1. Hospital Discharge Data and Vermont Health Surveillance Charles Bennett, Ph.D. Epidemiological Surveillance Chief Vermont Explor, Hospital Data Managers Meeting March 14, 2004

2. Health Surveillance Health surveillance is the collection, assembly, analysis and timely reporting of health data to appropriate users. Hospital discharge and Emergency Department data are datasets of great importance in understanding health conditions affecting Vermonters.

3. Health Surveillance Four Concerns Race and Ethnicity E-Codes More timely sharing of injury data Unique Personal Identifier Number (UPIN), a.k.a. Unique Patient Reference Number

4. Health Surveillance Four Concerns Race and Ethnicity E-Codes More timely sharing of injury data Unique Personal Identifier Number (UPIN) a.k.a. Unique Patient Reference Number

5. Race and Ethnicity The Office of Management & Budget has required all federal databases that inquire about race and ethnicity to include, as a minimum, a category of Hispanic, preferably asked as a question of ethnicity separate from race. Information in hospital records → UHDDS, birth records, cancer registry, etc. (Intake questions are important)

6. Hospitalizations of Vermonters, 1997-2001 (Excluding newborns and MCD 14) GroupPer 1000 Pop. Whites75.0 Blacks89.3 American Indian 7.7 Asian/Pacific Islander30.0 Hispanic11.2

7. Hospitalizations to Vermonters, 1997-2001 (Excluding newborns and MDC 14)

8. Ethnicity Questions U.S. Standard Birth Certificate When asked if mother/father is of Hispanic Origin, the responses are:  No, not Spanish/Hispanic/Latina  Yes, Mexican, Mexican American, Chicana  Yes, Puerto Rican  Yes, Cuban  Yes, other Spanish/Hispanic/Latina Specify___________________________

9. Questions on NHIS, BRFSS, YRBS, ATS, YTS (OMB) Which one or more of the following would you say is your race? Would you say: White, Black or African American, Asian, Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native, or Other? (Check all that apply) 1. White 2. Black or African American 3. Asian 4. Native Hawaiian or Other Pacific Islander 5. American Indian, Alaska Native or 6. Other [specify]______________

10. Questions on NHIS, BRFSS, YRBS, ATS, YTS Which one of these groups would you say best represents your race? 1. White 2. Black or African American 3. Asian 4. Native Hawaiian or Other Pacific Islander 5. American Indian, Alaska Native or 6. Other [specify]______________

11. Minority Population Data in VT Group (“Pre-bridged”)19902000 ∆% Total562,758608,8278.2 White 555,088591,4316.5 Black or AA 1,951 3,233 65.7 AI or AN 1,696 2,482 46.3 Asian or Pacific Isl. 3,134 5,538 72.3 Other Race 808 1,443 78.6 Two or More Races 0 7,335-- Hispanic or Latino 3,661 5,245 43.3 (of any race)

12. Minority Population Data in VT “Bridged” Group19902000 ∆% Total562,758608,8278.2 White 555,088595,9637.4 Black or AA 1,951 4,051 107.6 AI or AN 1,696 3,077 81.4 Asian or Pacific Isl. 3,215 5,736 78.4 Other Race N.A. N.A. Two or More Races N.A. N.A. Hispanic or Latino 3,661 5,504 50.3 (of any race)

13. Population Change 1990-2000

14. Issue of “Bridging” Current “bridging” is based on National model based upon National Health Interview Survey data. Vermont BRFSS yields very different result. Even first listed race, for persons of multiple race, is not always the one group that best represents respondent’s race.

15. Allocation of “Two or More Races” into “Bridge” Categories Race NCHIS (NHIS) VT BRFSS White453274%466176% Black or African American81813%2364% American Indian/Native Alaskan59510%106917% Asian/Pacific Islander1983%1773% Total6143100%6143100%

16. Health Surveillance Four Concerns Race and Ethnicity E-Codes More timely sharing of injury data Unique Personal Identifier Number (UPIN) a.k.a. Unique Patient Reference Number

17. E-Codes E-code reporting with injury diagnosis Location coding Perpetrator coding

18. E-Codes E-code reporting with injury diagnosis  E-code reporting has greatly improved since the addition of a special field in the data base.  In recent years, approximately 97 percent of all reports with a principle diagnosis of injury are accompanied with a correct E-code for nature of injury  The nature of injury code, however, is not always in the E-code field.

19. E-Codes E-code reporting with injury diagnosis Location coding

20. E-Codes Location coding  For unintentional injuries, location is reported about 40 percent of the time.  Unintentional injuries are the “bulk” of injuries.  Perhaps a second E-code field would help to encourage reporting.

21. E-Codes E-code reporting with injury diagnosis Location coding Perpetrator coding

22. E-Codes Perpetrator coding – Intentional assaults  The reporting of perpetrator codes for intentional assaults on children/youth (under 18 years of age) is, in recent years, running about 33 percent.  Reporting of perpetrator is called for in most recent ICD-9-CM code book for adults also.  Very few rapes have a perpetrator code.  Some 29 hosp. discharges have perpetrator codes without nature of injury e-code (1997-2001).  In 2002, 124 ED records had perpetrator codes without nature of injury e-code.

23. Health Surveillance Four Concerns Race and Ethnicity E-Codes More timely sharing of injury data Unique Personal Identifier Number (UPIN) a.k.a. Unique Patient Reference Number

24. Timely Reporting of Injury Data Current reporting is about 15 to 27 months after the events in question. CDC is pressing state programs for more timely surveillance of injury conditions. Quarterly reporting of hospital and ED data would permit response to emergent conditions. Reporting of suicide attempts may help to minimize extent of contagious condition.

25. Health Surveillance Four Concerns Race and Ethnicity E-Codes More timely sharing of injury data Unique Personal Identifier Number (UPIN), a.k.a. Unique Patient Reference Number

26. Unique Patient Reference Number For purposes of health surveillance, it is very important to distinguish between incidence and prevalence. UPIN facilitates accurate comparison of multiple records – to identify new cases as opposed to patients with repeated hospitalizations. UPIN would greatly enhance understanding of health conditions in VT – and guiding of programs in response.

27. Thank you for your attention... and your help.