FAQs - About Asthma Emergency Department Visits
What is SPARCS?
New York State maintains a statewide comprehensive data reporting system called the Statewide Planning and Research Cooperative System or SPARCS as a result of cooperation between the health care industry and government. SPARCS was initially created to collect information on discharges from hospitals, and currently collects patient level detail on patient characteristics, diagnoses and treatments, services, and charges for every hospital discharge, ambulatory surgery patient, and emergency department admission in New York State.
The SPARCS data system includes inpatient and outpatient [Ambulatory Surgery (AS) and Emergency Department (ED)] information. The regulations require that inpatient data be submitted by all Article 28 facilities certified for inpatient care and that outpatient data be submitted by all hospital-based ambulatory surgery services and all other facilities providing ambulatory surgery services. Each year approximately 2.5 million inpatient visits, over 7 million outpatient visits and more than six million ED outpatient visits in New York State are reported to SPARCS. The database contains over 120 data elements describing the patient, hospital, health care provider and hospital stay.
SPARCS continues to be a major management tool assisting hospitals, agencies, and health care organizations with decision making regarding financial planning and monitoring of inpatient and ambulatory surgery services and costs.
SPARCS is more useful for the surveillance of some diseases than for others because it includes only instances of disease and injury serious enough to require an ED visit or a hospital stay of at least 24 hours. Furthermore, the SPARCS data used here display the number of ED visits rather than the number of people who visited the EDs, which may result in inflated numbers because a person may have several ED visits for the same condition.
What are important issues for using asthma ED visit data to assess possible asthma-related problems?
Asthma is one of the leading chronic diseases of the lungs. The Behavioral Risk Factor Surveillance System estimated that 8.7% of adults in New York State in 2007 had current asthma, while the average number of ED visits due to asthma was seven visits per 100 adults with current asthma for the same time period.
ED visits for asthma are not only related to exposure to factors that trigger asthma episodes (see Asthma Triggers ), but also are related to access to primary care and quality of primary care. Good quality primary care that emphasizes treatment leading to effective management of the disease on a long-term basis may reduce the number of severe asthma episodes that require an ED visit. Therefore, it is important to monitor ED visits for asthma to assess the burden of the disease as well as to monitor the effectiveness of the health care system.
ED visit rates for asthma vary widely among communities.
Why are small numbers of cases or events a concern when looking at health data?
Questions about diseases and conditions such as asthma often lead to looking at the disease in small geographic areas such as neighborhoods and ZIP Codes. When the focus is on small areas, the number of health events is likely to be small. When dealing with small numbers of health events, privacy and confidentiality need to be maintained. In addition, people need to be aware that seemingly small changes in the number of events can dramatically change calculated rates.
Data should not be released in a way that may identify a person or release confidential information about that person.
In the tables of asthma ED visits by ZIP Code, the number of ED visits is not shown if the population is 33 or less (i.e., equal to or less than an average of 33 per year or 100 over a three-year period), or if the number of ED visits is one or two. A count of no ED visits is shown in the tables because a count of zero is not a threat to confidentiality.
In an area with a small number of ED visits per year, an increase or decrease of just one or two ED visits per year can cause the ED visit rate to change dramatically from year to year; such a rate is likely to be unstable.
In an area with a large number of ED visits each year, small increases or decreases in the number of ED visits have little effect on the ED visit rate (stable rate). (For additional information on this issue and the relative standard error [RSE], see Rates Based Small Numbers).
In the tables of asthma ED visits by ZIP Code, rates based on ten or fewer ED visits (RSE 30%) are considered unstable and are marked with an asterisk. These rates should be interpreted with caution.
Are there data to compare with the asthma ED visit rates in my community?
Asthma ED visit rates for each county, New York City, New York State excluding New York City, and New York State are available on this web site, in addition to the ZIP Code data. National data on asthma prevalence, ED visits, hospitalization and mortality are available from the U.S. Centers for Disease Control and Prevention( http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5101a1.htm).
Why are the asthma ED visit rates generated by multiple age groupings?
Health data are often generated by age groups to identify possible high-risk groups, as well as to provide information that is comparable to that from other states and to national goals and objectives.The reasons for including the age groupings in the tables of asthma ED visits are as follows:
|0-4 years||Common age break for pediatric asthma; Healthy People 2020 age grouping for asthma ED visits; age grouping used by the U.S. Centers for Disease Control and Prevention (CDC) in Surveillance for Asthma - United States, 1980-1999|
|0-17 years||Age break used for tracking asthma objectives for NYSDOH's health plan (Communities Working Together for a Healthier New York)|
|18-64 years||Age group representing the working adult population; with the 0-17 year and 65+ year age groups, provide the complete age distribution of asthma ED visits and allows for the calculation of age-adjusted rates.|
|65+ years||Healthy People 2020 age grouping for asthma ED visits|
|These age groups are common age groups that are used by policy makers, health care professionals, researchers as well as the general public.|
More information and links can be found at NYSDOH's Asthma Information.