Der Prophet gilt nichts im eigenen Land.Nullus propheta in patria.An ass in Germany is a professor in Rome.

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Materials: Extract data from PubMed("insurance, health"[MeSH Terms] OR "national health programs"[MeSH Terms] OR health insurance[TW] OR national health[TW] OR national insurance[TW] OR claims data*[TW] OR claim data*[TW] OR insurance claim*[TW] OR insurance data*[TW] OR administrative data*[TW] OR nationwide data*[TW] OR national data*[TW] OR NHIRD[TW] OR NHI[TW] OR BNHI[TW] OR population based[TW] OR population*[ti] OR nationwide[ti]) AND taiwan[All Fields] AND English[lang] AND 1996:2009[dp]* Accuracy not guaranteed !!!Courtesy of Yu-Chun Chen2010

Materials: Review of NHIRD Papers383 articles are includedCourtesy of Yu-Chun Chen

NHIRD Papers Grows ExponentiallyCourtesy of Yu-Chun Chen

NHIRD Papers Increase In Both Quantity and QualityCourtesy of Yu-Chun Chen

Cumulative Number of Papers Using NHIRD, 2000-2009a Annual growth rate=(no. of studies in current year no. of studies in previous year) / no. of studies in previous yearb Doubling time is estimated by fitted exponential model

Publish YearCumulative no. of NHIRD studiesCumulative no. of NHIRD studies indexed in JCR2008Cumulative no. of authorsCumulative no. of study fieldsCumulative no. of journals publishing papers200018112001211322200296367720032718833122200459461546141200585692198456200614012431011988200718316638414011120082762515102021592009383353667250210

Average 5-year annual growth rate 2005-2009 (%)a45.851.134.233.039.0Doubling timeb (year)1.801.732.222.212.01

Distribution of Study Topics Courtesy of Yu-Chun Chen

Top 10 subjects in MeSH2000-20042005-20092000-2009N = 59N = 329N =3 83Subject category MeSHNo.%RankNo.%RankNo.%Rank[H02] Health Occupations3762.7116048.6119751.41[E02] Therapeutics46.884313.124712.32[N03] Health Care Economics and Organizations610.243911.944511.73[N05] Health Care Quality, Access, and Evaluation35.1104112.534411.54[N02] Health Care Facilities, Manpower, and Services1016.92319.474110.75[H01] Natural Science Disciplines610.243510.654110.75[N04] Health Services Administration58.573410.363910.27[F04] Behavioral Disciplines and Activities610.24267.98328.48[I01] Social Sciences711.93247.310318.19[N06] Environment and Public Health46.88267.98307.810

Average IF in SCI FieldsCourtesy of Yu-Chun Chen

SCI categoryNo. of articleAverage IFHEALTH CARE SCIENCES & SERVICES511.798PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH472.625PSYCHIATRY413.272HEALTH POLICY & SERVICES391.868PHARMACOLOGY & PHARMACY342.740MEDICINE, GENERAL & INTERNAL331.541CLINICAL NEUROLOGY333.153OBSTETRICS & GYNECOLOGY212.202SURGERY172.349PEDIATRICS153.216CARDIAC & CARDIOVASCULAR SYSTEMS142.463ENDOCRINOLOGY & METABOLISM134.671GASTROENTEROLOGY & HEPATOLOGY133.669OPHTHALMOLOGY122.791IMMUNOLOGY123.804NEUROSCIENCES112.153RESPIRATORY SYSTEM113.148PERIPHERAL VASCULAR DISEASE105.532MEDICINE, RESEARCH & EXPERIMENTAL102.366

Productivity of authors: reproducible success?Courtesy of Yu-Chun Chen

Author# of articleLin HC99Lee HC36Chou YJ30Lee CH29Chen TJ25Chou P24Hwang SJ21Xirasagar S20

No. of articles per authorNo. of authorsCum. % to all authors (%)Cumulative contribution to articlesCumulative percentage to all research (%)>2081.217545.710 - 19183.923160.32 - 924540.636595.31396100.0383100.0

Author# of articleChen CS19Chen YH18Huang N18Chou LF16Liu TC16Chang HJ15Lin CH15Chen YC14Tang CH14Huang WF11Wang JD11Yang CY11

Status: 6 Apr 2011

Distribution of NHIRD Papersby Journal Impact Factor and Year

IF(2008)2000-20022003200420052006200720082009(n = 9)(n = 18)(n = 32)(n = 26)(n = 55)(n = 43)(n = 93)(n=107)>= 103[5-10)23155714[3-5)2661372028[1-3)15171232275049< 153245387NA3643186

Social Network Analysis as a Tool to Visualize Flow of Information

Analysis of studies using health databases

Sep 25, 2010

Collaboration Network: 2000-2009Chen YC et. al. Scientometrics (2010) Taiwans NHIRD: administrative health care database as study object in bibliometrics

Collaboration network: 2000Collaboration network, 2000

Collaboration network: 2001Collaboration network, 2001

Collaboration network: 2002Collaboration network, 2002

Collaboration network: 2003Collaboration network, 2003

Collaboration network: 2004Collaboration network, 2004

Collaboration network: 2005Collaboration network, 2005

Collaboration network: 2006Collaboration network, 2006

Collaboration network: 2007Collaboration network, 2007

Collaboration network: 2008Collaboration network, 2008

Collaboration network: 2009Collaboration network, 2009

Collaboration network: 2009 (label)Collaboration network, 2009

Design of Claims-Based Studies

Types of Study Designs / ComputationSimple descriptionAssociation / RelationshipComplex computation (Data mining)

Simple DescriptionDiseaseEpidemiologic features of Kawasaki disease in Taiwan, 1996-2002.A nationwide survey on epidemiological characteristics of childhood Henoch-Schnlein purpura in Taiwan.Prevalence and risks of chronic airway obstruction: a population cohort study in Taiwan.DrugUtilization of hepatoprotectants within the National Health Insurance in Taiwan.Demographics and patterns of acupuncture use in the Chinese population: the Taiwan experience.PersonRisks and causes of hospitalizations among physicians in TaiwanSpecialtyUse frequency of traditional Chinese medicine in Taiwan.SectorPatterns of ambulatory care utilization in Taiwan.

Association / RelationshipA B (no temporal consideration)Association between physician volume and hospitalization costs for patients with stroke in Taiwan: a nationwide population-based study.A B (temporal change)Seasonal variations in urinary calculi attacks and the association with climate: a population-based study.A => B (temporal sequence)Risk of extrapyramidal syndrome in schizophrenic patients treated with antipsychotics: a population-based study.Sudden sensorineural hearing loss increases the risk of stroke: A 5-year follow-up studyDoes elective caesarean section increase utilization of postpartum maternal medical care?* Control Group

Complex ComputationAssociation rule miningApplication of a data-mining technique to analyze coprescription patterns for antacids in Taiwan.Frequent itemset miningThe prescriptions frequencies and patterns of Chinese herbal medicine for allergic rhinitis in Taiwan.

Simple DescriptionDiseaseEpidemiologic features of Kawasaki disease in Taiwan, 1996-2002.A nationwide survey on epidemiological characteristics of childhood Henoch-Schonlein purpura in Taiwan.Prevalence and risks of chronic airway obstruction: a population cohort study in Taiwan.DrugUtilization of hepatoprotectants within the National Health Insurance in Taiwan.Demographics and patterns of acupuncture use in the Chinese population: the Taiwan experience.SpecialtyUse frequency of traditional Chinese medicine in Taiwan.SectorPatterns of ambulatory care utilization in Taiwan.Pediatrics : IF 4.789, Ranking 2 / 86 (Pediatrics)Chest : IF 5.154, Ranking 4 / 40 (Respiratory system)Rheumatology : IF 4.136, Ranking 7 / 22 (Rheumatology)

Association / RelationshipA B (no temporal consideration)Association between physician volume and hospitalization costs for patients with stroke in Taiwan: a nationwide population-based study.A B (temporal change)Seasonal variations in urinary calculi attacks and the association with climate: a population-based study.A => B (temporal sequence)Risk of extrapyramidal syndrome in schizophrenic patients treated with antipsychotics: a population-based study.Sudden sensorineural hearing loss increases the risk of stroke: A 5-year follow-up studyDoes elective caesarean section increase utilization of postpartum maternal medical care?Clin Pharmacol Ther : IF 7.586, Ranking 9 / 219 (Pharmacology )Med Care : IF 3.194, Ranking 5 / 62 (Health Care Sciences ...)Stroke : IF 6.499, Ranking 6 / 156 (Clinical Neurology)Stroke : IF 6.499, Ranking 6 / 156 (Clinical Neurology)J Urology : IF 3.952, Ranking 9 / 57 (Urology )

Complex ComputationAssociation rule miningApplication of a data-mining technique to analyze coprescription patterns for antacids in Taiwan.Frequent itemset miningThe prescriptions frequencies and patterns of Chinese herbal medicine for allergic rhinitis in Taiwan.Allergy : IF 6.204, Ranking 2 / 17 (Allergy)

NHIRD Datasets

*

File Structures of Datasets to ProcessSingle fileMultiple files:Of the same formatOf similar formats in different yearsOf different formats, but connected throughPrimary key / foreign keyLoop-up table

Main Tasks

1. READ

(Data Cleaning) (Garbage In, Garbage Out)

2. SELECT, FILTER APPEND, UNION JOIN, SORT

SAS

(1) (ID_Cohort)20002006

(2) (ID_Cohort) (exclusion criteria)20002006

(3) (ID_Cohort) (exclusion criteria) 20002006

SQL SQL (Structured Query Language)1970 IBM ///MS SQL Server, IBM DB2, Oracle, MySQLSAS 6.0 (Proc SQL)

Whats COOL in SQL ?SELECT, FILTER, APPEND, UNION, SORT, JOIN

SQL is designed for MULTIPLE RELATION tablesJOINMERGE (in SAS) is a special case of JOIN (equal join)Reads like English

(1) (ID_Cohort)20002006

SELECT hosp_cont_type, area_no, func_date FROM cd JOIN ID_Cohort ON cd.id = ID_Cohort.id JOIN HOSB2006 ON cd.hosp_id = HOSB2006.hosp_idQ: (ID_Cohort)

(2) (ID_Cohort) (exclusion criteria)20002006

SELECT id, min(func_date) as FirstVisit FROM cd JOIN ID_Cohort ON cd.id = ID_Cohort.id WHERE id NOT IN ( SELECT id FROM excludeCriteria ) GROUP BY id Q: (ID_Cohort) (exclusion criteria)

(3) (ID_Cohort) (exclusion criteria) 20002006

WITH tmpVisit AS ( SELECT id, min(func_date) as FirstVisit, max(func_date) as LastVisit FROM cd JOIN ID_Cohort ON cd.id = ID_Cohort.id WHERE id NOT IN ( SELECT id FROM excludeCriteria ) GROUP BY id ) SELECT id, DATEDIFF(month, FirstVisit, LastVisit) as Duration FROM tmpVisit Q: (ID_Cohort) (exclusion criteria)

SQL Also Works in SASSELECT hosp_cont_type, area_no, func_date FROM cd JOIN ID_Cohort ON cd.id = id_cohort.id JOIN HOSB2006 ON cd.hosp_id = HOSB2006.hosp_idQ: (ID_Cohort)

PROC SQL;

;QUIT;

SELECT hosp_cont_type, area_no, func_date FROM cd JOIN ID_Cohort ON cd.id = id_cohort.id JOIN HOSB2006 ON cd.hosp_id = HOSB2006.hosp_idSQL Also Works in SASQ: (ID_Cohort)

PATTERNS OF TRADITIONAL CHINESE MEDICINE (TCM) USE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD): A POPULATION STUDY IN TAIWANExample: Prevalence analysisYu-Chun Chen, Fang-Pey Chen, Tzeng-Ji Chen, Li-Fang Chou, Shinn-Jang Hwang. Hepato-Gastroenterology 2008;55:467-470. [SCI]

Research ObjectiveInflammatory bowel disease (IBD) ?IBD ?IBD ?

, ,

(CM_CD)1996-2005 , 228 , 82 GB

2005 12 : 444 MB1,550,000

Example: IBD

Data Processing with SQL Server 2005

SQL Server: Task 1. SQL, IBD_DATA

bulk insert IBD_DATA..HV ----- from xxxxx.dat -----with ----- ( batchsize = 100000, formatfile = '.fmt' )

SQL Server: Task 2. IBD : 555.x 556.x ()

SELECT id -----FROM HV ----- HVWHERE ----- LEFT(ACODE_ICD, 3) = '555' OR LEFT(ACODE_ICD, 3) = '556'

SQL Server: Task 2. Population: 2004 ()

SELECT Pop.*, IBDpt.ID----- FROM Pop ----- POPLEFT OUTER JOIN IBDpt ----- ON Pop.id = IBDpt.id-----

SQL Server: Task 3.

SELECT sex, age, count(*)------FROM JoinTABLE ------JoinTABLEGROUP BY sex, age------

SQL Server: Task 3.

ResultsPrevalence of IBD in Taiwan is 5.6 per 100,000; Male > FemaleWomen were more likely to use TCM than men (40.5% vs. 34.3%).45.5% patients had GI diagnoses at their TCM visits. Most of their TCM visits contained herbal remedies (90%).

I have a dream

The NHIRD research will enable the current generation of medical professionals in Taiwan to know the Amis better than the Amish.

* Amis :

Some suggestions

How can we start to do?Become familiar with the NHIRD codebooks and NHI regulationsThink of research problemsRead relevant literatureDiscuss with colleaguesFind friends familiar with data processingMotivation and courageTolerance and endurance*

Paper Production FlowIdeaMethodWritingToolsTeamsAtmosphereInfrastructureJournalIdeaEnglishMaterialsComputingStatistics

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