2012 VIReC Database and Me

2012 VIReC Database and Me

Cyber Seminar Series

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
2012 VIReC Database and Methods Cyber Semina

Improving Mortality Ascertain

Using the VHA Vital Status F

August 6, 2012

Presented by:

Elizabeth Tarlov PhD RN Elizabeth Tarlov, PhD, RN

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Session Objectives

At the conclusion of the program participants will be able to: 

– Identify Identify data sources for Veteran vital s

data sources for Veteran vital s

ascertainment 

– Understand the contents and structure 

VA Vital Status Files and their appropriafor mortality ascertainment 

– D ib li it ti f i th VHA Vi

Describ

e li

mit

ations 

of using th

e VHA Vi

Status File to ascertain mortality

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Session Topics

Data sources for Veteran vital statascertainment Using VHA Vital Status Files (VSF) ascertain mortality ascertain mortality Challenges in using the VHA VSF apotential strategies for addressing potential strategies for addressing Where to go for more information 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Audience Poll

How would you rate your knowledgmethods to ascertain death dates fVeterans in the VA? 

– 1 (No knowledge)– 2– 3– 4– 5 (Expert) 

Have you ever used the VHA VSF? 

– 1 Yes, including the Master File – 2 Yes, Only the Mini File – 3 No 

RESEARCHERS’ GU RESEARCHERS IDE TO VA DATA ’ GUIDE TO VA DATA 
Session Topics

Data sources for Veteran vital statascertainment VHA Vital Status Files structure ancontents contents Challenges in using the VHA VSF Where to go for more help 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
BIRLS Death File

Veterans Benefits Administration (VBA) 

B

Id ifi 

d 

Identification and 

Recor

ds 

Locator 

Syste

database extract Information sources: 

– Family – VHA hospitals VHA hospitals – VA National Cemetery Administration – Social Security Administration (SSA) Social Security Administration (SSA) 

Coverage: Veterans known to VA U dp

d

a

tes: MM onthl

y (comple

t e overlay

)

Location: Austin Information Technology (AITC) 

RESEARCHERS’ GU RESEARCHERS IDE TO VA DATA ’ GUIDE TO VA DATA 
VA CMS Vital Status File

Received from Centers for Medicare & MeServices (CMS) annually Information sources: 

– SSA – Medicare claims – Other (e.g., family) 

Coverage: Veterans enrolled in Medicare or >=

65 years)

Updates: Annual 

– Latest creation date: December 2011 

Available from VIReC 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
SSA Death Master File

Social Security Administration Information sources: 

– Multiple incl NDI (from State VS Offices) Multiple, incl. NDI (from State VS Offices) 

Coverage: 

– Individuals enrolled in SSA program since 1

Individuals enrolled in SSA program since 1

– Includes deaths occurring outside United St– More complete for over 65 population3 

Updates: 

– Weekl

y 

– VA receives annual overlay and weekly upd

AITC 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Patient Treatment File

(NPCD/MedSAS

) 

Source of information: CPRSCoverage: Inpatient Deaths

– VA hospitals – Non-VA when covered by VA (Fee Basis) 

Updates: Monthly AITC 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
New! National Death Index

Information source: National Center foHealth Statistics (State VS offices) 

– Gold standard for death ascertainment – ~18-month lag 

Recently acquired by VA Data steward: 

VA Office of Mental Health Office of Mental Health Operations, VNational Serious Mental Illness TreatmenResource and Evaluation Center (SMITRE

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
National Death Index (cont

SMITREC NDI Data Coverage: 

– VHA inpatient or outpatient users, FY1998 

with no indication of being alive at time of 

based on VHA utilization utilization 

– OEF/OIF Roster who were VHA enrollees, e

not user 

Complete through through end of FY20I l d f d th Inclu

des cause 

of death 

Contact information below 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
DOD M t R t 

Completeness of Mortality Ascer

Using the National Death Index as gold standard: 

DOD 

Source Sensitivity1,2 Most Recent Death Datesa 

BIRLS 64-80% April, 2012 

VA CMS 83% June, 2010 

SSA 89-95% July, 2012 

PTF 5-12% July, 2011 NDIb -­ FY2009 

1 Savas, et al. (20092 Sohn, et al. (2006) 

a Based on data contained in VHA VSF built July, 2012 

RESEARCHERS’ GU RESEARCHERS IDE TO VA DATA ’ GUIDE TO VA DATA 

Based on data contained in VHA VSF built July, 2012 

b Data steward: SMITREC 
Session Topics

Data sources for Veteran vital statascertainment VHA Vital Status Files structure ancontents contents Challenges in using the VHA VSF Where to go for more help 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
s

VHA VSF Background

Impet fo de elopment of VHA 

us for development of VHA 

– Death is a common outcome measure in – Conflicting results using single data sets 

VIReC VA-NDI Mortality Data MerProject (2003, SDR 03-157)

– Recommended the creation of a new VA 

combined mortality data 

– VIReC Technical Report 2: VA-NDI Morta

Merge Project (2006) Merge Project (2006) 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
VSF Available in 2006

Owner 

– Built by National Data Systems (NDS) – First available in October 2006 

Data access information 

– See VIReC Website 

Updated quarterly Veterans known to VA Veterans known to VA 

– alive on or born after 10/1/1991 

Two files Two files 

– Master, Mini 

SSN conversion file 

RESEARCHERS’ GU RESEARCHERS IDE TO VA DATA ’ GUIDE TO VA DATA 

SSN conversion file 
-

Vital Status Master File

Veterans and non veterans One record per SSN/DOB/Sex combinationVeterans and noncombination Over 22 million records (15.8 millioSSNs) 

– 65% of SSNs have one record – 35% withmulti d ple records 

– ~1.7 million non-veteran SSNs 

112 variables 112 variables 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Vital Status Mini File

One record per SSN Combined data Combined data Over 14 million records 16 variables 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Matching Cohort to VSF

Decisions 

– Use Mini File? – Use Master File? – Match on SSN, DOB, Sex? 

• All must match • Partial match (e.g., just year and sex) 

Possible Issues 

– Demographics do not match – Activity after date of death 

• 4.8% of deaths more than 31 days after 

activity 

Understand Construction of the File 

RESEARCHERS’ GU RESEARCHERS IDE TO VA DATA ’ GUIDE TO VA DATA 

Understand Construction of the File 
Construction of the VHA V

NDS Methodology 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the VHA VSF Construction of the VHA VSF – 

VBAData

VHA

Combine Sources•One record per VHA

Data SSN/DOB/SEX

•Last Activity Dates by

Source•Inpatient Deaths

Merge on SSN/DOB/S

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the Master 

Combine VA Data Sources 

– D t f a

t

a S k 

S ources for SSN/DOB/S SSN/DOB/S ex key com

• Medical SAS Inpatient Datasets and Cen• Inpatient and Outpatient Encounter (ENC• Non-VA care or Fee Files (FEE) • DSS Pharmacy Files (DSS) • Enrollment (ENR) 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the Master 

Combine VA Data Sources (cont.) 

– Data Sources for SSN/DOB/Sex key com

( ) cont. 

• VBA Compensation and Pension Files 

– Veterans Service Network (VETSNET) Co

Veterans Service Network (VETSNET) CoMaster File (VETSNET File) 

– Compensation and Pension Mini Master F

File) phasing out File) phasing out 

– Data Contributed 

• Date of last utilization or activit

y 

• Inpatient death dates (PTF and FEE) 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the VHA VSF Construction of the VHA VSF – 

VBAData

VHAData

Combine Sources•One record perSSN/DOB/SEX•Last Activity Dates by

Source•Inpatient Deaths

Merge on SSN/DOB/S

BIRLS

CMS

SSAD th ea s

Add Death Data•DOB, Sex, & DOD

•Select ‘best’ DOD Merge on SSN Only 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the Master 

Add Death Data 

– CMS Medicare data 

• Date of last utilization • Race • Submission flag by year (CMS INDYY) Submission flag by year (CMS

_INDYY) 

– SSA Death File 

• Does not contain Sex Does not contain Sex 

– BIRLS Death File – Matched to VA data on SSN onl

y 

– Demographics (DOB and Sex) and DOD

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the Master 

Select ‘best’ date of death for each SSN

/DOB

/Sex combination 

– Select inpatient DOD if present (PTF or – See Appendix A for selection routine fro

DOD sources (Inpatient, Medicare, SSA

– Put in DOD variable on the Master File r

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the VHA VSF Construction of the VHA VSF – 

VBAData

VHAData

Combine Sources•One record perSSN/DOB/SEX•Last Activity Dates by

Source•Inpatient Deaths

Merge on SSN/DOB/S

BIRLS

CMS

SSAD th ea s

Add Death Data•DOB, Sex, & DOD

•Select ‘best’ DOD Merge on SSN Only 

MasterFile

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Structure and Contents of the Ma

One record for each VA SSN/DOB/Scombination DOB and SEX 

– One set of DOB/Sex variables for each s

VSF data 

– All VA source variables have the same D– BIRLS, MM

edi care, and SSAma

t

c

h

ed onS

and may have different DOB and/or Sex

DOD 

– From Medicare, BIRLS, Inpatient (PTF & 

and SSA and SSA 

RESEARCHERS’ GU RESEARCHERS IDE TO VA DATA ’ GUIDE TO VA DATA 
Contents of the Master Fi

Last Activity Dates 

– VA sources and Medicare – Medicare date exclusions 

• DME (durable medical equipment) and U

Carrier claims Carrier claims 

Veteran Flags 

– Based on means test variables and othe

Based on means test variables and otheveteran indicators 

– Outpatient, Inpatient, Enrollment, and Outpatient, Inpatient, Enrollment, and 

Compensation and Pension 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Contents of the Master Fi

Medicare information 

– Race – Submission flag by year (CMS_INDYY) 

• 0 = ‘Not Submitted’ • 1 ‘S b itt d/N t E ll d’ 1 

= ‘S

u

b

mitt

ed/N

ot Enroll

ed’ 

• 2 = ‘Submitted/Enrolled’ 

Quality of the date Quality of the date 

– “Indicator” – Indicates if full or partial data present in 

Indicates if full or partial data present in (e.g., month, day, and year present; onpresent, etc.) 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the VHA VSF Construction of the VHA VSF – 

VBAData

VHA

Combine Sources•One record per VHA

Data SSN/DOB/SEX

•Last Activity Dates by

Source•Inpatient Deaths

Add Death Data•DOB, Sex, & DOD

•Select ‘best’ DOD

BIRLS

CMS

SSAD th

Master

Deaths

File

Merge on SSN/DOB/S

Merge on SSN Only

One record per SSN•Select veterans•Select ‘best’ DOB,

SEX, DOD for an SSN Combine data Combine data into•Obtain Date of Last

Activity Activity for an SSN One Record Per SSN

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the Mini F

Select only Veteran records Scenario 1: One record for an SSN Master File 

– Use DOB and Sex on record – Use ‘best’ DOD on record 

Scenario 2: Multiple records for an on t

he Master File 

– Multiple DOB/Sex combinations – Select ‘best’ DOB/Sex from all records – Select ‘best’ DOD from all records 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
o e a ue o t at a ab e s ou d 

What is ‘Best’?

Use of an algorithm to select the vaa demographic variable (DOB DOD a demographic variable (DOB, DODassociated with an SSN when more o

n

e v

alue f

or 

t

hat v

ariable i

s fou

n

d 

source data Goal is to select the true value for variable in the majority of cases variable in the majority of cases 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the Mini F

Scenario 2: Multiple records for an on the Master File 

– Select ‘best’ date of birth for each SSN 

the SSN/DOB/Sex combinations

• Select best utilization DOB date ‘best’ utilization DOB date

– Based on scoring method (Score range: 0 

» Priority: PTF, Encounter, DSS, FEE » 

Extra points if if complete

dd ate, sex present

BIRLS, SSA or Medicare 

• See Appendix B for selection routine from 

sources 

(Utilization, Me

dicare, SSA, BIRL

Enrollment, VBA C&P) 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the Mini F

Scenario 2: Multiple records for an on the Master File 

– Select ‘best’ Sex for each SSN among th

SSN/DOB/Sex combinations

• Similar to selection of best DOB

– Select ‘best’ date of death among the 

SSN/DOB/Sex combinations

• Select inpatient DOD if present (PTF or F• See Appendix A for selection routine from 

(Inpatient Medicare SSA BIRLS) (Inpatient, Medicare, SSA, BIRLS) 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
s 

Construction of the Mini F

Select last activity (two dates) 

– Utilization (health care) – All activity (health care and benefits) – From all SSN/DOB/Sex combinations fo

Presumed living status 

– ‘0’: no death date – ‘1’: death date – ‘2’: death date and health care usage m

31 da afte death 31 days after death 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Construction of the VHA VSF Construction of the VHA VSF – 

VBAData

VHA

Combine Sources•One record per VHA

Data SSN/DOB/SEX

•Last Activity Dates by

Source•Inpatient Deaths

Add Death Data•DOB, Sex, & DOD

•Select ‘best’ DOD

BIRLS

CMS

SSAD th

Master

Deaths

File

Merge on SSN/DOB/S

Merge on SSN Only

One record per SSN•Select veterans•Select ‘best’ DOB,

SEX, DOD for an SSN Combine data Combine data into•Obtain Date of Last

Activity Activity for an SSN One Record Per SSN

MiniFile

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Contents of the VHA VSF Min

One record per SSN ‘Best’ DOB, Sex, DOD Last health care utilization date Last acti i d ivity 

date 

Presumed living status Presumed living status Source indicators 

– DOB, DOD, and utilization dates 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Contents of the VHA VSF Min

DOB Source 

– VSF Mini created 1/24/2011

Source Number Percent Percent

Encounter 7,631,583 54.0%

Inpatient (PTF) 3,633,420 25.7%

Medicare Vital Status 1,358,684 9.6%Enrollment 1,046,359 7.4%

VBA C&P Files 317,587 2.2%

SSA Death Master 88,459 0.6%

DSS Pharmacy 28,094 0.2%

Fee Basis 22,858 0 2%.BIRLS Death File 2,888 0.0%

Total Records 14,129,932 100.0%

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Contents of the VHA VSF Min

DOB Consistency 

– VSF Master created 12/12/2010

Records Number Total 19,869,5SSNs for Veterans 14,009,0

> 1 Gender 1.

> 1 DOB > 1 DOB 36 

. 

Conflicting DOB parts 7.

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Contents of the VHA VSF Min

DOD Source 

– VSF Mini created 1/24/2011

Source Number Percent 

Medicare Vital Status 2,474,211 5SSA Death Master 1,066,916 2

Patient Treatment File 643,239 1

Birls Death File 145,396 

Fee Basis 65,592 

Total Deaths 4,395,354 10

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Session Topics

Data sources for Veteran vital statascertainment VHA Vital Status Files structure ancontents contents Challenges in using the VHA VSF apotential strategies for addressing potential strategies for addressing Where to go for more help 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Potential Challenges

Demographics do not matchActivity after date of death Activity after date of death Examples 

– SCRSSN 11111 SCRSSN 11111 

• VSF DOB does not match patient DOB 

– SCRSSN 22222 

• Last activity date is more than two years afte

– SCRSSN 33333

•

VS O d d SF D

OB an

d sex 

do not match i O 

h patient D

OB 

and the last activity date is after the death d

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Example 1

Patient demographics: Male born 7/15/194

Master File Master File Records

SSN DOB SEX ENC DOB

ENC

SEX

ENC Last

Date PTF DOB

PTF

SEX

PTF Last

Date CMS DOB

CMS

SEX

11111 7/01/1944 M 7/01/1944 M 4/10/1992 7/01/1944 M 4/22/1992 7/15/1944 M 11111 7/15/1944 M 7/15/1944 M 9/5/2006 7/15/1944 M 

Two records for the Sfor the SSN: different N: different DOB on Encou

on Encou

One source of One source of death data: death data: CMS (Medicare)

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Example 1

Patient demographics: Male born born 7/15/1944 

Master File Master File Records

SSN DOB SEX ENC DOB

ENC

SEX

ENC Last

Date PTF DOB

PTF

SEX

PTF Last

Date CMS DOB

CMS

SEX

11111 7/01/1944 M 7/01/1944 M 4/10/1992 7/01/1944 M 4/22/1992 7/15/1944 M 

11111 7/15/1944 M 7/15/1944 M 9/5/2006 7/15/1944 M 

Mini File Record

Death data a

SSN on

SSN DOB SEX

UTL Last

Date

UTL

SRC DOD

DOD

SRC Living IND

11111 7/01/1944 M 9/5/2006 ENC 9/10/2006 CMS 1

Most recent UTL date selected ‘best’ DOB selected Dec

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Example 2

Patient demographics: Male born born 7/15/1944 

Master File Master File Records

SSN DOB SEX ENC DOB

ENC

SEX

ENC Last

Date PTF DOB

PTF

SEX

PTF Last

Date CMS DOB

CMS

SEX

22222 7/15/1953 M 7/15/1943 M 9/1/2006 7/15/1943 M 4/22/1981 7/15/1944 M 22222 8/30/1980 F 8/30/1980 F 6/12/2009 7/15/1944 M 

Two records records for the Sfor the S for the Sfor the SSN: different N: different N: different N: different DOB and sex on and sex on and sex on and sex on 

One source of One source of death data: death data: CMS (Medicar

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Example 2

Patient demographics: Male born born 7/15/1944 

Master File Master File Records

SSN DOB SEX ENC DOB

ENC

SEX

ENC Last

Date PTF DOB

PTF

SEX

PTF Last

Date CMS DOB

CMS

SEX

22222 7/15/1953 M 7/15/1943 M 9/1/2006 7/15/1943 M 4/22/1981 7/15/1944 M 

22222 8/30/1980 F 8/30/1980 F 6/12/2009 7/15/1944 M 

Mini File Record

Death data 

SSN o

SSN DOB SEX

UTL Last

Date

UTL

SRC DOD

DOD

SRC Living IND

22222 7/15/1943 M 6/12/2009 ENC 9/10/2006 CMS 2

Most recent UTL date selected Acti

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Example 3

Patient demographics: Male born born 5/31/1968 

Master File Master File Records

SSN DOB SEX PTF DOB

PTF

SEX

PTF Last

Date SSA DOB SSA DOD CMS DOB

CMS

SEX C

33333 8/30/1980 F 8/30/1980 F 5/9/2009 5/31/1968 11/18/2005 5/31/1968 M 

One Record for the Sfor the SSN

Two sourceso sources of deathof death data: CMS (Medicare) data: CMS (Medicare) 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Example 3

Master File Master File Records 

SSN DOB SEX PTF DOB

PTF

SEX

PTF Last

Date SSA DOB SSA DOD CMS DOB

CMS

SEX C

33333 8/30/1980 F 8/30/1980 F 5/9/2009 5/31/1968 11/18/2005 5/31/1968 M 

Death data ad

SSN onlSSN onl

Mini File Records

SSN DOB SEX

UTL Last

Date

UTL

SRC DOD

DOD

SRC Living IND

33333 8/30/1980 8/30/1980 F 5/9/2009 5/9/2009 ENC 11/18/2005 11/18/2005 SSA 2

Most recent UTL date selected ‘best’ DOD selected 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Points to Consider

You may find inconsistencies betweVHA VSF demographics and your codemographics demographics To resolve these inconsistencies thMaster file will be usefulVHA VSF should not be used for buVHA VSF should not be used for buoperations regarding individual vet

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
cases e a

 t t t 

Possible Strategy

Use the Mini File for the initial seardeaths 

– Match on SSN 

Use the Master File to investigate ucases,fo for example: 

– Cohort DOB/Sex do not match Mini DOB

Fil 

demographics 

• M b ay e records on theMMaster File with m

– Activity after death Activity after death 

• Check DOB/Sex for DOD sources on Mas• Are all DOD on Master File the same? 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Possible Strategy

Consider additional validation step

– Compare the DOB and Sex for the DOD 

on 

t

h M Fil h DOB d S 

e Master File to co

hort DOB and Se

deaths 

– Use the NDI or State Vital Statistics Off

Use the NDI or State Vital Statistics Offcases lost to follow up 

• No death date • No VHA or VBA activity after end of follo• Remember NDI has 18-month lag 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Future Enhancements

VIReC Data Quality Review 

– Q tif i d fli ti Quantifying 

missing and confli

cting

demographics (DOB, Sex, DOD)

– Evaluating best DOB selection methodo

Evaluating best DOB selection methodo

Medicaid Data 

– Under 65 deaths Under 65 deaths 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Session Topics

Data sources for Veteran vital statascertainment VHA Vital Status Files structure ancontents contents Challenges in using the VHA VSF Where to go for more help 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
t

Help

N ti l D t National Data Systems 

– Dorothea Garrett – Larry Hughes – Send va.gov email to VIReC@va.gov fo

VIReC Webpage 

http://www.virec.research.va.gov 

– Information on VA data sources and how 

access data 

– Documentation on some VA datasets 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Help (cont’d)

HSRData HSRData Listserv Listserv 

– Join at the VIReC Web site – Discussion among >500 data stewards

Discussion among >500 data stewardsmanagers, and users 

– Past messages in archive (on intranet) 

VIReC Help Desk 

– VIReC staff will answer your question a

direct you to available resources on to

– VIR C@ e va.gov – (708) 202-2413 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Questions?

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Upcoming Seminar

October 1, 2012 

–

“Overview of VA Data Information Syste

Overview of VA Data, Information Syste

National Databases and Research Uses” 

– Denise M. Hynes, MPH, PhD, RN 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
t

References

1. Savas LS,d del J uncoDJDJ, BB astian LA,V Vernon SW 

Mortality ascertainment of women veterans: a comparison of sources of vital status informa1979-2002. Med Care Med Care 2009 47 125 2009;47:125-128. 

2. Sohn MW, Arnold N, Maynard C, Hynes DM. Ac

and completeness of mortality data in the Depof Veterans Affairs. Popul Health Metr 2006;4

3. Hill ME, Rosenwaike I. The Social Security 

Administration Administration s Death Master File: the compl

's Death Master File: the compl

of death reporting at older ages. Soc Secur Bu2001;64:45-51. 

4. Doody MM, Chi Chi mes KK . Th i it eSSocial Security

Administration "presumed living" search. Am Health 2000;90:1948-1949. 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Appendix A

Best Date of Death for VHA Vital Status File 1. If all sources (Inpatient, BIRLS, Medicare, SSA) have a different date: 

– If complete inpatient death date present use inpatient death date ; otherwi

– If Medicare death date present and the daywas not e qual to 28, 30 , and 31

Medicare date; otherwise 

– If SSA death date present and the day is not equal to 00, 01, and 15, use t

otherwise 

– If BIRLS death date present use the BIRLS date; otherwise – If Medicare death date present and the day equals 28, 30, or 31 use the M

otherwise otherwise 

– If SSA death date present, use the SSA date. 

2. If all sources have a date and the external dates (SSA and Medicare) matched 

internal dates (Inpatient and BIRLS) matched but the external dates did internal dates, use the inpatient death date. 

3. If the external sources only had matching dates: If the s only had matching dates: 

– If an inpatient death date is present, use the inpatient death date; otherwis

– Use the external date. 

4. If the internal sources only had matching dates use the internal source. 

5. If an external source matches an internal source: 

– Use the inpatient death date if the external source matches the inpatient de

otherwise 

6. If BIRLS date is present, use the BIRLS date; otherwise 

7. If the FEE date is present, use the FEE date. 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Appendix B

Best Date of Birth for VHA Vital Status File Best Date of Birth for VHA Vital Status File 1. If all sources had a different date: 

– If a complete Utilization birth date present, use the Utilization date (highe

Utilization birth date); otherwise 

– If Medicare birth date present use the Medicare date; otherwise birth date present, use the Medicare date; otherwise – If SSA birth date present , use the SSA date; otherwise 

– If Enrollment birth date present, use the Enrollment Date 

– If BIRLS birth date present, use the BIRLS date; otherwise – If VBA (C&P Mini) birth date present, use the VBA date; otherwise 

– Use incomplete Utilization birth date. 

2. If all sources have a date and the external dates (SSA and Medicare) matched 

internal dates (Utilization, BIRLS, VBS and Enrollment) matched but the did not match the internal dates, use the internal birth date. 

3. If the external sources only had matching dates: If the external sources only had matching dates: 

– If a complete Utilization birth date present, use the Utilization date; otherw

external date. 

4. If the internal sources only had matching dates use the internal date. 

5. If an external source matches an internal source: If an external source matches an internal source: 

– Use the Utilization birth date if the external source date matches the Utiliza

otherwise 

6. If BIRLS birth date present, use the BIRLS date; otherwise 

7. 8. Use incomplete Utilization birth date. 

If VBA (C&P Mini) birth date present, use the VBA date; otherwise 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
BONUS SLIDES

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
Other Sources of Mortality D

Not Available in VA

SSA Epidemiological Search 

– Provides date of death Provides date of death – Validates SSN – Provides ‘

presumed livin

g’ status 

• Based on SSA administrative data includ

– Payroll deductions, railroad retirement or 

payments death claims filed by beneficiapayments 

, death claims filed by beneficia

• Reduce loss to follow up 

– Deaths occurrin

g outside the US 

– Fees 

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
 t t 

, , ,

VA Validation Studies

S ho n, et al “A ccuracy and l f 

completeness of mo

data in the Department of Veterans Affairs” 

– Sample of 3,000 Veterans alive on 1/1/1999, 4.8% fem– 292 deaths from 1999-2002 – Gold standard: NDI

– BIRLS, PTF, Medicare, SSA

Savas, et al “Mortality Ascertainment of WomeVeterans: A Comparison of sources of Vital StaInformation, 1979-2002” 

– 6,297 deceased women Veterans 

• Texas death certificate record 1979-2002 • US National Registry of Women Veterans US National Registry of Women Veterans 

– Gold standard: Texas mortality database– BIRLS, PTF, SSA

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
VA Validation Studies

Sensitivity by age

– % gold standard’s deaths found in sour– Sohn 

Age BIRLS SSA Combine

< 65 67 6. 91 5. 95 

65 or older 80.5 92.3 99

– Savas 

Age BIRLS SSA Combine

25-44 64.0 88.7 9345-64 76.7 93.2 97

65 or older 81.5 95.6 98

RESEARCHERS’ GUIDE TO VA DATA RESEARCHERS’ GUIDE TO VA DATA 
VA Validation Studies

Sensitivity by data source

Study SSA Medicare BIRLS PTF So

Savas 93.8 N/A 77.2 5.2 

Sohn 92 1. 83 2. 77 4. 12 0. 

Conclusions 

– BIRLS should not be used alone – All sources provide unique cases – Sensitivity decreases with age

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