Search results

Purpose. This was a Data Capacity-Building Project, to build a robust comparative effectiveness research infrastructure, agenda, and collaborative partnerships focused on eliminating health disparities. Specifically, a database was built comprised of all Medicaid enrollees and claims in the states that share in common both adverse minority health outcomes and the historical roots of racial health disparities in the South.

Setting and Participants. A 100 percent sample of four years 2004-2007 of Medicaid Analytic Extract (MAX-file) data (plus Medicare-linked claims for dual-eligibles) from fourteen southern states, representing 3.8 to 5.4 million persons each year (one-third of all United States Medicaid enrollees, nearly half [48 percent] of African American and 21 percent of Latino Medicaid enrollees in the United States) was obtained from the Centers for Medicare and Medicaid Services (CMS). This region is the epicenter of the Black-White health disparities epidemic, and has also experienced a recent and rapid influx of Latino immigrants. This project provided support for personnel and infrastructure needed to efficiently organize and analyze these data to support minority investigators. The HBCU-based team had extensive previous experience training health services researchers (especially minority investigators) to use Medicaid claims data for research.

Specific Aims: Using Medicaid Claims Data

1. To build a Medicaid claims dataset (including socieconomic, contextual, and geospatial analytic variables, NDC cross-walk data and therapeutic class codes, as well as certain Medicare data for dual-eligibles) to support projects focused on the intersection between disparities research and comparative effectiveness research in clinically and socially complex patient populations.

2. To create an efficient process for assisting non-Morehouse investigators to develop research protocols, analysis plans, CMS data re-use requests, and analytic files for collaborative research.

3. To train, develop, cultivate, and support emerging minority investigators (especially at Historically Black colleges and universities (HBCUs) and other minority-serving institutions) as independently-funded health services researchers who are increasingly proficient in multivariate analysis of Medicaid and Medicare claims data.

4. Cultivate comparative effectiveness and disparities research collaborations with Georgia Tech experts in mathematics, complexity science, simulation modeling, and interactive computing.

Relevance. Medicaid patients are characterized by clinical and social complexity -- the very characteristics which often exclude them from clinical trials and yet drive health disparities. This Medicaid-based dataset populates studies that help users understand how local area, provider-level, and patient-level differences in treatment (natural experiments in comparative effectiveness) influence clinical and economic outcomes. Variation implies that disparities are not inevitable. The comparative impact of this natural variation can be measured in meaningful outcomes such as emergency department visits, hospital admissions, inpatient bed-days, deaths, and total Medicaid expenditures, as well as community-level disparity rate-ratios. Medicaid data allow users to follow a complex patient (e.g., comorbid diabetes and schizophrenia or COPD and CHF) from treatment to outcomes through every billable service in the health care system (i.e., from doctor's visit to lab tests to prescriptions to emergency room visits or hospital admissions). Morehouse School of Medicine has a unique ability to develop a new cadre of minority investigators to conduct and interpret the results of health services research with a racially sensitive, culturally competent perspective.

Data Overview. The Centers for Medicare and Medicaid Services produces the MAX-files from Medicaid Statistical Information System (MSIS) data submitted by each state, with some data cleaning and validation by CMS sub-contractors before data are released to researchers.

The MAX-file data from CMS were loaded onto encrypted, secure servers at Morehouse School of Medicine. Research analytic files were created for each sub-project, including sickle cell disease, diabetes and schizophrenia; asthma; dementia; and congestive heart failure. For specific sub-projects, contextual variables from census data or area resource file were linked by county FIPS code.

Data Access. The data cannot be made publicly available. Data are stored on Morehouse School of Medicine encrypted servers, and may be used only for projects covered within the aims of the original research protocol and Centers for Medicare and Medicaid Services (CMS)-approved data use agreement. Data sharing is allowed only for research protocols approved under data re-use requests by the CMS privacy board. The CMS process for data re-use requests is described at the ResDAC Web site.

Due to limitations of research staff within the Morehouse National Center for Primary Care, and limitations of the existing CMS data use agreement, only re-use requests consistent with the original aims of the approved research protocol are considered (temporal and geographic variation in racial-ethnic disparities in quality, access and outcomes for Medicaid enrollees in 14 southern states). Specific aims of the current research protocol define the boundaries of what kind of research questions could be answered or sub-projects developed within the existing research protocol and data use agreement (see above "Specific Aims" section). A worksheet for developing an analysis plan for a specific research question is attached. Parties interested in the data should contact George Rust, MD, MPH ([email protected]).

Six SAS program syntax files used for data analysis, however, are available on the ICPSR site.

Aside from data re-use requests, the Morehouse National Center for Primary Care is open to collaborations which address these research aims and are consistent with their health equity research priorities, in which analyses could be performed by the Morehouse National Center for Primary Care research team and papers authored or co-authored by faculty from other minority-serving institutions or affiliated with the Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN).

This survey explored the ways in which social influences, such as stress and racism, affected health, and the impact these influences had on the respondents' outlook on life. Respondents were questioned about their health status and their exercise, smoking, sleeping, and dieting habits, as well as about diagnosed health problems and depression and their effects on daily activities. Respondents were also asked a series of questions regarding their employment status, type of job and whether it was a supervisory position, the racial makeup of their workgroup, their perceptions of their position and job, the likelihood of their finding another job, hassles experienced while at work, and whether they had any trouble balancing family and work. Another series of questions asked respondents whether they had been a victim of a serious physical attack or assault, robbery, or home burglary, if they had ever been unfairly searched, stopped, or questioned by police, why they felt they had been treated this way, and if they felt they had ever been treated unfairly by a teacher, landlord, or neighbor. Opinions were also solicited on the respondents' experience with depression and anxiety. Respondents were asked whether they felt it was possible to reach their goals, how satisfied they were with their present situation, how often they felt depressed and how long this feeling lasted, whether they lost weight or sleep due to this feeling, how this feeling of depression made them view themselves, how often and how long they were worried about things that were not likely to happen, how often they worried about non-serious things, and how they felt physically when they were anxious or depressed. Another set of questions queried respondents on alcohol and drug use. Respondents were asked how often they drank alcohol, the most they had to drink at one time, whether they had experienced any addiction to alcohol or experienced any emotional or psychological problems associated with drinking, whether they had any problem controlling their drinking, whether they had used drugs outside of a doctor's order, what types of drugs they had used, how often and in what type of situations they had used these drugs, and whether they had any addiction to the drugs. Respondents were also asked whether they had a regular doctor, whether they went to a doctor's office or clinic to seek medical attention, the last time they had gone for a checkup, how they were treated by staff at the visit, whether they trusted their doctor, the reasons why they did or did not receive medical attention, and whether they had health insurance. Respondents were also asked for their perceptions of differences between Blacks and whites, attitudes toward affirmative action with regard to employment, and their attitude toward interracial relationships. Another battery of questions queried respondents on any fears or phobias they had, such as a fear of animals, water, or visiting a doctor or dentist. Questions focused on the severity of these fears, how long they had had these fears, and how much these fears interfered in daily activities. A final set of questions gathered demographic information on respondents such as highest level of education completed, political affiliation, religious affiliation, level of religious participation, importance of religion, birth date, whether they owned their own home or rented, how much they spent on food each week, total family income for the year 1994, and the height and weight of respondents.

The purpose of the National Health Interview Survey (NHIS) is to obtain information about the amount and distribution of illness, its effects in terms of disability and chronic impairments, and the kinds of health services people receive. Implementation of a redesigned NHIS, consisting of a basic module, a periodic module, and a topical module, began in 1997 (See NATIONAL HEALTH INTERVIEW SURVEY, 1997 [ICPSR 2954]).

The 2001 NHIS contains the Household, Family, Person, Sample Adult, Sample Child, Child Immunization, and Injury and Poison Episode data files from the basic module. Each record in the Household-Level File (Part 1) contains data on type of living quarters, number of families in the household responding and not responding, and the month and year of the interview for each sampling unit.

The Family-Level File (Part 2) is made up of reconstructed variables from the person-level data of the basic module and includes information on sex, age, race, marital status, Hispanic origin, education, veteran status, family income, family size, major activities, health status, activity limits, and employment status, along with industry and occupation.

As part of the basic module, the Person-Level File (Part 3) provides information on all family members with respect to health status, limitation of daily activities, cognitive impairment, and health conditions. Also included are data on years at current residence, region variables, height, weight, bed days, doctor visits, hospital stays, and health care access and utilization.

A randomly-selected adult in each family was interviewed for the Sample Adult File (Part 4) regarding respiratory conditions, renal conditions, AIDS, joint symptoms, health status, limitation of daily activities, and behaviors such as smoking, alcohol consumption, and physical activity. Also included in this file are variables pertaining to the Healthy People 2010 Objectives.

The Sample Child File (Part 5) provides information from an adult in the household on medical conditions of one child in the household, such as respiratory problems, seizures, allergies, and use of special equipment such as hearing aids, braces, or wheelchairs. Also included are variables regarding child behavior, the use of mental health services, and Attention Deficit Hyperactivity Disorder (ADHD).

The Child Immunization File (Part 6) presents information from shot records and supplies vaccination status, along with the number and dates of shots, and information about the chicken pox vaccine.

Episode-based information regarding injuries and poisonings are found in the Injury and Poison Episode File (Part 7), which examines the cause and date of injury or poisoning, loss of time from work or school, and whether the episode resulted in hospitalization.

Information in the Injury and Poison Verbatim File (Part 8) is comprised of narrative text describing injuries, including type of injury, how the injury occurred, and the body part injured.

The Washington, DC, Metropolitan Area Drug Study (DC*MADS) was conducted in 1991, and included special analyses of homeless and transient delivering live births in the DC hospitals. DC*MADS was undertaken to assess the full extent of the drug problem in one metropolitan area. The study was comprised of 16 separate studies that focused on different sub-groups, many of which are typically not included or are underrepresented in household surveys.

The DC*MADS: Drug Use Among Women Delivering Livebirths in DC Hospitals was designed to examine the nature and extent of drug use among women delivering live births in eight Washington, DC, hospitals participating in the study. Data from the questionnaires include prenatal care, health problems during pregnancy, pregnancy drug use history, needle use, polysubstance use, patterns of use, respondent's general experiences with drug use, including perceptions of the risks and consequences of use, occurrence of psychological and emotional problems, income and insurance coverage, treatment experiences, and maternal and infant outcomes. Medical records were abstracted from the women and their infants to document medical problems. Abstracted data on the mothers included demographics, discharge diagnoses, disposition at discharge, and results of urine screens. Abstracted data on infants included delivery information, status at discharge, discharge diagnoses/procedures, and first urine toxicology screen results.