Chronic Disease Surveillance and Office of Surveillance, Evaluation, and Research Potentially Preventable Hospitalizations Program 2015 Annual Meeting Nimisha Bhakta, MPH September 29, 2015
Presentation Overview 1. Overview of Surveillance 2. Health Promotion and Chronic Disease Prevention (HPCDP) and OSER 3. Chronic Disease Surveillance at HPCDP: data collection, analysis and dissemination 4. Programmatic perspective 5. OSER s role with PPH program 6. Resources 2
Public health surveillance Ongoing systematic collection, analysis, interpretation and dissemination of outcome-specific data for use in planning, implementing, and evaluating public health practice. Ref: Thacker S. Historical development. In: Teutsch S, Churchill R, eds. Principles and practice of public health surveillance. 2 nd ed. New York: Oxford University Press, 2000. 3
Why chronic disease surveillance is important? Malignant Neoplasms (Cancer) Chronic Lower Respiratory Diseases Cerebrovascular Disease (Stroke) Top 10 Causes of Death, Texas 2013 Disease of the Heart 9,787 9,238 40,150 38,289 Percentage of Adult Texans by Number of Chronic Conditions, 2013 20.0% 0.8% 35.8% Cause of Death Accidents (Injuries) Alzheimer's Disease Diabetes Mellitus Septicemia 9,341 5,284 5,262 3,879 Kidney Disease Influenza and Pneumonia 3,727 3,338 Total number of deaths due to top 10 causes 128,295 deaths Number of deaths due to chronic diseases (8 out of 10) 0 10,000 20,000 30,000 40,000 50,000 Number of Deaths 111,737 deaths or 87.1% of top 10 causes 43.5% No chronic conditions 1-2 chronic conditions 3-6 chronic conditions 7-10 chronic conditions In 2013, more than 6 in 10 adults reported every being diagnosed with at least one chronic condition. Most of these chronic diseases are preventable. Data Source: 2013 Texas Vital Statistical Unit (VSU), Center for Health Statistics, Texas. Note: Top ten list and order is based on Texas age-adjusted mortality rates for 2013. Data Source: 2013 Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services. Chronic Conditions were arthritis, asthma, cancer, cardiovascular disease, COPD, depression, diabetes, hypertension, kidney disease, and obesity. 4
HEALTH PROMOTION & CHRONIC DISEASE PREVENTION SECTION Information Specialist Team Office of Surveillance, Evaluation & Research (OSER) Diabetes Prevention & Control Branch Primary Prevention Branch Chronic Disease Branch Tobacco Prevention & Control Branch - Diabetes Prevention Program - School Health Program - Abstinence Program - Community & Worksite Wellness - Safe Riders Program - Potentially Preventable Hospitalization Program - Kidney Disease Education Program - Alzheimer's Disease Program - Comprehensive Cancer Control Program - Heart Disease and Stroke Program - Tobacco Prevention and Control Program 5
Office of Surveillance, Evaluation and Research (OSER) Bhakta, Nimisha, MPH (M) Office of Surveillance, Evaluation & Research Manager III H70000/58897/B24 Bagchi, Suparna, MSPH, DrPH Epidemiologist CDC Wu, Erin (TL) Epidemiologist III H70000/75490/B23 Shumate, Charles Research Specialist V H70000/8625/B23 Rodriguez, Gerardo Program Specialist V H70000/9330/B21 Vacant Program Specialist IV H70000/9352/B20 Frand, Chelsea Epidemiologist II H70000/8812/B21 Miyakado, Haruna Program Specialist V Epi II H70000/5253/B21 Vacant Database Administrator II H70000/7942/B20 Dodell, Sylvie Epidemiologist II H70000/9344/B21 Vacant Program Specialist V Epi II H70000/9334/B21 Mathabela, Blaise Epidemiologist I H70000/9333/B19
Surveillance Epidemiology, Biostatistics, Informatics Surveillance OSER Research Evaluation Evaluation Health Economics, Health Policy, Program Evaluation Research Machinery for publications, funding, Academics 7
OSER Surveillance Process Collection Analysis Dissemination Mostly Secondary Data BRFSS YRBSS Vital statistics Census Hospital discharge data Cancer registry Medicaid data Asthma callback survey SPAN FitnessGram HEDIS School health survey Tobacco Quitline data School survey of substance abuse among students Descriptive Statistics (information on patterns of occurrence or distribution by place, person, time. Generates hypothesis, exploratory in nature) Prevalence Incidence Rates (crude, specific and adjusted) Proportions Analytical Statistics (evaluate specific scientific hypotheses, confirmatory in nature) T-tests Chi-Square Contingency Tables Regression Analysis Correlation ANOVA Poisson distribution Disease specific surveillance reports Comprehensive chronic disease burden report Factsheets Presentations Posters Data requests GIS maps 8
Collection Data sources used by OSER BRFSS data on chronic diseases and risk factors among adults Vital statistics data - birth data, death data, population demographics Hospital discharge data inpatient hospital discharges Census data - poverty, health insurance, demographics Medicaid data Medicaid claims data Asthma callback survey Asthma specific survey based on BRFSS sample, adults and children Cancer registry cancer incidence and mortality YRBSS data on chronic diseases and risk factors among high school students 9
Analysis Descriptive statistics - Count: Number of hospital admissions occurred due to stroke, number of adults with diabetes - Ratio: Number of heart attacks among males vs. number of heart attacks among females - Prevalence: Number of existing cases in a population at a designated time period, often presented in terms of percentage - Incidence: Number of new cases in a population at a designated time period - Rates (crude, specific and adjusted): Number of deaths in a given population per 100,000 individuals 10
Analysis Prevalence of Selected Chronic Disease Among Adults, Texas, 2002-2010 and 2011-2013 35.0 30.0 25.0 25.5 24.6 25.8 27.0 26.1 28.6 28.9 29.5 31.7 30.4 29.2 30.9 Prevalence (%) 20.0 15.0 10.0 7.0 8.1 7.7 7.9 8.0 10.3 9.7 9.3 9.7 10.2 10.6 10.9 5.0 0.0 7.5 6.6 6.6 6.7 6.4 5.1 6.6 6.0 5.9 5.7 2.1 2.8 2.6 2.8 2.5 2.2 2.8 2.7 2.7 2.5 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year Obesity Heart Disease Stroke Diabetes Data Source: 2002-2013 Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services. 11
Analysis 300 Age-adjusted Mortality Rate Due to Heart Disease by Gender and Race/Ethnicity, Texas 2012 250 Male Female Mortality Rate per 100,000 People 200 150 100 50 0 222.2 153.2 265.6 186.7 168.9 111.2 110.2 74.4 White Black Hispanic Other Race/Ethnicity Data Source: Vital Statistics Unit, 2012. Center for Health Statistics, Texas Department of State Health Services. 12
Analysis Age-adjusted Hospital Discharge Rate per 10,000 Persons for Selected Chronic Diseases by Year, Texas, 2008-2013 30.0 Age-adjusted Rate per 10,000 25.0 20.0 15.0 10.0 5.0 0.0 2008 2009 2010 2011 2012 2013 Stroke 23.9 23.0 22.4 21.4 20.9 20.5 Diabetes 17.0 17.1 17.5 17.9 17.5 16.6 Hypertension 9.8 9.8 10.0 9.5 9.7 9.7 Data Source: 2008-2013 Texas Inpatient Public Use Data File, Texas Health Care Information Collection (THCIC), Department of State Health Services. 13
Analysis Analytical statistics - Regression Analysis: Outcome variable is binary (Yes/No). This example shows the association of obesity with race/ethnicity subgroups and a couple of acculturation measures. Association of Obesity with Race/Ethnicity and Acculturation Measures, TX BRFSS 2010 Odds Ratio (Log Scale) 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 1 1.5 1.9 1.8 1 0.9 1.1 0.4 1 0.8 0.9 0.2 0.4 Race/Ethnicity Language Spoken at Home Country of Origin Data Source: 2010 Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services. 14
Dissemination 2012 Asthma fact sheet 15
Dissemination 2015 Texas STEMI/Heart Attack Hospital Performance Measure Report 16
Dissemination Presentation at meetings, conferences, etc. 17
Dissemination Posters at meetings, conferences etc. 18
Dissemination Example of Data Request Report 19
Dissemination Examples of GIS Map 20
Hospital Charges Age-adjusted Hospital Discharge Rates and Total Hospital Charges, Texas 2013 Chronic Disease Age-adjusted Hospitalization Rates per 10,000 Total Hospital Charges Ischemic Heart Disease (IHD) 26.3 $6.4 billion Malignant Neoplasms 25.2 $5.0 billion Congestive Heart Failure (CHF) 23.2 $3.0 billion Stroke 20.5 $3.1 billion Diabetes 16.6 $2.1 billion Alzheimer s Disease 1.0 $62.7 million Data Source: 2013 Texas Inpatient Public Use Data File, Texas Health Care Information Collection (THCIC), Texas Department of State Health Services. Note: Each chronic disease was identified as the primary diagnosis for the hospital discharge. 21
Hospital Charges Medicaid Utilization and Reimbursements for Selected Chronic Diseases in Texas 2013 - FFS and Star & StarPlus Fiscal Year 2013 Inpatient Hospital Claims Reimbursement Outpatient Hospital Claims Reimbursement Physician Claims Reimbursement Total Reimbursement Amount Type 2 Diabetes $27,595,618 $13,833,378 $201,988,904 $243,417,901 Heart Disease $90,908,133 $15,071,710 $45,780,793 $151,760,637 Stroke $51,058,517 $6,348,759 $60,680,457 $118,087,734 High Blood Pressure $18,092,586 $14,105,022 $172,370,089 $204,567,698 Data Source: Medicaid Data, Research Team, Strategic Decision Support, Texas Health and Human Services Commission. FFS data were selected from the Texas Medicaid and Health Partnership (TMHP) Ad Hoc Query Platform (AHQP) Claims Universe. Star and Star/Plus data were selected from the Texas Medicaid and Health Partnership (TMHP) ENC_Best Picture Universe. 22
Programmatic Perspective How are these data used by chronic disease programs? Planning, implementing and evaluating programmatic activities Monitor burden of chronic conditions in Texas Identify high risk populations for targeted interventions Identify disparities, disproportionately affected geographic regions, subpopulations etc. Measure and evaluate progress of public health programs Writing grant applications, legislative reports, special funding requests Compare with state and national data and guidelines Data are extensively used by external partners and stakeholders 23
OSER s role - PPH program data Data transition Received detailed training and history of the program and data, and documents. Past: PPH program worked with Center for Health Statistics (CHS) and DSHS IT teams for data analysis and dissemination. Present: OSER is prepared to embrace PPHs data! NO gaps in data assistance. Future: Continue with providing data to counties, special data request assistance, adding more information, new comprehensive data visualization from CHS, more flexible user-friendly query system. 24
OSER s role - PPH program data What did OSER do so far: Attended many many meetings (!) to understand the program and data needs Met with CHS, learned history of data analysis (who did what as different teams helped with different functions, THCIC, IT), working with CHS on future data dissemination Hired an epidemiologist Haruna Miyakado Explored AHRQ website, understood how PPH conditions are identified, measured, and analyzed, changes that occur annually, attend webinar on PQI update Preliminary data analysis ongoing 25
OSER s role - PPH program data What does OSER plan to do within next year: Provide data assistance to funded counties A priority! Access and analyze hospital discharge data for PQIs/PPHs Continue working with CHS in developing the online query system Update 2014 PPHs data, adding more measures Create surveillance report for funded counties 26
Helpful Resources BRFSS Prevalence & Trends Data http://www.cdc.gov/brfss/brfssprevalence/index.html Texas Health Data, Center for Health Statistics (new site) http://healthdata.dshs.texas.gov/home Texas Death Data (legacy site) http://soupfin.tdh.state.tx.us/ Texas (MONAHRQ) Hospital Data: Utilization and Quality 2011 http://monahrq.dshs.texas.gov/index.html County Health Rankings, Texas, 2015 http://www.countyhealthrankings.org/app/texas/2015/overview The Center for Public Policy Priorities, Data Tools http://forabettertexas.org/data.html Office of the State Demographer and Texas State Data Center http://osd.texas.gov/ Centers for Disease Control and Prevention (CDC), Chronic Disease Cost Calculator www.cdc.gov/chronicdisease/calculator/ National Center for Health Statistics, Health Indicators Warehouse http://www.healthindicators.gov/ Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) http://hcupnet.ahrq.gov/ AHRQ National Healthcare Quality and Disparities Reports http://nhqrnet.ahrq.gov/inhqrdr/ Centers for Medicare and Medicaid Chronic Conditions Data Warehouse https://www.ccwdata.org/web/guest/home Medicare Chronic Conditions Data, Dashboards, and Maps Texas and National Data https://www.cms.gov/research-statistics-data-and- Systems/Statistics-Trends-and-Reports/Chronic- Conditions/CC_Main.html U.S. Census Bureau, Maps and Data http://www.census.gov/geo/maps-data/ U.S. Census Bureau, Small Area Health Insurance Estimates (SAHIE) for Counties and States http://www.census.gov/did/www/sahie/index.html U.S. Census Bureau Poverty Data https://www.census.gov/hhes/www/poverty/data/index.html U.S. Census Bureau, Small Area Income and Poverty Estimates (SAIPE) for School Districts, Counties, and States http://www.census.gov/did/www/saipe/index.html 27
Thank You! Nimisha Bhakta, MPH Manager Office of Surveillance, Evaluation and Research Nimisha.bhakta@dshs.state.tx.us