas.hnet.bc.ca
 Population projection P.E.O.P.L.E series
- www.bcstats.gov.bc.ca/health/
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Fraser Health Datasets
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Discharge Abstract
Meditech
Data Extracts from Meditech
Infection Surveillance
Health Incidents Reporting System
Workplace Health Injury Reporting
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Fraser Health Datasets
 Discharge Abstract Database (DAD)
- Contains hospital separations data
- Data entered by coding teams in Health Information
Services
- Each discharge and day surgery is entered
- Data content is set nationally by Canadian Institute
of Health Information (CIHI)
- Data is regularly submitted to CIHI
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Fraser Health Datasets
 Purpose of DAD
- Collecting, processing and analysing summaries of
hospital discharges and day surgeries
- Supporting management decision making at
hospital, authority and provincial level
- Facilitates comparative reporting
- Provides case grouping methods, length of stay and
resource utilization analysis
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Fraser Health Datasets
 Meditech
- Various Modules, including financial, materiel
management, human resources, admissions,
abstracting, etc.
- Data reported and extracted using canned or
custom reports
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Fraser Health Datasets
 Data Extracts from Meditech
- Ambulatory data
• All visits
• Includes data elements on age, dates and
locations
- Emergency Department Data
• All emergency visits
• Includes data elements on dates and times,
locations, triage acuity scores, age,
• Richer dataset after implementation of EDIS
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Fraser Health Datasets
 Infection Surveillance
- Antibiotic-resistant organisms (methicillin-resistant
Staphylococcus aureus (MRSA) and vancomycinresistant enterococci (VRE))
- Clostridium difficile-associated disease (CDAD)
- Surgical site infections
• Caesarean sections at 8 FH sites
• Cardiovascular surgery at RCH only
• Class 1 and class 2 surgeries at CGH
- Vascular access-associated blood stream infections
for chronic hemodialysis patients
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Fraser Health Datasets
 Health Incidents Reporting System
- Includes medication variance, falls and more
- Data elements include dates, times, age,
location, nature, severity, etc.
 Workplace Injury Reporting
- Data elements include dates, times, nature,
contributing factors, etc.
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Examples of studies using
population and
administrative datasets
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Case Study: How do we measure the
health of an organization?
The Healthy Workplace Initiative Experience
W Mughal, L Thomas-Olson, P Brown, D Keen
Workplace Health
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Overview
 Background on the Healthy Workplace
Initiative
 First Round Experience
 Challenges
 Second Round Experience
 Future Work
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Background on the
Healthy Workplace Initiative
 First Ministers’ Meeting 2004
- Pan-Canadian Health Human Resource
Strategy 2004
•
•
•
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First Nations Strategy
HHR
Interprofessional Education
Recruitment & Retention
- Healthy Workplace Initiative!
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Background on Funding
Objectives of Healthy Workplace Initiatives
 Improve the health and wellbeing of
healthcare workers
 Decrease absenteeism, turnover,
overtime, of healthcare workers to
improve the health system productivity
 Establish policy/settings that enhance the
workplace, thereby improving provision of
quality healthcare
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FH’s Healthy Workplace Initiative
“Development of a Healthy Workplace
Prevention Action Plan Through
Integrated Data Analysis”
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Issues/Drivers
 How do large organizations decide where
their limited resources are best spent to
improve health & wellness?
 “Data rich, information poor”
- Harnessing the potential that exists within
the vast sets of data present within the
organization
 Availability of substantial amount of data
with little integrated analysis
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Project Outline
 Develop a comprehensive multifactorial
model that includes multiple
organizational data sets to provide a
profile of the health of the workplaces
and the workers.
 By virtue of the industry, efforts were
made to collect other relevant data:
- Patient safety
- Security interventions
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Lit Review Findings
 Examples of systems and indicators
 Examples of interventions
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Health Surveillance System (WHO,
2002)
 Comprehensive system should steer the
organization to:
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Stimulate epidemiological research
Predictive activities (modeling)
Action-oriented research and interventions
Assess effectiveness of interventions
Provide guidance on policies and
programmes
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Health Surveillance System (WHO,
2002)
 Prevention and surveillance activities
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health assessments
occupational injury data
sentinel event notification
surveys, investigations and inspections
 Descriptive demographic data
- Health, injury, socio-economic, conditions
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Data Acquired
2005 calendar year
 Influenza Vaccination
 LTD (Frequency, Hours, Costs)
 Worker Injury (Frequency, Costs, Days Lost,
Nature)
 Payroll (sick, OT, Regular, others…)
 Span of Control
 Turnover
 Security Interventions*
 Adverse Events*
* At Organization/Site level only
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Indicators
Indicators Used in Literature
Demographics
(age, gender, etc.)
Mental Health Claims
Health Risk Ax
(incl. stress and personal risk factors)
Prevention Activities
Exposure Surveys
Overtime
Injury/illness records
Turnover
Health Claims
Absenteeism/Sick time
Pharmacy Claims
Immunizations
(Influenza, etc.)
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Levels of Reports
 Executive Team
 Executive Directors & Regional Directors
 Workplace Health Teams
- Responsible for areas in FH
- Includes acute, residential and community
care
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Annual Report Structure
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Introduction
Project Background
Costs Summary
Impact Factor
Indicator Summaries
Appendix
- Healthy Workplace Indicators
- Actual Costs and Frequencies
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Sample Indicators
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Sample Data Table
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Challenges Encountered
 Data Access
- Locating/Sourcing
 Data Quality
 Mapping/Integration
 Document preparation
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Second Round…revision to our
processes
1.
2.
3.
4.
5.
6.
7.
Finalize Organizational Map
Integrate data according to Map
Run tables and charts
Check for quality (“smell test”)
Report Production
Distribution and Communication
Evaluation
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Process…improved!
 Obtained “map” from Finance – as good
as it gets!
 Aware of known quality issues – no more
surprises
 Report templates already prepared
 2nd Annual Report released May 2007
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Future Work - Accountability
 Reports to go to Executive and Regional
Directors
 Inclusion in “Strategic Actions” list in
performance planning tool
 Annual performance targets
- To organizational average
- To provincial average
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Future Work - Application
 Enterprise risk management
 Integration within Workplace Health
Teams
 Identification of resources/opportunities
 Exploratory analyses
 Benchmarking internally/externally
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Future Work – Research Activities
 Development of research questions
arising from discussions
 Identification of research partners
 Identification of sources of funding
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If I had to do it all over again…
 Ensure that your mapping is accurate
 Check data quality before production
 This is just more information for the
decision-makers
- Evaluate it’s usefulness!
- Ensure contextual relevance (uptake)
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Hospital volume and mortality for mechanical ventilation
of medical and surgical patients: A population-based
analysis using administrative data
 Research Question
- Is hospital volume associated with improved survival for medical
and surgical patients receiving mechanical ventilation?
 Design
- Population-based retrospective cohort study
 Data source
- Ontario physician billing database
- Hospital discharge database (126 hospitals)
- Vital statistic
- Three databases were linked via unique, encrypted patient
identifier to create an electronic file of mechanical ventilation
episodes during the 1998-2000
Crit Care Med, 2006 Vol. 34, No.9
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Hospital volume and mortality for mechanical ventilation
of medical and surgical patients: A population-based
analysis using administrative data
 Definitions
- Hospital volume = mean annual number of ventilation episodes
performed at each hospital
- Hospitals were grouped into five volume categories (<100, 100-199,
200-299, 300-699, ≥700)
• Patient cohort
Excludes:
- Repeat episodes
- Episodes occurred across two or more hospitals
- Episodes associated with trauma
- Episodes with a duration <3days
- Patients were defined as surgical if ventilation was initiated on the same
day or subsequent day after surgery, otherwise, patients were define as n
“medical”
- Final cohort included 6,373 surgical and 13,846 medical patients
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Crit Care Med, 2006 Vol. 34, No.9
57
Hospital volume and mortality for mechanical ventilation
of medical and surgical patients: A population-based
analysis using administrative data
 Analyses
- Multivariable logistic regression analysis to examine
the relationship between hospital volume and 30
day mortality
 Results
- Volume had no effect on mortality for surgical patients with an
odds ratio of 1.01, 0.92-1.11 at 95% confidence interval
- Among medical patients, after adjustment for clustering, the
lowest volume category had a non significant increase in
mortality with an odds ratio 1.13, 0.87-1.1.47 at 95%
confidence interval
Crit Care Med, 2006 Vol. 34, No.9
58
The role of Decision Support
 Provide health information for the
evaluation and planning of health
services in FH
 Summarize and report data related to
population demographics, health status
and utilization of health services
 Endeavor to support research and
evaluation related data needs
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Ways to access data
 DSS Website
Population data that are common knowledge
and contain no personal information, e.g.
seniors population, population by age and sex,
population distribution/projections etc.
 Non-research data request - online process
For example, specific data for program
planning and evaluation Data Request Form
 Research related data request
Governed by “Policy for the Provision of
Research Related Services”
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Research Related Services
Policy for the Provision of Research-Related Services, Decision Support
 DSS determines its ability to provide
research related services at a cost
recovery basis
 Data requests must be presented with
evidence of “Authorization to Conduct
Research”
 Ensure compliance with policy and
legislations regarding privacy,
confidentiality and security
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Data Planning
 Although formal request for data occurs when
application has been submitted for ethics approval,
data planning typically starts much earlier
 Practical questions to be considered:
 Are required data being collected?
 Are data Accessible?
 Are there cross jurisdictional comparison issues?
 Cost & time
 Research intelligence unit, Decision Support (Data
Consult Form) and Health Records can provide
valuable advice
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Procedures………..
Applications to FH Research Ethics Board
Contact DSS Manager/Designate to have
DAR Form signed
(DAR) form
Manager/Designate ensures that a Data
Access Agreement (DAA) is completed
Data Access Agreement
Researcher will provide
Manager/Designate with a signed
copy of “Authorization to Begin
Research” before data can be
released
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A quick look at the DSS Website
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Questions/Comments?
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