Opioid-Related Emergency Department Visits
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Data Source: Texas Health Care Information Council (THCIC)
The Texas Health Care Information Council (THCIC) (now called Texas Health Care Information Collection program) was created by Chapter 108 of the Texas Health and Safety Code (THSC) and responsible for establishing and implementing the health care data collection system which collects hospital inpatient discharge data from all state licensed hospitals including state owned hospitals, except those rural hospitals that were exempt from the reporting requirements during this reporting time frame. The rule requirements for hospital inpatient data collection and reporting are listed under 25 Texas Administrative Code, Sections 421.1-421.9.
This opioid-related emergency department visits module offers aggregated data that are based upon data from the Inpatient Public Use Data File (PUDF) (also known as the DSHS Hospital Discharge Data (HDD)). The Inpatient PUDF contains patient-level information for patients which were admitted into the hospital for care after being seen in a hospital based emergency department (ED). The data do not include free-standing emergency centers. The inpatient hospital stay may last several hours to days, weeks or years, depending upon the condition or status of the patient before being discharged from the hospital, transferred to another healthcare facility or died in the hospital. Data for this module are derived from the information collected for individuals who reside in Texas (Patient State Code TX). Individuals who lived outside of Texas are excluded.
Inpatient Emergency Department Visit: The determination of an emergency department visit is based on the use of Revenue Codes indicating emergency department service line charges ('0450', '0451', '0452', '0456', and '0459'). These codes are used for payment determination and are generally more accurate than type of admission or source of admission codes.
Non-Fatal Visit: The determination of a non-fatal visit is based on the use of the patient status code (i.e., individuals without a patient status code of death: '20', '40', '41', or '42').
County: County of patients' residence in Texas. Visits where the county of residence was not recorded or was unknown are included in the statewide statistics so in some years the statewide total will be greater than the sum of the county totals.
Race/Ethnicity: The patient's race and ethnicity are combined. Hispanic race/ethnicity includes patients who identify themselves as Hispanic ethnicity regardless of race. The rest are grouped into their specific non-Hispanic race including White, Black, and Other.
Opioid Category: The categorization of non-fatal emergency department visits involving opioids is based on guidance from the Centers for Disease Control and Prevention (2018) using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). All visits are defined as non-fatal acute poisoning due to the effects of opioids, regardless of intent (e.g., intentional, unintentional, or undetermined). Principal diagnosis is derived solely from the Principal Diagnosis Code field. External cause of injury codes could be found in the Principal Diagnosis, Other Diagnosis, or External Cause of Injury fields. The Admitting Diagnosis field was excluded from the analysis.
"Any Opioid" are those visits which include a ICD-9-CM Principal Diagnosis of: 965.00 (poisoning by opium), 965.01 (poisoning by heroin), 965.02 (poisoning by methadone), or 965.09 (poisoning by other opiates and related narcotics); OR an ICD-9-CM External Cause of Injury of: E850.0 (accidental poisoning by heroin), E850.1 (accidental poisoning by methadone), or E850.2 (accidental poisoning by other opiates and related narcotics).
"Heroin" are those visits which include an ICD-9-CM Principal Diagnosis of 965.01 OR an ICD-9-CM External Cause of Injury of E850.0.
"Non-Heroin Opioids" are those visits which include an ICD-9-CM Principal Diagnosis of: 965.00, 965.02, or 965.09; OR an ICD-9-CM External Cause of Injury of E850.1 or E850.2.
Inpatient emergency department visits may involve more than one type of opioid (i.e., classified as both "Non-Heroin Opioids" and "Heroin"), so users should avoid adding totals by opioid category.
Centers for Disease Control and Prevention (2018). CDC's Opioid Overdose Indicator Support Toolkit: Guidance for building and reporting on opioid-related mortality, morbidity, and PDMP indicators (version 3.0).
For more information about the data, please visit Texas Health Care Information Collection (THCIC)
For more information about this module, please contact CHS-Info@dshs.texas.gov