Analysis of Transient Ischemic
Attacks Using the State-wide
THCIC* Database of Acute
Care Discharge Claims
Date:05-07-14
* Texas Health Care Information Collection
Susan Alex and Dr. Mari Tietze, Associate Professor
Research in Nursing NURS5023
Texas Woman’s University
T. Boone Pickens Institute of Health Sciences-Dallas Center
The Houston J. and Florence A. Doswell College of Nursing
Objectives
• Data source overview
• Data description of codes used for analysis
– Diagnostic Related Groupings (DRG*) code
– Diagnosis code
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Study background
Study design and methodology
Results
Conclusion
* = Diagnostic Related Groupings, also knows as Medicare Severity DRGs
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Data Source
Data Source
• Data file: Texas Health Care Information
Collection (THCIC) inpatient discharge claims
Public Use Data File (PUDF) from 2012Q1
through 2012Q4
• Total of 504 hospitals in THCIC list; 80.1% or all
Texas hospitals [n = 629]
• Reference source: www.dshs.state.tx.us/thcic
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THCIC Creation
Data Source
Texas Health Care Information Collection
Center for Health Statistics
On September 1, 2004 the THCIC joined the Texas Department of Health, the Texas
Commission on Alcohol and Drug Abuse, and part of the Texas Department of Mental
Health and Mental Retardation to form the Texas Department of State Health Services.
All functions of THCIC continue in the Center for Health Statistics. The THCIC was
created by the 74th Texas Legislature in 1995.
THCIC's primary purpose is to provide data that will enable Texas consumers and
health plan purchasers to make informed health care decisions. THCIC's charge is to
collect data and report on the quality performance of hospitals and health maintenance
organizations operating in Texas. The goal is to provide information that will enable
consumers to have an impact on the cost and quality of health care in Texas.
Legislation
THCIC was created by Chapter 108 of the Health and Safety Code.
Source: http://www.dshs.state.tx.us/thcic/GeneralInfo.shtm
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HIPAA Administrative Simplification
Statute and Rules
Data Source
To improve the efficiency and effectiveness of the health care system, the Health
Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191,
included Administrative Simplification provisions that required HHS to adopt
national standards for electronic health care transactions and code sets, unique health
identifiers, and security.
At the same time, Congress recognized that advances in electronic technology could
erode the privacy of health information. Consequently, Congress incorporated into
HIPAA provisions that mandated the adoption of Federal privacy protections for
individually identifiable health information.
This Rule sets national standards for protecting the confidentiality, integrity, and
availability of electronic protected health information. Compliance with the Security
Rule was required as of April 20, 2005 (April 20, 2006 for small health plans).
Office of Civil Rights administers and enforces the Privacy Rule and the Security Rule.
Source: http://www.hhs.gov/ocr/privacy/hipaa/administrative/
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Produce Lines by Service for 2010
Data Description
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indicates the
product line
being studied
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Row
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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20
21
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Product Line
Behavioral Health
Cardiology
Cardiovascular Surgery
Diabetes
Gastroenterology
General Surgery
Gynecology
Medicine
Neonate
Neurology
Neurosurgery
Normal Newborn
Obstetrics
Oncology
Orthopedics
Other Surgery
Pulmonary
Rehabilitation
Transplant
Ungroupable
Urology
Vascular Surgery
Summary
Claim Count
175,087
257,359
34,386
26,475
140,947
210,018
56,964
397,546
55,194
114,344
64,120
328,426
407,300
64,745
157,045
9,131
232,768
67,382
2,408
4,357
85,656
49,411
2,941,069
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DRG Codes
Data Description
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In October 2007, MS-DRGs increased to 745 from 335 CMS version
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Diagnosis-related group (DRG) is a system to classify hospital cases into one of
approximately 500 groups, also referred to as DRGs, expected to have similar
hospital resource use, developed for Medicare as part of the prospective payment
system. DRGs are assigned by a "grouper" program based on ICD diagnoses,
procedures, age, sex, discharge status, and the presence of complications or
comorbidities. DRGs have been used in the US since 1983 to determine how much
Medicare pays the hospital, since patients within each category are similar
clinically and are expected to use the same level of hospital resources. DRGs may
be further grouped into Major Diagnostic Categories (MDCs).
Source: http://en.wikipedia.org/wiki/Diagnosis-related_group
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DRG Codes by Major Diagnostic Category (MDC)
DRG
Code(s)
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indicates the
MDC being
studied
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120 113 129 163 216 326 405 453 570 614 653 707 734 765 791 799 820 853 876 895 901 928 939 957 969 981 998 -
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103
125
159
208
316
395
446
566
607
645
700
730
761
768
792
816
848
872
887
897
923
929
950
965
976
989
999
MDC Description
Data Description
PRE-MDC
MDC 01: DISEASES & DISORDERS OF THE NERVOUS SYSTEM
MDC 02: DISEASES & DISORDERS OF THE EYE
MDC 03: DISEASES & DISORDERS OF THE EAR, NOSE, MOUTH & THROAT
MDC 04: DISEASES & DISORDERS OF THE RESPIRATORY SYSTEM
MDC 05: DISEASES & DISORDERS OF THE CIRCULATORY SYSTEM
MDC 06: DISEASES & DISORDERS OF THE DIGESTIVE SYSTEM
MDC 07: DISEASES & DISORDERS OF THE HEPATOBILIARY SYSTEM & PANCREAS
MDC 08: DISEASES & DISORDERS OF THE MUSCULOSKELETAL SYSTEM & CONN TISSUE
MDC 09: DISEASES & DISORDERS OF THE SKIN, SUBCUTANEOUS TISSUE & BREAST
MDC 10: ENDOCRINE, NUTRITIONAL & METABOLIC DISEASES & DISORDERS
MDC 11: DISEASES & DISORDERS OF THE KIDNEY & URINARY TRACT
MDC 12: DISEASES & DISORDERS OF THE MALE REPRODUCTIVE SYSTEM
MDC 13: DISEASES & DISORDERS OF THE FEMALE REPRODUCTIVE SYSTEM
MDC 14: PREGNANCY, CHILDBIRTH & THE PUERPERIUM
MDC 15: NEWBORNS & OTHER NEONATES WITH CONDTN ORIG IN PERINATAL PERIOD
MDC 16: DISEASES & DISORDERS OF BLOOD, BLOOD FORMING ORGANS, IMMUNOLOG DISORD
MDC 17: MYELOPROLIFERATIVE DISEASES & DISORDERS, POORLY DIFFERENTIATED NEOPLASM
MDC 18: INFECTIOUS & PARASITIC DISEASES, SYSTEMIC OR UNSPECIFIED SITES
MDC 19: MENTAL DISEASES & DISORDERS
MDC 20: ALCOHOL/DRUG USE & ALCOHOL/DRUG INDUCED ORGANIC MENTAL DISORDERS
MDC 21: INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS
MDC 22: BURNS
MDC 23: FACTORS INFLUENCING HLTH STAT & OTHR CONTACTS WITH HLTH SERVCS
MDC 24: MULTIPLE SIGNIFICANT TRAUMA
MDC 25: HUMAN IMMUNODEFICIENCY VIRUS INFECTIONS
UNRELATED OPERATING ROOM PROCEDURES
INVALID AND UNGROUPABLE DRGS
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Diagnosis Codes
Data Description
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The International Statistical Classification of Diseases and Related Health Problems
(most commonly known by the abbreviation ICD) is a medical classification that
provides codes to classify diseases and a wide variety of signs, symptoms,
abnormal findings, complaints, social circumstances, and external causes of injury
or disease. Under this system, every health condition can be assigned to a unique
category and given a code, up to six characters long.
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The International Classification of Diseases is published by the World Health
Organization (WHO) and used worldwide for morbidity and mortality statistics,
reimbursement systems, and automated decision support in medicine. This system
is designed to promote international comparability in the collection, processing,
classification, and presentation of these statistics. The ICD is a core classification of
the WHO Family of International Classifications (WHO-FIC).[1]
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The ICD is revised periodically and is currently in its tenth edition.
[1]: http://www.who.int/classifications/en/
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indicates the
ICD-9 code
being studied
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ICD-9 Code Categories
Data Description
Diseases and Injuries Tabular Index
1. INFECTIOUS AND PARASITIC DISEASES (001-139)
2. NEOPLASMS (140-239)
3. ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES, AND IMMUNITY DISORDERS (240-279)
4. DISEASES OF THE BLOOD AND BLOOD-FORMING ORGANS (280-289)
5. MENTAL DISORDERS (290-319)
6. DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS (320-389)
7. DISEASES OF THE CIRCULATORY SYSTEM (390-459)
8. DISEASES OF THE RESPIRATORY SYSTEM (460-519)
9. DISEASES OF THE DIGESTIVE SYSTEM (520-579)
10. DISEASES OF THE GENITOURINARY SYSTEM (580-629)
11. COMPLICATIONS OF PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM (630-679)
12. DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE (680-709)
13. DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE (710-739)
14. CONGENITAL ANOMALIES (740-759)
15. CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD (760-779)
16. SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS (780-799)
17. INJURY AND POISONING (800-999)
SUPPLEMENTARY CLASSIFICATION OF FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH
SERVICES (V01-V89)
SUPPLEMENTARY CLASSIFICATION OF EXTERNAL CAUSES OF INJURY AND POISONING (E800-E999)
Source: http://icd9cm.chrisendres.com/index.php?action=contents
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Study Background
Background and PICO
• 85 % of strokes are due to ischemia.
• Transient Ischemic Attack is called “mini stroke” ,
it’s a warning sign for major stroke.
• Recognizing and treating TIA can reduce the risk of
major stroke.
• From my practical experience, it appears that the
charges vary among hospitals. So I wanted to
compare the charges among two major hospitals in
Dallas.
http://www.cdc.gov/stroke/types_of_stroke.htm
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Research Question
Res Question
Is there a difference between the total charges
to Transient Ischemic Attack patients admitted
among two major hospitals in Dallas?
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Design/Methodology
Design/Method
• Retrospective, non-experimental (observational)
study design using administrative discharge
claims data from the THCIC public use data file
(PUDF)
• Discharge claims of interest were extracted as a
Microsoft Excel file using the QlikView business
intelligent tool
• Microsoft Excel file was then opened in IBM SPSS
version 22.0 and subjected to statistical analysis
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Operational Definition(s)
Background and PICO
• Adult admissions -- discharge claims/cases, age 18 and
above
• Transient Ischemia-- DRG Transient Ischemia code(s)
069 “Transient Cerebral Ischemia Unspecified”.
• Hospital service delivery represented by total hospital
charge average
• Hospitals identified by Hospital short name
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Claims/Cases by Race
Results
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Claims/Cases by Age and Gender
Results
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Results
Is Dependent Variable Normally Distributed?
Dependent variable is not normally distributed for either hospital
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Normality of Distribution
Dependent variable is not normally distributed for either hospital
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Outlier Distribution for Dependent
Variable
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Design/Method
Source: Cronk, B.C.
(2008). How to Use
SPSS: A Step-by-Step
Guide to Analysis and
Interpretation, 5th
Edition. Glendale,
CA.: Pyrczak
Publishing.
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Statistical Analysis
Results
• There is significant statistical difference
between the two hospitals for total charges.
• A Mann-Whitney U Test revealed significant
difference in the hospital charges of hospital
A (Md = 11390.395, n= 79) and hospital B
(Md= 20121.590, n= 216), U = 3302, z = 8.061,p = 0.000, r = -0.469
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Conclusion
Conclusion
• Hospital B had an r value of -0.469 which is
significant for a large effect size.
• So it would be worth to further
investigation.
• Further comparison of other hospitals would
help as TIA affects such a larger population .
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Contact or Questions
Susan Alex
Supported by
Dr. Mari Tietze, PhD, RN-BC, FHIMSS
Texas Woman’s University
T. Boone Pickens Institute of Health Sciences-Dallas Center
The Houston J. and Florence A. Doswell College of Nursing
mtietze@twu.edu
214-689-6792