FAQs - About Asthma Hospital Discharge Data
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.
Information on patients admitted to hospitals that are not regulated by the Federal government is included in SPARCS (e.g., Veterans Administration and military hospitals are not included in SPARCS). When a patient is discharged from one of the hospitals included in SPARCS, a discharge data abstract is created from the information in the patient's chart. Each year approximately 2.5 million hospitalizations 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 a hospital stay of at least 24 hours. Furthermore, the SPARCS data used here are the number of hospitalizations rather than the number of people hospitalized, which may result in inflated numbers because a person may be hospitalized several times for the same condition.
What are important issues for using asthma hospital discharge data to assess possible asthma-related problems?
People who are hospitalized with asthma represent only a small proportion of people who have asthma, because hospitalizations are people whose condition was serious enough to require a hospital stay.
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 hospital discharge rate due to asthma was more than two hospitalizations per 100 adults with current asthma for the same time period.
Asthma hospitalizations are the result of exposure to factors that trigger asthma episodes (see Asthma Triggers ) as well as access to quality 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 requires a hospitalization. Therefore, it is important to monitor hospitalizations for asthma to assess the burden of the disease as well as to monitor the effectiveness of health care system.
The Agency for Healthcare Research and Quality (AHRQ), which is part of U.S. Department of Health and Human Services, has identified pediatric asthma hospitalization as an 'ambulatory care sensitive condition'. For these conditions, good outpatient care can potentially prevent the need for hospitalization. In addition, early intervention can sometimes prevent complications or more severe disease. Lower rates of these conditions might indicate better quality care.
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 hospital discharges by ZIP codes, the number of hospital discharges 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 hospital discharges is one or two. A count of no hospital discharges is shown in the tables because a count of zero is not a threat to confidentiality.
In an area with a small number of hospital discharges per year, an increase or decrease of just one or two hospital discharges per year can cause the hospital discharge rate to change dramatically from year to year; such a rate is likely to be unstable.
In an area with a large number of hospital discharges each year, small increases or decreases in the number of hospital discharges have little effect on the hospital discharge 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 hospital discharges by ZIP code, rates based on ten or fewer hospital discharges (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 hospital discharge rate in my community?
Asthma hospital discharge rates for each county, New York City, New York State excluding New York City, and New York State are available at this web site. In addition to the ZIP code data, national data on asthma prevalence, hospitalization, and mortality are available from the U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5101a1.htm).
Asthma data for New York City, including hospital discharges for children 0-14 years by neighborhood and ZIP code, are available at http://www.nyc.gov/html/doh/downloads/pdf/asthma/facts.pdf.
Why are the asthma hospital discharge 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 generating asthma hospital discharge rates by age group are as follows:
|0-4 years||Common age break for pediatric asthma; Healthy People 2020 age grouping for asthma hospitalization; age grouping used by the U.S. Centers for Disease Control and Prevention (CDC) in National Surveillance for Asthma - United States, 1980-2004|
|0-14 years||Used in tables of asthma hospitalizations for children by the New York City Department of Health and Mental Hygiene Asthma Facts|
|0-17 years||Healthy People 2020 age grouping for asthma hospitalizations; age group used by CDC in Asthma Prevalence, Health Care Use and Mortality, 2003-05, also used by AHRQ for asthma hospitalizations as an "ambulatory care sensitive condition"|
|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 hospitalizations and allows for calculation of age-adjusted rates.|
|65+ years||Healthy People 2010 age grouping for asthma hospitalizations|
|These age groups are commonly 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