2011 VIReC Database and Me

Cyber Seminar Series

RESEARCHERS’ GUIDE TO VA DATA
2011 VIReC Database and Methods Cyber Semina

Assessing VA Health Care U

Outpatient

October 3, 2011

Presented by:

Denise M Hynes MPH PhD RN Denise M. Hynes, MPH, PhD, RN

RESEARCHERS’ GUIDE TO VA DATA
Ac o edge e ts knowledgements

VIReC is a Health Services Research aDevelopment Service (HSR&D) ResouCenter funded by HSR&D Grant SDR 9VIReC staff contributing to the presentation materi

– Denise M. Hynes, PhD, MPH, RN– Kevin Stroupe, PhD– Bill Conway MS Tom Haywood MPH Bill Conway, MS, Tom Haywood, MPH, Puling Zh

Puling Zh

RESEARCHERS’ GUIDE TO VA DATA
Sess o Object es Session Objectives

H h t ti t h lth tiHow has outpatient healthcare utibeen measured in VA studies?Overview of Medical SAS OutpatiendatabasesFinding p information in the OutpatieMedical SAS databasesExamples of VA studies that have uthe Outpatient Medical SAS databaWhere to go for more help

RESEARCHERS’ GUIDE TO VA DATA
Sess o Object es Session Objectives

How has outpatient healthcare utilbeen measured in VA studies?O i f M di l SAS O t ti Overview of Medical SAS OutpatiendatabasesFinding information in the OutpatieMedical SAS databasesExamples of VA studies that have uthe Outpatient Medical SAS databaWhere to go for more help

RESEARCHERS’ GUIDE TO VA DATA
How has outpatient healthcare utilization 

measured in VA studies?:

Categories of outpatient provider car

H if oma ar, H darwoo

d,

Wagner, Brenner. Desc pt o o outpat e t ription 

of outpatie

n

t

utilization and costs in group of veterans with traumatic brain injury traumatic brain injury. J of Rehab R&D. 2009; 46 (8): 1003-1010.Outpatient utilization in f t i f four ca

tegories

of 

provider care used as an outcome

RESEARCHERS’ GUIDE TO VA DATA
How has outpatient healthcare utilization 

measured in VA studies?:

Use of Depression and PTSD Diagnos

Ch Ch dl R ib t Chan, Cheadle, R

eiber,

et 

al. Health care utilization a d ts costs o n

d its costs for 

depressed veterans with and without comorbid PTSD symptoms PTSD symptoms.Psychiatric Services. 2009; 60 (12): 1612-1617.Out

patient utilization in 

two categories of provider care used as an outcome

RESEARCHERS’ GUIDE TO VA DATA
How has outpatient healthcare utilization 

measured in VA studies?:

Veteran and non-Veteran Status

Frayne Yano NguFrayne, Yano, NguGender disparities Veterans Health Administration caimportance of accf t t t for ve

teran

s

t

a

tus

Care. 2008;46:54Outpatient primarutilization as predVeteran status, geeli

gibilit

y

RESEARCHERS’ GUIDE TO VA DATA

g y
How has outpatient healthcare utilization 

measured in VA studies?:

Colorectal cancer screening identifie

W lt Li d i t W

alter, Li

n

dquis

t,

Nugent, et al. Impact of age a d co o b d ty o a

n

d co

m

o

r

bidity

on 

colorectal cancer screening among older veterans veterans. Ann Intern Med. 2009;150:465-473.OP utilization used in cohort selection and also as di t i bl a predi

c

tor variabl

e

RESEARCHERS’ GUIDE TO VA DATA
How has outpatient healthcare utilization 

measured in VA studies?:

H if oma ar & ll co eagues

– Counts of Encounters– Primary Care Psych/SUD Rehab Othe

Primary Care, Psych/SUD, Rehab, Othe

Chan & colleagues 

– Diag oses n– Depression/PTSD, Depression w/o PTSD

Frayne & colleagues 

– Veteran status

(Veteran and Non-veter

Walter & colleagues 

– P d roce

dures

(C l l i ) C

olorectal screening

)

RESEARCHERS’ GUIDE TO VA DATA
Sess o Object es Session Objectives

H h t ti t h lth tiHow has outpatient healthcare utibeen measured in VA studies?Overview of Medical SAS OutpatiendatabasesFinding p information in the OutpatieMedical SAS databasesExamples of VA studies that have uthe Outpatient Medical SAS databaWhere to go for more help

RESEARCHERS’ GUIDE TO VA DATA
Aud e ce i n Poll

What is your PRIMARY interest in attending tod’ i? ay s session?

VA Research; VA Other; Non-VA ResearchNon-VA Other

How would you rate your overall knowledge VA Outpatient data?

1 (Never Used); 2; 3;4; 5 (Used Frequently, Very familiar)

RESEARCHERS’ GUIDE TO VA DATA
Two Groups of 

M di l SAS D t t Medical SAS D l SAS Datasets

Inpatient Care SAS DatasetsOutpatient Care SAS Datasets

– Frequently referred to as

• OPC (Outpatient Clinic File) or

• NPCD (National Patient Care Database• PCE (Patient Care Encounter)• MedicalSAS Outpatient Datasets

– Records generated for each encounter f

ambulatory y care and ancillary services 

recorded in VISTA

RESEARCHERS’ GUIDE TO VA DATA
VA Outpatient Data Flow 

t th M di l SAS D t t t

o th

e M

edical SAS D l SAS D

a

tase

t

s

RESEARCHERS’ GUIDE TO VA DATA
VA Medical SAS Outpatient Data

Datasets at AITC are named: MDPPRD.MDP.SAS.XXyy

XX th t l tt f d b l 

File Reference Reference Dates

XX

= th

e two l

etter re

ference co

d

e b

elow; yy

= 

Visit SF 1980 SF 1980 - pres

pres

Event SE 1998 – presInpatient IE 2005 - presEncounters IE 2005 Diagnosis Diagnosis SG 1997 – 200Procedure Procedure SC 1990 - 200

RESEARCHERS’ GUIDE TO VA DATA
Clinic Stops

Clinics are identified using Clinic S

Clinic S

Codes also called DSS Identifiers. also called DSS Identifiers.

RESEARCHERS’ GUIDE TO VA DATA
Clinic Stops

Clinic stops identified using two clinicodes

– Primary Clinic Stop Code (CL)

• Used to identify the production units or the 

centers for outpatient care

– Secondary Clinic Stop Code (CLC)

• Further sp ,, 

ecifies the team, service, or fund

Examples: 116714 Respiratory Therapy 

116329 Respiratory Therapy 

CL CLC

RESEARCHERS’ GUIDE TO VA DATA
Clinic Stops

Another clinic stop code example

– 323117 Primary Care/MED, Nursing (2nd Only)

– 323185 Primary Care/MED, Phys Extnd NP (Nrs 

– 323187 Primary Care/MED, Phys Extnd CNS (C– 323710 Primary Care/MED, Flu/Pneumococcal 

CL CLC

RESEARCHERS’ GUIDE TO VA DATA
Outpatient Outpatient Visit File (SF)File (SF)

Each Record =One day’s encounter(s) for a patient at a One record per visitUp to 15 primary clinic stops per vis

(CL1-CL15)

No diagnosis or procedure informati

RESEARCHERS’ GUIDE TO VA DATA
Outpatient Outpatient Visit File (SF)File (SF)

Top 5 Primary Clinic Stop values from million records in FY2009 Visit file:

Primary Clinic 

Stop Code 

Values %

108 Laboratory 18323 Primary Care/Med 17502 Mental Health-IND 4103 Telephone Triage 4147 Telephone/Ancillary 3

RESEARCHERS’ GUIDE TO VA DATA
Outpatient Outpatient Event (SE) File(SE) File

One record per clinic stop No limit on number of encounter recper dayCombines diagnostic and procedural in one dataset

RESEARCHERS’ GUIDE TO VA DATA
Outpatient Outpatient Event (SE) File(SE) File

ICD-9 Codes: Up to 10 diagnoses perecordCPT-4 Codes: 

– Until FY2003: 15 procedures, no repeats – Since FY2004: 20 proced 

ures, repetition 

Since FY2003 Encounter ID Since FY2003, Encounter ID 

– Links Event dataset with HERC Outpatien

Average Cost Dataset

RESEARCHERS’ GUIDE TO VA DATA
Outpatient Outpatient Event (SE) File(SE) File

One Secondary Clinic Stop per record Top 5 in first 3 million records in FY2Event file:

Secondary Clinic 

Stop Code 

Values %

(N ) one 70

117 Nursing (2nd only) 7125 Social Work SVC 3185 Phys Extnd NP (NRS 

PRCNR) 2nd

3

160 Clinical Pharmacy 2

RESEARCHERS’ GUIDE TO VA DATA
Visit vs. Event File

Visit

P ti t’ O t ti t P

atient’

s O

u

tpatient 

Clinic Stops during 

One Day

Primary Care Ophthalmology 

Clinic Stop Clinic Stop 

Event Event 
Data Element Examples: Visit vs. Eve

Event 

Variables

Visit 

Variables

Sh d

 (Up to 15) Primary Clinic 

Stop Codes

 SCRSSN

 Primary & 

Clinic St

P id 

Share

d

Variables

Stop Codes

 Religious preference Military period 

of service

 Date of encounter  VA Facility ID  Patient demographics

 Purpose of Visit 



Provider 

 Procedur Primary 

Diagnos

 Purpose of Visit  Means Test Indicator Patient eligibility 

code

Diagnos(ICD-9- 

 VA Appo Type of S

 H l 

omeles
Inpatient Encounters File

Patients in this file had an encounone of the VHA outpatient clinics th h d i ti t t t they h

ad an inpatient 

s

t

a

tus.

Patients with Inpatient Status, e.

– hospital– nursing home– domiciliary

RESEARCHERS’ GUIDE TO VA DATA
Inpatient Encounters File (IE

The Inpatient Encounters file excludservices that are included in the Outpatient Events files. Data are available beginning in FY20

RESEARCHERS’ GUIDE TO VA DATA
Inpatient Encounters File: 

S l t D t El t S

elect D

a

t

a Elemen

t

s

 SCRSSN Date of encounter  VA Facility ID Date and Time of inpatient stay admis Patient Demographics M T I di Means Test I

ndicator

 Patient eligibility code

 Primary & Secondary Clinic Stop Code Provider Type & ID Procedure codes (CPT

-4)

 Primary & Secondary ICD-9-CM Diagno

codes

RESEARCHERS’ GUIDE TO VA DATA
Inp ( atient Encounters File atient Encounters File (IE

One Primary and one Secondary ClinTop 5 Primary Clinic Stops in first 3 records in FY2009 Inpatient Encoun

Primary Clinic 

Stop Code 

Values %

105 X-Ray 13166 Chaplain-IND 9202 Rec Therapy Services 8205 Physical Therapy 8116 R it esp ratory Therapy 6

RESEARCHERS’ GUIDE TO VA DATA
VA Outpatient Diagnosis (SG) a

P d (SC) Fil Proce

dure (SC) Fil (SC) Files

Outpatient Diagnosis Dataset (SG)

– Contains outpatient ICD-9-CM diagnosis 

information

Outpatient Procedure Dataset (SC)

– Contains CPT-4 outpatient procedure inf

The VA Outpatient Diagnosis (SG) and Procedure (SC) Datasets were discontiFY2001. 

– The information contained in these datasets 

f ld d i t th E t (SE) d t t d l t fold

ed i

n

t

o th

e Event (SE) d

a

taset and l

a

ter 

in the Inpatient Encounters (IE) dataset

RESEARCHERS’ GUIDE TO VA DATA
Sess o Object es Session Objectives

H h t ti t h lth tiHow has outpatient healthcare utibeen measured in VA studies?Overview of Medical SAS OutpatiendatabasesFinding p information in the OutpatieMedical SAS databasesExamples of VA studies that have uthe Outpatient Medical SAS databaWhere to go for more help

RESEARCHERS’ GUIDE TO VA DATA
Assessing Outpatient Healthcare 

Fi di i f i Fi

nding i

n

f

o i

n O ti t upatien

t M di l SAS D 

M

edical SAS D l SAS D

a

Where do I find Emergency Departcare?

– Data relevant to Emergency Departmen

are located in the Outpatient files.

• Before 2007: Clinic Stop Code:

– 101102

• Since 2007: Primary Clinic Stop Codes 

– 130xxx [Emergency]

– 131xxx [Urgent Care]

RESEARCHERS’ GUIDE TO VA DATA
Assessing Outpatient Healthcare 

Finding info in Finding info in Oupatient Oupatient Medical SAS Da

Medical SAS Da

If an inpatient was admitted througER, how do you identify that it is an admission?

– VHA has no flag for patients admitted to 

inpatient stay from ER.

– R h d t t ti 

Researc

hers need t

o compare ou

tpatien

encounter visit dates to inpatient admisdate to determine if in

p y atient sta

ys follo

visit. 

RESEARCHERS’ GUIDE TO VA DATA
Assessing Outpatient Healthcare 

Finding info in Outpatient Medical SAS Da

How do I determine Outpatient Diag

– Up to 10 diagnosis (ICD-9) codes per re

• DXLSF 

= P i Di i f t P

rimary Diagnosis for encoun

t

e

• DXF2 – DXF10 = Secondary diagnoses

– Located in:

• Outpatient Event (SE) Dataset

– D t il bl f 1997 t t D

a

t

a avail

abl

e from 1997 t

o presen

t

» only 15% of records in FY99 contained a DXF2

• Inpatient Encounters (IE) Dataset

– D t il bl f 2005 t t D

a

t

a avail

abl

e from 2005 t

o presen

t

RESEARCHERS’ GUIDE TO VA DATA
Assessing Outpatient Healthcare 

Finding info in Outpatient Medical SAS Da

Outpatient Diagnoses (cont)

Top 5 DXLSF in first 3 million record2009 E t fil 2009 Event fil

e

DXLSF Values

%

30981 Post traumatic stress

disorder

5

4019 Essential Hypertension 

4

Unspecified

V6540 Other counseling NOS 4

25000 Diabetes Mellitus

4

V6549 Other specified counseling 3

RESEARCHERS’ GUIDE TO VA DATA
Assessing Outpatient Healthcare 

Finding info in Outpatient Medical SAS Da

How do I identify Outpatient Proced

– Outpatient services and procedures perfo

a provider recorded with CPT-4 codes.

• Variable Names: CPT1 – CPT20

–Located in 

• Outpatient Event (SE) Dataset• In

p ( atient Encounters 

(IE

) Dataset 

* Inpatient procedures in the Medical SAS I

Datasets are recorded with ICD-9 procedcodes.

RESEARCHERS’ GUIDE TO VA DATA
Assessing Outpatient Healthcare 

Finding info in Outpatient Medical SAS Da

Outpatient Procedures (cont)

Top 5 CPT1 of first 3 million records 2009 Event file

CPT1 Values

99213 Moderate severity OP visit for 

established pt 

7

98966 Telephone assessment by non-physician 799211 Minimal severity OP visit for established 

pt 

5

85025 CBC 499214 High severity OP visit for established pt 4

Note: no VA format library for CPT codes

RESEARCHERS’ GUIDE TO VA DATA
Assessing Outpatient Healthcare 

Finding info in Outpatient Medical SAS Da

How are provider types identified in the outpatient datasets?

– Physician Specialty recorded using CMS 

Provider Classification System. • Variable Name: PROV1

–PROV10

– Located in

• Outpatient Event (SE) Dataset• Inpatient Encounter (IE) Dataset 

RESEARCHERS’ GUIDE TO VA DATA
Assessing Outpatient Healthcare 

Finding info in Outpatient Medical SAS Da

Provider Types (cont)

T 5 P id T 

1st 3 d i FY 

Finding info in Outpatient Medical SAS Da

Top 5 Provider Types

1st

3

m recor

d

s i

n FY 

Event file :

Provider Values

%

Types

181000 Internal Medicine 15

070900 Registered Nurse

8

115500 Resident

4

010100 Clinical Social Worker

3

Please see VIReC’s MedSAS Outpatient ReUser Guide:

180700 Family Practice

3

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

l-SAS-Datasets/MedSAS-Outpt-RUG/MedSAS-RUOutpt09er pdf

RESEARCHERS’ GUIDE TO VA DATA

Outpt09er.pdf
Sess o Object es Session Objectives

H h t ti t h lth tiHow has outpatient healthcare utibeen measured in VA studies?Overview of Medical SAS OutpatiendatabasesFinding p information in the OutpatieMedical SAS databasesExamples of VA studies that have uthe Outpatient Medical SAS databaWhere to go for more help

RESEARCHERS’ GUIDE TO VA DATA
Research Example I:

F Y N t l M d C 2008 46 Frayne, Yano, Nguyen, et al. Med Care. 2008;46

This study detewhether gendedifferences in uand cost of VHA chang 

e after ac

for veteran vs veteran status.

RESEARCHERS’ GUIDE TO VA DATA
Research Example I:

F Y N t l M d C 2008 46 Frayne, Yano, Nguyen, et al. Med Care. 2008;46

This study y conducted a cross sectional analyVHA users in 2002. There were 4,429,414 VHA users

– 4 122 381 veterans 4,122,381 veterans 

• 178,849 women• 3,943,532 men

– 307,033 nonveterans

• 183,722 women (50.7% of female VHA use

• 123,311 men (3.0% of male VHA users)

Because some nonveteran groups have low and costs conclusions about gender dispariand costs, conclusions about gender disparisubstantially when veteran status is taken iaccount.

RESEARCHERS’ GUIDE TO VA DATA
Research Example I:

F Y N t l M d C 2008 46 Frayne, Yano, Nguyen, et al. Med Care. 2008;46

Methods:

Data Sources - Utilization

Data on inpatient and outpatient utilization werthe Medical SAS Datasets

– Outpatient primary care was determined from VA 

codes

Healthcare costs were determined from HERC PLevel DatasetVA healthcare eligibility was determined from ecode in outpatient data

– Non-veteran eligibility categories included: CHAM

TriCare, Employee, Collateral, Sharing

RESEARCHERS’ GUIDE TO VA DATA
Research Example I:

Frayne Yano Nguyen et al Med Care 2008;46:5Frayne, Yano, Nguyen, et al. Med Care. 2008;46:5

Results

RESEARCHERS’ GUIDE TO VA DATA
Research Example I:

Frayne Yano Nguyen et al Med Care 2008;46Frayne, Yano, Nguyen, et al. Med Care. 2008;46

Results

RESEARCHERS’ GUIDE TO VA DATA
Research Example II:

Walter, Lindquist, Nugent, et al. Ann Int Med. 2009;1

This HSR&D IIR studied how cliutilization (and predictor variaaffect overall col t l 

lorectal scree

use

RESEARCHERS’ GUIDE TO VA DATA
Research Example II:

Walter Lindquist Nugent et al Ann Walter, Lindquist, Nugent, et al. Ann Int Med 2009;1

Med. 2009;1

This study identified a cohort of the patientmedi l ca centers

w

h

o were screen-eli ibl 

li

gibl

e o

– Age 70 or older– At least 1 outpatient visit at one of the 4 

Centers from 1/1/2001 to 12/31/2002

– At least 1 VA healthcare system outpatien

Medicare outpatient visit in CY2000 (to mcomorbidity)

27,068 screen-eligible patients identified

– 10 091 age 70 10,091 age 70

-74

– 10,234 age 75-79– 6 743 age 

≥ 80

RESEARCHERS’ GUIDE TO VA DATA

–

6,743 age 

≥ 80
Research Example II:

Walter, Lindquist, Nugent, et al. Ann Int Med. 2009;1

Data sources included OP MedicalSAIP MedicalSAS data, Fee Basis FilesMedicare claims, Vital Status File Outcome measures

– Colorectal screening within 2 years– 5-year mortality

RESEARCHERS’ GUIDE TO VA DATA
Research Example II:

Walter Lindquist Nugent et al Ann Walter, Lindquist, Nugent, et al. Ann Int Med 2009;1

Med. 2009;1

Methods: Data Sources - Utilization

Predictor variables included number outpatient visits during the 2-year screening interval

– Gastroenterology clinic– General surgery clinic– General medicine

• Primary care• C di l ar

ology

• Endocrinology• Diabetes

• Hypertension• Pulmonary

RESEARCHERS’ GUIDE TO VA DATA

• Women’s Clinic 
Research Example II:

Walter, q ,g, Lindquist, Nugent, et al. Ann Int Med. 2009;1

Results

From Table 2: Two-Year Cumulative Colo ectal Cance Colorectal CancerScreening Incidence Among Persons 70 Years or Older, by Patient Characteristic

RESEARCHERS’ GUIDE TO VA DATA
Sess o Object es Session Objectives

H h t ti t h lth tiHow has outpatient healthcare utibeen measured in VA studies?Overview of Medical SAS OutpatiendatabasesFinding p information in the OutpatieMedical SAS databasesExamples of VA studies that have uthe Outpatient Medical SAS databaWhere to go for more help

RESEARCHERS’ GUIDE TO VA DATA
VIReC Help

VIReC Webpage

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

– Information on VA data sources and how 

access data

– Documentation on some VA datasets, i.e.

Medical SAS datasets:

• http://www virec research va gov/DataSo

http://www.virec.research.va.gov/DataSoe/Medical-SAS-Datasets/SASdocumentatio

• http://vaww.virec.research.va.gov/DataSo

me/M di l /Medical-SAS-D t t /M dSAS Datasets/MedSAS-Ott u p -RUG/Refs/Refs-Outpt09.pdf

• Includes lists of variables and their datase

locations

– Descriptions of each of the variables– Values for selected variables

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

HSRData Listserv

– Join at the VIReC Web site 

(requires valid “va.gov” email address)

– Discussion among research data users

stewards, managers

– Past messages in archive

VIReC Help Desk

– VIReC staff will answer your question a

direct you to available resources on to

– VIReC@va.gov– (708) 202-2413

RESEARCHERS’ GUIDE TO VA DATA

( )
Data ccess o at o Access Information

Using Data at the Austin InformatioTechnology Center

– http://www virec research va gov/index 

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

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

ning-NewUsersToolkit/UsingDataAAC.ht

RESEARCHERS’ GUIDE TO VA DATA
Selected Recent References o

Measuremen easurement f VA O t ti t 

t 

of VA O

u

tpatient 

Chan, D., Cheadle, A. D., Reiber, G., Unutzer, J., Chaney, E. F. (2009). Health carcosts for depressed veterans with and without comorbid PTSD symptoms. Psych(12) 1612 (12), 1612-1617.Singh, J. A., Sloan, J. (2009). Higher comorbidity, poor functional status and higutilization in veterans with prevalent total knee arthroplasty or total hip arthrop28, 1025-1033.Sin

g, ( ) h J. A. (2009). Discordance between sel

f-re

p py g ort of 

p

h

ysician dia

gnosis and 

diagnosis of arthritis and its predictors. J of Rheum. 36(9), 2000-2008.Homaifar, B. Y., Harwood, J. E., Wagner, T. H., Brenner, L.A. (2009) Description utilization and costs in group of veterans with traumatic brain injury. J of Reha

1010.

Frayne S M Yano E Frayne, S. M., Yano, E. M Nguyen V Q Yu W ., Nguyen, V. Q., Yu, W., Ananth, L Chiu V Y L., Chiu, V. Y., Phibbs, disparities in Veterans Health Administration care: importance of accounting for Care. 46, 549-553. Walter, L. C., Lindquist, K., Nugent, S., Schult, T., Lee, S. J., Casadei, M. A., PartiImpact of age and comorbidity on colorectal cancer screening among older veteMed 150 Med, 150, 465-473.Ragel, B. T., Taggard, D. A., Klimo, P., Jr., Liu, J. M., Robison, S., & Sholes, A. H. the neurosurgical caseload at a military hospital: initial experience with a joint Affairs (VA) sharing agreement. Mil Med, 174, 103-105.Kramer, B. J., Jouldjian, S., Washington, D. L., Harker, J. O., Saliba, D., & Yano, care for american I di d Indian and 

al k as

ka nati ve women.

Womens H lth I 19 Health Issues, 19, 

Safford, M. M., Brimacombe, M., Zhang, Q., Rajan, M., Xie, M., Thompson, W. et acomplexity in quality comparisons for glycemic control: An observational study. Hope, O. A., Zeber, J. E., Kressin, N. R., Bokhour, B. G., Vancott, A. C., Cramer, J. New-onset 

geriatric e

pile

p

s

y care: Race, settin

g of dia

gnosis, and choice of anti

RESEARCHERS’ GUIDE TO VA DATA

g p py , g g , 

Epilepsia.
Selected Recent References o

Measuremen easurement f VA O t ti t 

t 

of VA O

u

tpatient 

Stuck, R. M., Sohn, M. W., Budiman-Mak, E., Lee, T. A., & Weiss, K. B. (2008). Chrisk elevation in the obese diabetic population. Am J Med, 121, 1008-1014.Mohamed, S. & Rosenheck, R. (2008). Pharmacotherapy for older veterans diagposttraumatic stress disorder in Veterans Administration. Am J Geriatr PsychiatLee, T. A., Pickard, A. S., Au, D. H., Bartle, B., & Weiss, K. B. (2008). Risk for deamedications for recently diagnosed chronic obstructive pulmonary disease. Ann 380-390.

Kamalesh, M., Subramanian, U., Ariana, A., Eckert, G. J., & Sawada, S. (2008). P

postmyocardial infarction mortality among veteran women--does a sex bias exisAffairs medical system? Can J Cardiol, 24, 691-695.

Kreyenbuhl, J., Dixon, L. B., McCarthy, J. F., Soliman, S., Ignacio, R. V., & ValensDoes Adherence to Medications f f or Type 2 Diabetes Differ Between Individuals W

Schizophrenia? Schizophr.Bull. 

Fontana, A. & Rosenheck, R. (2008). Treatment-seeking veterans of Iraq and Afcomparison with veterans of previous wars. J Nerv Ment Dis, 196, 513-521.Pu

g, , h M. J., Van Cott, , ,, A. C., Cramer, J. A., Knoefel, , J. E. Amuan, , M. E. Tabares, 

 J

Trends in antiepileptic drug prescribing for older patients with new-onset epilepNeurology, 70, 2171-2178.Heisler, M., Hogan, M. M., Hofer, T. P., Schmittdiel, J. A., Pladevall, M., & Kerr, E. more is not better: treatment intensification among hypertensive patients with adherence. Circulation, 117, 2884-2892.Carey, K., Montez-Rath, M. E., Rosen, A. K., Christiansen, C. L., Loveland, S., & EUse of VA and Medicare services by dually eligible veterans with psychiatric proRes, 43, 1164-1183.

RESEARCHERS’ GUIDE TO VA DATA
Selected Recent References o

Measuremen easurement f VA O t ti t U t 

of VA O

u

tpatient Us

Anger, J. T., Saigal, C. S., Wang, M., & Yano, E. M. (2008). Urologic disease burdStates: veteran users of Department of Veterans Affairs healthcare. Urology, 72Abraham, N. S., Hartman, C., Castillo, D., Richardson, P., & Smalley, W. (2008). national provider prescription of PPI gastroprotection among elderly NSAID use

Gastroenterol, 103, 323-332.

Walbrown, M. A., Aspinall, S. L., Bayliss, N. K., Stone, R. A., Cunningham, F., Squ(2008) Evaluation of Clostridium (2008). Evaluation of Clostridium difficile-associated diarrhea with a drug formu

associated diarrhea with a drug formu

preferred fluoroquinolones. J Manag Care Pharm, 14, 34-40.Liu, C. F., Chapko, M. K., Perkins, M. W., Fortney, J., & Maciejewski, M. L. (2008)contract primary care on health care expenditures and quality of care. Med Care 

314.

Logan, W. C., Jr., Sloane, R., Lyles, K. W., Goldstein, B., & Hoenig, H. M. (2008). 

fractures in a cohort of veterans with chronic multiple sclerosis or traumatic spiArch Phys Med Rehabil, 89, 237-243.

Pugh, M. J., Rosen, A. K., Montez-Rath, M., Amuan, M. E., Fincke, B. G., Burk, M. Potentially inappropriate prescribing for the elderly: effects of geriatric care at thealth care system level. Med Care, 46, 167-173.Abrams, T. E., Vaughan-Sarrazin, M., & Rosenthal, G. E. (2008). Variations in thbetween psychiatric comorbidity and hospital mortality according to the method psychiatric diagnoses. J Gen Intern Med, 23, 317-322.Tseng, C. L., Kern, E. F., Miller, D. R., Tseng, C. L., Kern, E. F., Miller, D. R., Tiwari, A., Maney, M., Rajan, M. et al. (200

, M. et al. (200

of nephrologic care in patients with diabetes mellitus and chronic kidney diseasMed, 168, 55-62.Singh, J. A. & Strand, V. (2008). Gout is associated with more comorbidities, poquality of life and higher healthcare utilisation in US veterans. Ann Rheum Dis, 6

RESEARCHERS’ GUIDE TO VA DATA
Selected Recent References o

M t f VA O t ti t U

Frayne, S. M., Yu, W., Yano, E. M., Ananth, L., Iqbal, S., Thrailkill, A. et al. (2007). care: planning for tomorrow's Veterans Health Administration. J Womens Health (

Measuremen easurement 

of VA O

u

tpatient Us

care: planning for tomorrow s Veterans Health Administration. J Womens Health (1188-1199.Smith, B. M., Evans, C. T., Kurichi, J. E., Weaver, F. M., Patel, N., & Burns, S. P. (20respiratory tract infection visits of veterans with spinal cord injuries and disorder

risk factors. J Spinal Cord Med, 30, 355-361.

Bierman A S Pugh M J Dhalla I Amuan M Bierman, A. S., Pugh, M. J., Dhalla, I., Amuan, M., Fincke B G Rosen A et al (20

, B. G., Rosen, A. et al. (20

differences in inappropriate prescribing among elderly veterans. Am J Geriatr Pha161.Subramanian, U., Eckert, G., Yeung, A., & Tierney, W. M. (2007). A single health simportant prognostic value among outpatients with chronic heart failure. J Clin Ep811.Miller, D. R., Gardner, J. A., Hendricks, A. M., Zhang, Q., & Fincke, B. G. (2007). Heutilization and expenditures associated with the use of insulin glargine. Clin Ther, Orlando, L. A., Owen, W. F., & Matchar, D. B. (2007). Relationship between nephroprogression of chronic kidney disease. N C.Med J, 68, 9-16.Wolinsky, F. D., An, H., Liu, L., Miller, T. R., & Rosenthal, G. E. (2007). Exploring thdual use of the VHA and Medicare with mortality: separating the contributions of outpatient services. BMC Health Serv Res, 7, 70.Giordano, T. P., Henderson, L., Landgren, O., Chiao, E. Y., Kramer, J. R., El-Serag, Risk of non-Hodgkin lymphoma and lymphoproliferative precursor diseases in US hepatitis C virus. JAMA, 297, 2010-2017.Maciejewski, M. L., Perkins, M., Li, Y. F., Chapko, M., Fortney, J. C., & Liu, C. F. (20expenditures of veterans obtaining primary care in community clinics and VA medobservational cohort study. BMC Health Serv Res, 7, 56.

RESEARCHERS’ GUIDE TO VA DATA
Selected Recent References o

M t f VA O t ti t U

Berlowitz, D. R. & Pugh, M. J. (2007). Pharmacoepidemiology in community-dwantiepileptic drugs. Int Rev Neurobiol., 81, 153-163.

Measuremen easurement 

of VA O

u

tpatient Us

antiepileptic drugs. Int Rev Neurobiol., 81, 153 163.Hynes, D. M., Koelling, K., Stroupe, K., Arnold, N., Mallin, K., Sohn, M. W. et al. access to and use of Medicare and Veterans Affairs health care. Med Care, 45, 2

RESEARCHERS’ GUIDE TO VA DATA
Questions?

RESEARCHERS’ GUIDE TO VA DATA