Assessing VA Health Care Use: Inpatient

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RESEARCHERS’ GUIDE TO VA DATA

2009-2010 VIReC Database and 2009-2010 VIReC Database and Methods Cyber Seminar SeriesMethods Cyber Seminar Series

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Assessing VA Health Care Use:Assessing VA Health Care Use:InpatientInpatient

Session 2Session 2

May 4, 2009May 4, 2009

Presented by:Denise M. Hynes, PhD, RN

Center Principal Investigator, VIReC

2009-2010 VIReC Database and Methods Cyber Seminar Series

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Session ObjectivesSession Objectives

How has healthcare utilization been How has healthcare utilization been measured in VA studies?measured in VA studies?Overview of Medical SAS inpatient Overview of Medical SAS inpatient databasesdatabasesFinding information in the Inpatient Medical Finding information in the Inpatient Medical SAS databasesSAS databasesExamples of VA studies that have measured Examples of VA studies that have measured VA healthcare utilizationVA healthcare utilizationWhere to go for more helpWhere to go for more help

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How has healthcare utilization been How has healthcare utilization been measured in VA studies?measured in VA studies?Overview of Medical SAS inpatient Overview of Medical SAS inpatient databasesdatabasesFinding information in the Inpatient Finding information in the Inpatient Medical SAS databasesMedical SAS databasesExamples of VA studies that have Examples of VA studies that have measured VA healthcare utilizationmeasured VA healthcare utilizationWhere to go for more helpWhere to go for more help

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How has healthcare utilization been How has healthcare utilization been measured in VA studies?measured in VA studies?

Cully, J. A., Zimmer, Cully, J. A., Zimmer, M., Khan, M. M., & M., Khan, M. M., & Petersen, L. A. (2008). Petersen, L. A. (2008). Quality of depression Quality of depression care and its impact on care and its impact on health service use and health service use and mortality among mortality among veterans. veterans. Psychiatr Psychiatr Serv., 59,Serv., 59, 1399-1405. 1399-1405.

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Frayne, S. M., Yu, W., Frayne, S. M., Yu, W., Yano, E. M., Ananth, Yano, E. M., Ananth, L., Iqbal, S., Thrailkill, L., Iqbal, S., Thrailkill, A. et al. (2007). A. et al. (2007). Gender and use of Gender and use of care: planning for care: planning for tomorrow's Veterans tomorrow's Veterans Health Administration. Health Administration. J Womens Health J Womens Health (Larchmt.)., 16,(Larchmt.)., 16, 1188- 1188-1199.1199.

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Romano, P. S., Mull, H. Romano, P. S., Mull, H. J., Rivard, P. E., Zhao, J., Rivard, P. E., Zhao, S., Henderson, W. G., S., Henderson, W. G., Loveland, S. et al. Loveland, S. et al. (2009). Validity of (2009). Validity of selected AHRQ patient selected AHRQ patient safety indicators safety indicators based on VA National based on VA National Surgical Quality Surgical Quality Improvement Program Improvement Program data. data. Health Serv Health Serv Res., 44,Res., 44, 182-204. 182-204.

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Stineman, M. G., Kwong, Stineman, M. G., Kwong, P. L., Kurichi, J. E., Prvu-P. L., Kurichi, J. E., Prvu-Bettger, J. A., Vogel, W. Bettger, J. A., Vogel, W. B., Maislin, G. et al. B., Maislin, G. et al. (2008). The effectiveness (2008). The effectiveness of inpatient of inpatient rehabilitation in the rehabilitation in the acute postoperative acute postoperative phase of care after phase of care after transtibial or transtibial or transfemoral transfemoral amputation: study of an amputation: study of an integrated health care integrated health care delivery system. delivery system. Arch Arch Phys Med Rehabil., 89,Phys Med Rehabil., 89, 1863-1872.1863-1872.

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Weeks, W. B., West, A. Weeks, W. B., West, A. N., Wallace, A. E., & N., Wallace, A. E., & Fisher, E. S. (2008). Fisher, E. S. (2008). Comparing the Comparing the characteristics, characteristics, utilization, efficiency, utilization, efficiency, and outcomes of VA and outcomes of VA and non-VA inpatient and non-VA inpatient care provided to VA care provided to VA enrollees: a case enrollees: a case study in New York. study in New York. Med Care., 46,Med Care., 46, 863- 863-871.871.

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West, A. N., Weeks, W. West, A. N., Weeks, W. B., Wright, S. M., B., Wright, S. M., Wallace, A. E., & Wallace, A. E., & Fisher, E. S. (2008). Fisher, E. S. (2008). When VA patients When VA patients have non-VA have non-VA hospitalizations, who hospitalizations, who pays for what pays for what services, and what are services, and what are the research the research implications? A New implications? A New York case study. York case study. Med Med Care., 46,Care., 46, 872-877. 872-877.

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How has healthcare utilization been How has healthcare utilization been measured in VA studies?measured in VA studies?Overview of Medical SAS inpatient Overview of Medical SAS inpatient databasesdatabasesFinding information in the Inpatient Medical Finding information in the Inpatient Medical SAS databasesSAS databasesExamples of VA studies that have measured Examples of VA studies that have measured VA healthcare utilizationVA healthcare utilizationWhere to go for more helpWhere to go for more help

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How has healthcare utilization been measured How has healthcare utilization been measured in VA studies?in VA studies?

Medical SAS Inpatient and Outpatient Medical SAS Inpatient and Outpatient DatasetsDatasets

• Most important datasets for VA healthcare utilization information

• National VHA health care delivery data• SAS datasets housed on mainframe computer at

Austin Information Technology Center (AITC)– Divided into inpatient and outpatient datasets– Datasets available on a quarterly basis– In general, researchers are advised to use the

annual, closed-out datasets– Common element: patient identifier

(scrambled SSN)

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General DescriptionGeneral Description

Inpatient services are recorded in the Medical SAS Inpatient services are recorded in the Medical SAS (MedSAS) Inpatient datasets (MedSAS) Inpatient datasets

Also known as PTF (Patient Treatment File)Also known as PTF (Patient Treatment File)

Common dataset structure, generally stable over Common dataset structure, generally stable over timetime

Broken out by fiscal year of discharge dateBroken out by fiscal year of discharge date– Admission may have occurred in a previous fiscal

year

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Inpatient Data FlowInpatient Data Flow

Data Flow from the VHA Medical Centers to the Austin Information Technology

Center (AITC) to the Medical SAS Inpatient Datasets

VHA Medical Centers PTF (local VISTA system)

Medical SAS Inpatient Datasets

Acute Care: Main, Procedure, Bed Section, Surgery Datasets

Extended Care: Main, Procedure, Bed Section, Surgery Datasets

Observation Care: Main, Procedure, Bed Section Datasets

Non-VA Care: Main, Procedure, Bed Section, Surgery Datasets

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Four datasetsFour datasets within each category of care within each category of care

FileFile ReferenceReference DatesDates

MainMain PMyyPMyy 1970 - present1970 - present

BedsectionBedsection PByyPByy 1984 – present1984 – present

ProcedureProcedure PPyyPPyy 1988 – present1988 – present

SurgerySurgery PSyyPSyy 1984 - present1984 - present

Where yy= last 2-digits fiscal year

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Data element Data element examplesexamples

Patient demographicsPatient demographicsPrimary/Secondary DiagnosisPrimary/Secondary DiagnosisLength of StayLength of StayICD-9 Procedure and Surgery CodesICD-9 Procedure and Surgery CodesPatient identifier (SCRSSN) Patient identifier (SCRSSN) Facility & VISN identifiers of where care providedFacility & VISN identifiers of where care providedAdmission & Discharge Date & TimeAdmission & Discharge Date & TimeDischarge Type (e.g., Regular, Death-Autopsy, Non-bed Discharge Type (e.g., Regular, Death-Autopsy, Non-bed Care)Care)For a complete list:For a complete list:– http://vaww.virec.research.va.gov/References/RUG/

RUG-Inpatient06.pdf

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Data Access InformationData Access Information

Data Steward: Data Steward: – National Data Systems (NDS) (John Quinn)

Website/Where to go to find more:Website/Where to go to find more:– http://vaww.va.gov/nds/

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Strengths of Medical SAS DatasetsStrengths of Medical SAS Datasets

Centralized data sourceCentralized data source

Large number of patientsLarge number of patients

Unique identifier (SCRSSN: Scrambled Unique identifier (SCRSSN: Scrambled Social Security Number) allows linking Social Security Number) allows linking records across files/yearsrecords across files/years

Quality assessments are conducted on Quality assessments are conducted on datasetsdatasets

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Limitations of Medical SAS DatasetsLimitations of Medical SAS Datasets

Not all care dimensionsNot all care dimensions– VA databases contain limited information on the use of non-VA services

Incentives to codingIncentives to coding– Some conditions may be over-reported in

administrative data compared with medical records (coding errors)

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Overview of Medical SAS inpatient Overview of Medical SAS inpatient databasesdatabases

Finding information in the Inpatient Finding information in the Inpatient Medical SAS databasesMedical SAS databases

Examples of VA studies that have Examples of VA studies that have measured VA healthcare utilizationmeasured VA healthcare utilization

Where to go for more helpWhere to go for more help

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Assessing Inpatient Healthcare Use:Assessing Inpatient Healthcare Use: Finding info in Inpatient Medical SAS DatasetsFinding info in Inpatient Medical SAS Datasets

Where do I find information about Where do I find information about admissions and admissions and dischargesdischarges??

All inpatient datasets include:• admission date and time• station the patient is admitted to• principal diagnosis code for admission• discharge date and time• discharge status (in Main dataset only)• discharge type (e.g., Regular, Death-Autopsy,

Non-bed Care)

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Assessing Inpatient Healthcare Use:Assessing Inpatient Healthcare Use:Finding info in Inpatient Medical SAS DatasetsFinding info in Inpatient Medical SAS Datasets

Where can I find information on a Where can I find information on a patient’s patient’s diagnosisdiagnosis??

There are three sets of diagnosis codes:There are three sets of diagnosis codes:– Diagnosis responsible for Admission

• Principal Diagnosis (DXPRIME)• Condition determined to be chiefly responsible for the

admission – Diagnosis related to Full Hospital Stay

• Primary Diagnosis (DXLSF)• Diagnosis responsible for the major part of the full

stay– Diagnosis related to Bed Section

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Where do I find information about inpatient Where do I find information about inpatient proceduresprocedures??– Inpatient procedure datasets contain:

• Procedures not occurring in an operating room (coded in ICD-9-CM)

• Dialysis type & number of dialysis treatments

– Inpatient surgery datasets contain:• Surgeries performed in operating room (coded in ICD-

9-CM)

– A “procedure” in one facility may be considered “surgery” in another facility. Check both datasets.

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How do I identify the specialty of the How do I identify the specialty of the physician managing the patient’s care?physician managing the patient’s care?– Use bed section to identify physician specialty

• Found in Bedsection and Procedure datasets• Up to 25 bedsections per inpatient stay• Most common acute bedsections

– General (acute) medicine– High Intensity General Psychiatry– Medical ICU– General Surgery– Surgical ICU

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How do I identify care for a defined How do I identify care for a defined period of timeperiod of time??

– Records are created at discharge for the full stay, even if the admission was in a prior year– Exception: Claims for Non-VA Care are included

in the dataset for the fiscal year they were submitted, not the year for which care was provided

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How do I compute How do I compute acute length of stayacute length of stay (LS)? (LS)?

– Inpatient Main dataset includes information on care characteristics, including LOS, which

may include extended care stay– Use bed section data in Inpatient dataset

(inpatient main or inpatient bedsection?)• Date & time of transfer into & out of bed section

(BSINDAY & BSOUTDAY) to compute acute care LOS

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Overview of Medical SAS inpatient and Overview of Medical SAS inpatient and outpatient databasesoutpatient databases

Finding information in the Inpatient Medical Finding information in the Inpatient Medical SAS databasesSAS databases

Examples of VA studies that have measured Examples of VA studies that have measured VA healthcare utilizationVA healthcare utilization


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Research Example I:Research Example I: Stroupe KT, et al. (2006)Stroupe KT, et al. (2006)

Angina With Extremely Serious Operative Mortality Evaluation Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) Trial (AWESOME) Trial

Urgent revascularization of medically refractory, high-risk myocardial ischemia patients – Compared Percutaneous

Coronary Interventions (PCI) vs. Coronary Artery Bypass Grafts (CABG)

– Cost-effectiveness analysis of PCI vs. CABG

– Compared survival

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Research Example I:Research Example I:Stroupe KT, et al. (2006)Stroupe KT, et al. (2006)

The original AWESOME trial ran from Feb. 1995 – Feb. 2000.

Using data from administrative databases follow-up was extended through Sep. 2003 Concluded that the PCI-assigned patients had lower medical costs and better survival, suggesting that PCI is the “economically dominant strategy” in high-risk patients

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Methods:Methods:Data Sources - UtilizationData Sources - Utilization

Data on hospital stays and outpatient visits in VA were Data on hospital stays and outpatient visits in VA were from the MedSAS Datasetsfrom the MedSAS Datasets– Inpatient files:

• Acute Inpatient Files • Extended Care Files • Observation Files

– Outpatient files: Outpatient Visit File; Outpatient Event File; Outpatient Procedure File

– PCI or CABG procedure definition: procedure codes in inpatient and outpatient files, surgery codes in surgery files, and CPT codes in outpatient event file.

Non-VA care paid for by VA was from the Fee Basis FilesNon-VA care paid for by VA was from the Fee Basis FilesMedicare claims data Medicare claims data – 296 (67%) Medicare-eligible patients (i.e., 65 years of age or

older) at enrollment

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Results: Results: Healthcare UtilizationHealthcare Utilization

PCIPCI

N=218N=218CABGCABG

N=227N=227P-ValueP-Value

Initial revascularization, % patientsInitial revascularization, % patients

PCIPCI 9898 55 <0.0001<0.0001

CABGCABG 11 9494 <0.0001<0.0001

3 Years of Follow-up3 Years of Follow-up

Subsequent revasc.% patientsSubsequent revasc.% patients

PCIPCI 2929 1111 <0.0001<0.0001

CABG CABG 1515 77 0.0040.004

Non-revascularizations, meanNon-revascularizations, mean

Number of Acute Hospital StayNumber of Acute Hospital Stay 2.1 2.1 2.2 2.2 0.40 0.40

Number of Non-Acute Stay Number of Non-Acute Stay 0.5 0.5 0.3 0.3 0.20 0.20

Outpatients Visits Outpatients Visits 58.6 58.6 59.4 59.4 0.88 0.88

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Results: Results: Healthcare UtilizationHealthcare Utilization

PCIPCI

N=218N=218CABGCABG

N=227N=227P-ValueP-Value

3 to 5 Years of Follow-up3 to 5 Years of Follow-up

Subsequent revascularizations, % Subsequent revascularizations, % patients patients

PCIPCI 33 33 0.950.95

CABGCABG 66 33 0.090.09

Non-revascularizations, meanNon-revascularizations, mean

Number of Acute Hospital StayNumber of Acute Hospital Stay 0.70.7 0.80.8 0.610.61

Number of Non-Acute Stay Number of Non-Acute Stay 0.10.1 0.20.2 0.430.43

Outpatients Visits Outpatients Visits 2828 3030 0.590.59

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Research Example IIResearch Example IICost and Effectiveness of ESRD Care ProjectCost and Effectiveness of ESRD Care Project

PI: Denise M. Hynes, RN, MPH, PhDPI: Denise M. Hynes, RN, MPH, PhD

This prospective observational studyThis prospective observational study examined examined total costs of care and quality of life of patients total costs of care and quality of life of patients receiving hemodialysis in VA or non-VA dialysis receiving hemodialysis in VA or non-VA dialysis facilitiesfacilities

Conclusion: Conclusion: – Veterans using VA dialysis have

• higher inpatient costs• greater caregiver burden• markers for worse health status

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Research Example II:Research Example II:Hynes DMHynes DM

Implications: Implications: – Because veterans with ESRD are eligible for

Medicare, VA policymakers may consider transferring expensive dialysis care from VA to Medicare-covered facilities

– Transferring patients to Medicare-covered facilities could shift more costs to patients

– Data suggests that VA is providing care to patients who are sicker. The VA may be particularly important for providing comprehensive care to those veterans who are most ill and most in need of intensive care.

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Research Example II:Research Example II: Hynes DMHynes DM Methods:Methods:

Data Sources - UtilizationData Sources - Utilization

Type of DataType of Data Data SourceData Source

Health care utilization MedSAS Inpatient and Outpatient Datasets

Demographics MedSAS Inpatient and Outpatient Datasets

Diagnostic Codes MedSAS Inpatient and Outpatient Datasets

VA Health Care Costs HERC Average Costs Dataset

Pharmacy Data PBM Data

Laboratory Data DSS National Data Extract Lab Results

Non-VA Healthcare Use Medicare Claims Data

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Research Example II: Research Example II: Hynes DMHynes DM

Results: Results: Healthcare Utilization at 6 Months Healthcare Utilization at 6 Months

VA VA DialysisDialysis

N = 179N = 179

Non-VA Non-VA DialysisDialysis

N = 147N = 147

Percent of Patients Percent of Patients HospitalizedHospitalized

50%50% 42%42%

Number of Hospital Number of Hospital AdmissionsAdmissions

1.21.2 0.90.9

Number of Hospital Number of Hospital Days*Days*

10.710.7 5.55.5

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Overview of Medical SAS inpatient and Overview of Medical SAS inpatient and outpatient databasesoutpatient databases

Finding information in the Inpatient Medical Finding information in the Inpatient Medical SAS databasesSAS databases

Examples of VA studies that have measured Examples of VA studies that have measured VA healthcare utilizationVA healthcare utilization


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VIReC HelpVIReC Help

VIReC WebpageVIReC Webpage http://www.virec.research.va.govhttp://www.virec.research.va.gov

– Information on VA data sources and how to access data

– Documentation on some VA datasets, i.e., Medical SAS datasets:

• http://www.virec.research.va.gov/DataSourcesName/Medical-SAS-Datasets/SAS.htm

• Includes lists of variables and their dataset locations

• Descriptions of each of the variables• Values for selected variables

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VIReC Help (cont’d)VIReC Help (cont’d)

HSRData ListservHSRData Listserv– Join at VIReC Web site– Discussion among > 350 data stewards,

managers, and users– Past messages in archive (on intranet)VIReC Help DeskVIReC Help Desk– VIReC staff will answer your question and/or

direct you to available resources on topics– [email protected] – (708) 202-2413

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Suggested other resources:Suggested other resources: Medical SAS Datasets: Medical SAS Datasets:Data Quality InformationData Quality Information

Quality assessments performed by the Office of Inspector General, the Medical Care Cost Recovery program, and special workgroupsData Quality, Information Assurance, Office of Information – http://vaww.vhaco.va.gov/dataquality/default.htm

VHA Coding Council - VHA Coding Handbook – http://vaww1.va.gov/health/him/VHACC/VA_HIM_P/

coding_council1.htm

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Sample BibliographySample Bibliography

Cully, J. A., Zimmer, M., Khan, M. M., & Petersen, L. A. (2008). Quality of depression care and its impact on health service use and mortality among veterans. Psychiatr Serv., 59, 1399-1405.

Damush, T. M., Jia, H., Ried, L. D., Qin, H., Cameon, R., Plue, L. et al. (2008). Case-finding algorithm for post-stroke depression in the veterans health administration. Int J Geriatr Psychiatry., 23, 517-522.

Fontana, A. & Rosenheck, R. (2008). Treatment-seeking veterans of Iraq and Afghanistan: comparison with veterans of previous wars. J Nerv Ment Dis., 196, 513-521.

Frayne, S. M., Yu, W., Yano, E. M., Ananth, L., Iqbal, S., Thrailkill, A. et al. (2007). Gender and use of care: planning for tomorrow's Veterans Health Administration. J Womens Health (Larchmt.)., 16, 1188-1199.

Frayne, S. M., Yano, E. M., Nguyen, V. Q., Yu, W., Ananth, L., Chiu, V. Y. et al. (2008). Gender disparities in Veterans Health Administration care: importance of accounting for veteran status. Med Care., 46, 549-553.

Fuller MA, Shermock KM, Secic M, Laich JS, Durkin MB. 2002. Service use and costs among VA patients with schizophrenia taking risperidone or olanzapine. Psychiatr Serv. 53(7):855-60.

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Kurichi, J. E., Stineman, M. G., Kwong, P. L., Bates, B. E., & Reker, D. M. (2007). Assessing and using comorbidity measures in elderly veterans with lower extremity amputations. Gerontology., 53, 255-259.

Kurichi, J. E., Small, D. S., Bates, B. E., Prvu-Bettger, J. A., Kwong, P. L., Vogel, W. B. et al. (2009). Possible Incremental Benefits of Specialized Rehabilitation Bed Units Among Veterans After Lower Extremity Amputation. Med Care., %20..

Lee, T. A., Pickard, A. S., Au, D. H., Bartle, B., & Weiss, K. B. (2008). Risk for death associated with medications for recently diagnosed chronic obstructive pulmonary disease. Ann Intern Med., 149, 380-390

Logan, W. C., Jr., Sloane, R., Lyles, K. W., Goldstein, B., & Hoenig, H. M. (2008). Incidence of fractures in a cohort of veterans with chronic multiple sclerosis or traumatic spinal cord injury. Arch Phys Med Rehabil., 89, 237-243

Miller, D. R., Gardner, J. A., Hendricks, A. M., Zhang, Q., & Fincke, B. G. (2007). Health care resource utilization and expenditures associated with the use of insulin glargine. Clin Ther., 29, 478-487

Movahed, M. R., Hashemzadeh, M., & Jamal, M. (2007). Increased prevalence of ventricular fibrillation in patients with type 2 diabetes mellitus. Heart Vessels., 22, 251-253

Movahed, M. R., Hashemzadeh, M., & Jamal, M. M. (2007). Significant increase in the prevalence of non-rheumatic aortic valve disease in patients with type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes., 115, 105-107.

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Murphy PA, Cowper DC, Seppala G, Stroupe KT, Hynes DM. 2002. Veterans Health Administration inpatient and outpatient care data: a rich resource of research data. Effective Clinical Practice. 5:e4.

Payne SM, Lee A, Clark JA, Rogers WH, Miller DR, Skinner KM, Ren XS, Kazis LE. 2005. Utilization of medical services by Veterans Health Study (VHS) respondents. J Ambul Care Manage. Apr-Jun;28(2):125-40.

Pugh, M. J., Rosen, A. K., Montez-Rath, M., Amuan, M. E., Fincke, B. G., Burk, M. et al. 2008. Potentially inappropriate prescribing for the elderly: effects of geriatric care at the patient and health care system level. Med Care., 46, 167-173.

Romano, P. S., Mull, H. J., Rivard, P. E., Zhao, S., Henderson, W. G., Loveland, S. et al. 2009. Validity of selected AHRQ patient safety indicators based on VA National Surgical Quality Improvement Program data. Health Serv Res., 44, 182-204

Savas, L. S., del Junco, D. J., Bastian, L. A., & Vernon, S. W. 2009. Mortality ascertainment of women veterans: a comparison of sources of vital status information, 1979-2002. Med Care., 47, 125-128

Singh, J. A. & Strand, V. 2009. Health care utilization in patients with spondyloarthropathies. Rheumatology (Oxford)., 48, 272-276

Sonnenberg, A., Richardson, P. A., & Abraham, N. S. 2009. Hospitalizations for Inflammatory Bowel Disease Among US Military Veterans 1975-2006. Dig.Dis Sci

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Stineman, M. G., Kwong, P. L., Kurichi, J. E., Prvu-Bettger, J. A., Vogel, W. B., Maislin, G. et al. (2008). The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system. Arch Phys Med Rehabil., 89, 1863-1872

Stroupe KT, et al. 2006. Cost-Effectiveness of coronary artery bypass grafts versus percutaneous coronary intervention for revascularization of high-risk patients. Circulation. 114: 1251-57.

Weeks, W. B. & West, A. N. (2007). Where do veterans health administration patients obtain heart, liver, and kidney transplants? Mil Med., 172, 1154-1159

Weeks, W. B., West, A. N., Wallace, A. E., Lee, R. E., Goodman, D. C., Dimick, J. B. et al. (2007). Reducing avoidable deaths among veterans: directing private-sector surgical care to high-performance hospitals. Am J Public Health., 97, 2186-2192

Weeks, W. B., West, A. N., Wallace, A. E., & Fisher, E. S. (2008). Comparing the characteristics, utilization, efficiency, and outcomes of VA and non-VA inpatient care provided to VA enrollees: a case study in New York. Med Care., 46, 863-871

West, A. N., Weeks, W. B., Wright, S. M., Wallace, A. E., & Fisher, E. S. (2008). When VA patients have non-VA hospitalizations, who pays for what services, and what are the research implications? A New York case study. Med Care., 46, 872-877

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Questions?Questions?

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Questions from Lecture 1Questions from Lecture 1

Where do I find vital signs data?Where do I find vital signs data?– Located in VistA and the Corporate Data

Warehouse (CDW)– More information on CDW in upcoming

lecture (March 1, 2010)Where do I find laboratory data? Where do I find laboratory data? – Located in VistA and the VA Decision

Support System (DSS) Clinical National Data Extract-Lab and Lab Results

– More information on DSS NDE Lab in upcoming lecture (August 3, 2009)

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Upcoming LecturesUpcoming Lectures

June 1, 2009June 1, 2009– Assessing VA Health Care Use: Outpatient– Kevin Stroupe, PhD

July 6, 2009July 6, 2009– Measuring Outpatient Pharmacy Use in the VA

using VA Pharmacy Data– Todd Lee, PhD

Assessing VA Health Care Use: Inpatient

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