Future NCHS-Linked Data Using Linked Data and Natural Language - - PowerPoint PPT Presentation

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Future NCHS-Linked Data

Using Linked Data and Natural Language Processing to Support Patient-Centered Outcomes Research on Opioids

Merianne Rose T. Spencer, M.P.H. National Center for Health Statistics Centers for Disease Control and Prevention

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Presentation Outline

• Provide background about the HHS patient centered
• utcomes research trust fund (PCORTF)
• Describe two 2018 PCORTF opioid projects led by NCHS
• Highlight new data to be made available from these

projects

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Background of the PCORTF18

• The Patient Protection and Affordable Care Act of 2010 established the

patient centered outcomes research trust fund (PCORTF) to help build the national capacity and infrastructure needed for research on

• utcomes and effectiveness of health care treatment and preventions for

better healthcare decision-making

• For the fiscal year 2018, HHS had approximately $25 million available

for PCOR activities (i.e., PCORTF18)

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NCHS OS-PCORTF Opioid Projects Selected FY18

• Strengthening the Data Infrastructure for Outcomes Research on

Mortality Associated with Opioid Poisonings (CDC/NCHS)

• Enhancing Identification of Opioid-Involved Health Outcomes with

Linked Hospital Care and Mortality Data (CDC/NCHS)

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Strengthening the Data Infrastructure for Outcomes Research on Mortality Associated with Opioid Poisonings (CDC/NCHS)

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Introduction of Mortality Infrastructure

• The National Vital Statistics System (NVSS), which encompasses the processing

and coding of vital records from 57 jurisdictions*

• NCHS serves as a centralized hub to assign cause-of-death (ICD-10 codes) to

death records received by states and disseminates the data for health statistics, surveillance and for research

• Some data made available from NVSS includes:
• NVSS public-use files (can be downloaded and accessed through online tools, such

as CDC WONDER)

• NVSS multiple cause of death mortality restricted use-files
• National Death Index
• Provisional estimates, including quarterly death rates and monthly drug overdose

death rates

*50 states, New York City, District of Columbia and 5 US territories (American Samoa, Guam, Norther Marianas, Puerto Rico, and Virgin Islands)

7 Data collectio ion & exchange

• f death info

forma rmatio ion

• Death occurs and death

investigation may take place (e.g., interviews, toxicology, ancillary tests), if injury-related

• Death is certified by death

certifier (i.e., physicians, medical examiners, coroners)

• State vital records offices submit

information to NCHS

Data process ssing & data coding

• NCHS receives birth and death

records from state vital records

• ffices;
• Processes and conducts data

quality checks;

• Codes and assigns cause(s) of

death;

• Develops and prepares statistical

files and other data for analysis

Dissemin inatio ion of mortalit lity y data

• Releases data products (e.g.,

statistical files, provisional estimates, National Death Index)

• Disseminates mortality statistics

via online platforms (e.g., CDC WONDER), conferences, presentations, statistical reports and other venues

• Interacts with media, answers

and responds to inquiries

HIGH-LEVEL VIEW OF THE MORTALITY SYSTEM DATA INFRASTRUCTURE

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Data collecti tion

• n &

& exchang ange e of death th informa rmatio tion

• Improve data collection

mechanisms and exchange of death information at the death scene (i.e., between medical examiners/coroners, state vital records offices, autopsy centers, laboratory sites)

• Improve infrastructure of how

states submit records to NCHS

Data proce

• cessi

ssing ng & data coding ng

• Improve timeliness of how

NCHS processes and codes records received by states

• Develop capacity to better

identify and report on the specific types of drugs involved in the deaths beyond ICD-10 codes assigned for cause of death

Disse semina mination

• n of

morta tality ty data

• Enhance public health

surveillance and reporting of drug overdoses involving

• pioids
• Increase access to data

necessary for public health preparedness and response

• Support researchers and other

end-users of data products

OPPORTUNITIES FOR MODERNIZING THE MORTALITY SYSTEM INFRASTRUCTURE

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Data col

• llectio

lection n & & excha hang nge of death h inform

• rmatio

ion

• TASK 3 – Improve the

exchange of drug information between state vital registration systems and medical examiner/coroner case management systems Data process

• cessin

ing g & data codin ding

• TASK 1 – Modernize the coding

system with IT infrastructure improvements (e.g., NLP, machine learning)

• TASK 2 – Develop supplemental

drug information that would be captured from death certificate literal text Dissemin inatio ion of mortali lity data

• TASK 1&2 (subtask) – Make

supplemental drug data available to researchers

• TASK 4 – Enhance the Vital

Statistics Rapid Release (VSRR) program for improved public health surveillance

• TASK 6 – Study effects of
• pioids (including birth
• utcomes)

NCHS’S APPROACH TO PCOR PROJECT, STRENGTHENING THE DATA INFRASTRUCTURE

FOR OUTCOMES RESEARCH ON MORTALITY ASSOCIATED WITH OPIOID POISONINGS

• TASK 5 – Engage researchers throughout process to ensure that mortality data infrastructure improvements are

aligned with researchers’ needs

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End-Products

• Enhancements to improve data quality and to

provide more specific information about drugs involved in the death:

• NCHS’s public-use and restricted mortality

statistical files released

• National Death Index
• Provisional estimates provided by the Vital

Statistics Rapid Release program

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Enhancing Identification of Opioid-Involved Health Outcomes with Linked Hospital Care and Mortality Data (CDC/NCHS)

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Enhancing Identification of Opioid-involved Health Outcomes with Linked Hospital Care and Mortality Data (NCHS)

Project Goals:

• Develop methods that identify specific opioids (e.g., fentanyl and heroin)

involved in outcomes such as drug-related hospital visits and drug poisoning deaths using NCHS data:

• National Hospital Care Survey (NHCS), the National Death Index (NDI), and the

National Vital Statistics System restricted mortality data (NVSS-M)

• Make these newly linked data files available to researchers
• Share and disseminate about these data products and seek input from the

research community

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Data Sources

• National Hospital Care Survey (NHCS)
• Nationally representative sample of 581 hospitals inpatient and emergency

department visits that includes patient demographics, diagnoses, procedures, lab tests, medications, and emergency department clinical notes

• National Death Index (NDI)
• Confirms death occurred with select patients and includes cause-of-death information

(International Classification of Diseases, tenth edition, ICD-10)

• National Vital Statistics System Mortality Drug Overdose File (NVSS-M-DO)
• A supplemental data file developed in collaboration with the FDA and NCHS, which

contains identified specific substances mentioned on death certificate literal text and causes of death

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Existing Gaps for Understanding Opioid-Involved Hospital Visits

• Hospital visits and cause-of-death information on opioid-involved
• utcomes are from two independent data sources
• Opioid-involved hospital visits rely on claims diagnosis and procedure

codes, which underrepresent the number of hospital visits resulting from

• pioid use
• Cause of death is available to researchers using ICD-10 codes, which

does not track specific drugs such as fentanyl or novel substances

• Drug vocabulary for identifying new drugs and nomenclature is outdated

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Solutions for Addressing Gaps

• Link files in-house and leverage natural language processing to
• Identify specific opioid agents involved in hospital visits and deaths
• Build upon and establish an updated drug vocabulary for identifying

new drugs and nomenclature that classifies novel substances

• Analyze data files, create data files and publish findings about these

new enhancements

• Provide documentation and make datafiles available to

researchers on the Research Data Center

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Overview of Data Linkage & NLP Tasks

National Hospital Care Survey (NHCS), National Death Index (NDI) and National Vital Statistics System Restricted Mortality File on Drug Overdose Deaths (NVSS-M-DO) will be linked in an iterative process:

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NHCS/NDI file (already linked as part of a previously funded PCORTF project) will be linked to NVSS-M-DO (2014 & 2016)

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2016 NHCS data contains EHR clinical notes. Use NLP on clinical notes to identify opioid-involved ED visits not identified in medical codes.

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The NHCS/NDI/NVSS-M-DO file will be analyzed and used to establish methods to better identify hospital visits involved with opioid poisonings. Findings will be published.

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End Products

Enhanced data will be made available after the completion of the PCOR projects including:

• Data files containing hospitalizations, cause of death and

information on specific drugs involved (2014, 2016)

• Enhanced drug vocabulary and methodologies for

identifying opioid-involved outcomes (i.e., hospitalizations and death)

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Thank You!

Merianne Rose T. Spencer, M.P.H. Health Statistician, National Center for Health Statistics Centers for Disease Control and Prevention Email: kvd1@cdc.gov Phone: 301-458-4377