G. Decision Support System (DSS)

4. How does the utilization reported in the DSS National Data Extracts (NDEs) compare to other VA databases?

The HERC DSS team has prepared a report (see HERC Technical Report #23 at http://vaww.herc.research.va.gov) of how the DSS data compare with the PTF and NPCD files so that they can make the best use of the DSS cost estimates in their research projects. Towards this end, this report summarizes the results of linking the DSS NDEs with the NPCD and PTF files in FY04. The report includes the results of the FY03 comparison for reference. We found that the numbers of inpatient discharges recorded in the NDE discharge file and the PTF discharge files were nearly identical.  Although the number of unmatched DSS NDE discharges increased from 62 discharges in FY03 to 135 discharges in FY04, the percentage of unmatched records remained well below 1%. When we compared the FY04 DSS NDE treating specialty file with the FY04 PTF bedsection file, we found that 73.3% DSS bedsection stays matched exactly with the PTF database in FY04.  In FY03, 73.2% matched.  When we adjusted for different rules for setting bedsection admission and discharge dates, however, the match rates for FY03 and FY04 were very high.  For example, for FY04, the PTF files included 97.8% of the stays in the DSS treating specialty file.  The DSS treating specialty file included 99.7% of the stays recorded in the acute care (PB) PTF bedsection file and 97.4% of the stays in the extended care (XB) PTF bedsection file.   We studied FY04 data and found that 9% of the records in the NPCD event file did not have any care in the DSS outpatient visits extract.  When we included DSS “low cost” data, however, 99.4% of all NPCD records that were expected to be in DSS were found there.  Compared with FY03, we attained far greater concordance between these files in FY04 by including low cost DSS encounters in our comparison.  “Low cost” data refer to those outpatient encounters that are either not assigned costs or assigned costs between -$1 and $1.  The significance of this finding is that by including low cost DSS encounters in the FY04 comparison between the DSS and NPCD databases, outpatient utilization thought to be missing from DSS was found, and almost all outpatient care was found to be reported in DSS. 
View an overview of the Decision Support System (DSS)