Working with the Emilia-Romagna Region, the Center helped to design a population-based longitudinal health care database for the 5 million individuals who were residents of Emilia-Romagna in the period 2002 through 2011. The database is built from encounter-based records of an individual’s interaction with the health care system using administrative data, capable of individual and geographic levels of analyses. Since Italy has a National Health Service, all residents of the region are included, without limitations concerning age or insurance status. The database includes:
- Demographic information for all residents, including gender, birth and death dates, location of birth, current residence, and primary care physician.
- Hospital discharge abstract data, including ICD-9-CM diagnosis and procedure codes, admission and discharge dates, and DRG-based payments. These data include both acute hospital stays and “day hospital” encounters.
- Outpatient pharmacy data at the individual prescription level, including drug codes, pharmacy payments, and patient co-payments.
- Specialty care, including type of service (laboratory, diagnostics, therapeutic procedures, rehabilitation, specialist visits), service costs, patient co-payments, dates of service, and physician information.
- Home health data, including the type of service, provider of the service (physician, nurse, therapist, etc.), hours of service provided, number of visits, reason for the visit, and diagnosis.
- Hospice data.
- Information on each primary care physician in the region, including payments received, specialty, years in practice, and patient load.
All of this information, linkable at both patient and physician levels, is currently available for nine consecutive years (2002-2011) with continuing data collection.
The value of the database has been increased by adding clinical classifications mapped from the hospital and pharmacy data. The Disease Staging classification has been used to classify the severity of primary diagnosis and co-morbidity for hospitalized patients and to identify individuals who may be at higher risk for utilizing more extensive or expensive health services in the future. Another set of indicators (Chronic Condition Drug Groups - CCDGs) uses outpatient pharmacy data and the Italian national formulary to identify individuals with selected chronic diseases.