NHLBI Workshop

Data Needs for Cardiovascular Events, Management, and Outcomes

HMO Populations and Clinical Databases as a Source for Monitoring Trends in CVD Morbidity & Mortality -
Dr. Joseph Selby

Key Points

  • Integrated HMOs are an increasingly rich source of longitudinal data on CVD events, risk factors and quality of care
  • Membership is quite stable
  • Large registries of persons with CVD diagnoses are being created
  • Many of these HMOs share the same electronic medical record, and data definitions are being harmonized across HMOs

HMO Research Network (HMORN) -- 13 million members

  • Fallon Health Care, Worcester, MA
  • Group Health Cooperative, Seattle, WA
  • Harvard Pilgrim Health Care, Boston, MA
  • HealthPartners Research Foundation, Minneapolis, MN
  • Henry Ford Health System, Detroit, MI
  • Kaiser Permanente Colorado, Denver, CO
  • Kaiser Permanente Georgia, Atlanta, GA
  • Kaiser Permanente Hawaii, Honolulu, HI
  • Kaiser Permanente Northwest, Portland, OR
  • Kaiser Permanente Northern CA, Oakland, CA
  • Kaiser Permanente Southern CA, Pasadena, CA
  • Lovelace Clinic Foundation, Albuquerque, NM
  • Scott and White Health System, Temple, Texas
  • United Healthcare, Minnetonka, MN

Major Collaborative Projects of the HMO Research Network (HMORN)

Coordinating Center
Vaccine Safety Datalink - CDC CDC CDC
Cancer Research Network - National Cancer Institute NCI Group Health Cooperative
Center for Education and Research on Therapeutics (CERT) AHRQ Harvard Pilgrim
Coordinated Clinical Studies Network Roadmap/
Group Health Cooperative

Data are Improving

  • Membership (denominators & demographics)
  • Complete hospital discharge data (endpoints, procedures, comorbidities)
  • Outpatient diagnoses & procedures (comorbidities and endpoints)
  • Pharmacy data (comorbidities, quality of care)
  • Laboratory results (risk factors)
  • Outpatient measurements (BP, smoking status, BMI)

Availability of CVD Risk Factor Data among 1.2 million persons, age 45 and above, 1/1/04; Kaiser Permanente Northern California

  Men (n=580,817) Women (n=663,661)
Blood Pressure 86% 92%
LDL-C 68% 69%
HDL-C 73% 75%
Fasting Glucose 63% 64%
Current Smoking Status 85% 92%
Creatinine 81% 84%
BMI 55% 60%
Race/ethnicity 70% 75%

Examples of Studies Conducted in Kaiser Permanente, Northern California

  • Joint Control of Three CVD Risk Factors in the KP Population, 2001 to 2003:
    The 3D Study -- Support: Pfizer, Inc.
  • Troponin Measurement and Trends in Acute Coronary Syndrome Hospital Discharge Diagnosis
    • To determine the role of troponin measurement in the changing distribution of ACS hospitalization discharge diagnoses in Kaiser Permanente Northern California (KPNC)
    • All data, including cardiac biomarkers, were obtained from KPNC electronic databases.
    • All hospital discharges for ACS from KPNC hospitals between 1994-2003 were determined (primary discharge codes 410.x, 411.1, 414.x primary with 411.1 secondary)
  • Kaiser Permanente Acute Coronary Syndrome Registry (KP-ACS)
    • Modeled after National Registry of Myocardial Infarction (NRMI)
    • Systematic chart review of all hospitalized acute myocardial infarction and troponin (+) unstable angina patients at 17 Kaiser facilities since 2002 (AMI) & 2004 (UA)
    • ~9,000-10,000 reviewed cases annually
  • Kaiser Permanente Chronic Heart Failure Registry (KP-CHF)
    • Chronic heart failure (CHF) identified from hospitalizations and ambulatory visit (outpatient, ED) databases
    • 96% of primary hospital discharge diagnoses and 85-90% of cases identified from outpatient diagnoses are verified using Framingham criteria at chart review
    • 1996-2002: 59,772 adults > or = 20 years met registry criteria for CHF in Kaiser No. Cal.
    • Registry is updated annually and linked to treatment & clinical outcomes


  • Data from integrated HMOs can provide a timely look at incidence, complications, mortality for a variety of CVD conditions
  • Rich clinical data allows adjustment for population differences in comorbidities and disease severity
  • Data definitions can be standardized across settings
  • Data may allow exploration of possible artifactual differences in observed patterns


  • HMO patients do not represent the extremes of U.S. SES spectrum
  • Time trends, geographic variation, subject to differences and changes in clinical and coding practices
  • Data completeness is sometimes a question
  • Potentially, time trends may be affected by differing enrollment/departure over time

Back to Workshop Agenda

Skip footer links and go to content
Twitter iconTwitterExternal link Disclaimer         Facebook iconFacebookimage of external link icon         YouTube iconYouTubeimage of external link icon         Google+ iconGoogle+image of external link icon