HOSPITAL INPATIENT & EMERGENCY DEPARTMENT ANALYTICAL SYSTEM

HOSPITAL INPATIENT & EMERGENCY DEPARTMENT ANALYTICAL SYSTEM healthdata.brhpc.rg The system prduces data reprts frm the fllwing mdules: Preventin Quality Indicatrs Acuity Stratificatin (Emergency Department) Avidable - NYU Algrithm (Emergency Department) Chrnic Cnditins Suicide Incidence Pediatric Quality Indicatrs Brward Reginal Health Planning Cuncil, Inc. 915 Middle River Drive, Suite 120 Frt Lauderdale, Flrida 33304 Phne 954.561.9681 - Fax 954.561.9685 http://healthdata.brhpc.rg

TABLE OF CONTENTS Page Data Surces... 1 Preventin Quality Indicatrs (PQI)... 2 Definitin.. 2 Data Surce. 3 Data Prcessing. 4 Data Analysis.. 5 Website.. 5 Acuity Stratificatin (Emergency Department).. 8 Definitin.. 8 Data Surce. 8 Data Prcessing. 9 Data Analysis.. 10 Website.. 10 Avidable - NYU Algrithm (Emergency Department). 13 Definitin.. 13 Data Surce. 14 Data Prcessing. 15 Data Analysis.. 15 Website.. 16 Chrnic Cnditins... 19 Definitin.. 19 Data Surce. 19 Data Prcessing. 20 Data Analysis.. 20 Website.. 21 Suicide Incidence..... 24 Definitin.. 24 Data Surce. 24 Data Prcessing. 25 Data Analysis.. 26 Website.. 26

Pediatric Quality Indicatrs (PDI)... 29 Definitin.. 29 Data Surce. 30 Data Prcessing. 31 Data Analysis.. 31 Website.. 32 Appendix A (Website Graphical Presentatin).. 35 Appendix B (Exclusins).. 36 Appendix C (Cde Translatins) 37 Appendix D (Analytical Queries) 38 Appendix E (NYU ED Algrithm) 39 Appendix F (Cdes - Chrnic Cnditins & Suicide Incidence). 41 Appendix G (GIS Mapping & Graphing resurces All Mdules) 46 This Hspital Inpatient & Emergency Department Analytical System Manual and all future revisins: Cpyright Brward Reginal Health Planning Cuncil, Inc. 2011 All rights reserved.

Data Surces Flrida AHCA Inpatient Discharge Data (Used by mdules Preventin Quality Indicatrs, Chrnic Cnditins and Suicide Incidence) Hspital Inpatient Discharge Data has been cllected since 1988. Beginning with 1997 data, shrt term acute care psychiatric hspitals are included in the Hspital Detailed Patient Database. Beginning with 2006 data, lng term psychiatric hspitals are included in the Hspital Detailed Patient Database. Fr the Hspital Inpatient Discharge Data Layut & File Descriptin, please visit (Lk under Data Dictinary ): www.flridahealthfinder.gv/researchers/orderdata/rder-data.shtml Fr mre infrmatin cncerning the cllectin f Hspital Inpatient Discharge Data, please visit: http://ahca.myflrida.cm/schs/hpdunit.shtml Flrida AHCA Emergency Department (ED) Patient Data (Used by mdules Acuity Stratificatin and Avidable - NYU Algrithm) Emergency Department (ED) Data is a new additin starting with the first quarter f 2005. Data includes all emergency department visits in which emergency department registratin ccurs and the patient is nt admitted fr inpatient care at the reprting entity. Fr Emergency Department Patient Data Layut and File Descriptin, please visit (Lk under Data Dictinary ): www.flridahealthfinder.gv/researchers/orderdata/rder-data.shtml Fr mre infrmatin cncerning the cllectin f Emergency Department (ED) Patient data, please visit: http://ahca.myflrida.cm/schs/apdunit.shtml 1

Preventin Quality Indicatrs Definitin The Preventin Quality Indicatrs (PQIs) are a set f measures that can be used with hspital inpatient discharge data t identify quality f care fr "ambulatry care-sensitive cnditins." These are cnditins fr which gd utpatient care can ptentially prevent the need fr hspitalizatin r fr which early interventin can prevent cmplicatins r mre severe disease. The Mdule reprts the cases f interest (ie, Numeratr) as per the AHRQ definitin f each PQI. Als the ppulatin at risk (ie, Denminatr) is calculated whenever pssible (fr mre infrmatin regarding denminatrs see the Denminatrs sectin at the bttm f the PQI table belw). In the situatins where a Denminatr can be calculated, the Observed Rate (ie, Obs.Rate) is als calculated. The Observed Rate is the raw rate generated fr the chsen data (ie, the number cases f interest ut f the number f persns at risk fr that event - Numeratr/Denminatr) There are 14 Preventin Quality Indicatrs. The fllwing table cntains their basic definitins: PQI 1 2* 3 5 7 8 9* 10 11 12 13 14 15 Name/Descriptin (See *Denminatrs at bttm f table fr clarificatin f denminatrs) Diabetes shrt-term cmplicatin: All nn-maternal/nn-nenatal discharges f age 18 years and lder with ICD-9-CM principal diagnsis cde fr shrt-term cmplicatins (ketacidsis, hypersmlarity, cma) Perfrated appendix: Discharges with ICD-9-CM diagnsis cde fr perfratins r abscesses f appendix (see belw) in any field amng cases meeting the inclusin rules fr the denminatr. Diabetes lng-term cmplicatin: Discharges age 18 years and lder with ICD-9-CM principal diagnsis cde fr lng-term cmplicatins (renal, eye, neurlgical, circulatry, r cmplicatins nt therwise specified) Chrnic bstructive pulmnary disease: All nn-maternal discharges f age 18 years and lder with ICD-9-CM principal diagnsis cde fr COPD. Hypertensin: All nn-maternal discharges f age 18 years and lder with ICD-9-CM principal diagnsis cde fr hypertensin. Cngestive heart failure: All nn-maternal/nn-nenatal discharges f age 18 years and lder with ICD-9-CM principal diagnsis cde fr CHF. Lw Birth Weight: Number f births with ICD-9-CM diagnsis cde fr less than 2500 grams in any field amng cases meeting the inclusin and exclusin rules fr the denminatr. Dehydratin: All nn-maternal discharges f age 18 years and lder with ICD-9-CM principal diagnsis cde fr hypvlemia. Bacterial pneumnia: All nn-maternal discharges f age 18 years and lder with ICD-9-CM principal diagnsis cde fr bacterial pneumnia. Urinary tract infectin: All nn-maternal discharges f age 18 years and lder with ICD-9-CM principal diagnsis cde f urinary tract infectin. Angina admissin withut prcedure: All nn-maternal discharges f age 18 years and lder with ICD-9-CM principal diagnsis cde fr angina. Uncntrlled diabetes: All nn-maternal discharges f age 18 years and lder with ICD-9-CM principal diagnsis cde fr uncntrlled diabetes, withut mentin f a shrt-term r lng-term cmplicatin. Adult asthma: All nn-maternal discharges f age 18 years and lder with ICD-9-CM principal diagnsis cde f asthma. 2

16 Rate f lwer-extremity amputatin amng patients with diabetes: All nn-maternal discharges f age 18 years and lder with ICD-9-CM prcedure cde fr lwer-extremity amputatin in any field and diagnsis cde f diabetes in any field. *Denminatrs: Fr all PQIs except PQI-2 and PQI-9: the denminatr is represented by the ppulatin f the Cunty/ZipCde/Age Grup/Gender/Race depending n the stratifier chsen. Nte: Fr stratifiers: Payer, Hspital and Admsrc (Admissin Surce) there is n available ppulatin data, therefre a denminatr cannt be calculated. (The ppulatin data is supplied by Nielsn Claritas) Fr PQI-2 and PQI-9, the denminatr is calculated based n the cases and nt the ppulatin: PQI-2: All nn-maternal discharges f age 18 years and lder with diagnsis cde fr appendicitis in any field. PQI-9: All Newbrn/Nenate in-hspital live birth. Detailed and cmprehensive infrmatin is available nline frm the AHRQ website: Fr detailed infrmatin describing hw the PQIs were develped as well as prviding detailed evidence fr each indicatr: http://www.qualityindicatrs.ahrq.gv/dwnlads/pqi/pqi_guide_v31.pdf Fr detailed definitins f each PQI, including all ICD-9-CM and DRG cdes that are included in r excluded frm the numeratr and denminatr (Nte that exclusins frm the denminatr are autmatically applied t the numeratr): http://www.qualityindicatrs.ahrq.gv/dwnlads/pqi/pqi_technical_specs_v32.pdf Histrical Nte: Yu may have nticed that PQI-4 and PQI-6 d nt exist. PQI-4 and PQI-6 did exist at ne time but have since been mved t the AHRQ Pediatric Quality Indicatrs (This mve was dne by AHRQ befre the PQI Prject began) Data Surce Flrida AHCA Inpatient Discharge Data: This data is delivered as quarterly database files (DBASE/DBF files). These database files, fr the years 2004-2008, can range frm apprximately 600,000 t 670,000 recrds/cases fr the state f Flrida per quarter. As an example, fr 2006 there were 2,555,220 recrds/cases fr the state f Flrida. The fields f interest frm the data surce are: Field Name YEAR QTR FACLNBR FAC_COUNTY RACE AGE GENDER ZIPCODE PTCOUNTY Descriptin Reprting Year Reprting Quarter Hspital ID Hspitals Cunty Patients Race/Ethnicity Patients Age (in years) Patients Gender Patients Zip Cde f residence Patients Cunty f residence 3

ADMSRC PAYER PRINDIAG OTHDIAG1 thru OTHDIAG30 PRINPROC OTHPROC1 thru OTHPROC30 ECODE1, ECODE2 and ECODE3 DRG TCHGS Surce f Admissin Primary surce f reimbursement Principal diagnsis cde Secndary diagnsis cdes Principal prcedure cde Secndary prcedures cdes External Cause f Injury Cdes Diagnsis Related Grup Ttal Grss Charges Fr detailed infrmatin regarding all the fields and their pssible values, see the AHCA website: http://www.flridahealthfinder.gv/researchers/orderdata/rder-data.aspx (Lk fr Hspital Discharge Data under the Data Dictinary sectin) Data Prcessing The Inpatient Discharge Data DBASE/DBF data surce files have t be prcessed befre analyzing can be dne. The prcedure is such: (The recrd/case exclusins are dne here.) 1. Cnvert each DBF file t CSV (cmma delimited) file. While cnverting: a. Cases fr which the Patient Cunty (PTCOUNTY) is equal t 99 are remved. PTCOUNTY = 99 describe ut f state/unknwn cunty f residence f the patient. b. Cases fr which the Gender is unknwn r nt specified are remved. c. Cases that d nt reflect the crrect Year/Quarter f the input data surce are remved. 2. Imprt CSV file int temprary table (datasurcepqi). 3. Data transfrmatin and cleansing is nw dne n the imprted data in the temprary table. (Nte: Sme f this data transfrmatin is dne t match the AHRQ PQI sftware. We use this prgram t help validate the cnversin/analysis) a. Cnvert Patient Cunty (PTCOUNTY) and Hspital Cunty (FAC_COUNTY) frm AHCA cunty cde t full FIPS Cunty cde (Federal Infrmatin Prcessing Standard). b. Cnvert AHCA Race cde t AHRQ PQI sftware Race cdes* c. Cnvert AHCA Payer cde t AHRQ PQI sftware Payer cdes* d. Cnvert AHCA ADMSRC cde t AHRQ PQI sftware Admsrc cdes* e. The perids/decimal pints are remved frm all Ecde, Diagnsis and Prcedure cdes f. Once transfrmatin and cleaning is dne, the temprary table is exprted t a CSV file that is imprted int the AHRQ PQI sftware t analyze and run a basic reprt t use as validatin. *Fr a table f the actual cde cnversins see Appendix C (Cde Translatins) 4

Data Analysis Once the Data Prcessing is cmplete, the data in the temprary table (datasurcepqi) is ready t be analyzed. The prcedure is such: 1. The Year and Quarter are cnfirmed fr the surce data. 2. The queries* are run fr all 14 PQIs, ppulating the apprpriate Analyzed Data Table. Each PQI has an assigned Analyzed Data Table (PQI_1_Num, PQI_2_Num, PQI_2_Den, etc) a. While running the analytical queries, the system als adds a clumn (AGECATEGORY) and sets the Age Categry based n the patient age. b. Fr all PQIs, cases are excluded if the Admissin Surce shws it was a transfer frm anther institutin/hspital. c. Fr all PQIs, (except PQI-9) cases are excluded if the Diagnsis Related Grup (DRG) field shws pregnancy, childbirth, and puerperium r newbrn and ther nenates. d. Fr all PQIs, (except PQI-9) cases are excluded if the Age is less than 18 years. 3. The frnt-end website is nw ready t access the newly entered and analyzed data. *T view the actual analytical queries used, please refer t Appendix D (Analytical Queries) Nte: The Data Prcessing / Data Analysis cycle is repeated fr all Year/Quarter data surce files. WebSite (healthdata.brhpc.rg) The website has the ability t create stratified reprts based n the PQI data. 1) The basic chices n which all reprts are based are: Cunty The chice All Cunties is available. If this is selected then extra stratifiers are made available in the Stratify by sectin. These extra stratifiers are Cunty and District. Individual Cunty Year Chse multiple years fr cmparisn by using the Click fr Multiple Years checkbx. Quarter Individual Year 2) Display Optins: Shw Charge infrmatin Selecting Yes will display the ttal f undiscunted charges fr services rendered by the hspital fr the cases n the reprt. The default is N. Exprtable Selecting Yes will allw yu t exprt the generated reprt data. The tw file frmats supprted fr exprt are (1) CSV/Excel (Cmma delimited) fr use with Excel, ther spreadsheet prgrams r any ther prgram that can receive a Cmma delimited file and (2) Adbe PDF 5

frmat, suitable fr printing. Un-checking this ptin will exclude this exprt ability and will display "Paging" ptins (ie, yu can chse hw many recrds t shw per page, g directly t a page, etc. This is suitable when yu dn't want t exprt and the reprt is a very lng reprt, since it significantly increases the dwnlad speed). The default is Yes. Shw Rates Selecting Yes will display the Observed Rates (Obs.Rate) were apprpriate. This includes cases/chsen stratifiers with ppulatin at risk (denminatr) data available. The Observed Rate is the raw rate generated fr the chsen data (ie, the number f times an event ccurs ut f the number f persns at risk fr that event - Numeratr/Denminatr). The default is Yes. If n stratifier is chsen, the ppulatin f the selected Cunty is used as the denminatr. If all stratfiers chsen have ppulatin data (Cunty/ZipCde/Age Grup/Gender/Race) then the stratifiers ppulatin is used as the denminatr (Payer/Hspital/Admsrc d nt have ppulatin data) Nte: PQI-2 and PQI-9 always have denminatrs as explained abve in the "Denminatrs" sectin. If "Shw Rates?" is unchecked then the Observed Rates wiill nt shw fr any PQI. Same Patient & Hspital Cunty Selecting Yes will exclude cases fr which the Patient Cunty is different frm the Hspital Cunty fr each case (This is the default behavir f the AHRQ PQI definitins) Selecting N will include cases fr which the Patient Cunty is different frm the Hspital Cunty fr each case (One use f this may be fr situatins where a particular hspital will always have mst f their patients frm ther cunties) 3) PQI & Stratifiers: Individual PQIs r All PQIs can be chsen (If individual PQIs are chsen then it is required t select at least ne stratifier) All PQIs is chsen by default. Stratificatins can be dne three (3) levels deep. The available stratifiers are: Payer: Financial class (ie, hw the charges were paid) If this stratifier is selected, "Select Payer (s)?" checkbx will give the user the ability t restrict utput t ne r mre Payer types. Pssible values: Medicare Medicaid Private incl. HMO Self-Pay N charge/charity Other. Zip Cde: Zip Cde where the patient resides in. If this stratifier is selected, "Select ZipCde(s)?" checkbx will give the user the ability t restrict utput t ne r mre zip cdes r zip cde grup. Age Grup: The age grup f the patient. Nte that PQI-9 (Lw birth weight) is nly cncerned with newbrns/nenates. The age grups available are: 18 39 40 64 65+. Hspital: The hspital f each case. If this stratifier is selected, "Select Hspital(s)?" checkbx will give the user the ability t restrict utput t ne r mre hspitals r chse a hspital grup. 6

Gender: The gender f the patient. Pssible values: Male Female. Race: The race/ethnicity f the patient. Pssible values: White Black Hispanic Asian/Pacific Island Native American Other Admsrc: The admissin surce (ie, hw did the patient first enter the hspital system). Pssible values: ER Curt/law enfrcement Rutine/Birth/Other Nte: nt available fr ED data. If All f Flrida is chsen frm the Cunty chices, the fllwing stratifiers are available: Cunty 4) Reprt Generatin District (Health Planning Cuncil Districts) The reprt is displayed via a blue windwed verlay. Once the reprt is generated the blue windwed verlay will appear with a message stating that the reprt is Lading and that the reprt is being dwnladed t yur cmputer. The length f time this message will be displayed depends n the size f the reprt and yur dwnlad speed. Once the reprt is dwnladed, it is then displayed. At the tp f the blue windwed verlay there is a descriptin f the generated reprt (Year, Cunty, Stratifiers, etc) Fr a view f help infrmatin there is a link at the tp *Fr Help click here that pens up a pp windw with a tutrial/help. If the ptin Exprtable was selected Yes, then at the tp right will appear a selectin f exprt types. The chices are: Excel: CSV/Excel (Cmma delimited) fr use with Excel, ther spreadsheet prgrams r any ther prgram that can receive a Cmma delimited file. PDF Wide (Letter): Adbe PDF frmat, landscape mde letter sized paper. PDF Wide (Legal): Adbe PDF frmat, landscape mde legal sized paper. PDF Letter: Adbe PDF frmat, prtrait mde letter size paper. *Fr a graphical view/example f the websites functins, please see Appendix A (Website) 7

Acuity Stratificatin (Emergency Department) Definitin The Acuity Stratificatin Mdule reprts the number f cases (ie, Numeratr) fr each f the five CPT (Current Prcedural Terminlgy) cdes that describe the acuity f the medical prblem(s). All emergency department visits can be defined by ne f these CPT cdes (Nte: sme cases may nt have any f these CPT cdes. These cases are excluded. See the Data Prcessing sectin belw fr mre infrmatin). If mre than ne f these CPT cdes was assessed fr any given case, the case was categrized based n the severest CPT cde. There are 5 CPT cdes fr acuity stratificatin. The fllwing table cntains their basic definitins: CPT Cde Descriptin 99281 Usually, the presenting prblem(s) are self limited r f minr severity. 99282 Usually, the presenting prblem(s) are f lw t mderate severity. 99283 Usually, the presenting prblem(s) are f mderate severity. 99284 99285 Usually, the presenting prblem(s) are f high severity, and require urgent evaluatin by the physician but d nt pse an immediate significant threat t life r physilgic functin. Usually, the presenting prblem(s) are f high severity and pse an immediate significant threat t life r physilgic functin. Data Surce Flrida AHCA Emergency Department (ED) Patient Data: This data is delivered as quarterly database files (DBASE/DBF files). These database files, fr the years 2005-2007, can range frm apprximately 1,400,000 t 1,500,000 recrds/cases fr the state f Flrida per quarter. As an example, fr 2007 there were 5,777,921 recrds/cases fr the state f Flrida. The fields f interest frm the data surce are: Field Name YEAR QTR FACLNBR FAC_COUNTY RACE AGE GENDER ZIPCODE PTCOUNTY PAYER Descriptin Reprting Year Reprting Quarter Hspital ID Hspitals Cunty Patients Race/Ethnicity Patients Age (in years) Patients Gender Patients Zip Cde f residence Patients Cunty f residence Primary surce f reimbursement 8

PRINCPT OTHCPT1 thru OTHCPT9 TCHGS Principal CPT cde Secndary CPT cdes Ttal Grss Charges Fr detailed infrmatin regarding all the fields and their pssible values, see the AHCA website: http://www.flridahealthfinder.gv/researchers/orderdata/rder-data.aspx (Lk fr Hspital Discharge Data under the Data Dictinary sectin) Data Prcessing This same data surce will be used fr the Avidable - NYU Algrithm (Emergency Department) Mdule. Because f this, the data surce will first be prcessed by the New Yrk University ED Classificatin Algrithm. The Acuity Stratificatin will ignre the added clumns the algrithm adds t the surce data. Fr detailed and backgrund infrmatin regarding this Algrithm please visit: http://wagner.nyu.edu/chpsr/index.html?p=4 Nte: Since a third party prgram (New Yrk University ED Classificatin Algrithm) is used, the Data Prcessing and the Data Analysis are dne in reverse (where first the data surce is analyzed and then it s prcessed) 1. Using the ED Algrithm: a. The Micrsft Access Versin f the ED Algrithm is used. Therefre, Micrsft Access needs t be installed. b. The Micrsft Access Versin f the ED Algrithm is run, which cnsists f a step by step prcedure f (1) Imprting the surce data file (2) Describing the fields (3) Declaring yur values (4) Prducing utput (Analyzed data surce) c. This Analyzed data surce cntains the same number f recrds/cases with added clumns prduced by the ED algrithm. See Appendix E (NYU ED Algrithm). 2. The Analyzed data surce is imprted int the database (5 CPT tables representing the 5 CPT cdes fr acuity stratificatin. 3. Data transfrmatin and cleansing is nw dne n the CPT tables. a. All recrds/cases that d nt have any f the 5 CPT cdes fr acuity stratificatin in any f the fields PRINCPT, OTHCPT1 thru OTHCPT9 are remved. b. A Main CPT is set fr each recrd based n the severest CPT cde fund in the fields PRINCPT, OTHCPT1 thru OTHCPT9. c. Cnvert Patient Cunty (PTCOUNTY) and Hspital Cunty (FAC_COUNTY) frm AHCA cunty cde t full FIPS Cunty cde (Federal Infrmatin Prcessing Standard). d. Cnvert AHCA Race cde t AHRQ PQI sftware Race cdes* e. Cnvert AHCA Payer cde t AHRQ PQI sftware Payer cdes* f. The frnt-end website is nw ready t access the newly entered and analyzed data. *Fr a table f the actual cde cnversins see Appendix C (Cde Translatins) 9

Data Analysis (See Data Prcessing sectin abve) Since a third party prgram (New Yrk University ED Classificatin Algrithm) is used, the Data Prcessing and the Data Analysis are dne in reverse (where first the data surce is analyzed and then it s prcessed) Nte: The Data Prcessing / Data Analysis cycle is repeated fr all Year/Quarter data surce files. WebSite (healthdata.brhpc.rg) The website has the ability t create stratified reprts based n the Acuity f the cases in the Emergency Department (ED) Data. 1) The basic chices n which all reprts are based are: Cunty The chice All Cunties is available. If this is selected then extra stratifiers are made available in the Stratify by sectin. These extra stratifiers are Cunty and District. Individual Cunty Year Chse multiple years fr cmparisn by using the Click fr Multiple Years checkbx. Quarter Individual Year 2) Display Optins: Shw Charge infrmatin Selecting Yes will display the ttal f undiscunted charges fr services rendered by the hspital fr the cases n the reprt. The default is N. Exprtable Selecting Yes will allw yu t exprt the generated reprt data. The tw file frmats supprted fr exprt are (1) CSV/Excel (Cmma delimited) fr use with Excel, ther spreadsheet prgrams r any ther prgram that can receive a Cmma delimited file and (2) Adbe PDF frmat, suitable fr printing. Un-checking this ptin will exclude this exprt ability and will display "Paging" ptins (ie, yu can chse hw many recrds t shw per page, g directly t a page, etc. This is suitable when yu dn't want t exprt and the reprt is a very lng reprt, since it significantly increases the dwnlad speed). The default is Yes. Same Patient & Hspital Cunty 3) Stratifiers: Selecting Yes will exclude cases fr which the Patient Cunty is different frm the Hspital Cunty fr each case. Selecting N will include cases fr which the Patient Cunty is different frm the Hspital Cunty fr each case. Stratificatins can be dne three (3) levels deep. The available stratifiers are: 10

Payer: Financial class (ie, hw the charges were paid) If this stratifier is selected, "Select Payer (s)?" checkbx will give the user the ability t restrict utput t ne r mre Payer types. Pssible values: Medicare Medicaid Private incl. HMO Self-Pay N charge/charity Other. Zip Cde: Zip Cde where the patient resides in. If this stratifier is selected, "Select ZipCde(s)?" checkbx will give the user the ability t restrict utput t ne r mre zip cdes r zip cde grup. Age Grup: The age grup f the patient. Nte that PQI-9 (Lw birth weight) is nly cncerned with newbrns/nenates. The age grups available are: 18 39 40 64 65+. Hspital: The hspital f each case. If this stratifier is selected, "Select Hspital(s)?" checkbx will give the user the ability t restrict utput t ne r mre hspitals r chse a hspital grup. Gender: The gender f the patient. Pssible values: Male Female. Race: The race/ethnicity f the patient. Pssible values: White Black Hispanic Asian/Pacific Island Native American Other If All f Flrida is chsen frm the Cunty chices, the fllwing stratifiers are available: Cunty 4) Reprt Generatin District (Health Planning Cuncil Districts) The reprt is displayed via a blue windwed verlay. Once the reprt is generated the blue windwed verlay will appear with a message stating that the reprt is Lading and that the reprt is being dwnladed t yur cmputer. The length f time this message will be displayed depends n the size f the reprt and yur dwnlad speed. Once the reprt is dwnladed, it is then displayed. At the tp f the blue windwed verlay there is a descriptin f the generated reprt (Year, Cunty, Stratifiers, etc) Fr a view f help infrmatin there is a link at the tp *Fr Help click here that pens up a pp windw with a tutrial/help. 11

If the ptin Exprtable was selected Yes, then at the tp right will appear a selectin f exprt types. The chices are: Excel: CSV/Excel (Cmma delimited) fr use with Excel, ther spreadsheet prgrams r any ther prgram that can receive a Cmma delimited file. PDF Wide (Letter): Adbe PDF frmat, landscape mde letter sized paper. PDF Wide (Legal): Adbe PDF frmat, landscape mde legal sized paper. PDF Letter: Adbe PDF frmat, prtrait mde letter size paper. *Fr a graphical view/example f the websites functins, please see Appendix A (Website) 12

Avidable - NYU Algrithm (Emergency Department) Definitin The Avidable - NYU Algrithm (Emergency Department) Mdule reprts the number f cases (ie, Numeratr) fr each f the five CPT (Current Prcedural Terminlgy) cdes that describe the acuity f the medical prblem(s) as well as data prduced by the New Yrk University ED Classificatin Algrithm. All emergency department visits can be defined by ne f these CPT cdes (Nte: sme cases may nt have any f these CPT cdes. These cases are excluded. See the Data Prcessing sectin belw fr mre infrmatin). If mre than ne f these CPT cdes was assessed fr any given case, the case was categrized based n the severest CPT cde. There are 5 CPT cdes fr acuity stratificatin. The fllwing table cntains their basic definitins: CPT Cde Descriptin 99281 Usually, the presenting prblem(s) are self limited r f minr severity. 99282 Usually, the presenting prblem(s) are f lw t mderate severity. 99283 Usually, the presenting prblem(s) are f mderate severity. 99284 99285 Usually, the presenting prblem(s) are f high severity, and require urgent evaluatin by the physician but d nt pse an immediate significant threat t life r physilgic functin. Usually, the presenting prblem(s) are f high severity and pse an immediate significant threat t life r physilgic functin. There are 2 base reprts that can be stratified: (1) ED Visits by Emergency Status. All NON-Drug/Alchl/Psychiatric/Injury The NYU Ed Algrithm classifies the cases as: NnEm: Nn-Emergent EmPCT: Emergent/Primary Care Treatable EmPrev: Emergent - ED Care Needed - Preventable/Avidable EmNnPrev: Emergent - ED Care Needed - NOT Preventable/Avidable (2) ED Visits by primary diagnsis f injury, mental health prblems, alchl, r substance abuse. ONLY Drug/Alchl/Psychiatric/Injury/Unclassified These cases are classified separately frm the ED Visits by Emergency Status : Injury - Injury principal diagnses Psych - Mental health principal diagnses DrugAlc - Alchl /Drug-related health principal diagnses 13

Unclass - Nt classified - nt in ne f the abve categries *Fr mre detailed infrmatin regarding the New Yrk University ED Classificatin Algrithm see Appendix E (NYU ED Algrithm). Nte: These tw base reprts separate the data fr each CPT acuity cde between All NON- Drug/Alchl/Psychiatric/Injury and ONLY Drug/Alchl/Psychiatric/Injury/Unclassified. S, the Numeratr fr each f the base reprts will add up t the Numeratr generated by the Acuity Stratificatin Mdule. Data Surce Flrida AHCA Emergency Department (ED) Patient Data: This data is delivered as quarterly database files (DBASE/DBF files). These database files, fr the years 2005-2007, can range frm apprximately 1,400,000 t 1,500,000 recrds/cases fr the state f Flrida per quarter. As an example, fr 2007 there were 5,777,921 recrds/cases fr the state f Flrida. The fields f interest frm the data surce are: Field Name YEAR QTR FACLNBR FAC_COUNTY RACE AGE GENDER ZIPCODE PTCOUNTY PAYER PRINCPT OTHCPT1 thru OTHCPT9 TCHGS Field Name ED1 ED2 ED3 ED4 DrugAlc Psych Injury Unclass Descriptin Reprting Year Reprting Quarter Hspital ID Hspitals Cunty Patients Race/Ethnicity Patients Age (in years) Patients Gender Patients Zip Cde f residence Patients Cunty f residence Primary surce f reimbursement Principal CPT cde Secndary CPT cdes Ttal Grss Charges Fields added by the New Yrk University ED Classificatin Algrithm Descriptin Nn-emergent (%) Emergent/Primary Care Treatable (%) Emergent - ED Care Needed - Preventable/Avidable (%) Emergent - ED Care Needed - Nt Preventable/Avidable (%) Drug & Alchl related health - principal diagnsis Mental health - principal diagnsis Injury related - principal diagnsis Nt classified Fr detailed infrmatin regarding all the fields and their pssible values, see the AHCA website: http://www.flridahealthfinder.gv/researchers/orderdata/rder-data.aspx 14

(Lk fr Emergency Department Data under the Data Dictinary sectin) Data Prcessing The data surce will first be prcessed by the New Yrk University ED Classificatin Algrithm. Fr detailed and backgrund infrmatin regarding this Algrithm please visit: http://wagner.nyu.edu/chpsr/index.html?p=4 Nte: Since a third party prgram (New Yrk University ED Classificatin Algrithm) is used, the Data Prcessing and the Data Analysis are dne in reverse (where first the data surce is analyzed and then it s prcessed) 1. Using the ED Algrithm: a. The Micrsft Access Versin f the ED Algrithm is used. Therefre, Micrsft Access needs t be installed. b. The Micrsft Access Versin f the ED Algrithm is run, which cnsists f a step by step prcedure f (1) Imprting the surce data file (2) Describing the fields (3) Declaring yur values (4) Prducing utput (Analyzed data surce) c. This Analyzed data surce cntains the same number f recrds/cases with added clumns prduced by the ED algrithm. See Appendix E (NYU ED Algrithm). 2. The Analyzed data surce is imprted int the database (5 CPT tables representing the 5 CPT cdes fr acuity stratificatin. 3. Data transfrmatin and cleansing is nw dne n the CPT tables. a. All recrds/cases that d nt have any f the 5 CPT cdes fr acuity stratificatin in any f the fields PRINCPT, OTHCPT1 thru OTHCPT9 are remved. b. A Main CPT is set fr each recrd based n the severest CPT cde fund in the fields PRINCPT, OTHCPT1 thru OTHCPT9. c. Cnvert Patient Cunty (PTCOUNTY) and Hspital Cunty (FAC_COUNTY) frm AHCA cunty cde t full FIPS Cunty cde (Federal Infrmatin Prcessing Standard). d. Cnvert AHCA Race cde t AHRQ PQI sftware Race cdes* e. Cnvert AHCA Payer cde t AHRQ PQI sftware Payer cdes* f. The frnt-end website is nw ready t access the newly entered and analyzed data. *Fr a table f the actual cde cnversins see Appendix C (Cde Translatins) Data Analysis (See Data Prcessing sectin abve) Since a third party prgram (New Yrk University ED Classificatin Algrithm) is used, the Data Prcessing and the Data Analysis are dne in reverse (where first the data surce is analyzed and then it s prcessed) Nte: The Data Prcessing / Data Analysis cycle is repeated fr all Year/Quarter data surce files. 15

WebSite (healthdata.brhpc.rg) The website has the ability t create stratified reprts based n the Acuity f the cases in the Emergency Department (ED) Data. 1) The basic chices n which all reprts are based are: Cunty The chice All Cunties is available. If this is selected then extra stratifiers are made available in the Stratify by sectin. These extra stratifiers are Cunty and District. Individual Cunty Year Chse multiple years fr cmparisn by using the Click fr Multiple Years checkbx. Quarter Individual Year 2) Display Optins: Shw Charge infrmatin Selecting Yes will display the ttal f undiscunted charges fr services rendered by the hspital fr the cases n the reprt. The default is N. Exprtable Selecting Yes will allw yu t exprt the generated reprt data. The tw file frmats supprted fr exprt are (1) CSV/Excel (Cmma delimited) fr use with Excel, ther spreadsheet prgrams r any ther prgram that can receive a Cmma delimited file and (2) Adbe PDF frmat, suitable fr printing. Un-checking this ptin will exclude this exprt ability and will display "Paging" ptins (ie, yu can chse hw many recrds t shw per page, g directly t a page, etc. This is suitable when yu dn't want t exprt and the reprt is a very lng reprt, since it significantly increases the dwnlad speed). The default is Yes. Cmbine CPT Cdes Selecting Yes will add the Numeratrs and Percentages (ie, Nn-emergent, Emergent/Primary Care Treatable, Emergent - ED Care Needed - Preventable/Avidable, Emergent - ED Care Needed - Nt Preventable/Avidable ) f the all 5 CPT acuity cdes and display this sum. (Nte: This nly applies when ED Visits by Emergency Status is selected. Als, at least ne stratifier must be chsen and nt applicable t multi-year cmparisn) Same Patient & Hspital Cunty Selecting Yes will exclude cases fr which the Patient Cunty is different frm the Hspital Cunty fr each case. Selecting N will include cases fr which the Patient Cunty is different frm the Hspital Cunty fr each case. 3) Stratifiers: Stratificatins can be dne three (3) levels deep. The available stratifiers are: 16

Chrnic Cnditins Definitin The Chrnic Cnditin Mdule reprts the number f cases (ie, Numeratr) fr which the Diagnsis cdes f the recrd/case indicate a Chrnic Cnditin. The Chrnic Cnditin Indicatr tl, develped as part f the Healthcare Cst and Utilizatin Prject (HCUP), stratifies chrnic diseases based n ICD-9-CM diagnsis cdes. A chrnic cnditin is a cnditin lasting 12 mnths r lnger and meeting ne r bth f the fllwing tests: (a) the cnditin places limitatins n selfcare, independent living and scial interactins; (b) the cnditin results in the need fr nging interventin with medical prducts, services and special equipment. The identificatin f chrnic cnditins is based n all five-digit ICD-9-CM diagnsis cdes, excluding external cause f injury cdes (E cdes). *Fr a list f all the ICD-9-CM diagnsis cdes used t define a chrnic cnditin, please see Appendix F (Cdes - Chrnic Cnditins & Suicide Incidence) There are 5 Chrnic Cnditins that are reprted: Chrnic Cnditins AIDS Asthma Cngestive Heart Failure (CHF) Hypertensin Diabetes Data Surce Flrida AHCA Inpatient Discharge Data: This data is delivered as quarterly database files (DBASE/DBF files). These database files, fr the years 2004-2008, can range frm apprximately 600,000 t 670,000 recrds/cases fr the state f Flrida per quarter. As an example, fr 2006 there were 2,555,220 recrds/cases fr the state f Flrida. The fields f interest frm the data surce are: Field Name YEAR QTR FACLNBR FAC_COUNTY RACE AGE GENDER ZIPCODE PTCOUNTY Descriptin Reprting Year Reprting Quarter Hspital ID Hspitals Cunty Patients Race/Ethnicity Patients Age (in years) Patients Gender Patients Zip Cde f residence Patients Cunty f residence 19

ADMSRC PAYER PRINDIAG OTHDIAG1 thru OTHDIAG30 TCHGS Surce f Admissin Primary surce f reimbursement Principal diagnsis cde Secndary diagnsis cdes Ttal Grss Charges Fr detailed infrmatin regarding all the fields and their pssible values, see the AHCA website: http://www.flridahealthfinder.gv/researchers/orderdata/rder-data.aspx (Lk fr Hspital Discharge Datat under the Data Dictinary sectin) Data Prcessing The Inpatient Discharge Data DBASE/DBF data surce files have t be prcessed befre analyzing can be dne. The prcedure is such: (The recrd/case exclusins are dne here.) 1. Cnvert each DBF file t CSV (cmma delimited) file. While cnverting: a. Cases fr which the Patient Cunty (PTCOUNTY) is equal t 99 are remved. PTCOUNTY = 99 describe ut f state/unknwn cunty f residence f the patient. b. Cases fr which the Gender is unknwn r nt specified are remved. c. Cases that d nt reflect the crrect Year/Quarter f the input data surce are remved. 2. Imprt CSV file int temprary table (datasurce). 3. Data transfrmatin and cleansing is nw dne n the imprted data in the temprary table. (Nte: Data transfrmatin is dne t be cnsistent with the PQI mdule.) a. Cnvert Patient Cunty (PTCOUNTY) and Hspital Cunty (FAC_COUNTY) frm AHCA cunty cde t full FIPS Cunty cde (Federal Infrmatin Prcessing Standard). b. Cnvert AHCA Race cde t AHRQ PQI sftware Race cdes* c. Cnvert AHCA Payer cde t AHRQ PQI sftware Payer cdes* d. Cnvert AHCA ADMSRC cde t AHRQ PQI sftware Admsrc cdes* e. The perids/decimal pints are remved frm all Diagnsis cdes *Fr a table f the actual cde cnversins see Appendix C (Cde Translatins) Data Analysis Once the Data Prcessing is cmplete, the data in the temprary table (datasurce) is ready t be analyzed. The prcedure is such: 1. The Year and Quarter are cnfirmed fr the surce data. 2. The queries* are run fr all 5 Chrnic Cnditins, ppulating the apprpriate Analyzed Data Table. Each Chrnic Cnditin has an assigned Analyzed Data Table (Ana_AIDS, Ana_Asthma, Ana_CHF, Ana_Diabetes, Ana_Hypertensin) 20

a. While running the analytical queries, the system als adds a clumn (AGECATEGORY) and sets the Age Categry based n the patient age. 3. The frnt-end website is nw ready t access the newly entered and analyzed data. *T view the actual analytical queries used, please refer t Appendix D (Analytical Queries) Nte: The Data Prcessing / Data Analysis cycle is repeated fr all Year/Quarter data surce files. WebSite (healthdata.brhpc.rg) The website has the ability t create stratified reprts based n the Chrnic Cnditins data. 1) The basic chices n which all reprts are based are: Cunty The chice All Cunties is available. If this is selected then extra stratifiers are made available in the Stratify by sectin. These extra stratifiers are Cunty and District. Individual Cunty Year Chse multiple years fr cmparisn by using the Click fr Multiple Years checkbx. Quarter Individual Year 2) Display Optins: Shw Charge infrmatin Selecting Yes will display the ttal f undiscunted charges fr services rendered by the hspital fr the cases n the reprt. The default is N. Exprtable Selecting Yes will allw yu t exprt the generated reprt data. The tw file frmats supprted fr exprt are (1) CSV/Excel (Cmma delimited) fr use with Excel, ther spreadsheet prgrams r any ther prgram that can receive a Cmma delimited file and (2) Adbe PDF frmat, suitable fr printing. Un-checking this ptin will exclude this exprt ability and will display "Paging" ptins (ie, yu can chse hw many recrds t shw per page, g directly t a page, etc. This is suitable when yu dn't want t exprt and the reprt is a very lng reprt, since it significantly increases the dwnlad speed). The default is Yes. Same Patient & Hspital Cunty Selecting Yes will exclude cases fr which the Patient Cunty is different frm the Hspital Cunty fr each case. Selecting N will include cases fr which the Patient Cunty is different frm the Hspital Cunty fr each case. 3) Stratifiers: Stratificatins can be dne three (3) levels deep. The available stratifiers are: 21

Payer: Financial class (ie, hw the charges were paid) If this stratifier is selected, "Select Payer (s)?" checkbx will give the user the ability t restrict utput t ne r mre Payer types. Pssible values: Medicare Medicaid Private incl. HMO Self-Pay N charge/charity Other. Zip Cde: Zip Cde where the patient resides in. If this stratifier is selected, "Select ZipCde(s)?" checkbx will give the user the ability t restrict utput t ne r mre zip cdes r zip cde grup. Age Grup: The age grup f the patient. Nte that PQI-9 (Lw birth weight) is nly cncerned with newbrns/nenates. The age grups available are: 18 39 40 64 65+. Hspital: The hspital f each case. If this stratifier is selected, "Select Hspital(s)?" checkbx will give the user the ability t restrict utput t ne r mre hspitals r chse a hspital grup. Gender: The gender f the patient. Pssible values: Male Female. Race: The race/ethnicity f the patient. Pssible values: White Black Hispanic Asian/Pacific Island Native American Other Admsrc: The admissin surce (ie, hw did the patient first enter the hspital system). Pssible values: ER Curt/law enfrcement Rutine/Birth/Other Nte: nt available fr ED data. If All f Flrida is chsen frm the Cunty chices, the fllwing stratifiers are available: Cunty 4) Reprt Generatin District (Health Planning Cuncil Districts) The reprt is displayed via a blue windwed verlay. Once the reprt is generated the blue windwed verlay will appear with a message stating that the reprt is Lading and that the reprt is being 22

dwnladed t yur cmputer. The length f time this message will be displayed depends n the size f the reprt and yur dwnlad speed. Once the reprt is dwnladed, it is then displayed. At the tp f the blue windwed verlay there is a descriptin f the generated reprt (Year, Cunty, Stratifiers, etc) Fr a view f help infrmatin there is a link at the tp *Fr Help click here that pens up a pp windw with a tutrial/help. If the ptin Exprtable was selected Yes, then at the tp right will appear a selectin f exprt types. The chices are: Excel: CSV/Excel (Cmma delimited) fr use with Excel, ther spreadsheet prgrams r any ther prgram that can receive a Cmma delimited file. PDF Wide (Letter): Adbe PDF frmat, landscape mde letter sized paper. PDF Wide (Legal): Adbe PDF frmat, landscape mde legal sized paper. PDF Letter: Adbe PDF frmat, prtrait mde letter size paper. *Fr a graphical view/example f the websites functins, please see Appendix A (Website) 23

Suicide Incidence Definitin The Suicide Incidence Mdule reprts the number f cases (ie, Numeratr) fr which the E-Cdes (External Cause f Injury) f the recrd/case indicate a self-inflicted injury. Recrds are included when they cntain any f the ECODES in Appendix F (Cdes - Chrnic Cnditins & Suicide Incidence) fr any f the ECODE fields (ECODE1, ECODE2, ECODE3) Nte: The same recrd/case may exist in 1 t 3 different ECODE categries (ie, a recrd/case may have ECODE1 = E9502, ECODE2 = E9503 and ECODE3 = E9504, therefre, this recrd will be cunted fr each f thse ECODES) E-cdes: E-cdes r external cause f injury cdes are diagnstic categries, using the 9th revisin f the Internatinal Classificatin f Diseases (ICD-9). E-cdes differ frm nature f injury cdes (N-cdes) in prviding data n the cause, rather than type, f injury. Fr example, a traumatic head injury, cded with an N- cde, culd result frm, say, a car accident r gunsht wund, bth cded with E-cdes. Additinally, E-cdes distinguish self-inflicted injuries, essential infrmatin fr suicide surveillance. *Fr a list f all the ICD-9-CM E-Cdes used t define Suicide Incidence, please see Appendix F (Cdes - Chrnic Cnditins & Suicide Incidence) There are 10 majr categries fr Suicide Incidence: E-Cde E950 E951 E952 E953 E954 E955 E956 E957 E958 E959 Descriptin Slid r liquid substances Gases in dmestic use Other gases and vaprs Hanging strangulatin and suffcatin Submersin (drwning) Firearms air guns and explsives Cutting and piercing instrument Jumping frm high place Other and unspecified means Late effects f self-inflicted injury Data Surce Flrida AHCA Inpatient Discharge Data: This data is delivered as quarterly database files (DBASE/DBF files). These database files, fr the years 2004-2008, can range frm apprximately 600,000 t 670,000 recrds/cases fr the state f Flrida per quarter. As an example, fr 2006 there were 2,555,220 recrds/cases fr the state f Flrida. The fields f interest frm the data surce are: 24

Field Name YEAR QTR FACLNBR FAC_COUNTY RACE AGE GENDER ZIPCODE PTCOUNTY ADMSRC PAYER ECODE1, ECODE2 and ECODE3 TCHGS Descriptin Reprting Year Reprting Quarter Hspital ID Hspitals Cunty Patients Race/Ethnicity Patients Age (in years) Patients Gender Patients Zip Cde f residence Patients Cunty f residence Surce f Admissin Primary surce f reimbursement External Cause f Injury Cdes Ttal Grss Charges Fr detailed infrmatin regarding all the fields and their pssible values, see the AHCA website: http://www.flridahealthfinder.gv/researchers/orderdata/rder-data.aspx (Lk fr Hspital Discharge Data under the Data Dictinary sectin) Data Prcessing The Inpatient Discharge Data DBASE/DBF data surce files have t be prcessed befre analyzing can be dne. The prcedure is such: (The recrd/case exclusins are dne here.) 1. Cnvert each DBF file t CSV (cmma delimited) file. While cnverting: a. Cases fr which the Patient Cunty (PTCOUNTY) is equal t 99 are remved. PTCOUNTY = 99 describe ut f state/unknwn cunty f residence f the patient. b. Cases fr which the Gender is unknwn r nt specified are remved. c. Cases that d nt reflect the crrect Year/Quarter f the input data surce are remved. 2. Imprt CSV file int temprary table (datasurce). 3. Data transfrmatin and cleansing is nw dne n the imprted data in the temprary table. (Nte: Data transfrmatin is dne t be cnsistent with the PQI mdule.) a. Cnvert Patient Cunty (PTCOUNTY) and Hspital Cunty (FAC_COUNTY) frm AHCA cunty cde t full FIPS Cunty cde (Federal Infrmatin Prcessing Standard). b. Cnvert AHCA Race cde t AHRQ PQI sftware Race cdes* c. Cnvert AHCA Payer cde t AHRQ PQI sftware Payer cdes* d. Cnvert AHCA ADMSRC cde t AHRQ PQI sftware Admsrc cdes* *Fr a table f the actual cde cnversins see Appendix C (Cde Translatins) 25

Data Analysis Once the Data Prcessing is cmplete, the data in the temprary table (datasurce) is ready t be analyzed. The prcedure is such: 1. The Year and Quarter are cnfirmed fr the surce data. 2. The queries* are run fr all Suicide Incidence E-Cde, ppulating the apprpriate Analyzed Data Table (ECdes_Suicide) a. While running the analytical queries, the system als adds a clumn (AGECATEGORY) and sets the Age Categry based n the patient age. 3. The frnt-end website is nw ready t access the newly entered and analyzed data. *T view the actual analytical queries used, please refer t Appendix D (Analytical Queries) Nte: The Data Prcessing / Data Analysis cycle is repeated fr all Year/Quarter data surce files. WebSite (healthdata.brhpc.rg) The website has the ability t create stratified reprts based n the Suicide Incidence data. 1) The basic chices n which all reprts are based are: Cunty The chice All Cunties is available. If this is selected then extra stratifiers are made available in the Stratify by sectin. These extra stratifiers are Cunty and District. Individual Cunty Year Chse multiple years fr cmparisn by using the Click fr Multiple Years checkbx. Quarter Individual Year 2) Display Optins: Shw Charge infrmatin Selecting Yes will display the ttal f undiscunted charges fr services rendered by the hspital fr the cases n the reprt. The default is N. Exprtable Selecting Yes will allw yu t exprt the generated reprt data. The tw file frmats supprted fr exprt are (1) CSV/Excel (Cmma delimited) fr use with Excel, ther spreadsheet prgrams r any ther prgram that can receive a Cmma delimited file and (2) Adbe PDF frmat, suitable fr printing. Un-checking this ptin will exclude this exprt ability and will display "Paging" ptins (ie, yu can chse hw many recrds t shw per page, g directly t a page, etc. This is suitable when yu dn't want t exprt and the reprt is a very lng reprt, since it significantly increases the dwnlad speed). The default is Yes. Shw Detail 26

Selecting Yes will display the Numeratr fr all pssible categries fr Suicide Incidence. *Fr a list f all the ICD-9-CM E-Cdes used t define Suicide Incidence, please see Appendix F (Cdes - Chrnic Cnditins & Suicide Incidence). Selecting N will display nly the 10 majr categries. The default is N. Same Patient & Hspital Cunty Selecting Yes will exclude cases fr which the Patient Cunty is different frm the Hspital Cunty fr each case. Selecting N will include cases fr which the Patient Cunty is different frm the Hspital Cunty fr each case. 3) Stratifiers: Stratificatins can be dne three (3) levels deep. The available stratifiers are: Payer: Financial class (ie, hw the charges were paid) If this stratifier is selected, "Select Payer (s)?" checkbx will give the user the ability t restrict utput t ne r mre Payer types. Pssible values: Medicare Medicaid Private incl. HMO Self-Pay N charge/charity Other. Zip Cde: Zip Cde where the patient resides in. If this stratifier is selected, "Select ZipCde(s)?" checkbx will give the user the ability t restrict utput t ne r mre zip cdes r zip cde grup. Age Grup: The age grup f the patient. Nte that PQI-9 (Lw birth weight) is nly cncerned with newbrns/nenates. The age grups available are: 18 39 40 64 65+. Hspital: The hspital f each case. If this stratifier is selected, "Select Hspital(s)?" checkbx will give the user the ability t restrict utput t ne r mre hspitals r chse a hspital grup. Gender: The gender f the patient. Pssible values: Male Female. Race: The race/ethnicity f the patient. Pssible values: White Black Hispanic Asian/Pacific Island Native American Other Admsrc: The admissin surce (ie, hw did the patient first enter the hspital system). Pssible values: ER 27

Curt/law enfrcement Rutine/Birth/Other Nte: nt available fr ED data. If All f Flrida is chsen frm the Cunty chices, the fllwing stratifiers are available: Cunty 4) Reprt Generatin District (Health Planning Cuncil Districts) The reprt is displayed via a blue windwed verlay. Once the reprt is generated the blue windwed verlay will appear with a message stating that the reprt is Lading and that the reprt is being dwnladed t yur cmputer. The length f time this message will be displayed depends n the size f the reprt and yur dwnlad speed. Once the reprt is dwnladed, it is then displayed. At the tp f the blue windwed verlay there is a descriptin f the generated reprt (Year, Cunty, Stratifiers, etc) Fr a view f help infrmatin there is a link at the tp *Fr Help click here that pens up a pp windw with a tutrial/help. If the ptin Exprtable was selected Yes, then at the tp right will appear a selectin f exprt types. The chices are: Excel: CSV/Excel (Cmma delimited) fr use with Excel, ther spreadsheet prgrams r any ther prgram that can receive a Cmma delimited file. PDF Wide (Letter): Adbe PDF frmat, landscape mde letter sized paper. PDF Wide (Legal): Adbe PDF frmat, landscape mde legal sized paper. PDF Letter: Adbe PDF frmat, prtrait mde letter size paper. *Fr a graphical view/example f the websites functins, please see Appendix A (Website) 28

Pediatric Quality Indicatrs Definitin The Pediatric Quality Indicatrs (PDIs) are a set f measures that can be used with hspital inpatient discharge data t prvide a perspective n the quality f pediatric healthcare. Specifically, PDIs screen fr prblems that pediatric patients experience as a result f expsure t the healthcare system and that may be amenable t preventin by changes at the system r prvider level. Develpment f quality indicatrs fr the pediatric ppulatin invlves many f the same challenges assciated with the develpment f quality indicatrs fr the adult ppulatin. These challenges include the need t carefully define indicatrs using administrative data, establish validity and reliability, detect bias and design apprpriate risk adjustment, and vercme challenges f implementatin and use. Hwever, the special ppulatin f children invkes additinal, special challenges. Fur factrs differential epidemilgy f child healthcare relative t adult healthcare, dependency, demgraphics, and develpment can pervade all aspects f children s healthcare; simply applying adult indicatrs t yunger age ranges is insufficient. This PDIs fcus n ptentially preventable cmplicatins and iatrgenic events fr pediatric patients treated in hspitals, and n preventable hspitalizatins amng pediatric patients. The PDIs apply t the special characteristics f the pediatric ppulatin; screen fr prblems that pediatric patients experience as a result f expsure t the healthcare system and that may be amenable t preventin by changes at the prvider level r area level; and, help t evaluate preventive care fr children in an utpatient setting, and mst children are rarely hspitalized. The Mdule reprts the cases f interest (ie, Numeratr) as per the AHRQ definitin f each PDI. Als the ppulatin at risk (ie, Denminatr) is calculated whenever pssible (fr mre infrmatin regarding denminatrs, see the Denminatrs sectin at the bttm f the PDI table belw). In the situatins where a Denminatr can be calculated, the Observed Rate (ie, Obs.Rate) is als calculated. The Observed Rate is the raw rate generated fr the chsen data (ie, the number cases f interest ut f the number f persns at risk fr that event - Numeratr/Denminatr) PDI 14 15 16 17* 18 Name/Descriptin (See *Denminatrs at bttm f table fr clarificatin f denminatrs) PDI-14 (Asthma): All nn-maternal discharges ages 2 t 17 years with ICD-9-CM principal diagnsis cde f asthma. PDI-15 (Diabetes Shrt-term Cmplicatins): All nn-maternal discharges ages 6 t 17 years with ICD-9-CM principal diagnsis cde fr shrt-term cmplicatins (ketacidsis, hypersmlarity, cma). PDI-16 (Gastrenteritis): All nn-maternal discharges ages 3 mnths t 17 years with ICD-9-CM principal diagnsis cde fr gastrenteritis r with secndary diagnsis cde f gastrenteritis and a principal diagnsis cde f dehydratin. PDI-17 (Perfrated Appendix): All nn-maternal discharges ages 1 t 17 years with ICD-9-CM diagnsis cde fr perfratins r abscesses f appendix in any field. PDI-18 (Urinary Tract Infectin): All nn-maternal discharges ages 3 mnths t 17 years with ICD-9-CM principal diagnsis cde f urinary tract infectin. *Denminatrs: Fr all PDIs except PDI-17: the denminatr is represented by the ppulatin f the Cunty/ZipCde/Age Grup/Gender/Race depending n the stratifier chsen. Nte: Fr stratifiers: Payer, Hspital and Admsrc (Admissin Surce) there is n available ppulatin data, therefre a denminatr cannt be calculated. (The ppulatin data is supplied by Nielsn Claritas) Fr PDI-17 (Perfrated Appendix), the denminatr is calculated based n the cases and nt the ppulatin: PDI-17: All nn-maternal discharges ages 1 t 17 years in Area/Cunty with diagnsis cde fr appendicitis in any field. 29

Detailed and cmprehensive infrmatin is available nline frm the AHRQ website: Fr detailed infrmatin describing hw the PDIs were develped as well as prviding detailed evidence fr each indicatr: http://www.qualityindicatrs.ahrq.gv/mdules/pdi_verview.aspx Fr detailed definitins f each PDI, including all ICD-9-CM and DRG cdes that are included in r excluded frm the numeratr and denminatr (Nte that exclusins frm the denminatr are autmatically applied t the numeratr): http://www.qualityindicatrs.ahrq.gv/mdules/pdi_techspec.aspx Nte: PDI-1 thrugh PDI-13 are nt part f this Data Warehuse since they are nt area-level indicatrs. Data Surce Flrida AHCA Inpatient Discharge Data: This data is delivered as quarterly database files (DBASE/DBF files). These database files, fr the years 2004-2009, can range frm apprximately 600,000 t 670,000 recrds/cases fr the state f Flrida per quarter. As an example, fr 2006 there were 2,555,220 recrds/cases fr the state f Flrida. The fields f interest frm the data surce are: Field Name YEAR QTR FACLNBR FAC_COUNTY RACE AGE GENDER ZIPCODE PTCOUNTY ADMSRC PAYER PRINDIAG OTHDIAG1 thru OTHDIAG30 PRINPROC OTHPROC1 thru OTHPROC30 ECODE1, ECODE2 and ECODE3 DRG TCHGS Descriptin Reprting Year Reprting Quarter Hspital ID Hspitals Cunty Patients Race/Ethnicity Patients Age (in years) Patients Gender Patients Zip Cde f residence Patients Cunty f residence Surce f Admissin Primary surce f reimbursement Principal diagnsis cde Secndary diagnsis cdes Principal prcedure cde Secndary prcedures cdes External Cause f Injury Cdes Diagnsis Related Grup Ttal Grss Charges Fr detailed infrmatin regarding all the fields and their pssible values, see the AHCA website: http://www.flridahealthfinder.gv/researchers/orderdata/rder-data.aspx (Lk fr Hspital Discharge Data under the Data Dictinary sectin) 30

Data Prcessing The Inpatient Discharge Data DBASE/DBF data surce files have t be prcessed befre analyzing can be dne. The prcedure is such: (The recrd/case exclusins are dne here.) 4. Cnvert each DBF file t CSV (cmma delimited) file. While cnverting: a. Cases fr which the Patient Cunty (PTCOUNTY) is equal t 99 are remved. PTCOUNTY = 99 describe ut f state/unknwn cunty f residence f the patient. b. Cases fr which the Gender is unknwn r nt specified are remved. c. Cases that d nt reflect the crrect Year/Quarter f the input data surce are remved. 5. Imprt CSV file int temprary table (datasurcepdi). 6. Data transfrmatin and cleansing is nw dne n the imprted data in the temprary table. (Nte: Sme f this data transfrmatin is dne t match the AHRQ PQI sftware. We use this prgram t help validate the cnversin/analysis) a. Cnvert Patient Cunty (PTCOUNTY) and Hspital Cunty (FAC_COUNTY) frm AHCA cunty cde t full FIPS Cunty cde (Federal Infrmatin Prcessing Standard). b. Cnvert AHCA Race cde t AHRQ PDI sftware Race cdes* c. Cnvert AHCA Payer cde t AHRQ PDI sftware Payer cdes* d. Cnvert AHCA ADMSRC cde t AHRQ PDI sftware Admsrc cdes* e. The perids/decimal pints are remved frm all Ecde, Diagnsis and Prcedure cdes f. Once transfrmatin and cleaning is dne, the temprary table is exprted t a CSV file that is imprted int the AHRQ PDI sftware t analyze and run a basic reprt t use as validatin. *Fr a table f the actual cde cnversins see Appendix C (Cde Translatins) Data Analysis Once the Data Prcessing is cmplete, the data in the temprary table (datasurcepdi) is ready t be analyzed. The prcedure is such: 4. The Year and Quarter are cnfirmed fr the surce data. 5. The queries* are run fr all 5 PDIs, ppulating the apprpriate Analyzed Data Table. Each PDI has an assigned Analyzed Data Table (PDI_14_Num, PDI_15_Num, PDI_16_Num, etc) a. While running the analytical queries, the system als adds a clumn (AGECATEGORY) and sets the Age Categry based n the patient age. b. Fr all PDIs, cases are excluded if the Admissin Surce shws it was a transfer frm anther institutin/hspital. c. Fr all PDIs cases are excluded if the Age is mre than 17 years. 6. The frnt-end website is nw ready t access the newly entered and analyzed data. *T view the actual analytical queries used, please refer t Appendix D (Analytical Queries) Nte: The Data Prcessing / Data Analysis cycle is repeated fr all Year/Quarter data surce files. 31

WebSite (healthdata.brhpc.rg) The website has the ability t create stratified reprts based n the PDI data. 1) The basic chices n which all reprts are based are: Cunty The chice All Cunties is available. If this is selected then extra stratifiers are made available in the Stratify by sectin. These extra stratifiers are Cunty and District. Individual Cunty. (Safety Net grup f hspitals is als available) Year Chse multiple years fr cmparisn by using the Click fr Multiple Years checkbx. Quarter Individual Year 2) Display Optins: Shw Charge infrmatin Selecting Yes will display the ttal f undiscunted charges fr services rendered by the hspital fr the cases n the reprt. The default is N. Exprtable Selecting Yes will allw yu t exprt the generated reprt data. The tw file frmats supprted fr exprt are (1) CSV/Excel (Cmma delimited) fr use with Excel, ther spreadsheet prgrams r any ther prgram that can receive a Cmma delimited file and (2) Adbe PDF frmat, suitable fr printing. Un-checking this ptin will exclude this exprt ability and will display "Paging" ptins (ie, yu can chse hw many recrds t shw per page, g directly t a page, etc. This is suitable when yu dn't want t exprt and the reprt is a very lng reprt, since it significantly increases the dwnlad speed). The default is Yes. PDI 16 & 18 issue Please nte that fr PDI-16 (Gastrenteritis) and PDI-18 (Urinary Tract Infectin) there is an issue with the AHRQ analysis requirements and the available AHCA Inpatient data. The AHRQ analysis requirements, fr PDI-16 and PDI-18, state "All nn-maternal discharges ages 3 mnths t 17 years" (ie, children 0-89 days f age need t be excluded). The AHCA data des nt have data fr the "Age in days" fr recrds indicating an Age f zer (0). Therefre, it is nt pssible t exclude recrds f children with age 29-89 days. (0-28 days f age are excluded via a Nenate exclusin) Selecting "(1) Include children 29 thrugh 89 days f age." will therefre verestimate the numeratr by including recrds fr which the age f the patient is 29 t 89 days f age. Selecting "(2) Exclude all children under 1 year f age." will therefre underestimate the numeratr by excluding recrds fr which the age f the patient is 90 t 364 days f age. Select recrds where (Patient & Hspital Cunty) Each recrd in the AHCA inpatient data has a Patient Cunty and a Facility Cunty. Recrds will be included based n the fllwing fur ptins: Using "Brward" Cunty as an example: (1) Brward Cunty residents discharged frm Brward Cunty hspitals: Include recrds fr which the Patient Cunty is Brward AND the Hspital Cunty is Brward. 32

(2) Brward Cunty hspital discharges where patient is frm anywhere: Include recrds fr which the Patient Cunty is frm anywhere AND the Hspital Cunty is Brward. (3) Brward Cunty residents discharged frm any Flrida hspital: Include recrds fr which the Patient Cunty is Brward AND the Hspital Cunty is any Cunty in Flrida. (4) Brward Cunty is the Hspital Cunty OR the Patient Cunty: Include recrds fr which the Patient Cunty is Brward OR the Hspital Cunty is Brward. (In ther wrds, cmbine all the recrds frm (2) and (3) abve and remve any duplicate recrds.) Of interest when yu want all recrds assciated with Brward Cunty regardless f whether it's Patient r Hspital Cunty. 3) PDI & Stratifiers: Individual PDIs r All PDIs can be chsen (If individual PDIs are chsen then it is required t select at least ne stratifier) All PDIs is chsen by default. Stratificatins can be dne three (3) levels deep. The available stratifiers are: Payer: Financial class (ie, hw the charges were paid) If this stratifier is selected, "Select Payer (s)?" checkbx will give the user the ability t restrict utput t ne r mre Payer types. Pssible values: Medicare Medicaid Private incl. HMO Self-Pay N charge/charity Other. Zip Cde: Zip Cde where the patient resides in. If this stratifier is selected, "Select ZipCde(s)?" checkbx will give the user the ability t restrict utput t ne r mre zip cdes r zip cde grup. Age Grup: The age grup f the patient. The age grups available are: 3 mnths 4 2 4 5 9 10 14 15 17 Hspital: The hspital f each case. If this stratifier is selected, "Select Hspital(s)?" checkbx will give the user the ability t restrict utput t ne r mre hspitals r chse a hspital grup. Gender: The gender f the patient. Pssible values: Male Female. Race: The race/ethnicity f the patient. Pssible values: White Black Hispanic Asian/Pacific Island Native American 33

Other Admsrc: The admissin surce (ie, hw did the patient first enter the hspital system). Pssible values: ER Curt/law enfrcement Rutine/Birth/Other Nte: nt available fr ED data. If All f Flrida is chsen frm the Cunty chices, the fllwing stratifiers are available: Cunty 4) Reprt Generatin District (Health Planning Cuncil Districts) The reprt is displayed via a blue windwed verlay. Once the reprt is generated the blue windwed verlay will appear with a message stating that the reprt is Lading and that the reprt is being dwnladed t yur cmputer. The length f time this message will be displayed depends n the size f the reprt and yur dwnlad speed. Once the reprt is dwnladed, it is then displayed. At the tp f the blue windwed verlay there is a descriptin f the generated reprt (Year, Cunty, Stratifiers, etc) If the ptin Exprtable was selected Yes, then at the tp right will appear a selectin f exprt types. The chices are: Excel: CSV/Excel (Cmma delimited) fr use with Excel, ther spreadsheet prgrams r any ther prgram that can receive a Cmma delimited file. PDF Wide (Letter): Adbe PDF frmat, landscape mde letter sized paper. PDF Wide (Legal): Adbe PDF frmat, landscape mde legal sized paper. PDF Letter: Adbe PDF frmat, prtrait mde letter size paper. *Fr a graphical view/example f the websites functins, please see Appendix A (Website) 34

Appendix A (Website Graphical Presentatin) * We will prduce multiple Graphical Presentatins (f reprt generatin) In rder t facilitate adding mre in the future, this has been mved t an external dcument: Hspital_Inpatient_ED_Analytical_System-Graphical_Presentatin.pdf. 35

Appendix B (Exclusins) Exclusins fr the different mdules and their data surces Data Surce: Flrida AHCA Emergency Department (ED) Patient Data Mdules: Acuity Stratificatin, Avidable - NYU Algrithm Data Surce: Flrida AHCA Inpatient Discharge Data Mdules: Preventin Quality Indicatrs, Chrnic Cnditins, Suicide Incidence Nte: Fr all Mdules, cases with different Patient Cunties and Hspital Cunties are nw included. It is up t the user, when running reprts n the website, t decide whether t exclude these cases. Mdules Preventin Quality Indicatrs Acuity Stratificatin (Emergency Department) Avidable - NYU Algrithm (Emergency Department) Chrnic Cnditins Suicide Incidence Exclusins Cases fr which the Patient Cunty (PTCOUNTY) describes ut f state/unknwn cunty f residence f the patient. Cases fr which the Gender is unknwn r nt specified are remved. Fr all PQIs, cases are excluded if the Admissin Surce shws it was a transfer frm anther institutin/hspital. Fr all PQIs, (except PQI-9) cases are excluded if the Diagnsis Related Grup (DRG) field shws pregnancy, childbirth, and puerperium r newbrn and ther nenates. Fr all PQIs, (except PQI-9) cases are excluded if the Age is less than 18 years. All recrds that d nt have ne f the fllwing 5 CPT cdes (in the CPT cde fields) are discarded. (CPT cdes: 99281, 99282, 99283, 99284, 99285) Nte: Frm these 10 CPT cde fields, the CPT cde fund with the mst severe acuity is used t categrize each patient recrd. All recrds that d nt have ne f the fllwing 5 CPT cdes (in the CPT cde fields) are discarded. (CPT cdes: 99281, 99282, 99283, 99284, 99285) Nte: Frm these 10 CPT cde fields, the CPT cde fund with the mst severe acuity is used t categrize each patient recrd. N Exclusins. See Chrnic Cnditins Mdule fr infrmatin n the specific Diagnsis Cdes used t define Chrnic Cnditins (These wuld cnstitute the inclusins) N Exclusins. See Suicide Incidence Mdule fr infrmatin n the specific E-Cdes used t define Suicide Incidence (These wuld cnstitute the inclusins) 36

Appendix C (Cde Translatins) The fllwing fields are translated in rder t match the AHRQ PQI prgram. (All Mdules fllw suit) Field AHCA Value Translated Value Race 1 2 3 4 5, 6 7, 8 5 4 2 1 3 6 Payer A, B C, D E, F, G L N H, I, J, K, M, O 1 2 3 4 5 6 Admrsc 07 04 05, 06 08 01, 02, 03, 09, 10, 11,12,13,14,15 1 2 3 4 5 Fr detailed infrmatin regarding all the fields and their pssible values, see the AHCA website: http://www.flridahealthfinder.gv/researchers/orderdata/rder-data.aspx Fr Inpatient Data Surce: Lk fr Inpatient/Psychiatric Hspital Patient Data Layut under the Data Dictinary sectin) Fr Emergency Data Surce: Lk fr Emergency Department Patient Data Layut under the Data Dictinary sectin 37

Appendix D (Analytical Queries) * Due t the physical size f the queries and the resulting large number f pages, this has been mved t an external dcument: Hspital_Inpatient_ED_Analytical_System-Analytical_Queries.pdf. 38

Appendix E (NYU ED Algrithm) Backgrund/Intrductin With supprt frm the Cmmnwealth Fund, the Rbert Wd Jhnsn Fundatin, and the United Hspital Fund f New Yrk, the NYU Center fr Health and Public Service Research has develped an algrithm t help classify ED utilizatin. The algrithm was develped with the advice f a panel f ED and primary care physicians, and it is based n an examinatin f a sample f almst 6,000 full ED recrds. Data abstracted frm these recrds included the initial cmplaint, presenting symptms, vital signs, medical histry, age, gender, diagnses, prcedures perfrmed, and resurces used in the ED. Based n this infrmatin, each case was classified int ne f the fllwing categries: Nn-emergent - The patient s initial cmplaint, presenting symptms, vital signs, medical histry, and age indicated that immediate medical care was nt required within 12 hurs; Emergent/Primary Care Treatable - Based n infrmatin in the recrd, treatment was required within 12 hurs, but care culd have been prvided effectively and safely in a primary care setting. The cmplaint did nt require cntinuus bservatin, and n prcedures were perfrmed r resurces used that are nt available in a primary care setting (e.g., CAT scan r certain lab tests); Emergent - ED Care Needed - Preventable/Avidable - Emergency department care was required based n the cmplaint r prcedures perfrmed/resurces used, but the emergent nature f the cnditin was ptentially preventable/avidable if timely and effective ambulatry care had been received during the episde f illness (e.g., the flare-ups f asthma, diabetes, cngestive heart failure, etc.); and Emergent - ED Care Needed - Nt Preventable/Avidable - Emergency department care was required and ambulatry care treatment culd nt have prevented the cnditin (e.g., trauma, appendicitis, mycardial infarctin, etc.). This infrmatin that was used t develp the algrithm required analysis f the full medical recrd. Since such detailed infrmatin is nt generally available n cmputerized ED r claims recrds, these classificatins were then mapped t the discharge diagnsis f each case in ur sample t determine fr each diagnsis the percentage f sample cases that fell int these fur categries. Fr example, patients discharged with a final diagnsis f abdminal pain may include bth patients wh arrived at the ED cmplaining f stmach pain, as well as thse wh reprted chest pain (and a pssible heart attack). Accrdingly, fr abdminal pain, the algrithm assigns a specific percentage f the visit int the categries f nn-emergent, emergent/primary care treatable, and emergent/ed care needed-nt preventable/avidable based n what we bserved in ur sample fr cases with an ultimate discharge diagnsis f abdminal pain. It is imprtant t recgnize that the algrithm is nt intended as a triage tl r a mechanism t determine whether ED use in a specific case is apprpriate (e.g., fr reimbursement purpses). Since few diagnstic categries are clear-cut in all cases, the algrithm assigns cases prbabilistically n a percentage basis, reflecting this ptential uncertainty and variatin. Since the riginal develpment f the algrithm, users have expressed an interest in examining separately cases invlving a primary diagnsis f injury, mental health prblems, alchl, r substance abuse. Accrdingly, we have pulled these cnditins ut f the standard classificatin scheme, and tabulate them separately. There are als a residual f cnditins (apprximately 15%) where ur sample was nt f sufficient size t assign percentages fr the standard classificatin - these cnditins are als tabulated separately. See the attachment fr schematic diagram f algrithm. Using the Micrsft Access 2000 Versin f the ED Algrithm The Micrsft Access versin f the ED algrithm is cntained in the fllwing files: 39

NYU ED Algrithm X.X.MDB" (X.X is the versin number this file may als have an.mde extensin)- This is the applicatin that will run under Micrsft Access 2000. (It may als run under ther versins f Access, but it has nly been tested using Access 2000.); "NYUED.HLP" Help file fr the abve applicatin. Place the tw files listed abve in the same directry n yur hard drive, pen yur cpy f Micrsft Access, G t yur File menu, select Open, navigate t the.mdb r.mde file listed abve, and pen it. All further instructins can then be accessed by pressing F1 n yur keybard. Cntext-specific help can be accessed after selected each menu chice, EXCEPT fr the "Imprt a Dataset" menu chice. T access help fr that functin, please press F1 when viewing the main menu, and then select "Imprt a Dataset" frm Help Table f Cntents. This versin f the ED algrithm requires that yur ED dataset be available in ASCII (text), Access,.DBF, r Excel frmat. (It's unlikely that yur data will be in Excel frmat, unless yu have relatively few encunter recrds, since the Excel frmat can nly cntain a limited number f recrds.) The advantage f the Access versin f the algrithm is that, in additin t prducing a micrdata (recrd-level) file (see belw), it will als prduce spreadsheets with summary recrds aggregated by zip cde, insurance status, age and gender grupings, and ther classificatin variables if available. Analyzing Micrdata (Recrd-Level) Output f all Three Versins f the ED Algrithm All three versins f the ED algrithm prgramming the Access, SAS, and SPSS versins will prduce a micrdata (recrd-level) file, with ne recrd fr each encunter recrd in yur ED database. (The Access versin additinally prduces spreadsheets with summary recrds aggregated by zip cde, insurance status, age and gender grupings, and ther classificatin variables if available.) The utput micrdata file will simply have a new set f variables in additin t yur riginal data set variables. The names f the new variables are: ne = Nn-emergent epct = Emergent/Primary Care Treatable edcnpa = Emergent - ED Care Needed - Preventable/Avidable edcnnpa = Emergent - ED Care Needed - Nt Preventable/Avidable injury = Injury principal diagnses psych = Mental health principal diagnses alchl = Alchl-related health principal diagnses drug = Drug-related health principal diagnses (excluding alchl) unclassified = Nt classified - nt in ne f the abve categries Fr each ED encunter, the numbers in the new fields represent the relative percentage f cases fr that diagnsis falling int the varius classificatin categries. Fr example, in the case f urinary tract infectins (ICD-9-CM cde 599.0), each case is assigned 66% nn-emergent, 17% emergent/primary care treatable, and 17% emergent - ED care needed - preventable/avidable. The sum f the values in the new data fields will always ttal 1, and the injury, psych, alchl, drug, and unclassified fields are always binary (equal t 1 r 0). T prfile a hspital, payr grup, zip cde area, patient type, etc., simply aggregate these values t find the ttal percentage f cases falling int each f the categries. Fr mre infrmatin n hw these categries were cnstructed, please cnsult the articles n ur website, at http://www.nyu.edu/wagner/chpsr/index.html?p=62 40

Appendix F (Cdes - Chrnic Cnditins & Suicide Incidence) Cdes - Chrnic Cnditins Diabetes 250 Diabetes mellitus 250.0 Diabetes mellitus withut mentin f cmplicatin 250.00 Diabetes mellitus withut cmplicatin type ii r unspecified type nt stated as uncntrlled 250.01 Diabetes mellitus withut cmplicatin type i nt stated as uncntrlled 250.02 Diabetes mellitus withut cmplicatin type ii r unspecified type uncntrlled 250.03 Diabetes mellitus withut cmplicatin type i uncntrlled 250.1 Diabetes with ketacidsis 250.10 Diabetes mellitus with ketacidsis type ii r unspecified type nt stated as uncntrlled 250.11 Diabetes mellitus with ketacidsis type i nt stated as uncntrlled 250.12 Diabetes mellitus with ketacidsis type ii r unspecified type uncntrlled 250.13 Diabetes mellitus with ketacidsis type i uncntrlled 250.2 Diabetes with hypersmlarity 250.20 Diabetes mellitus with hypersmlarity type ii r unspecified type nt stated as uncntrlled 250.21 Diabetes mellitus with hypersmlarity type i nt stated as uncntrlled 250.22 Diabetes mellitus with hypersmlarity type ii r unspecified type uncntrlled 250.23 Diabetes mellitus with hypersmlarity type i uncntrlled 250.3 Diabetes with ther cma 250.30 Diabetes mellitus with ther cma type ii r unspecified type nt stated as uncntrlled 250.31 Diabetes mellitus with ther cma type i nt stated as uncntrlled 250.32 Diabetes mellitus with ther cma type ii r unspecified type uncntrlled 250.33 Diabetes mellitus with ther cma type i uncntrlled 250.4 Diabetes with renal manifestatins 250.40 Diabetes mellitus with renal manifestatins type ii r unspecified type nt stated as uncntrlled 250.41 Diabetes mellitus with renal manifestatins type i nt stated as uncntrlled 250.42 Diabetes mellitus with renal manifestatins type ii r unspecified type uncntrlled 250.43 Diabetes mellitus with renal manifestatins type i uncntrlled 250.5 Diabetes with phthalmic manifestatins 250.50 Diabetes mellitus with phthalmic manifestatins type ii r unspecified type nt stated as uncntrlled 250.51 Diabetes mellitus with phthalmic manifestatins type i nt stated as uncntrlled 41

250.52 Diabetes mellitus with phthalmic manifestatins type ii r unspecified type uncntrlled 250.53 Diabetes mellitus with phthalmic manifestatins type i uncntrlled 250.6 Diabetes with neurlgical manifestatins 250.60 Diabetes mellitus with neurlgical manifestatins type ii r unspecified type nt stated as uncntrlled 250.61 Diabetes mellitus with neurlgical manifestatins type i nt stated as uncntrlled 250.62 Diabetes mellitus with neurlgical manifestatins type ii r unspecified type uncntrlled 250.63 Diabetes mellitus with neurlgical manifestatins type i uncntrlled 250.7 Diabetes with peripheral circulatry disrders 250.70 Diabetes mellitus with peripheral circulatry disrders type ii r unspecified type nt stated as uncntrlled 250.71 Diabetes mellitus with peripheral circulatry disrders type i nt stated as uncntrlled 250.72 Diabetes mellitus with peripheral circulatry disrders type ii r unspecified type uncntrlled 250.73 Diabetes mellitus with peripheral circulatry disrders type i uncntrlled 250.8 Diabetes with ther specified manifestatins 250.80 Diabetes mellitus with ther specified manifestatins type ii r unspecified type nt stated as uncntrlled 250.81 Diabetes mellitus with ther specified manifestatins type i nt stated as uncntrlled 250.82 Diabetes mellitus with ther specified manifestatins type ii r unspecified type uncntrlled 250.83 Diabetes mellitus with ther specified manifestatins type i uncntrlled 250.9 Diabetes with unspecified cmplicatin 250.90 Diabetes mellitus with unspecified cmplicatin type ii r unspecified type nt stated as uncntrlled 250.91 Diabetes mellitus with unspecified cmplicatin type i nt stated as uncntrlled 250.92 Diabetes mellitus with unspecified cmplicatin type ii r unspecified type uncntrlled 250.93 Diabetes mellitus with unspecified cmplicatin type i uncntrlled Asthma 493 Asthma 493.0 Extrinsic asthma 493.00 Extrinsic asthma unspecified 493.01 Extrinsic asthma with status asthmaticus 493.02 Extrinsic asthma with (acute) exacerbatin 493.1 Intrinsic asthma 493.10 Intrinsic asthma unspecified 42

493.11 Intrinsic asthma with status asthmaticus 493.12 Intrinsic asthma with (acute) exacerbatin 493.2 Chrnic bstructive asthma 493.20 Chrnic bstructive asthma unspecified 493.21 Chrnic bstructive asthma with status asthmaticus 493.22 Chrnic bstructive asthma with (acute) exacerbatin 493.8 Other specified asthma 493.81 Exercise-induced brnchspasm 493.82 Cugh variant asthma 493.9 Asthma unspecified 493.90 Asthma unspecified 493.91 Asthma unspecified type with status asthmaticus 493.92 Asthma unspecified with (acute) exacerbatin Cngestive Heart Failure 428 Heart failure 428.0 Cngestive heart failure unspecified 428.1 Left heart failure 428.2 Systlic heart failure 428.20 Unspecified systlic heart failure 428.21 Acute systlic heart failure 428.22 Chrnic systlic heart failure 428.23 Acute n chrnic systlic heart failure 428.3 Diastlic heart failure 428.30 Unspecified diastlic heart failure 428.31 Acute diastlic heart failure 428.32 Chrnic diastlic heart failure 428.33 Acute n chrnic diastlic heart failure 428.4 Cmbined systlic and diastlic heart failure 428.40 Unspecified cmbined systlic and diastlic heart failure 428.41 Acute cmbined systlic and diastlic heart failure 428.42 Chrnic cmbined systlic and diastlic heart failure 428.43 Acute n chrnic cmbined systlic and diastlic heart failure 43

Hypertensin 401 Essential hypertensin 401.0 Malignant essential hypertensin 401.1 Benign essential hypertensin 401.9 Unspecified essential hypertensin AIDS 042 Human immundeficiency virus (hiv) disease 042 Excludes: Acquired immune deficiency syndrme Acquired immundeficiency syndrme AIDS AIDS-like syndrme AIDS-related cmplex ARC HIV infectin, symptmatic Asymptmatic HIV infectin status (V08) Expsure t HIV virus (V01.79) Nnspecific serlgic evidence f HIV (795.71) Cdes - Suicide Incidence E950 E9500 E9501 E9502 E9503 E9504 E9505 E9506 E9507 E9508 E9509 E951 E9510 E9511 E9518 Suicide and self-inflicted pisning by slid r liquid substances... by analgesics antipyretics and antirheumatics... by barbiturates... by ther sedatives and hypntics... by tranquilizers and ther psychtrpic agents... by ther specified drugs and medicinal substances... by unspecified drug r medicinal substance... by agricultural and hrticultural chemical and pharmaceutical preparatins ther than plant fds and fertilizers... by crrsive and caustic substances... by arsenic and its cmpunds... by ther and unspecified slid and liquid substances Suicide and self-inflicted pisning by gases in dmestic use... by gas distributed by pipeline... by liquefied petrleum gas distributed in mbile cntainers... by ther utility gas 44

E952 E9520 E9521 E9528 E9529 E953 E9530 E9531 E9538 E9539 E954 E955 E9550 E9551 E9552 E9553 E9554 E9555 E9556 E9557 E9559 E956 E957 E9570 E9571 E9572 E9579 E958 E9580 E9581 E9582 E9583 E9584 E9585 E9586 E9587 E9588 E9589 E959 Suicide and self-inflicted pisning by ther gases and vaprs... by mtr vehicle exhaust gas... by ther carbn mnxide... by ther specified gases and vaprs... by unspecified gases and vaprs Suicide and self-inflicted injury by hanging strangulatin and suffcatin... by hanging... by suffcatin by plastic bag... by ther specified means... by unspecified means Suicide and self-inflicted injury by submersin (drwning) Suicide and self-inflicted injury by firearms air guns and explsives... by handgun... by shtgun... by hunting rifle... by military firearms... by ther and unspecified firearm... by explsives... by air gun... by paintball gun... by firearms and explsives unspecified Suicide and self-inflicted injury by cutting and piercing instrument Suicide and self-inflicted injuries by jumping frm high place... injuries by jumping frm residential premises... injuries by jumping frm ther man-made structures... injuries by jumping frm natural sites... injuries by jumping frm unspecified site Suicide and self-inflicted injury by ther and unspecified means... by jumping r lying befre mving bject... by burns fire... by scald... by extremes f cld... by electrcutin... by crashing f mtr vehicle... by crashing f aircraft... by caustic substances except pisning... by ther specified means... by unspecified means Late effects f self-inflicted injury 45

Appendix G (GIS Mapping & Graphing resurces All Mdules) All mdules have the GIS mapping and graphing resurce ptin. Mapping: t enable mapping, select "Hspital" as the nly stratifier. ( Hspital is necessary because the mapping tl requires a pint n the map) While viewing the reprt, a Map it ptin will be displayed. Clicking Map It displays the ptin t view a Full-screen r Standard versin f the Map. Clicking Map It pens up the Map windw. The map is interactive. The map can be mved and zmed. Clicking the hspital pints and/r the hspital list displays the reprt infrmatin fr each hspital. The map can als be exprted t a PDF file. 46

Graphing: t enable graphing, please select at least ne stratifier. While viewing the reprt, a Graph it ptin will be displayed. Clicking Graph It displays the ptins t select the clumns t graph and the graph type. Clicking Graph It pens up the Graph windw, displaying the selected clumn in either bar r pie graph. The graph can als be exprted t a PDF file. 47