Using AHRQ Data at Census RDC’s Health Data Workshop May 6, 2009 Doris Lefkowitz.

Using AHRQ Data at Census RDC’sUsing AHRQ Data at Census RDC’s

Health Data WorkshopHealth Data WorkshopMay 6, 2009May 6, 2009

Doris LefkowitzDoris Lefkowitz

OutlineOutline

Discuss Key Features of the Medical Discuss Key Features of the Medical Expenditure Panel SurveyExpenditure Panel Survey

Discuss how to apply to use MEPS data Discuss how to apply to use MEPS data at an RDCat an RDC

Discuss How to get additional information Discuss How to get additional information on MEPSon MEPS

MEPSMEPS

Medical Expenditure Panel Survey Medical Expenditure Panel Survey Relatively large, longitudinal study of the US Relatively large, longitudinal study of the US

civilian, non-institutionalized populationcivilian, non-institutionalized population Collects information for all members of the Collects information for all members of the

householdhousehold Conducted in 1977, 1987 and annually since Conducted in 1977, 1987 and annually since

19961996

MEPS Survey ComponentsMEPS Survey Components

MEPS-HC -- Household ComponentMEPS-HC -- Household Component

MEPS-MPC -- Medical Provider ComponentMEPS-MPC -- Medical Provider Component

MEPS-IC -- Insurance ComponentMEPS-IC -- Insurance Component

Key Features of MEPS-HCKey Features of MEPS-HC

Survey of U.S. civilian noninstitutionalized populationSurvey of U.S. civilian noninstitutionalized population Sub-sample of respondents to the National Health Interview Sub-sample of respondents to the National Health Interview

Survey (NHIS)Survey (NHIS) Oversample of policy relevant target groupsOversample of policy relevant target groups Panel Survey – new panel introduced each yearPanel Survey – new panel introduced each year

– Continuous data collection over 2 ½ year periodContinuous data collection over 2 ½ year period– 5 in-person interviews (CAPI)5 in-person interviews (CAPI)

Sample size: about 12K families and 32K persons since 2001Sample size: about 12K families and 32K persons since 2001

Household ParticipationHousehold Participation

Verbal consent obtained from household respondent. Each household Verbal consent obtained from household respondent. Each household member is asked to give written consent to allow us to contact their member is asked to give written consent to allow us to contact their medical providersmedical providers

Informed consent procedure includes a video and written materials Informed consent procedure includes a video and written materials mailed to the householdmailed to the household

Each household is interviewed 5 times over 2 ½ years Each household is interviewed 5 times over 2 ½ years Interviews typically last 1.5 -2 hours and are conducted in the home on Interviews typically last 1.5 -2 hours and are conducted in the home on

a laptop computer by a trained interviewer a laptop computer by a trained interviewer A single respondent provides most of the information for the householdA single respondent provides most of the information for the household

MEPS Panel Design: Data Reference PeriodsMEPS Panel Design: Data Reference Periods

20052005 20062006 20072007

Q1Q1 Q2Q2 Q3Q3 Q4Q4 Q1Q1 Q2Q2 Q3Q3 Q4Q4 Q1Q1 Q2Q2 Q3Q3 Q4Q4

Panel 9Panel 9 Round 3Round 3

Round 4Round 4

Round 5Round 5


Round 2Round 2

Round 3Round 3

Round 4Round 4

Round 5Round 5


Round 2Round 2

Round 3Round 3

Round 4Round 4

Round 5Round 5


Round 2Round 2

Round 3Round 3

Sample SizeSample Size N = 32,320N = 32,320 N = 32,577N = 32,577 N = 29,370N = 29,370

N is equal to the number of people with a positive person weight on the file.

MEPS-HC MEPS-HC Core Interview ContentCore Interview Content

DemographicsDemographics Charges and PaymentsCharges and Payments Health StatusHealth Status ConditionsConditions Utilization Utilization EmploymentEmployment Health InsuranceHealth Insurance

Healthcare UseHealthcare Use

Hospitalizations Hospitalizations Outpatient and emergency department visitsOutpatient and emergency department visits Visits to physicians and other health care providers (nurses, Visits to physicians and other health care providers (nurses,

PA, OT/PT, therapists, mental health professionals)PA, OT/PT, therapists, mental health professionals) Prescribed medicationsPrescribed medications Home health careHome health care Durable medical equipment and supplies Durable medical equipment and supplies Dental careDental care

Detail for each eventDetail for each event

Date Date Provider name and type Provider name and type Condition associated with the event Condition associated with the event Some details about the event (tests performed, Some details about the event (tests performed,

medications prescribed)medications prescribed) Charges, payments Charges, payments

MEPS- HC Supplemental CAPI MEPS- HC Supplemental CAPI SectionsSections

Sections asked in rounds 2 and 4:Sections asked in rounds 2 and 4: Access to careAccess to care Child preventive healthChild preventive health Satisfaction with health plans & Satisfaction with health plans &

providersproviders

Sections asked in rounds 3 and 5:Sections asked in rounds 3 and 5: Assets Assets (round 5 only)(round 5 only) IncomeIncome Preventive CarePreventive Care

MEPS-HC Supplemental Paper MEPS-HC Supplemental Paper QuestionnairesQuestionnaires

Diabetes Care SAQDiabetes Care SAQ

Adult SAQAdult SAQ

Types of MEPS-HC FilesTypes of MEPS-HC Files

Full-year Files - calendar year dataFull-year Files - calendar year data

Point-in-time Files - snap shot first Point-in-time Files - snap shot first part of yearpart of year

Levels of MEPS-HC Public Levels of MEPS-HC Public Use FilesUse Files

Person Level - detailed person Person Level - detailed person informationinformation

Event Level - detailed event level Event Level - detailed event level informationinformation

Condition Level - detailed condition Condition Level - detailed condition informationinformation

Job Level - detailed job informationJob Level - detailed job information

All hospitals (and associated doctors), All hospitals (and associated doctors), emergency rooms, and out-patient emergency rooms, and out-patient departments used by respondents departments used by respondents

All home health agenciesAll home health agencies All pharmaciesAll pharmacies A sample of office-based physiciansA sample of office-based physicians

MEPS Medical Provider MEPS Medical Provider Component (MPC) SampleComponent (MPC) Sample

MEPS Medical Provider MEPS Medical Provider Component (MPC) - PurposeComponent (MPC) - Purpose

Compensate for household item Compensate for household item non-responsenon-response

Accuracy and detailAccuracy and detail Imputation sourceImputation source Methodological studiesMethodological studies

MEPS: Pharmacy ComponentMEPS: Pharmacy Component

8000 pharmacies sampled8000 pharmacies sampled– data on prescribed medicines purchased data on prescribed medicines purchased

by households by households Data obtained:Data obtained:

– Medication NameMedication Name

– National Drug Code (NDC)National Drug Code (NDC)

– Quantity DispensedQuantity Dispensed

– Strength and FormStrength and Form

– Sources of Payment Sources of Payment

– Amount Paid by Each SourceAmount Paid by Each Source

MEPS Insurance Component (IC)MEPS Insurance Component (IC)

An independent survey of employers and unions An independent survey of employers and unions not linked to the household surveynot linked to the household survey

The sample contains information from about The sample contains information from about 45,000 establishments drawn from a Census 45,000 establishments drawn from a Census Bureau frame and supports national and state-Bureau frame and supports national and state-level estimates for all 50 states. level estimates for all 50 states.

Data released in tabular form on the MEPS web Data released in tabular form on the MEPS web sitesite

MEPS-IC PurposeMEPS-IC Purpose

Employer-sponsored Health InsuranceEmployer-sponsored Health Insurance

– AvailabilityAvailability

– EnrollmentEnrollment

– Benefit and payment provisionsBenefit and payment provisions

– CostCost

Data Use Restrictions - MEPSData Use Restrictions - MEPS

AHRQ makes specific promises to people and AHRQ makes specific promises to people and establishments who participate in the MEPSestablishments who participate in the MEPS– Data will only be used for research and statistical Data will only be used for research and statistical

purposespurposes– Data that COULD be used to identify them will not Data that COULD be used to identify them will not

be released beyond AHRQ and its contractorsbe released beyond AHRQ and its contractors– Information about them will only be reported in a Information about them will only be reported in a

summary fashionsummary fashion

Data Use Restrictions – IRBData Use Restrictions – IRB

Our IRB reviews our data collection and Our IRB reviews our data collection and release proceduresrelease procedures– Affirms the ideas of our authorizing legislationAffirms the ideas of our authorizing legislation– Requires review by a nosologist and pharmacist Requires review by a nosologist and pharmacist

for rare conditions and medications to reduce for rare conditions and medications to reduce inferential identificationinferential identification

– Requires judgments to be made on releases of Requires judgments to be made on releases of certain variablescertain variables

AHRQ Data Center HistoryAHRQ Data Center History

AHRQ has operated a data center at its Rockville AHRQ has operated a data center at its Rockville headquarters since 2000headquarters since 2000

Provides researchers access to non-public use MEPS data;Provides researchers access to non-public use MEPS data;

Partnership with Census RDC’s is an extension of our Partnership with Census RDC’s is an extension of our commitment to have MEPS data used to the fullest extent commitment to have MEPS data used to the fullest extent possiblepossible

AHRQ Data Center (ADC)AHRQ Data Center (ADC)

Mode of data access Mode of data access

– on secure LAN at AHRQ - Rockville, on secure LAN at AHRQ - Rockville, Maryland Maryland

– task order agreement with data task order agreement with data contractor contractor

– combinations of bothcombinations of both

AHRQ Data CenterAHRQ Data Center

Researcher may bring data in, but not outResearcher may bring data in, but not out Researcher has access only to data needed for approved Researcher has access only to data needed for approved

projectproject All tabular data will be reviewed for confidentiality before All tabular data will be reviewed for confidentiality before

release from Centerrelease from Center Only approved tables can leave the CenterOnly approved tables can leave the Center Center will store data files, foreign merge files, and all Center will store data files, foreign merge files, and all

outputs needed for replicationoutputs needed for replication

AHRQ FacilitiesAHRQ Facilities Secure roomSecure room Terminal connected to secure LANTerminal connected to secure LAN SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep, SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep,

EQS software available, and others upon request EQS software available, and others upon request Limited staff support by people who know:Limited staff support by people who know:

– the datathe data– the confidentiality issuesthe confidentiality issues– the softwarethe software

AHRQ Application AHRQ Application ProcessProcess

Application procedures are on the Application procedures are on the MEPS web siteMEPS web site

Submit proposal to data center Submit proposal to data center coordinatorcoordinator

Review within 1 week for feasibility, Review within 1 week for feasibility, and data availabilityand data availability

Institutional Review Board (IRB) Institutional Review Board (IRB) review requiredreview required

AHRQ FeesAHRQ Fees

User fee of $150.00 for approved projects to cover User fee of $150.00 for approved projects to cover technical assistance, simple file construction, and/or up 2 technical assistance, simple file construction, and/or up 2 hours of programming support from data contractorhours of programming support from data contractor

Additional programming support available from an AHRQ Additional programming support available from an AHRQ contractor at a cost of $80.00/hrcontractor at a cost of $80.00/hr

User fee waived for full-time studentsUser fee waived for full-time students User fee waived for those intending to move to a Census User fee waived for those intending to move to a Census

RDCRDC

AHRQ Remote AccessAHRQ Remote Access

Once the researcher has an established Once the researcher has an established data center project, and has worked on site data center project, and has worked on site to develop and debug programs, jobs may to develop and debug programs, jobs may be submitted to our Data Center Supervisor be submitted to our Data Center Supervisor to run. to run.

Out-put will be reviewed for confidentiality Out-put will be reviewed for confidentiality and mailed to the userand mailed to the user

Confidential Data Confidential Data Available for ADC ProjectsAvailable for ADC Projects

Geographic data and links based on Geographic data and links based on geographic datageographic data

State IdentifiersState Identifiers HC-IC linked files for 1996-99HC-IC linked files for 1996-99 MEPS NHC for 1996MEPS NHC for 1996 Selected Medical Provider Component Selected Medical Provider Component

DataData

Confidential Data Confidential Data Available for ADC ProjectsAvailable for ADC Projects

Fully specified ICD-9 codesFully specified ICD-9 codes Continuous measure of poverty statusContinuous measure of poverty status Fully specified Industry and Occupation Fully specified Industry and Occupation

codescodes Asset dataAsset data Imputed NDC codes for prescription drugsImputed NDC codes for prescription drugs Federal and state marginal tax ratesFederal and state marginal tax rates Other variables developed by AHQR Other variables developed by AHQR

researchersresearchers

Partnership with CensusPartnership with Census

Applicants can begin contact with Applicants can begin contact with either AHRQ or their local Census either AHRQ or their local Census RDCRDC

AHRQ will request the applicant fill out AHRQ will request the applicant fill out the AHRQ data center applicationthe AHRQ data center application


AHRQ reviews the applicationAHRQ reviews the application– Does the project conform with AHRQ’s Does the project conform with AHRQ’s

authorizing legislationauthorizing legislation

– Does the data available support the analysisDoes the data available support the analysis

AHRQ sign off is quick, usually completed in AHRQ sign off is quick, usually completed in less that 2 weeksless that 2 weeks


While AHRQ requests an AHRQ data center While AHRQ requests an AHRQ data center application for persons wishing to use the Census application for persons wishing to use the Census RDC, the application fee is waivedRDC, the application fee is waived

These procedures apply to MEPS household data These procedures apply to MEPS household data only. MEPS Insurance Component data follows only. MEPS Insurance Component data follows the customary Census procedures for Title 13 the customary Census procedures for Title 13 datadata


Application process moves to Census for approvalApplication process moves to Census for approval

AHRQ will begin preparing the analytic file for the AHRQ will begin preparing the analytic file for the projectproject

During the Census review and security process, During the Census review and security process, applicant could chose to use the AHRQ data centerapplicant could chose to use the AHRQ data center


AHRQ staff historically provide extensive AHRQ staff historically provide extensive support for all data users support for all data users

We have an active list serve and routinely We have an active list serve and routinely answer hundreds of user questions each answer hundreds of user questions each yearyear

Customers using Census RDCs should not Customers using Census RDCs should not hesitate to continue to interact with AHRQhesitate to continue to interact with AHRQ

Other ResourcesOther Resources

Information found on the MEPS Web Information found on the MEPS Web site: site: www.meps.ahrq.govwww.meps.ahrq.gov Overview of MEPS, Fact Sheets, and FAQsOverview of MEPS, Fact Sheets, and FAQs Survey instrumentsSurvey instruments Findings/Statistical Briefs/Chart booksFindings/Statistical Briefs/Chart books Methods reportsMethods reports Data files Data files BibliographyBibliography MEPS data workshop information and schedule MEPS data workshop information and schedule Mailing list/List serverMailing list/List server Data Center InformationData Center Information

Using AHRQ Data at Census RDC’s Health Data Workshop May 6, 2009 Doris Lefkowitz.

Documents

use meps data

meps survey componentsmepshc

yearlevels of meps

household respondent

household componentmepsmpc

ahrq data

households data

householdeach household