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Book Categories |
Preface | xi | |
Acknowledgments | xiii | |
Chapter 1 | Health Care Data | |
Introduction | 1 | |
People and Health Care | 2 | |
Recipients/Users/Patients | 2 | |
Providers | 3 | |
Health Care Language | 4 | |
Diagnoses | 4 | |
Treatment Protocols | 5 | |
Combinations of Diagnoses and Treatments | 5 | |
Types of Administrative Files | 5 | |
HCFA-1500 | 6 | |
Pharmacy | 6 | |
UB-92 | 6 | |
Claims and Encounters | 7 | |
Conclusion | 8 | |
Chapter 2 | Health Care Codes | |
Introduction | 9 | |
The Coding of Diagnoses | 11 | |
ICD-9-CM Diagnosis Codes | 11 | |
ICD-10-CM Diagnoses | 15 | |
Diagnostic Related Groups | 15 | |
Major Diagnostic Categories | 19 | |
The Coding of Procedures | 21 | |
ICD-9-CM Surgical Procedures | 22 | |
Level I | CPT codes | 24 |
Level II | HCPCS | 27 |
Level III | Local Codes | 28 |
Pharmacy-Specific Codes | 29 | |
National Drug Codes | 29 | |
Therapeutic Class | 30 | |
Generic Product Packaging Codes | 33 | |
Billing Codes or Revenue Codes | 33 | |
Location of Codes and Descriptors | 35 | |
ICD-9 Diagnosis Codes | 35 | |
DRGs | 37 | |
ICD-9 Surgical Procedures | 37 | |
CPT, HCPCS, and Local Codes | 37 | |
Billing or Revenue Codes | 37 | |
Short Example of Code Usage | 38 | |
Conclusion | 39 | |
Chapter 3 | Data Forms, Layouts, and Files | |
Introduction | 41 | |
Data Forms | 42 | |
HCFA-1500 | 42 | |
Pharmacy | 45 | |
UB-92 | 45 | |
Data Layouts | 49 | |
HCFA-1500 File Layout | 50 | |
Pharmacy File Layout | 52 | |
UB-92 File Layout | 52 | |
Data Files | 53 | |
Source Data Format | 53 | |
HCFA-1500 Data File | 53 | |
Pharmacy Data File | 54 | |
UB-92 Data File | 55 | |
Data in Other Formats | 56 | |
Conclusion | 57 | |
Chapter 4 | Reading the Data | |
Introduction | 59 | |
Step 1 | Write the SAS Code | 60 |
Reading the Variables | 62 | |
Step 2 | Test the Code | 65 |
Step 3 | Correct the Code | 66 |
Diagnoses (Dx) and Solutions (Rx) to the Errors | 67 | |
Step 4 | Re-Test the Code | 68 |
Step 5 | Check the Results | 69 |
Printing the Data | 70 | |
Diagnoses (Dx) and Solutions (Rx) to the Errors | 70 | |
Step 6 | Correct the Code | 71 |
Diagnoses (Dx) and Solutions (Rx) to Missing Dates | 71 | |
Creating User-Defined Formats and Informats | 72 | |
Step 7 | Check the Results | 73 |
Step 8 | Enhance the Code | 73 |
Comments | 73 | |
The LENGTH Statement | 74 | |
The FORMAT Statement | 75 | |
Variable Labels | 75 | |
Pharmacy Files: New ideas | 76 | |
UB-92 Files: New Ideas | 77 | |
ARRAY Statements | 77 | |
Conditional Selection upon Input | 79 | |
Putting It All Together | 81 | |
Reading SAS Data Sets | 82 | |
Data in Other Formats | 83 | |
Working with Data and Files across Years | 84 | |
Conclusion | 85 | |
Chapter 5 | Validating the Data | |
Introduction | 87 | |
The Data Content | 88 | |
The CONTENTS Procedure | 89 | |
Viewing the Data | 90 | |
Quantity: Volume of Data | 92 | |
Services | 94 | |
Visits | 95 | |
Users | 97 | |
Selected Populations or Sub-groups | 97 | |
Discharges and Stays | 100 | |
Charges and Payments | 102 | |
Quantity: Completeness | 102 | |
Frequencies | 103 | |
Frequency of Missing Values | 104 | |
Dates | 105 | |
Numeric Fields | 106 | |
Quality: Accuracy | 108 | |
Chart Review | 108 | |
Frequency of Codes | 108 | |
Two-Way Tables | 110 | |
Means | 111 | |
Comparative Data Sources | 112 | |
Quality: Clinical Relevance | 113 | |
Conclusion | 113 | |
Chapter 6 | Manipulating the Data | |
Introduction | 116 | |
Operators | 116 | |
Missing Values | 118 | |
Exclusion of Selected Observations | 118 | |
Calculations | 119 | |
Date Formats and Functions | 120 | |
The MDY Function | 120 | |
The TODAY Function | 120 | |
Parsing Dates | 121 | |
Date Formats | 121 | |
Numeric Functions | 122 | |
The INT Function | 122 | |
The TRUNC and ROUND Functions | 123 | |
Character Functions | 123 | |
The COMPRESS Function | 124 | |
The DEQUOTE Function | 124 | |
The SUBSTR Function | 125 | |
The SCAN and INDEX Functions | 125 | |
The CONTAINS Operator in Where Statements | 126 | |
The COLON Operator Modifier | 127 | |
Other Character Functions | 129 | |
Creating new variables | 129 | |
Character-to-Numeric Recording | 130 | |
Numeric-to-Character Recoding | 131 | |
More about Formats | 132 | |
Stratification and Aggregation | 132 | |
Subset and Selection | 133 | |
Reporting Options | 134 | |
Transforming Data Sets | 135 | |
Using Arrays | 137 | |
PROC TRANSPOSE | 139 | |
More Macros | 139 | |
Conclusion | 141 | |
Chapter 7 | Combining the Data | |
Introduction | 143 | |
Data Structures and Terminology | 144 | |
Concatenation and Appending | 145 | |
Study Design | 145 | |
Concatenation: The Set Statement | 146 | |
Appending | 147 | |
Interleaving | 150 | |
Merging Data | 153 | |
One-to-One Match Merge | 153 | |
Many-to-One Match Merge | 158 | |
Many-to-Many Match Merge | 159 | |
Other Types of Merges | 165 | |
Conclusion | 165 | |
Chapter 8 | Analysis and Reporting: The Basics | |
Introduction | 167 | |
Basic Statistical Concepts | 168 | |
Variable Types | 168 | |
Independent versus Dependent | 169 | |
Population versus Sample | 170 | |
The Normal Distribution | 171 | |
SAS Procedures | 171 | |
Descriptive Statistics | 172 | |
Measures of Central Tendency | 173 | |
Measures of Variability | 173 | |
Useful Procedures | 174 | |
Prescription for Use | 179 | |
Data Summarization | 179 | |
Summary Statistics | 179 | |
Row and Column Totals | 184 | |
Other Useful Procedures | 187 | |
Prescription for Use | 187 | |
Analytics | 187 | |
Measures of Association | 188 | |
Comparing Population Means | 189 | |
Other Useful Procedures | 190 | |
Prescription for Use | 191 | |
Information Presentation | 192 | |
Tables | 192 | |
Plots, Charts, and Maps | 194 | |
Other Useful Procedures | 196 | |
Prescription for Use | 196 | |
Conclusion | 196 | |
Chapter 9 | Case Study | |
Introduction | 198 | |
Study Design | 198 | |
Data Files | 199 | |
Initial Analytic Steps | 201 | |
Identification of ER visits | 201 | |
Preliminary Steps | 202 | |
Demographic Field Identification | 202 | |
Algorithm for Age Calculation | 202 | |
Formatting Specifications | 203 | |
Other Key Points | 203 | |
Comparative Frequencies | 203 | |
Study Design Modifications | 205 | |
SAS Programs | 205 | |
Step 1 | Identify Format Library and Create New Formats | 206 |
Step 2 | Build SAS Macros to Access Different Years | 206 |
Step 3 | Sort and Subset the Physician Claims Files | 206 |
Step 4 | Sort and Subset the Outpatient Claims Files | 208 |
Step 5 | Merge the Claims Files and Enrollment Files | 208 |
Step 6 | Summarize the Claims Dollars | 209 |
Step 7 | Create a Data Set to Store Charges | 210 |
Step 8 | Sort to Unduplicate Dates in Claims Files | 211 |
Step 9 | Merge the Visit Data Sets | 211 |
Step 10 | Produce a Report of Top 20 Diagnoses | 212 |
Step 11 | Produce Summarized Tables | 213 |
Step 12 | End the SAS Macro and Pass the Parameters | 213 |
Results | 214 | |
Output Data Sets | 214 | |
More about_TYPE_ | 215 | |
Tables | 216 | |
Graphs | 217 | |
Further Studies | 220 | |
Conclusion | 221 | |
Chapter 10 | The Future of Health Care Data | |
Introduction | 223 | |
Future Information Flow | 224 | |
HIPAA: Electronic Data Transmittal | 224 | |
Standard Formats | 225 | |
Electronic Data Submissions | 227 | |
National Provider Identifier (NPI) | 227 | |
Electronic Death Registration Systems (EDRS) | 227 | |
Future Coding Systems | 228 | |
ICD-10 | 228 | |
Current System: New Initiatives | 230 | |
ICD-10-CM and ICD-10-PCS | 230 | |
Future Technology | 230 | |
Internet Health Care | 230 | |
Medical Records Privacy | 231 | |
Future Health Care Economics | 231 | |
Risk Adjustment | 232 | |
Some Predictive Models | 233 | |
HEDIS | 234 | |
Pharmacy-Based Models | 234 | |
AIDS Risk Adjustment | 234 | |
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