The Healthcare Cost and Utilization Project (HCUP) (Text Version)
On September 21, 2011, Claudia Steiner and Hannah Davis made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (31 MB).
Slide 1
The Healthcare Cost and Utilization Project (HCUP)
HCUP Data Resources for Research & Policy
P. Hannah Davis, MS
Claudia Steiner, MD, MPH
Agency for Healthcare Research and Quality
Slide 2
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases:
- Where does data come from?
- HCUP State Databases.
- HCUP Nationwide Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products:
- Software Tools.
- Supplemental Files.
- Online Tools.
- Methods Reports.
- Additional HCUP Resources:
- HCUP Publications.
- User Support.
Slide 3
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products.
- Additional HCUP Resources.
Slide 4
What is HCUP?
- HCUP Databases.
- Research Tools.
- Research Publications.
- User Support.
Slide 5
What is HCUP?
- HCUP is the largest collection of multi-year, all-payer data that includes inpatient and selected outpatient data that is based on the hospital billing record.
Slide 6
Why Do We Need Another Hospital Data Source?
Hospital Data Source | Description |
---|---|
National Hospital Discharge Survey (NHDS) National Hospital Ambulatory Care Survey (NHAMCS) Centers for Disease Control and Prevention (CDC) |
→Samples |
Medical Expenditure Panel Survey (MEPS) Agency for Healthcare Research and Quality (AHRQ) |
→Survey |
Medicare Provider Analysis and Review (MedPAR) Centers for Medicare and Medicaid Services (CMS) |
→Medicare Claims |
Slide 7
What can you get from HCUP?
Topic | Specific Findings |
---|---|
Cost | Hospital costs for treating patients with septicemia surged 174 percent between 2001 and 2007 (NIS) |
Access | Americans in low-income areas visit EDs at rates 90 percent higher compared to those in the highest income areas (NEDS) |
Quality | Oregon and Vermont had the Nation's lowest rates of avoidable hospitalizations for asthma in children ages 2 to 17 (PQI software, SID) |
Utilization | Patients in rural hospitals were older (42 percent were 65 plus) than those in urban public hospitals (23 percent were 65 plus). (NIS) |
Slide 8
HCUP Supports High Impact Health Services, Policy & Clinical Research
A number of images of logos from news publications and medical journals are shown.
Slide 9
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products.
- Additional HCUP Resources.
Slide 10
The HCUP Partnership
Circular flowchart with bidirectional arrows.
State
Federal
Industry
Slide 11
What Is the Agency for Healthcare Research and Quality (AHRQ)?
- The Agency for Healthcare Research and Quality (AHRQ) is a federal agency under the Department of Health and Human Services.
Below the text is an organizational chart showing all the different agencies under HHS.
Slide 12
Agency for Healthcare Research and Quality (AHRQ)
Mission:
- To improve the quality, safety, efficiency, and effectiveness of health care for all Americans.
Strategic Goals:
- Support improvements in health outcomes.
- Strengthen quality measurement and improvement.
- Identify strategies that:
- Improve access.
- Foster appropriate use.
- Reduce unnecessary expenditures.
Slide 13
Current HCUP State 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 14
Current HCUP State Partners (continued)
- 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.
- Montana Hospital Association.
- Nebraska Hospital Association.
- Nevada Division of Health Care Financing and Policy, Department of Health and Human Services.
Slide 15
Current HCUP State Partners (continued)
- New Hampshire Department of Health & Human Services.
- 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 16
Current HCUP State Partners (continued)
- 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.
44 States and continuing to recruit additional States to the HCUP Partnership.
Slide 17
HCUP Partners Providing 2010 Inpatient Data
Image: A map of the United States is shown with the HCUP participating states highlighted.
Slide 18
HCUP Partners Providing 2010 Ambulatory Surgery Data
Image: A map of the United States is shown with the participating HCUP partner states providing 2010 ambulatory surgery data are highlighted.
Slide 19
HCUP Partners Providing 2010 Emergency Department Data
Image: A map of the United States is shown with the HCUP partner states providing 2010 emergency department data are highlighted.
Slide 20
Partnership: HCUP Database Participation By State
Image: A map of the United States is shown with the state participation in the HCUP database is highlighted by different colors.
Slide 21
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases:
- Where does data come from?
- HCUP State Databases.
- HCUP Nationwide Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products.
- Additional HCUP Resources.
Slide 22
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases:
- Where do the data come from?
- HCUP State Databases.
- HCUP Nationwide Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products.
- Additional HCUP Resources.
Slide 23
The Foundation of HCUP Data is Hospital Billing Data
Demographic Data
Diagnoses Procedures Charges
Slide 24
From Patient Hospital Visit to HCUP Record
Flowchart showing the billing process.
Patient Perspective:
ED Visit/Scheduled Admission/Transfer→Reception→Admit→Provide Care→Discharge
Data Perspective:
Patient Record (from ED Visit through Provide Care)→Discharge Summary→Medical Coder→Billing Dept.→Bill Generated
Slide 25
The Making of HCUP Data
- Patient enters hospital.
- Billing record created.
- Hospital sends billing data and any additional data elements to data organizations.
- States store data in varying formats.
- AHRQ standardizes data to create uniform HCUP databases.
Slide 26
The HCUP Process
- Standardized file formats and variable values.
- Value-added variables:
- Hospital characteristics:
- Region, Urban/rural, Teaching status, Ownership/control, Bed size.
- Severity Measures:
- APR-DRGs, APS-DRGs, Disease Staging, Comorbidity Measures.
- Hospital characteristics:
- Basic quality checks.
Slide 27
Where Do We Get HCUP Data?
Image of a pie chart:
Typically not included in HCUP data: 14% (N=787), includes Federal and Other/LTC.
Included in HCUP data: 86% (N=5,008).
HCUP data is mostly from community hospitals.
Source: American Hospital Association (AHA), 2009.
Slide 28
What Are Community Hospitals?
American Hospital Association Definition:
Non-Federal, short-term, general, and other specialty hospitals, excluding hospital units of other institutions (e.g., prisons)
Included | Excluded |
---|---|
Multi-specialty general hospitals | Long-term care |
OB-GYN | Psychiatric |
ENT | Alcoholism/Chemical dependency |
Orthopedic | Rehabilitation |
Pediatric | DoD / VA / IHS |
Public | |
Academic medical centers |
Slide 29
What Are Community Hospitals?
- HCUP generally does not receive data from non-community hospitals.
- However, if a patient is treated in a community hospital, their information is included.
Most Frequent Principal Diagnosis |
Number of Discharges (thousands) |
---|---|
1. Newborns | 4,159 |
2. Pneumonia | 1,165 |
3. Congestive heart failure | 1,023 |
4. Osteoarthritis | 921 |
5. Mood disorders | 873 |
6. Coronary atherosclerosis | 832 |
7. Cardiac dysrhythmias | 807 |
Source: Nationwide Inpatient Sample, 2009
Slide 30
HCUP Has Six Types of Databases
- Three state-level databases:
- State Inpatient Databases (SID)
- State Emergency Department Databases (SEDD)
- State Ambulatory Surgery Databases (SASD)
Slide 31
HCUP Has Six Types of Databases
- Three nationwide databases:
- Nationwide Inpatient Sample (NIS)
- Kids' Inpatient Database (KID)
- Nationwide Emergency Department Sample (NEDS)
Slide 32
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases:
- Where does data come from?
- HCUP State Databases.
- HCUP Nationwide Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products.
- Additional HCUP Resources.
Slide 33
HCUP State Databases
State Inpatient Databases (SID): All inpatient hospital discharge data (including those admissions that started in the ED) from participating HCUP States.
State Ambulatory Surgery Databases (SASD): Ambulatory surgery data (hospital based and some freestanding) from participating HCUP States.
State Emergency Department Databases (SEDD): Emergency department data (treat and release) from participating HCUP States.
Slide 34
What Data Elements are Included in the HCUP databases?
Data Elements:
- Patient demographics (age, sex).
- Diagnoses & procedures.
- Expected payer.
- Length of stay.
- Patient disposition.
- Admission source & type.
- Admission month.
- Weekend admission.
Slide 35
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 36
Example: Payer Detail Varies by State
PAY1_X | PAY1 (Standardized) | ||
---|---|---|---|
Value | Description | Value | Description |
010 | Medicare | 1 | Medicare |
011 | Medicare (HMO) | ||
012 | Medicare (Managed care—Other) | ||
013 | Medicare (fee for service) | ||
020 | Medi-Cal | 2 | Medi-Cal |
021 | Medi-Cal (HMO) | ||
022 | Medi-Cal (Managed care—Other) | ||
023 | Medi-Cal (fee for service) | ||
030 | Private Coverage | 3 | Private insurance |
031 | Private Coverage (HMO) | ||
032 | Private Coverage (Managed care—Other) | ||
033 | Private Coverage (fee for service) | ||
08n, where n=0-3 | Self-pay | 4 | Self-pay |
-- | 5 | No charge |
Slide 37
Example: Race Detail Varies by State
RACE_X | RACE (Standardized) | ||
---|---|---|---|
Value | Description | Value | Description |
1 | White | 1 | White |
2 | Black | 2 | Black |
3 | Hispanic | 3 | Hispanic |
4 | Hawaiian | 4 | Asian or Pacific Islander |
5 | Chinese | ||
6 | Filipino | ||
7 | Japanese | ||
8 | Other Asian | ||
9 | Other Pacific Islander | ||
10 | Native American | 5 | Native American |
11 | Mixed or Other | 6 | Other |
Slide 38
Partner State Files vs. HCUP State Files
- HCUP State Files vs. Data Files received directly from the State:
HCUP State Files | Partner State Files |
---|---|
Both files include all data that states provide | |
Subset of data elements | All data elements |
Value-added data elements | May not have same value-added elements |
Uniformly coded across the states | Not uniformly coded across states |
Standard data quality checks | Variability in quality checks by state |
Lag time | More timely |
Slide 39
States Releasing Databases through HCUP Central Distributor:
- 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.
Remember: Not all states participate in all years and for all databases.
Slide 40
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases:
- Where does data come from?
- HCUP State Databases.
- HCUP Nationwide Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products.
- Additional HCUP Resources.
Slide 41
HCUP National Databases
Nationwide Inpatient Sample (NIS): Inpatient hospital discharge data (including those admissions that started in the ED) from a sample of hospitals in participating HCUP States.
Kids' Inpatient Database (KID): Pediatric inpatient hospital discharge data (including those admissions that started in the ED) from a sample of pediatric discharges in participating HCUP States.
Nationwide Emergency Department Sample (NEDS): Emergency department data (treat and release & admitted) from a sample of hospitals in participating HCUP States.
Slide 42
NIS Is a Stratified Sample of Hospitals From the SID
State Inpatient Databases (SID)
N = ~ 4K hospitals
~ 32M records
Nationwide Impatient Sample (NIS)
N = ~ 1K hospitals
~ 8M records
State is NOT included as a stratum
5 NIS Strata
- U.S. Region.
- Urban/Rural.
- Teaching Status.
- Ownership/Control.
- Bed Size.
Stratified Sample of Hospitals
100% of all discharges from each hospital
Slide 43
KID Is a Stratified Sample of Discharges From the SID
State Inpatient Databases (SID)
N = ~ 4K hospitals
~ 32M records
3 Strata
- Uncomplicated Births.
- Complicated Births.
- Pediatric Non-Births.
State is NOT included as a stratum
10% stratified sample of uncomplicated Births
80% stratified sample of other pediatric Discharges
Kids' Inpatient Database (KID)
N = ~ 4K hospitals
~ 3M records
Slide 44
NEDS Is a Stratified Sample of Hospitals from the SEDD and SID
5 NEDS Strata
State Inpatient Databases (SID)
State Emergency Department Databases (SEDD)
- U.S. Region.
- Urban/Rural.
- Teaching Status.
- Ownership/Control.
- Trauma.
State is Not included as a stratum
Stratified Sample of Hospitals
Nationwide Emergency Department Sample(NEDS)
N = ~ 1K hospitals
~ 28M records
Slide 45
What Types of Care Are and Are Not Captured by HCUP?
Included in HCUP | |
---|---|
Inpatient care | State Inpatient Databases (SID) Nationwide Inpatient Sample (NIS) Kids' Inpatient Database (KID) |
Emergency Department | State Emergency Department Databases (SEDD) Nationwide Emergency Department Sample (NEDS) |
Ambulatory Surgery | State Ambulatory Surgery Databases (SASD) |
Not Included in HCUP |
---|
Physician office visits |
Pharmacy |
Labs/Radiology |
Slide 46
What is HCUP and What Is It Not?
HCUP is... | HCUP is NOT... |
---|---|
Discharge database for health care encounters | A survey |
All payer, including the uninsured | Specific to a single payer, e.g. Medicare |
Hospital, ambulatory surgery, emergency department data | Office visits, pharmacy, laboratory, radiology |
All hospital discharges | Only a sample |
Accessible multiple ways: raw data, regular reports, online | Just another database |
Slide 47
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 and national level |
Supplemental files available to facilitate research |
Limitations |
---|
Differences in coding across hospitals |
Limited clinical details |
Lack revenue information |
May not include all hospitals |
May not show complete experience of care |
No data on individuals outside of hospital system |
Slide 48
Some Limitations Can be Addressed by Linking to Other Databases
HCUP Databases:
- SID
- SEDO.
- NEDS.
- SASD.
- KID.
- NIS.
Are cross-linked to:
American Hospital Association (AHA) Annual Survey (AHAID)
Health Resources and Services Administration's (HRSA) Area Resource File (ARF) (County)
Zip Code Files from Census or Vendor (ZIP Codes)
Medicare Cost Reports (Medicare ID)
Trauma Information Exchange Program (TIEP) (AHAID)
Slide 49
Summary
- Six types of HCUP databases.
- Databases are based on administrative hospital data.
- Available for multiple years:
- NIS (1988-2009).
- NEDS (2006, 2007, 2008).
- KID (1997, 2000, 2003, 2006, 2009).
- SID (1990- 2009).
- SASD (1997- 2009).
- SEDD (1999-2009).
- Can look at breadth of health care issues.
- Can be linked to external files.
Slide 50
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases:
- Where does data come from?
- HCUP State Databases.
- HCUP Nationwide Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products.
- Additional HCUP Resources.
Slide 51
The HCUP Database Process
- Processed data sent to HCUP Partners.
- State databases may become available to public through:
- State Data Organization.
- OR.
- HCUP Central Distributor.
Slide 52
HCUP Data Files Process
- Visit HCUP-US Web site.
- Review HCUP Database Documentation & Summary Statistics.
- Review Methods Reports and Online Tutorials.
- Complete Data Use Agreement Online Training and Sign Data Use Agreement.
- Secure administrative data: SID, SASD, SED, NIS, KID, NEDS.
Slide 53
To Purchase HCUP Data: Two Methods
Method 1 HCUP Central Distributor
http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp
Method 2 HCUP Partner States
http://www.hcup-us.ahrq.gov/partners.jsp
Slide 54
Purchase Data through 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 55
Additional Requirement: Electronic Data Use Agreement (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.
Takes 15 minutes to complete
http://www.hcup-us.ahrq.gov/tech_assist/dua.jsp
Slide 56
Pricing Information Per Data Year
- National Databases (NIS, KID, NEDS):
- NIS: $350 (CY 2009; student price $50)
$160-200 (earlier years; student price $20). - KID: $350 (CY 2009; student price $50)
$200 (earlier years; student price $20). - NEDS: $500 (student price $75).
- NIS: $350 (CY 2009; student price $50)
- State Databases (SID, SASD, SEDD):
- Varies by state, database, year, and type of applicant.
- $35–$3,185.
Slide 57
Software Requirements of Working with the Full HCUP Files
Software Package | Load Programs | Format Programs | Example Statistical Coding | HCUP Tools Programs |
---|---|---|---|---|
SAS® | X | X | X | X |
STATA® | X | X | X | |
SPSS® | X | X | ||
SUDAAN® | X |
MS Excel® and Access® are not good options!
Slide 58
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products:
- Software Tools.
- Supplemental Files.
- Online Tools.
- Methods Reports.
- Additional HCUP Resources.
Slide 59
Software Tools
- Clinical Classifications Software.
- Procedure Classes.
- Chronic Condition Indicator.
- Comorbidity Software.
- Utilization Flags.
- AHRQ Quality Indicators:
- Prevention Quality Indicators.
- Inpatient Quality Indicators.
- Patient Safety Indicators.
- Pediatric Indicators.
Slide 60
ICD and CPT: The Clinical Backbone of Claims Data
- ICD-9-CM Diagnosis and Procedures Codes:
- Included in both inpatient and outpatient databases.
- Common Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS):
- Procedure coding for outpatient data.
Slide 61
Clinical Classifications Software (CCS)
- Clusters diagnosis and procedure codes into categories:
- >12,000 diagnosis codes → ~260 categories.
- > 4,000 procedure codes → ~230 categories.
- Useful for presenting descriptive statistics, understanding patterns.
ICD-9-CM Codes
CCS for ICD-9 CM:
0031 0202 0223 0362 0380 0381 03810 03811 03819 0382 0383 03840 03841 03842 03843 03844 03849 0388 0389 0545 449 7907: CCS 6 Hepatitis Category
0700 0701 0702 07020 07021 07022 07023 0703 07030 07031 07032 07033 0704 07041 07042 07043 07044 07049: CCS 2: Septicemia Category
Slide 62
Clinical Classifications Software (CCS)
In the process of being updated to ICD-10-CM:
- ICD-9-CM diagnoses:
- Single-level.
- Multi-level.
- ICD-9-CM procedures:
- Single-level.
- Multi-level.
- ICD-10 for mortality.
- Services and Procedures:
- Common Procedural Terminology (AMA).
Slide 63
Procedure Classes
- Groups ICD-9-CM procedure codes into one of four categories.
- Major procedures defined as OR procedures (DRGs).
ICD-9-CM Procedure Codes:
- Minor Diagnostic:
- Ex: Electrocardiogram.
- Major Diagnostic:
- Ex: Pericardial Biopsy.
- Minor Therapeutic:
- Ex: Pacemaker.
- Major Therapeutic:
- Ex: CABG.
Slide 64
Chronic Condition Indicator (CCI)
- Groups ICD-9-CM diagnosis codes in Chronic or Non-Chronic Categories.
ICD-9-CM Diagnosis Codes:
- Chronic:
- Ex: Diabetes.
- Non-Chronic:
- Ex: Food Poisoning.
Slide 65
Comorbidity Software
- Creates and appends indicator flags to each record for 29 major comorbidities.
ICD-9-CM Codes, DRGs on Administrative Data → Comorbidity Software → 29 Comorbidity Groups:
- CHF.
- Valvular disease.
- Pulm circ disorders.
- Peripheral vascular dx.
- Hypertension.
- Paralysis.
- Other neuro disorders.
- Chronic pulmonary dx.
- DM w/o complications.
- DM w/complications.
- Hypothyroidism.
- Renal failure.
- Liver disease ...
Slide 66
Utilization Flags
- Reveals additional information about the use of health care services.
- Combines ICD-9-CM procedure codes and UB-04 revenue codes.
Utilization Flag Software → ICD-9-CM codes + UB-04 codes →:
- Emergency Room.
- Chest X-ray/ CT Scan.
- Intensive Care Unit.
Slide 67
AHRQ Quality Indicators
- Creates measures of health care quality using inpatient administrative data:
- 4 Quality Indicators.
- Prevention Quality Indicators.
- Inpatient Quality Indicators.
- Patient Safety Indicators.
- Pediatric Indicators.
- 4 Quality Indicators.
Below the text are images of the covers of the 4 AHRQ Quality Indicator publications.
Slide 68
Prevention Quality Indicators (PQIs)
- Identify hospital admissions that are potentially preventable through high-quality outpatient care.
- Examples of PQI Measures:
- Diabetes Short-term Complication Admission Rate.
- Diabetes Long-term Complication Admission Rate.
- Pediatric Asthma Admission Rate.
- Pediatric Gastroenteritis Admission Rate.
- Hypertension Admission Rate.
Below the text is an image of the cover for the AHRQ publication "Guide to Prevention Quality Indicators".
Slide 69
Inpatient Quality Indicators (IQIs)
- Reflect quality of care inside hospitals:
- Inpatient mortality for medical conditions and surgical procedures.
- Utilization of procedures.
- Volume of procedures.
- Examples of IQI Measures:
- Esophageal Resection Volume.
- Pneumonia Mortality Rate.
- Coronary Artery Bypass Graft Mortality Rate.
- Cesarean Section Delivery Rate.
Below the text is an image of the cover for the AHRQ publication "Guide to Inpatient Quality Indicators".
Slide 70
Patient Safety Indicators (PSIs)
- Identify potentially avoidable complications and iatrogenic events.
- Examples of PSI Measures:
- Complications of Anesthesia.
- Death in Low-Mortality DRGs.
- Decubitus Ulcer.
- Failure to Rescue.
- Foreign Body Left During Procedure.
- Iatrogenic Pneumothorax.
Below the text is an image of the cover for the AHRQ publication "Guide to Patient Safety Indicators".
Slide 71
Pediatric Quality Indicators (PDIs)
- Identify potentially avoidable hospitalizations among children.
- Examples of PDI Measures:
- Accidental Puncture or Laceration.
- Decubitus Ulcer.
- Foreign Body Left During Procedure.
- Pediatric Heart Surgery Mortality.
- Postoperative Hemorrhage or Hematoma.
Below the text is an image of the cover for the AHRQ publication "Guide to Pediatric Quality Indicators".
Slide 72
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products:
- Software Tools.
- Supplemental Files.
- Online Tools.
- Methods Reports.
- Additional HCUP Resources
Slide 73
Supplemental Files
- Supplemental Variables for Revisit Analyses.
- Cost-to-Charge Ratio Files.
- Hospital Market Structure Files.
- Trends Files (NIS & KID).
- NIS Hospital Ownership File.
- AHA Linkage Files.
Slide 74
HCUP Supplemental Variables for Revisit Analyses
- Used to track sequential visits for a patient:
- Within a state.
- Across hospitals, ED, and ambulatory surgery settings.
- Adheres to strict privacy guidelines.
- Allows linkage across settings and time:
- Hospital readmissions.
- ED visits following hospital discharge.
- Inpatient hospitalizations following ambulatory surgery visits.
Slide 75
HCUP Supplemental Variables for Revisit Analyses
- There are two HCUP supplemental variables:
- Synthetic person-level identifiers:
- Verified against the patient's date of birth and gender.
- Examined for completeness (VisitLink).
- Timing variable determines the number of days between events for an individual (DaysToEvent):
- Without the use of actual dates.
- Synthetic person-level identifiers:
- Limited to HCUP state databases with encrypted patient identifiers.
- HCUP revisit variables can be used only with the SID, SASD, and SEDD.
Slide 76
HCUP Supplemental Variables for Revisit Analyses by State
State | SID | SEDD | SASD |
---|---|---|---|
Arizona | 2003-2007 | 2005-2007 | |
Arkansas | 2004-2008 | ||
California | 2003-2009 | 2005-2009 | 2005-2009 |
Florida | 2004-2009 | 2005-2009 | 2004-2009 |
Hawaii | 2006-2009 | 2006-2009 | |
Nebraska | 2003-2009 | 2003-2009 | 2003-2009 |
Nevada | 2003-2007 | ||
New York | 2003-2009 | 2003-2009 | |
North Carolina | 2003-2009 | 2007-2009 | 2003-2009 |
Utah | 2003-2009 | 2003-2008 | 2003-2008 |
Washington | 2003-2009 |
Slide 77
Example of Adding Readmissions/ Revisit Data to HCUP State Files
- Example of how to use the revisit files:
- Examines rates of acute care utilization and rehospitalizations for patients with sickle cell disease in eight geographically dispersed states.
- Findings:
- Acute care encounters and rehospitalizations were frequent.
- Specifically for 18-30 year olds.
Acute Care Utilization and Rehospitalizations for Sickle Cell Disease. Brousseau DC, Owens PL, Mosso AL, Panepinto JA, Steiner CA. JAMA 2010;303(13):1288-1294.
Slide 78
Charges vs. Costs vs. Price
- Charges: What the hospital charged for care (includes charge BEFORE discount).
- Costs: What it cost the hospital to provide the care.
- Price (Payment): What the insurer/individual paid for the care.
HCUP Databases include charge information
Cost information can be estimated
Slide 79
Cost-to-Charge Ratio Files
- Enable conversion of charge data to cost data on the NIS, KID, and SID
Hospital-Level Data → Apply Ratios → Convert Charges to Costs
Slide 80
Hospital Market Structure (HMS) Files
- Contain various measures of hospital market competition.
- Allow users to broadly characterize the intensity of competition that hospitals face:
- Using various definitions of market area.
Slide 81
Additional HCUP Supplemental Files
- Trends Files (NIS & KID):
- Discharge-level files that provide trend weights and data elements that are consistently defined across data years.
- NIS Hospital Ownership File:
- Hospital-level files 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.
http://www.hcup-us.ahrq.gov/tools_software.jsp
Slide 82
Image: A screen shot of the HCUP Tools and Software page: http://www.hcup-us.ahrq.gov/tools_software.jsp is shown.
Slide 83
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products:
- Software Tools.
- Supplemental Files.
- Online Tools.
- Methods Reports.
- Additional HCUP Resources.
Slide 84
Online Tools
- MONAHRQ:
- A desktop software tool that enables organizations to input their own hospital administrative data and/or the CMS Hospital Compare data to generate a data-driven Web site.
- http://monahrq.ahrq.gov/.
- HCUPnet:
- Free, interactive online query system.
- http://hcup.ahrq.gov/hcupnet.
Slide 85
How to Use MONAHRQ
- Download the free MONAHRQ software from AHRQ's Web site.
- Load hospital discharge data and/or Hospital Compare measure results.
- Select data analysis and Web site options, and run MONAHRQ.
- MONAHRQ generates your Web site onto your own computer.
- Host your MONAHRQ Web site as you prefer:
- Internal: better understand your data and answer questions.
- Private: provide a password-protected site for member organizations.
- Public: report healthcare information to the community.
Slide 86
Key Features of HCUPnet
- Free, interactive online query system.
- Users generate tables of outcomes by diagnoses and procedures.
- Data can be cross-classified by patient and hospital characteristics.
- HCUPnet Can Produce:
- Simple statistics.
- Sample size calculations.
- Trends information.
- Rank ordering of diagnoses and procedures.
- Significance testing.
- HCUPnet Cannot Produce:
- More complicated queries.
- Multivariate analyses.
- Statistics involving certain variables.
Slide 87
Image: A screen shot of the Welcome Page of H-CUPnet: http://hcup.ahrq.gov/hcup.net is shown.
Slide 88
HCUPnet Demonstration
Image: A screen shot of the AHRQ HCUPnet Demonstration web site is shown.
Slide 89
Image: A screen shot of the AHRQ HCUPnet welcome page is shown. The heading Statistics on Hospital Stays is circled.
Slide 90
Image: A screen shot of the AHRQ HCUPnet query page is shown. An arrow points to Statistics on specific diagnoses or procedures.
Slide 91
Image: A screen shot of the AHRQ HCUPnet Select Year page is shown. An arrow points to the year 2009.
Slide 92
Image: A screen shot of the AHRQ HCUPnet select query type page is shown. An arrow points to Diagnoses grouped by Clinical Classification Software (CCS).
Slide 93
Image: A screen shot of the AHRQ HCUPnet diagnosis selection page is shown. An arrow points to Principal diagnosis.
Slide 94
Image: A screen shot of the AHRQ HCUPnet CCS category browse page is shown.
Slide 95
Image: A screen shot of the AHRQ HCUPnet outcomes and measures page is shown.
Slide 96
Image: A screen shot of the AHRQ HCUPnet patient and hospital characteristics page is shown.
Slide 97
Image: A screen shot of the AHRQ HCUPnet results page is shown. A chart showing 2009 statistics for the diagnosis Acute myocardial infection is shown.
Slide 98
Image: A screen shot of the AHRQ HCUPnet query type selection page is shown. An arrow points to Trends.
Slide 99
Image: A screen shot of the AHRQ HCUPnet diagnosis or procedure selection page is shown. An arrow points to Diagnoses grouped by Clinical Classification Software (CCS).
Slide 100
Image: A screen shot of the AHRQ HCUPnet diagnosis page is shown. An arrow points to Principal diagnoses.
Slide 101
Image: A screen shot of the AHRQ HCUPnet CCS category browse page is shown. The diagnosis Septicemia is shown selected.
Slide 102
Image: A screen shot of the AHRQ HCUPnet outcomes and measures page is shown. The box Hospital charges, mean is selected.
Slide 103
Image: A screen shot of the AHRQ HCUPnet results page is shown. An arrow points to the option Show Graphs of Trend Data.
Slide 104
Image: A screen shot of the AHRQ HCUPnet national statistics page showing a graph on total number of discharges 1993-2009 for septicemia is shown.
Slide 105
Image: A screen shot of the AHRQ HCUPnet welcome page is shown. The heading Statistics on Emergency Department Use (Beta Version) is circled.
Slide 106
Image: A screen shot of the AHRQ HCUPnet emergency department visit/stays page is shown. An arrow points to All ED visits.
Slide 107
Image: A screen shot of the AHRQ HCUPnet query type page is shown. An arrow points to Statistics on specific diagnoses.
Slide 108
Image: A screen shot of the AHRQ HCUPnet NEDS year selection web site page is shown. An arrow points to the year 2008.
Slide 109
Image: A screen shot of the AHRQ HCUPnet NEDS CCS diagnosis or procedure selection web site page is shown. An arrow points to Diagnoses grouped by Clinical Classification Software (CCS).
Slide 110
Image: A screen shot of the AHRQ HCUPnet NEDS diagnosis web site page is shown. An arrow points to First-listed diagnosis.
Slide 111
Image: A screen shot of the AHRQ HCUPnet NEDS CCS browse web site page is shown. The selection Asthma is highlighted.
Slide 112
Image: A screen shot of the AHRQ HCUPnet NEDS outcomes and measures web site page is shown. The box Percent submitted to the hospital is selected.
Slide 113
Image: A screen shot of the AHRQ HCUPnet NEDS patient and hospital characteristics selection web site page is shown. The box Trauma center designation (trauma center vs.not?) is selected.
Slide 114
Image: A screen shot of the AHRQ HCUPnet NEDS 2008 national statistics web site page is shown. A chart showing the total number of visits by patient and hospital characteristics for CCS first-listed diagnosis category of asthma is shown.
Slide 115
Image: A screen shot of the AHRQ HCUPnet web site page is shown. The heading AHRQ Quality Indicators (QIs) is circled.
Slide 116
Image: A screen shot of the AHRQ HCUPnet indicator selection web site page is shown. An arrow points to Detailed statistics for 2007.
Slide 117
Image: A screen shot of the AHRQ HCUPnet Prevention Quality Indicators (PQIs) web site page is shown. An arrow points to Diabetes short term complications.
Slide 118
Image: A screen shot of the AHRQ HCUPnet 2007 National Quality Indicator statistics web site page is shown. A chart showing 2007 Admissions for diabetes with short-term complications is shown.
Slide 119
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products:
- Software Tools.
- Supplemental Files.
- Online Tools.
- Methods Reports.
- Additional HCUP Resources
Slide 120
HCUP Methods Reports
- Methodological information on the HCUP databases and software tools.
Image: A screen shot of the AHRQ HCUPnet Web site is shown.
Slide 121
HCUP Methods Reports: Example
Population Denominator Data for Use with the HCUP Databases (Updated with 2009 Population Data) Barret M, Hunter K, Coffey R, Levit K. HCUP Methods. Series Report # 2010-02. Online April 12, 2010.
http://www.hcup-us.ahrq.gov/reports/methods.jsp.
Slide 122
Example of Using Rate Calculations
Images of data from the publication in Slide 121 are shown including:
Does the South have the highest prevalence of CDAD hospital stays?
Rate of CDAD stays highest in the Northeast and lowest in the West.
Adjust for population differences.
Slide 123
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products.
- Additional HCUP Resources:
- HCUP Publications.
- User Support.
Slide 124
HCUP Publications
- Statistical Briefs.
- Annual Reports.
- Special Analysis Reports.
- Fact Books.
Slide 125
Image: A screen shot of http://www.hcup-us.ahrq.gov/reports.jsp is shown.
Slide 126
Statistical Briefs
Image: A screen shot of 3 HCUP Statistical Briefs are shown.
Slide 127
HCUP Facts and Figures
Image: A screen shot of 3 pages from the HCUP Facts and Figures publications are shown.
Slide 128
Special Analysis Reports
Images of the cover page and a figure from the publication State Uses of Hospital Discharge Databases to Reduce Racial and Ethnic Disparities, 2010 are shown.
Slide 129
Publications Search Page on HCUP-US
- Simple or advanced search options:
- Data Year.
- Database, Tool, & Product.
- Author.
- Title.
- State.
Slide 130
Today's Objectives
- Project Overview.
- The HCUP Partnership.
- The HCUP Databases.
- Obtaining HCUP Databases.
- The HCUP Tools and Products.
- Additional HCUP Resources:
- HCUP Publications.
- User Support.
Slide 131
HCUP User Support Web Site
- Find detailed information on HCUP databases, tools, and products.
- Access HCUPnet.
- Find comprehensive list of HCUP-related publications, database reports, and fact books.
- Access technical assistance.
Slide 132
Interactive On-line HCUP Overview Course Available
- Provides information about HCUP data, software tools, and products.
- Length 90 min
http://www.hcup-us.ahrq.gov/overviewcourse.jsp.
Images of the HCUP Overview Course pages are shown.
Slide 133
HCUP Sample Design
- Tutorial explains the sampling strategy of the three nationwide databases—the NIS, KID, and NEDS.
- Length 30 min.
http://www.hcup-us.ahrq.gov/tech_assist/tutorials.jsp.
Images from the tutorial pages are shown.
Slide 134
Load and Check HCUP Data
- Provides instructions on how to unzip HCUP data, save it on your computer, and load data into a statistical software package.
- Length 20 min.
http://www.hcup-us.ahrq.gov/tech_assist/tutorials.jsp.
Images from the Load and Check HCUP Data section of the tutorial are shown.
Slide 135
Producing National HCUP Estimates
- Explains how to produce national estimates from the three nationwide databases (NIS, NEDS, KID).
- Length 45 min.
http://www.hcup-us.ahrq.gov/tech_assist/tutorials.jsp.
Images from the HCUP National Esimates section of the tutorial are shown
Slide 136
Calculating Standard Errors
- Explains how to accurately determine the precision of the estimates produced from the HCUP nationwide databases.
- Length 30 min.
http://www.hcup-us.ahrq.gov/tech_assist/tutorials.jsp.
Images from the Calculating Standard Errors section of the tutorial are shown
Slide 137
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
Slide 138
Join the HCUP E-mail List
- HCUP Newsletter, published quarterly:
- User Tech Tips.
- Upcoming Events.
- New Data Releases.
- New Reports.
https://subscriptions.ahrq.gov/accounts/USAHRQ/subscriber/new?topic_id=USAHRQ_65
Slide 139
Healthcare Cost and Utilization Project (HCUP)
Slide 140
Questions/Comments?
Time for Questions and/or Comments.