Tag Archives: databases

Tools help reporters follow tax dollars that fund medical research

Brenda Goodman

About Brenda Goodman

Brenda Goodman (@GoodmanBrenda), an Atlanta-based freelancer, is AHCJ’s topic leader on medical studies, curating related material at healthjournalism.org. She welcomes questions and suggestions on medical study resources and tip sheets at brenda@healthjournalism.org.

Image by Pia Christensen

Image by Pia Christensen

Why did the chicken cross the road? We’ve never known, but we may soon find out thanks to a United Kingdom project that aims to study human-chicken interactions.

It’s no joke, and it’s caused quite a flap across the pond because it’s costing taxpayers there £1.95 million, or roughly $3.1 million. Not everybody thinks it’s a crazy idea. Nature recently ran an editorial defending the research. The journal editors write:

We know surprisingly little about the history of human–chicken relations, such as how chickens first came to Britain.

Reading about that project got me thinking … in this era of sequestration cuts, what research projects have wrangled scarce public dollars in this country, and how much are we paying for them?

You can search government grants for research in a few places. Grants awarded by the federal department of Health and Human Services can be searched using the TAGGS tool, for Tracking Accountability in Government Grants.

A quick advanced search on the keyword “chicken” turned up four studies of chickens, but no foul play. Two studies deal with chicken genes, one is using chickens as a model for human disease, and the last is researching how chickens become colonized with bacteria that gives humans food poisoning.

You can also search grants by state, institution, and the name of the investigator.

The NIH has a different grant searching tool called RePORTER (Research Online Grant Reporting Tools). Using the advanced search there, the term “chicken” turned up 132 results, mostly because it also pulled up studies of chickenpox.

In addition to the keyword search you can search by funding category, location, and the names of investigators.

Have you used these tools to enterprise stories? Tell us about it in the comments section below. Don’t forget to include a link to your story.

Leaded aviation fuel a threat to public health, children

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

KUOW’s John Ryan used federal data and a few key sources to delve deep into issues surrounding one of the few remaining sources of airborne lead in the United States, a leaded aviation fuel known as “avgas.” In the process, he reveals damage that even low levels of lead exposure could be doing to children.

screen-shot-2012-01-31-at-93645-pm

Avgas accounts for less than 1 percent of the nation’s liquid fuel use. Yet enough piston–engine planes fly enough miles on avgas to belch out half of all the lead going into the nation’s air.

Lead paint in old buildings remains a bigger threat, but even low levels of childhood exposure, one source tells Ryan, can manifest itself in “Decreases in IQ, changes in test scores, changes in attention, hearing threshold, all sorts of things like that.”

Earlier this month (January), an expert panel advising the Centers for Disease Control and Prevention cut in half the levels of lead in children that should alarm parents or doctors. Researchers have yet to find any level of lead exposure that doesn’t cause harm.

Michael Kosnett, a medical toxicologist at the University of Colorado, told Ryan, “In any one child, it’s not something that’s going to necessarily cause them to display any kind of signs and symptoms. But if you can lower the lead exposure of a population of children, you’re going to give that population more of an opportunity to have gifted children and to have children who have higher IQs, and that’s certainly a desirable public health goal.”

Marie Lynn Miranda, an environmental health scientist and a dean at the University of Michigan, points out that “Living close to an airport can increase your blood lead level anywhere from 2 to 4 percent,” acknowledging that is a small amount but that evidence indicates even small amounts of lead are bad. She also notes that “lead is especially a problem for the low–income families that are most likely to live near airports.”

Pilots who still use avgas say their businesses would be dead in the water if they couldn’t get the leaded fuel, an argument Ryan contrasts with quotes from a Europe-based lead-free avgas producer, who sells it for 40 cents less a gallon, but hasn’t been able to break into the U.S. market “Because no one thinks that there will be demand for an unleaded–grade aviation gasoline.”

The federal database Ryan used, The National Emissions Inventory, is posted online by the EPA.

NYT reporters tease hip replacement numbers from difficult data

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing for The New York Times, Barry Meier and Janet Roberts analyzed a particularly tricky batch of federal reports detailing a variety of complaints with popular metal-on-metal hip replacements. They found that, since January, the FDA has received more complaints (5,000-plus) about the devices than it did, total, from 2007 to 2010.

kidsPhoto by Michael Simmons via Flickr

While processing the data, the paper’s staff did their best to parse duplicate reports, international filings and other inconsistencies, but the reporters make it clear that the numbers are still best viewed in general terms. Even so, they demonstrate that the surge in complaints and lawsuits involving metal-on-metal hips — and the resulting mass defection of doctors who once implanted them — signals a broad shift in hip replacement surgery, one of the most common such procedures in the country. It also signals another blow for device manufacturers and patients, and a related windfall for the legal profession.

The vast majority of filings appear to reflect patients who have had an all-metal hip removed, or will soon undergo such a procedure because a device failed after only a few years; typically, replacement hips last 15 years or more.

The mounting complaints confirm what many experts have feared — that all-metal replacement hips are on a trajectory to become the biggest and most costly medical implant problem since Medtronic recalled a widely used heart device component in 2007. About 7,700 complaints have been filed in connection with that recall.

As problems and questions grow, most surgeons are abandoning the all-metal hips, saying they are unwilling to expose new patients to potential dangers when safer alternatives — mainly replacements that combine metal and plastic components — are available. Some researchers also fear that many all-metal hips suffer from a generic flaw. Current use of all metal devices has plummeted to about 5 percent of the market, though a few of the models are performing relatively well in select patients.

Reporter finds the story behind food code violations

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

All the time that The Muskegon Chronicle‘s Brian McVicar has been spending with his county health department’s inspection records has paid off with a slew of stories, with the most recent turning the spotlight on the thousands of food code violations area businesses have racked up in recent years.

ozPhoto by bookgrl via Flickr

For this particular story, McVicar crunched the numbers on 22,000 violations, 37 percent of them critical, logged over a four-year period. Among the most salient, he writes, were “Raw chicken and crabmeat sitting out at room temperature, food kept past its expiration date, cockroaches, mice and fruit flies living in kitchens, employees not following proper hand washing procedures.”

In addition to the typical rogue restaurants, McVicar found that a wide range of local businesses were guilty of health code violations, including “Schools, hospitals, and food stands found in places such as Michigan’s Adventure Amusement Park.”

With his broad-based, data-oriented methodology, McVicar provides a model for other local reporters looking to move beyond the typical “cherrypick the cockroach horror stories” approach that is so often found in inspection-record stories.

Stories in the series:

Reporter FOIA’s database further exposing the toll war takes on returning vets

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing for the Bay Citizen and The New York Times, Aaron Glantz brings a new, data-based take on the mental and physical toll the wars in Iraq and Afghanistan have taken on returning veterans, thanks to what he calls “an obscure government database called the Beneficiary Identification Records Locator Subsystem death file,” which he obtained via FOIA.

The database, which reveals a high rate of suicide and fatally risky behavior, lists all veterans who earned Veterans Affairs benefits since 1973.

Records from that database, provided to The Bay Citizen under the Freedom of Information Act, show that the VA is aware of 4,194 Iraq and Afghanistan veterans who died after leaving the military. More than half died within two years of discharge. Nearly 1,200 were receiving disability compensation for a mental health condition, the most common of which was post-traumatic stress disorder.

Names were redacted, but Glantz nonetheless managed to identify a number of veterans, including a troubled 26-year-old man who threw himself under a train just three days after being turned away by the VA. In the course of his investigation, Glantz has managed to fill in some of the gaps in the federal records, a process which has shown just how lacking the VA’s data can be.

In October, The Bay Citizen, using public health records, reported that 1,000 California veterans under 35 died from 2005 to 2008 — three times the number killed in Iraq and Afghanistan during the same period. At the time, the VA said it did not keep track of the number of Iraq and Afghanistan veterans who died after leaving the military.

The VA database does not include veterans who never applied for benefits or who were not receiving benefits at the time of their death, according to the agency. The VA said it also did not keep track of the cause of death.

When confronted with his agency’s shortcomings, a VA representative responded in a manner that belied his agency’s lack of focus on recordkeeping.

David Bayard, a VA spokesman, said the agency was working hard to treat veterans with mental health issues. “VA has some pretty fine programs,” Mr. Bayard said, “but unfortunately we aren’t always successful.”

CMS releases hospital-by-hospital data on never events

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

About nine months after its original due date, the Centers for Medicare and Medicaid Services have overcome industry opposition and made data for hospital acquired conditions publicly available online. The data come in a 1.2 MB zip file, inside of which you’ll find a hulking 26,889-line spreadsheet.

The sheet breaks down the nation’s 4,700 or so hospitals, using Medicare fee-for-service claims from October 2008 through June 2010, based on the rates of eight different “never events,” each of which is compared with the national rate for the event in question. The hospitals can be sorted by name and state. Below, I’ve illustrated the national rates for all included HACs.

hac

According to MedPage Today’s Emily Walker, CMS published the data to help patients make informed decisions and to help hospitals improve their quality of care. They did so, she points out, over strenuous industry objections.

The data was originally scheduled to be published in September 2010 but was met with strong resistance from hospital groups such as the American Hospital Association (AHA); the groups say that CMS never made specifics available for how it calculates the HAC rates, making “fundamental assessments of the accuracy of capturing the incidence of these conditions” impossible to conduct.

“Hospitals continue to urge CMS not to publish these data,” read a March 31 joint statement from the AHA, the Federation of American Hospitals and the Association of American Medical Colleges.

Institute launches global health data clearinghouse

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Last month, the University of Washington’s Institute for Health Metrics and Evaluation (about) launched the Global Health Data Exchange (or GHDx), a sort of clearinghouse for global public health data sets. At launch, the site boasted about 1,000 data sets and promised it will index and host “information about microdata, aggregated data, and research results with a focus on health-related and demographic datasets.”

dataThe data is accompanied by visualization and GIS tools. For updates on the site, add the GHDx blog to your RSS. And, if you’re looking for a more direct connection, you can plug right into the RSS of new databases.

At present, the data is global in nature, though there are still plenty of domestic and comparative sets that will be of use to just about any U.S. reporter. Many of them will be familiar to data-heads, but it’s still handy to have it all in one place. The site will point directly to data providers when possible, and will work to provide public data for direct download. Free site registration is required before downloading.

The health highlights of two years of Guardian data

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In two years, the Guardian’s data blog has published more than 600 data sets. I know this because, thanks to their nifty summary post, I just browsed the full list. In addition to more than a few UK analogues to the sort of stuff we see from AHRQ and NCHS, such as UK life expectancy, birth rates and aging populations and public spending, they’ve also got the sort of global health stuff that any journalist or blogger could pull out and use in a post tomorrow. I’ve collected some of my favorites and tried to strike a good balance between unique stuff and broad-spectrum, widely available global health data.

And finally, for no particular reason, here’s the outcome of every freedom of information request ever filed by the BBC. Also in the category of “data for curious journalists/insiders”? Several years of UK libel cases.

WSJ explains why Medicare data is hidden

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In The Wall Street Journal, reporters Mark Schoofs and Maurice Tamman have pulled off an impressive feat, weaving a tale of freedom of information and databases so compelling that it’s already attracted hundreds of comments and attention from all over. At its heart, it’s the tale of why public Medicare payment data does not identify the doctors and individual providers who receive about an eighth of its annual disbursements. If the practitioners were identified, the authors argue, the public and press would be better equipped to expose and deter fraud.

The Medicare claims database, partially available for around $18,300 a year, is one of the most powerful health data resources in the world. It’s also hamstrung:

While the services and earnings of hospitals and other institutional providers can be publicly identified, such information is kept strictly confidential for doctors and other individual providers. The reason is that the American Medical Association, the doctors’ trade group, successfully sued the government more than three decades ago to keep secret how much money individual physicians receive from Medicare. The AMA has continued to defend this ruling, including in two cases in which federal appeals courts issued decisions last year.

This time around, The Wall Street Journal and the Center for Public Integrity took the AMA on. For health journalists, their description of what followed is really the crux of the story:

The Wall Street Journal, in conjunction with the nonprofit Center for Public Integrity, attempted for nearly a year to obtain the database. As part of the effort, the CPI filed a lawsuit against the Department of Health and Human Services, which houses the Medicare program. The Journal and CPI wanted the data at no cost; the government wanted $100,000 for eight years of data. In a settlement, The Journal and CPI obtained the requested data at a substantially reduced fee. They later obtained a decryption key to identify individual providers but signed a contract agreeing not to publish such identities in most cases.

The database, technically known as the Carrier Standard Analytic File, focuses on doctors and others paid on a fee-for-service basis. It contains 5% of all beneficiaries, and includes all doctor claims that Medicare paid directly in association with their care.

There’s far more to the story including information about the Consumers’ Checkbook lawsuit and the penultimate paragraphs on just how clear-cut fraud cases can be, once you know what to look for. An article on the Center for Public Integrity’s website promises more reporting, presumably based on the database, of “some of the questionable spending that occurs in the Medicare program.”

Related

Physician Panel Prescribes the Fees Paid by Medicare

CMS failed to report disciplined providers

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

ProPublica’s Marian Wang reports that the Centers for Medicare & Medicaid Services “essentially undermined” HHS efforts to create a national database of disciplined health care providers by failing to report disciplinary actions. The news comes from a report by the HHS Office of Inspector General (23-page PDF).

According to Wang, the investigation “found that CMS, which oversees health care programs serving about 45 million Medicare beneficiaries and 59 million Medicaid beneficiaries, took disciplinary action against numerous bad medical providers but did not report those actions to the Healthcare Integrity and Protection Data Bank.” As anyone who’s been following ProPublica’s award-winning “When Caregivers Harm” series knows, the database is chronically deficient, and – despite federal requirements – CMS isn’t helping.

CMS is required by law to report the following types of disciplinary action to the database: revocations and suspensions of laboratory certifications; terminations of providers from participation in Medicare; civil monetary penalties against all types of providers, managed care plans, and prescription drug plans.

Some of the data that should’ve been reported includes 148 sanctions imposed against laboratories in 2007 and 30 sanctions taken against managed care and prescription drug plans between January 2006 and July 31, 2009. From 2004 to 2008, the agency banned 45 nursing homes from participating in Medicare, and those actions were not reported until fall 2009, long after the required reporting timeframe, the inspector general’s office said.

According to officials, it was all just a big misunderstanding.