AHRQ Data Resources to Inform Health Policy Research: HCUP (Text Version)

On September 29, 2010, Hannah Davis made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (18.4 MB). Free PowerPoint® Viewer (Plugin Software Help).

Slide 1

AHRQ Data Resources to Inform Health Policy Research: HCUP

The Healthcare Cost and Utilization Project (HCUP)
P. Hannah Davis, M.S.
Claudia Steiner, M.D., M.P.H.

AHRQ Annual Conference
September 29, 2010

Slide 2

Agenda

• What is HCUP? How is it derived?
• Types of HCUP databases to support healthcare rsch
• HCUP research resources to facilitate data use
• HCUP Publications for ready-made information
• User Support to help you use HCUP resources

Slide 3

Healthcare Cost and Utilization Project (HCUP)
[Image: The HCUP logo]

The largest collection of multi-year, all-payer, encounter-level:

• Inpatient
• Emergency department
• Ambulatory surgery
• Hospital-based administrative data

Slide 4

HCUP is a Family of Databases, Tools & Products

Image: The HCUP logo is shown in a circle. Arrows point out to the following items:

• HCUP Databases [Images of colorful data bins]
• Research Publications [Images of print publications]
• User Support [Image of a woman working at a computer]
• Research Products [Images of CDs]

Slide 5

HCUP Partners Providing 2009 Inpatient Data

Image: A map of the United States is shown with each State color-coded to show whether or not it participates in HCUP. The non-participating States are Alaska, Idaho, Montana, North Dakota, Mississippi, and Alabama.

Slide 6

HCUP Partners Providing 2009 Emergency Department Data

Image: A map of the United States is shown with each State color-coded to show whether or not it participates in HCUP's Emergency Department Database. The non-participating States are Alaska, Oregon, Washington, Nevada, Idaho, Montana, Wyoming, Colorado, New Mexico, Texas, Oklahoma, North Dakota, Arkansas, Louisiana Mississippi, Illinois, Michigan, Alabama, West Virginia, Virginia, Pennsylvania, and Delaware.

Slide 7

HCUP Partners Providing 2009 Ambulatory Surgery Data

Image: A map of the United States is shown with each State color-coded to show whether or not it participates in HCUP's Ambulatory Surgery Database. The non-participating states are Alaska, Oregon, Washington, Nevada, Idaho, Montana, Wyoming, Colorado, New Mexico, Texas, Oklahoma, North Dakota, Arkansas, Louisiana Mississippi, Illinois, Michigan, Alabama, West Virginia, Virginia, Pennsylvania, and Delaware.

Slide 8

HCUP Database Participation 2009 Data Year

Image: A map of the United States is shown with each State color-coded to show how it participates in HCUP.

Non-participating:

• AK
• ID
• MT
• ND
• MS
• AL
• DE

Partners Providing Inpatient Data Only:

• WA
• OR
• NV
• WY
• NM
• TX
• AR
• LA
• IL
• WV
• VA
• PA

Partners Providing Inpatient & Ambulatory Surgery Data:

• CO
• PK
• MI

Partners Providing Inpatient & Emergency Department Data:

• AZ
• MA
• RI

Partners Providing Inpatient, Ambulatory Surgery, & Emergency Department Data:

• CA
• UT
• SD
• NE
• KS
• MN
• IA
• MO
• WI
• IN
• KY
• TN
• OH
• GA
• FL
• SC
• NC
• MD
• NJ
• NY
• CT
• VT
• NH
• ME

Slide 9

Current HCUP Partners

• Arizona Department of Health Services
• Arkansas Department of Health
• California Office of Statewide Health Planning & Development
• Colorado Hospital Association
• Connecticut Integrated Health Information (Chime, Inc.)
• Florida Agency for Health Care Administration
• Georgia Hospital Association
• Hawaii Health Information Corporation
• Illinois Department of Public Health
• Indiana Hospital & Health Association
• Iowa Hospital Association
• Kansas Hospital Association

Slide 10

Current HCUP Partners

• Kentucky Cabinet for Health and Family Services
• Louisiana Department of Health and Hospitals
• Maine Health Data Organization
• Maryland Health Services Cost Review Commission
• Massachusetts Division of Health Care Finance and Policy
• Michigan Health & Hospital Association
• Minnesota Hospital Association
• Missouri Hospital Industry Data Institute
• Nebraska Hospital Association
• Nevada Division of Health Care Financing and Policy, Department of Health and Human Services
• New Hampshire Department of Health & Human Services

Slide 11

Current HCUP Partners

• New Jersey Department of Health and Senior Services
• New Mexico Health Policy Commission
• New York State Department of Health
• North Carolina Department of Health and Human Services
• Ohio Hospital Association
• Oklahoma Health Care Information Center for Health Statistics
• Oregon Association of Hospitals and Health Systems
• Pennsylvania Health Care Cost Containment Council
• Rhode Island Department of Health
• South Carolina State Budget & Control Board
• South Dakota Association of Health Care Organizations
• Tennessee Hospital Association

Slide 12

Current HCUP Partners

• Texas Department of State Health Services
• Utah Department of Health
• Vermont Association of Hospitals and Health Systems
• Virginia Health Information
• Washington State Department of Health
• West Virginia Health Care Authority
• Wisconsin Department of Health and Family Services
• Wyoming Hospital Association

Continuing to recruit additional States to join the HCUP Partnership!

Slide 13

Overview of HCUP Data

Image: A man is shown standing near medical equipment and writing down information.

Slide 14

The Core of HCUP: Hospital-Based IP, ED, AS Databases

Image: Colorful bins represent the follow HCUP databases:

• State Inpatient Databases (SID)
• State Emergency Department Databases (SEDD)
• Nationwide Emergency Department Sample (NEDS)
• State Ambulatory Surgery Databases (SASD)
• Nationwide Inpatient Sample (NIS)
• Kids' Inpatient Database (KID)

Inpatient, Emergency Department, and Ambulatory Surgery Databases Based on Hospital Billing Data.

Slide 15

HCUP Data Mostly from Community Hospitals

Image: A pie chart displays the following data:

Typically not included in HCUP data:

• Federal/Other/LTC 14% (N=805)

Included in HCUP data:

• Community: 86% (N=5,010)

Source: American Hospital Association (AHA), 2008.

Slide 16

What Are Community Hospitals?

AHA definition of community hospitals: Non-Federal, short-term, general, and other specialty hospitals, excluding hospital units of other institutions (e.g., prisons).

Include these hospitals:

• Multi-specialty general hospitals
• OB-GYN
• ENT
• Orthopedic
• Pediatric
• Public
• Academic medical centers

Exclude these hospitals:

• Long-term care
• Psychiatric
• Alcoholism/Chemical
• Dependency
• Rehabilitation
• DoD/VA/IHS

Slide 17

What Types of Care Are and Are Not Captured by HCUP?

Inpatient:

• State Inpatient Databases (SID)
• Nationwide Inpatient Sample (NIS)
• Kids' Inpatient Database (KID)

ED and Ambulatory Surgery:

• Emergency Room Visits:
  • State Emergency Department Database (SEDD)
  • Nationwide Emergency Department Sample (NEDS)
• Ambulatory Surgeries:
  • State Ambulatory Surgery Database (SASD)

[Physician Office Visit]

[Pharmacy/Lab/Radiology]

Slide 18

From Patient Hospital Visit to HCUP Record

Image: A chart displays the following process from both the patient's and the data perspective.

Patient Perspective:

• ED Visit
  Scheduled Admission
  Transfer →
• Reception
• Admit
• Provide Care
• Discharge →

Data Perspective:

• Patient Record (Dotted lines connect this box to "ED Visit/Scheduled Admission/Transfer" above and to the same-name text box below.)
• Patient Record (Bold lines connect this box to "Reception," "Admit," and "Provide Care" above.)
• Discharge Summary:
  • Medical Coder
  • Billing Dept. →
  • Bill Generated [Image of bill statement]

Slide 19

The Foundation of HCUP Data is Hospital Billing Data

Demographic Data
Image: a double-headed arrow
Diagnoses, Procedures, Charges

Image: Billing records are shown.

Slide 20

The Making of HCUP Data

Image: A series of images connected by a long, curving arrow depicts the following process:

• Patient enters hospital [Image: A patient with a doctor]
• Billing record created [Image: Billing records]
• Hospital sends billing data and any additional data elements to.Data Organizations [Image: A man working at a computer]
• States store data in varying formats [Image: Map of the United states]
• AHRQ standardizes data to create uniform HCUP databases [Image: HCUP logo]

Slide 21

Value of HCUP Processing

• Standardization of file formats and variable values
• Basic quality checks
• Value-added variables:
  • Hospital characteristics:
    • Region, Urban/rural, Teaching status, Ownership/control, Bed size
  • Severity Measures:
    • APR-DRGs, APS-DRGs, Disease Staging, Comorbidity Measures

Slide 22

The HCUP Database Process

Image: A chart is superimposed over a map of the United States. The chart depicts the following process:

• AHRQ HCUP Databases
• HCUP Central Distributor (A double-headed arrow extends across the map of the U.S.)
• SIGN DUA (Multiple arrows extend out toward images of compact data discs, bearing the following labels):
  • SID
  • SEDD
  • SASD
  • KID
  • NEDS
  • NIS

Slide 23

HCUP Differs from Other Federal Govt Data Sources

Slide 24

What is HCUP and What Is It Not?

Slide 25

Hospital Billing Data Have Benefits and Limitations

Benefits:

• Large number of visit records
• Uniformity of coding
• Routine, regular collection
• Ease of access
• All-payer
• Available at local, state, regional, national level
• Supplemental files available to facilitate research

Limitations:

• Differences in coding across hospitals
• No data on individuals outside of hospital system
• May not show complete episode of care
• May not include all hospitals
• Lack revenue information
• Limited clinical details

Slide 26

Some Limitations Can be Addressed by Linking to Other Databases

HCUP Databases:

Image: Six colored data bins are labeled SID, SEDD, NEDS, SASD, NIS, and KID. From these bins, a series of double-headed arrows are arrayed.

 

• The first arrow is labeled "AHAID" and points to "American Hospital Association (AHA) Annual Survey."
• The second arrow is labeled "County" and points to "Health Resources and Services Administration's (HRSA) Area Resource File (ARF)."
• The third arrow is labeled "ZIP Code" and points to "ZIP Code files from Census or Vendor."
• The fourth arrow is labeled "Medicare ID" and points to "Medicare Cost Reports."
• The fifth arrow is labeled "AHAID" and points to "Trauma Information Exchange Program (TIEP)."

Slide 27

HCUP Has Six Types of Databases

• State Emergency Department Databases (SEDD)
• State Inpatient Databases (SID)
• State Ambulatory Surgery Databases (SASD)
• Nationwide Emergency Department Sample (NEDS)
• Nationwide Inpatient Sample (NIS)
• Kids' Inpatient Database (KID)

Slide 28

HCUP State Databases (SID, SEDD, SASD)

Images: An ambulance and doctors working in surgery are shown.

Slide 29

HCUP State Databases

• SID—All inpatient hospital discharge data (including those admissions that started in the ED) from participating HCUP States.
• SEDD—Emergency department data (treat and release) from participating HCUP States.
• SASD—Ambulatory surgery data (hospital based and some freestanding) from participating HCUP States.

Slide 30

What Data Elements Are Included?

UB-04 or CMS 1500 Billing Forms.

Image: The UB-04 or CMS 1500 Billing Forms are shown. A bracket encompasses the forms and points to the following list of data elements:

• Patient demographics (age, sex)
• Diagnoses & procedures
• (ICD-9-CM, DRG)
• Expected payer
• Length of stay
• Patient disposition
• Admission source & type
• Admission month
• Weekend admission

Slide 31

Some Data Elements Vary by State

• Race/Ethnicity
• Patient county
• Patient ZIP Code
• Severity of illness
• Birthweight
• Procedure date (days from admission)
• Primary payer details
• Secondary payer
• Detailed charges
• Patient identifiers encrypted
• Physician identifiers encrypted
• Physician specialty
• Hospital identifier unencrypted

Slide 32

Example: Payer Detail Varies by State

A red circle encompasses Values B, I, S, H, and 3 on the above table.

Slide 33

Example: Race Detail Varies by State

A red circle encompasses Values 4-9 under RaceX and Value 4 under RACE on the above table.

Slide 34

Software Requirements of Working with the Full HCUP Files

Image: Four logos for SAS, SPSS, STATA, and SUDAAN are shown. Arrows point down from each logo to the text listed below:

SAS:

• Load Programs
• Format Programs
• Example Statistical Coding
• HCUP Tools Programs

SPSS:

• Load Programs
• Format Programs
• Example Statistical Coding

STATA:

• Load Programs
• Example Statistical Coding

SUDAAN:

• Example Statistical Coding

MS Excel® and Access® are NOT GOOD Options!
 

Slide 35

States Releasing State Databases through HCUP Central Distributor

1990-2009*
 

• Arizona
• Arkansas
• California
• Colorado
• Florida
• Hawaii
• Iowa
• Kentucky
• Maine
• Maryland
• Massachusetts
• Michigan
• Nebraska
• Nevada
• New Jersey
• New York
• North Carolina
• Oregon
• Rhode Island
• South Carolina
• South Dakota
• Utah
• Vermont
• Washington
• West Virginia
• Wisconsin

* Not all states participate in all years and for all databases.

Slide 36

HCUP National Databases (NIS, KID, NEDS)

Images: An ambulance and doctors working in surgery are shown.

Slide 37

HCUP National Databases

Images: Three colored data bins captioned NIS, KID, and NEDS are shown next to the following descriptions.

• NIS—Inpatient hospital discharge data (including those admissions that started in the ED) from a sample of hospitals in participating HCUP States.
• KID—Pediatric inpatient hospital discharge data (including those admissions that started in the ED) from a sample of pediatric discharges in participating HCUP States.
• NEDS—Emergency department data (treat and release & admitted) from a sample of hospitals in participating HCUP States.

Slide 38

HCUP National Databases are Sampled from State Databases

Image: A cluster of small green data bins is captioned "State Inpatient Databases"; arrows point down from these small bins to three larger colored data bins captioned NIS, KID, and NEDS. Another small cluster of red data bins is captioned "State Emergency Department Databases"; one arrows points down from this cluster to the NEDS data bin.

Slide 39

NIS is a Stratified Sample of Hospitals from the SID

Image: A cluster of small green data bins is captioned "State Inpatient Databases." Beneath the cluster is the following text: "N = ~4K hospitals, ~32M records." To the right of this cluster is a text box captioned "5 NIS Strata." In the box are:

• U.S. Region [Image: A map of the United States]
• Urban/Rural [Image: The Hospital "H" sign]
• Teaching status [Image: A person in a white lab coat]
• Ownership/Control [Image: A row of buildings]
• Bed Size: [Image: A row of beds]

A large arrow labeled "Stratified Sample of Hospitals" points from this box to a large, yellow data bin captioned "Nationwide Inpatient Sample." Beneath the data bin is the following text: "N = ~1K hospitals, ~8M records."

At the top of the figure is the following note: "State is NOT included as a stratum."

Slide 40

KID is a Stratified Sample of Discharges from the SID

Image: A cluster of small green data bins is captioned "State Inpatient Databases." Beneath the cluster is the following text: "N = ~4K hospitals, ~6M records." To the right of this cluster is a text box captioned "3 Strata." In the box are:

• Uncomplicated births [Image: A newborn infant]
• Uncomplicated births [Image: An infant in the arms of a health care professional]
• Pediatric Non-births [Image: A little girl]

Two large arrows labeled "10% stratified sample of uncomplicated births" and "80% stratified sample of other ped discharges" point from this box to a large, purple data bin captioned "Kids' Inpatient Database." Beneath the data bin is the following text: "N = ~4K hospitals, ~3M records."

At the top of the figure is the following note: "State is NOT included as a stratum."

Slide 41

HCUP NEDS Data

Image: A red data bin is captioned "SEDD—Treat-and-Release ED Visits." A green data bin is captioned "SID—Admitted ED Visits." Arrows point down from both SEDD and SID to a multicolored data bin captioned NEDS. On either side of the NEDS data bin is the following text:

• About 84% of ED visits are treat-and-release.
• About 16% of ED visits result in a hospital stay.

Slide 42

NEDS is a Stratified Sample of Hospitals from the SEDD and SID

Image: A cluster of small red and green data bins is captioned "SEDD and SID." Beneath the cluster is the following text: "N = ~2K Hospital-based EDs, ~64M ED visits." To the right of this cluster is a text box captioned "5 NEDS Strata." In the box are:

• U.S. Region [Image: A map of the United States]
• Urban/Rural [Image: The Hospital "H" sign]
• Teaching status [Image: A person in a white lab coat]
• Ownership/Control [Image: A row of buildings]
• Trauma: [Image: An ambulance]

A large arrow labeled "Stratified Sample of Hospitals" points from this box to a large, multicolored data bin captioned "NEDS." Beneath the data bin is the following text: "N = ~1K Hospital-based EDs, ~26M ED visits."

At the top of the figure is the following note: "Similar to the NIS and KID Strata: State is NOT included as a stratum."

Slide 43

NIS, NEDS, KID: Must be Weighted to Produce National and Regional Estimates

Image: Three colored bins are labeled NIS, NEDS, and KID. Arrows point from each bin to a text box captioned "DISCWT." One arrow points from this box to a map of the United States.

Slide 44

NIS, NEDS, KID: Must be Weighted to Produce National and Regional Estimates

Image: Two colored bins are labeled NIS and NEDS. Arrows point from each bin to a text box captioned "HOSPWT." One arrow points from this box to a map of the United States.

Slide 45

Types of Research the National Databases Can Support

• Utilization and cost of hospital inpatient, ED, and ambulatory care
• Trends in healthcare utilization and costs
• Quality of care
• Impact of health policy changes
• Diffusion of medical technology
• Medical practice variation
• Medical treatment effectiveness

Slide 46

How to Obtain HCUP Data & Access HCUP Resources

Images: An ambulance and doctors working in surgery are shown.

Slide 47

Database Summary

• Six types of HCUP databases.
• Databases are based on administrative hospital data.
• Available for multiple years:
  • NIS (1988-2008)
  • NEDS (2006, 2007)
  • KID (1997, 2000, 2003, 2006)
  • SID (1990-2009)
  • SASD (1997-2009)
  • SEDD (1999-2009)
• Can look at breadth of healthcare issues.
• Can be linked to external files.

Slide 48

Obtain HCUP Data—Two Methods

HCUP Central Distributor
http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp

HCUP Partner States
http://www.hcup-us.ahrq.gov/partners.jsp

Images: Screen shots of the two HCUP Web site pages linked above are shown.

Slide 49

How to Obtain HCUP Data through the HCUP Central Distributor

• Step 1: Download and complete application kit:
  • http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp
• Step 2: Obtain more information (if needed):
  • Phone: 866-556-HCUP (4287) toll free
  • E-mail: HCUPDistributor@ahrq.gov
• Step 3: Take Data Use Agreement (DUA) on-line training and sign DUA.
• Step 4: Send order form, signed DUA, and payment to HCUP Central Distributor.

Slide 50

Additional Requirement: Electronic DUA Course

Purpose of the Course:

• Emphasize the importance of data protection.
• Reduce the risk of inadvertent violations.
• Describe your individual responsibility when using HCUP data.

http://www.hcup-us.ahrq.gov/tech_assist/dua.jsp

Takes 15 minutes to complete.

Image: A screen shots of the HCUP DUA page linked above is shown.

Slide 51

Pricing Information per Data Year

National Databases (NIS, KID, NEDS [Image: the databases are represented by colored data bins])

• NIS: $350 (CY2008-2007; student price $50):
  • $200 (CY2000-CY2006; student price $20)
• KID: $200 (student price $20)
• NEDS: $500 (student price $75)

State Databases (SID, SASD, SEDD [Image: the databases are represented by colored data bins])

• $35—$3,000 (varies by State)

Slide 52

HCUP is a Family of Databases, Tools & Products

Image: The HCUP logo is shown in a circle. Arrows point out to the following items:

• HCUP Databases [Images of colorful data bins]
• Research Publications [Images of print publications]
• User Support [Image of a woman working at a computer]
• Research Products [Images of CDs]

Slide 53

HCUP Provides Many Data Tools and Research Products

• Software Tools
• Supplemental Files
• Online Tools
• Methods Reports
• Statistical Briefs
• Publications using HCUP Data
  • With search feature

Slide 54

Most HCUP Tools can be applied to any Administrative Database

Image: Colored data bins are labeled SID, NEDS, NIS, KID, SEDD, SASD, and Other Administrative Databases. A large bracket encompasses all the data bins and points toward the following list:

• Clinical Classification Software
• Procedure Classes
• Chronic Condition Indicator
• Comorbidity
• Utilization Flags
• AHRQ QIs

Slide 55

Most Tools Based On Medical Coding Classifications

• ICD-9-CM (ICD-10-CM soon)
• CPT
• HCPCS
• DRGs
• MDC
• CCS

Images: The covers of the ICD-9-CM Manual, the 2010 CPT manual, and a list of single-level CCS codes are shown.

Slide 56

What Codes Are Used in HCUP Data Files

Detailed Codes:

• ICD-9-CM
  • Diagnosis Codes
  • Procedure Codes
• CPT
• HCPCS

Grouped Codes:

• DRG
• MDC
• CCS

Inpatient Databases:

• ICD-9-CM
• DRG
• MDC
• CCS

Outpatient Databases:

• ICD-9-CM
• CPT
• HCPCS
• CCS

Image: Colored data bins are labeled SID, NEDS, NIS, KID, SEDD, and SASD.

Slide 57

Image: A screen shot of the HCUP Tools and Software page at http://www.hcup-us.ahrq.gov/tools_software.jsp is shown.

Slide 58

Clinical Classifications Software (CCS) for ICD-9-CM

Groups ICD-9-CM codes into clinically meaningful categories.

Image: A compact disc is labeled "CCS for ICD-9-CM"; an arrow points from the disc to six colored data bins labeled NEDS, NIS, KID, SID, SEDD, and SAD. An arrow points from these bins to the following text:

ICD-9-CM Codes:

• 0031 0202 0223 0362 0380 0381 03810 03811 03819 0382 0383 03840 03841 03842 03843 03844 03849 0388 0389 0545 449 7907
• 0700 0701 0702 07020 07021 07022 07023 0703 07030 07031 07032 07033 0704 07041 07042 07043 07044 07049 0705 07051 07052 07053 07054 07059 0706 07070 07071 0709 57140 57141 57149 5731 5732 5733

Brackets follow the two listed sets of codes above and point respectively toward two listed items in the following text box:

CCS Codes:

• CCS 2: Septicemia
• CCS 6: Hepatitis

Slide 59

Clinical Classification Software (CCS) for Services and Procedures

The CCS collapses CPT codes into a smaller number of clinically-meaningful categories that can be more useful for presenting descriptive statistics than are individual CPT or HCPCS codes.

9,000 CPT/HCPCS codes and 6,000 HCPCS codes → Image: compact disc → 244 Mutually Exclusive Clinical Classifications

Slide 60

Procedure Classes

Groups ICD-9-CM Codes into One of Four Categories to Distinguish Between Diagnostic/Therapeutic Procedures

Image: An oval is labeled "ICD-9-CM Diagnosis Codes." Arrows point down to four boxes:

• Minor Diagnostic
• Minor Therapeutic
• Major Diagnostic
• Major Therapeutic

Slide 61

Chronic Condition Indicator (CCI)

Groups ICD-9-CM Diagnosis Codes into Chronic or Non-Chronic Categories.

Image: An oval is labeled "ICD-9-CM Diagnosis Codes." Two arrows point down to two boxes:

• Chronic
• Non-Chronic

Slide 62

Comorbidity Software

ICD-9-CM Codes, DRGs on Administrative Data → Comorbidity Software [Image: compact disc] → → → 29 Comorbidity Classifications

The Comorbidity Software is based on the ICD-9-CM coding scheme. Creates 29 variables that identify major comorbidities.

Elixhauser et al., Medical Care, 1998

Slide 63

Utilization Flags

Reveals additional information about use of health care services.

Image: A compact disc is labeled Utilization Flag Software; an arrow points from the disc to three colored data bins labeled SID, SEDD, and SAD. An arrow points from these bins to "ICD-9-CM codes + UB-04 codes"; and another arrow points from this text to a box containing the following text:

• Emergency Room
• Chest X-ray/CT Scan
• Intensive Care Unit

Slide 64

30 Utilization Flags

Utilization Flags:

Accommodation:

• Intensive Care Unit (ICU)
• Coronary Care Unit (CCU)
• Newborn Level II
• Newborn Level III
• Newborn Level IV

Cardiac Services:

• Cardiac Catheterization Lab
• Cardiac Stress Test
• Echocardiogram
• Electrocardiogram (EKG)

Imaging and Diagnostic Tests:

• Computed Tomography (CT) Scan
• Chest X-Ray
• Electroencephalogram (EEG)
• Ultrasound
• Magnetic Resonance Technology (MRT)
• Nuclear Medicine

Devices:

• Pacemaker
• Other Implants

Therapeutic Services:

• Lithotripsy
• Occupational Therapy
• Physical Therapy
• Respiratory Therapy
• Therapeutic Radiology and Chemotherapy
• Renal Dialysis
• Speech-Language Pathology
• Erythropoietin (EPO)
• Mental Health and Substance Abuse
• Blood

There are not ICD-9-CM codes for all services. Concern exists that some diagnostic procedures may be under-reported.

Slide 65

AHRQ Quality Indicator Software

Creates Measures of Health Care Quality Using Inpatient Administrative Data.

Image: A compact disc is labeled QI Software; an arrow points from the disc to three colored data bins labeled SID, NIS, and KID. Three arrows point from these bins to boxes containing the following text:

• Prevention Quality Indicators
• Inpatient Quality Indicators
• Patient Safety Indicators
• Pediatric Indicators

Slide 66

Prevention Quality Indicators (PQI)

Examples of PQI Measures.

Admission rates for:

• Diabetes Long-term Complications
• Diabetes Short-term Complications
• Pediatric Asthma
• Chronic Obstructive Pulmonary Disease
• Pediatric Gastroenteritis
• Hypertension

Image: The cover of the Guide to Prevention Quality Indicators is shown.

Slide 67

Inpatient Quality Indicators (IQI)

Examples of IQI Measures:

• Mortality—medical conditions:
  • AMI
  • Pneumonia
• Mortality—procedures:
  • Hip replacement
• Hospital-level utilization:
  • C-section
• Area-level utilization:
  • Hysterectomy
• Volume:
  • Abdominal aortic aneurysm repair

Image: The cover of the Guide to Prevention Quality Indicators is shown.

Slide 68

Patient Safety Indicators (PSI)

Examples of PSI Measures:

• Foreign Body Left During Procedure
• Iatrogenic Pneumothorax
• Central Venous Catheter Blood Stream Infection
• Postop Hip Fracture
• Postop Hemorrhage or Hematoma
• Postop Physiologic and Metabolic Derangements
• Death among surgical inpatients

Image: The cover of the Guide to Prevention Safety Indicators is shown.

Slide 69

Pediatric Quality Indicators (PDI)

Examples of PDI Measures:

• Accidental Puncture or Laceration
• Decubitus Ulcer
• Foreign Body Left During Procedure
• Pediatric Heart Surgery Mortality
• Postop Hemorrhage or Hematoma
• Postop Sepsis

Images: A doctor with a patient, and a baby in an incubator are shown.

Slide 70

Image: A screen shot of the AHRQ Quality Indicators (QI) Web site: http://www.qualityindicators.ahrq.gov.

Slide 71

HCUP Supplemental Files can only be applied to HCUP Databases

Image: Six colored data bins are labeled SID, NIS, SEDD, NEDS, KID, and SASD. A bracket encompasses all six bins and points to the following list:

• Cost-to-Charge Ratios
• Hospital Market
• Revisit Analyses
• NIS Hospital Ownership
• American Hospital Association (AHA) Linkage
• NIS Trends
• KID Trends.

Slide 72

Cost-to-Charge Ratio Files

Hospital-Level NIS/SID Data → Apply Ratios → Convert Charges to Costs

The Cost-to-Charge Ratio Files enable conversion of charge data to cost data on the NIS, KID, and SID.

Slide 73

Charges vs. Costs vs. Price

HCUP Databases include CHARGE information. COST information can be estimated.

Slide 74

Hospital Market Structure (HMS)* Files

The HMS Files contain measures of hospital market competition. Available free-of-charge from the HCUP Central Distributor.

*Wong and Mutter, Review of Industrial Organization, 2005.

Slide 75

HCUP Supplemental Files for Revisit Analyses

The HCUP Supplemental Files for Revisit Analyses are discharge-level files designed to facilitate analyses that need to track patients across time and hospital settings in the SID, SASD, and SEDD.

Slide 76

HCUP Databases can be combined to provide a more complete picture

Image: Three data bins are arranged in a triangular formation and respectively labeled SID, SASD, and SEDD; double-headed arrows point from each bin to the other two.

Researchers can link or combine the HCUP databases to track patients across time and settings.

Slide 77

Additional HCUP Supplemental Files

• Trends Files (NIS & KID):
  • Discharge-level files that provide the data user with trend weights and data elements that are consistently defined across data years.
• NIS Hospital Ownership File:
  • Hospital-level files designed to facilitate analysis of the NIS by hospital ownership categories.
• AHA Linkage Files:
  • Enable researchers to link hospital identifiers in some State databases to the AHA Annual Survey Databases.

Slide 78

Online Tools

• MONAHRQ:
  • A Web-based software tool that enables organizations to input their own hospital administrative data and generate a data-driven Web site.
• HCUPnet
  • Free, interactive online query system.
  • http://hcupnet.ahrq.gov/

Slide 79

Key features of MONAHRQ

• Currently based on hospital discharge data.
• Host user downloads MONAHRQ software from AHRQ Web site.
• Host user applies software to own data locally Software.
• Host user creates local Web site on their own server.
• Host user makes Web site available.
• Internally to better understand own data and to answer questions .
• To member organizations, e.g., through a password protected site.
• Publicly to provide information to the community.

http://www.monahrq.ahrq.gov

Slide 80

Image: A screen shot of the State Health Care Information Portal is shown.

Slide 81

HCUPnet: Quick, free access to HCUP Data

• Free, interactive online query system
• Users generate tables of outcomes by diagnoses and procedures
• Data can be cross-classified by patient and hospital characteristics

Slide 82

HCUPnet can answer a variety of questions

• What percentage of hospitalizations for children are uninsured, by State?
• What are the most expensive conditions treated in U.S. hospitals?
• What is the trend in admissions for depression?
• Will there be sufficient cases to do my analysis?
• How do my estimates compare with HCUPnet (validation)?

Slide 83

Image: A screen shot of http://hcupnet.ahrq.gov/ is shown.

Slide 84

A screen shot of an HCUPnet page where the user can select the type of query they want.

Slide 85

Image: A screen shot of an HCUPnet page asking the user what information they want.

Slide 86

Image: A screen shot of an HCUPnet page for browsing or searching for CCS categories is shown.

Slide 87

Image: A screen shot of an HCUPnet page for selecting outcomes and measures is shown.

Slide 88

Image: A screen shot of an HCUPnet page for selecting patient and hospital characteristics is shown.

Slide 89

Image: A screen shot of HCUPnet results in tabular form is shown.

Slide 90

Image: A screen shot of HCUPnet trend data is shown.

Slide 91

Image: A screen shot of an HCUPnet page for selecting diagnoses and procedures is shown.

Slide 92

Image: A screen shot of the 2008 National statistics—related diagnoses or procedures is shown.

Slide 93

Image: A screen shot of the 2008 National statistics—principal diagnosis only is shown.

Slide 94

HCUPnet Capabilities

HCUPnet...

Slide 95

HCUP is a Family of Databases, Tools & Products

Image: The HCUP logo is shown in a circle. Arrows point out to the following items:

• HCUP Databases [Images of colorful data bins]
• Research Publications [Images of print publications]
• User Support [Image of a woman working at a computer]
• Research Products [Images of CDs]

Slide 96

HCUP Methods Reports

• Methodological information on the HCUP databases and software tools

Image: A screen shot of the HCUP Methods Series list on the HCUp Web site is shown.

Slide 97

HCUP Methods Reports

Population Denominator Data for Use with the HCUP Databases (Updated with 2009 Population Data)
Barrett M, Hunter K, Coffey R, Levit K.
April 12, 2010

Image: The cover of the HCUP Methods report cited above is shown.

http://www.hcup-us.ahrq.gov/reports/methods.jsp

Slide 98

Percentage of discharges by region

Image: Bar graph shows the following:

Image: Bar graph shows the following:

Does the South have the highest prevalence of CDAD hospital stays?

Slide 99

CDAD rates using a population denominator

Image: Bar graph shows the following:

Slide 100

HCUP Publications

• Statistical Briefs
• Facts and Figures
• Fact Books

Images: The covers of HCUP publications are shown.

Slide 101

Image: A screen shot of the HCUP Reports page is shown.

Slide 102

Statistical Brief Topics

• More than 95 briefs posted—a new brief posted every two to three weeks:
  • Ambulatory Surgeries
  • Rural Hospitalizations
  • Motor Vehicle Accidents
  • Childbirth
  • Brain Cancer

Image: Statistical Brief #59 is shown.

Slide 103

HCUP Facts and Figures

Image: The HCUP Facts and Figures book cover is shown along with screen shots of "Number of Inpatient Hospital Stays and Average Length of Stay, 1993-2007" and "Percent Contribution to Aggregate Costs by Principal CCS Body System and Confition Category, 1997-2007".

Slide 104

New: Publications Search Page on HCUP-US

• Simple or advanced search options:
  • Data Year
  • Database, Tool, & Product
  • Key Word
  • Publication Type
  • Author
  • Title
  • State

Images: A stack of books and a magnifying glass are shown.

Slide 105

HCUP Supports High Impact Health Services, Policy & Clinical Research

Images: A collage of journal and magazine titles is displayed.

Slide 106

HCUP is a Family of Databases, Tools & Products

Image: The HCUP logo is shown in a circle. Arrows point out to the following items:

• HCUP Databases [Images of colorful data bins]
• Research Publications [Images of print publications]
• User Support [Image of a woman working at a computer]
• Research Products [Images of CDs]

Slide 107

HCUP User Support Web site

• Find detailed information on HCUP databases, tools, and products
• Access HCUPnet
• Find comprehensive listing of HCUP-related publications, database reports, and fact books
• Access technical assistance

Image: A screen shot of HCUP User Support Web site at http://www.hcup-us.ahrq.gov is shown.

Slide 108

Using HCUP Technical Assistance

• Active Technical Assistance
• Responds to inquiries about HCUP data, products, and tools
• Collects user feedback and suggestions for improvement

E-mail: hcup@ahrq.gov

Image: A woman working at a computer is shown.

Slide 109

Interactive On-line HCUP Overview Course Available

Image: A screen shot of the HCUP Overview Course Introduction page at of http://www.hcup-us.ahrq.gov/overviewcourse.jsp is shown.

Slide 110

Additional HCUP Online Courses: Methods Focus

• Now available:
  • HCUP Sample Design Tutorial
• New courses:
  • Loading and Checking HCUP Data Files
  • Producing National Estimates with HCUP Data

Image: A screen shot of the HCUP Tutorials page at http://www.hcup-us.ahrq.gov/tech_assist/tutorials.jsp is shown.

Slide 111

Join the HCUP Mailing List

HCUP Newsletter —New Data Releases —New Reports

Image: A screen shot of the HCUP E-mail Updates page at http://www.ahrq.gov/data/hcup/hcuplist.htm is shown.

Slide 112

HCUP 20th Anniversary!

Image: The HCUP logo with a text that reads "Celebrating 20 Years of Powerful Data."

Slide 113

Healthcare Cost and Utilization Project (HCUP)
[Image: The HCUP logo]

The largest collection of multi-year, all-payer, encounter-level:

• Inpatient
• Emergency department
• Ambulatory surgery
• Hospital-based administrative data

Slide 114

Questions/Comments?

Time for Questions and/or Comments

Image: A photograph of a school of fish.