The Healthcare Cost and Utilization Project (HCUP) (Text Version)

Slide Presentation from the AHRQ 2011 Annual Conference

Slide presentation from the AHRQ 2011 conference.

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). .


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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

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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.

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Today's Objectives

  • Project Overview.
  • The HCUP Partnership.
  • The HCUP Databases.
  • Obtaining HCUP Databases.
  • The HCUP Tools and Products.
  • Additional HCUP Resources.

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What is HCUP?

  • HCUP Databases.
  • Research Tools.
  • Research Publications.
  • User Support.

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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.

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Why Do We Need Another Hospital Data Source?

Hospital Data SourceDescription
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

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What can you get from HCUP?

TopicSpecific Findings
CostHospital costs for treating patients with septicemia surged 174 percent between 2001 and 2007 (NIS)
AccessAmericans in low-income areas visit EDs at rates 90 percent higher compared to those in the highest income areas (NEDS)
QualityOregon and Vermont had the Nation's lowest rates of avoidable hospitalizations for asthma in children ages 2 to 17 (PQI software, SID)
UtilizationPatients in rural hospitals were older (42 percent were 65 plus) than those in urban public hospitals (23 percent were 65 plus). (NIS)

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HCUP Supports High Impact Health Services, Policy & Clinical Research

A number of images of logos from news publications are shown.

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Today's Objectives

  • Project Overview.
  • The HCUP Partnership.
  • The HCUP Databases.
  • Obtaining HCUP Databases.
  • The HCUP Tools and Products.
  • Additional HCUP Resources.

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The HCUP Partnership

State
Federal
Industry

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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.

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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.

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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.

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Current HCUP State 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.
  • Montana Hospital Association.
  • Nebraska Hospital Association.
  • Nevada Division of Health Care Financing and Policy, Department of Health and Human Services.

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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.

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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.

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HCUP Partners Providing 2010 Inpatient Data

Image: A map of the United States is shown with the HCUP participating states highlighted.

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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.

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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.

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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.

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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.

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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.

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The Foundation of HCUP Data is Hospital Billing Data

Demographic Data
Diagnoses Procedures Charges

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From Patient Hospital Visit to HCUP Record

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

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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.

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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.
  • Basic quality checks.

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Where Do We Get HCUP Data?

Typically not included in HCUP data

Included in HCUP data

86% (N=5,008)
14% (N=787)

HCUP data is mostly from community hospitals.

Source: American Hospital Association (AHA), 2009.

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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)

IncludedExcluded
Multi-specialty general hospitalsLong-term care
OB-GYNPsychiatric
ENTAlcoholism/Chemical dependency
OrthopedicRehabilitation
PediatricDoD / VA / IHS
Public 
Academic medical centers 

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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. Newborns4,159
2. Pneumonia1,165
3. Congestive heart failure1,023
4. Osteoarthritis921
5. Mood disorders873
6. Coronary atherosclerosis832
7. Cardiac dysrhythmias807

Source: Nationwide Inpatient Sample, 2009

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HCUP Has Six Types of Databases

  • Three state-level databases.

State Inpatient Databases (SID)
State Emergency Department Databases (SEDD)
State Ambulatory Surgery Databases (SASD)

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HCUP Has Six Types of Databases

  • Three nationwide databases.

Nationwide Inpatient Sample (NIS)
Kids' Inpatient Database (KID)
Nationwide Emergency Department Sample (NEDS)

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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.

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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.

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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.

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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.

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Example: Payer Detail Varies by State

PAY1_XPAY1 (Standardized)
ValueDescriptionValueDescription
010Medicare1Medicare
011Medicare (HMO)
012Medicare (Managed care—Other)
013Medicare (fee for service)
020Medi-Cal2Medi-Cal
021Medi-Cal (HMO)
022Medi-Cal (Managed care—Other)
023Medi-Cal (fee for service)
030Private Coverage3Private insurance
031Private Coverage (HMO)
032Private Coverage (Managed care—Other)
033Private Coverage (fee for service)
08n, where n=0-3Self-pay4Self-pay
-- 5No charge

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Example: Race Detail Varies by State

RACE_XRACE (Standardized)
ValueDescriptionValueDescription
1White1White
2Black2Black
3Hispanic3Hispanic
4Hawaiian4Asian or Pacific Islander
5Chinese
6Filipino
7Japanese
8Other Asian
9Other Pacific Islander
10Native American5Native American
11Mixed or Other6Other

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Partner State Files vs. HCUP State Files

  • HCUP State Files vs. Data Files received directly from the State:
HCUP State FilesPartner State Files
Both files include all data that states provide
Subset of data elementsAll data elements
Value-added data elementsMay not have same value-added elements
Uniformly coded across the statesNot uniformly coded across states
Standard data quality checksVariability in quality checks by state
Lag timeMore timely

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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.

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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.

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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.

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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

  1. U.S. Region.
  2. Urban/Rural.
  3. Teaching Status.
  4. Ownership/Control.
  5. Bed Size.

Stratified Sample of Hospitals
100% of all discharges from each hospital

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KID Is a Stratified Sample of Discharges From the SID

State Inpatient Databases (SID)

N = ~ 4K hospitals
~ 32M records

3 Strata

  1. Uncomplicated Births.
  2. Complicated Births.
  3. Pediatric Non-Bi rths.

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

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

5 NEDS Strata

State Inpatient Databases (SID)

State Emergency Department Databases (SEDD)

  1. U.S. Region.
  2. Urban/Rural.
  3. Teaching Status.
  4. Ownership/Control.
  5. Trauma.

State is Not included as a stratum

Stratified Sample of Hospitals

Nationwide Emergency Department Sample(NEDS)

N = ~ 1K hospitals
~ 28M records

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

Included in HCUP
Inpatient careState Inpatient Databases (SID)
Nationwide Inpatient Sample (NIS)
Kids' Inpatient Database (KID)
Emergency DepartmentState Emergency Department Databases (SEDD)
Nationwide Emergency Department Sample (NEDS)
Ambulatory SurgeryState Ambulatory Surgery Databases (SASD)
Not Included in HCUP
Physician office visits
Pharmacy
Labs/Radiology

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What is HCUP and What Is It Not?

HCUP is...HCUP is NOT...
Discharge database for health care encountersA survey
All payer, including the uninsuredSpecific to a single payer, e.g. Medicare
Hospital, ambulatory surgery, emergency department dataOffice visits, pharmacy, laboratory, radiology
All hospital dischargesOnly a sample
Accessible multiple ways: raw data, regular reports, onlineJust another database

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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
 

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Some Limitations Can be Addressed by Linking to Other Databases

HCUP Databases:

  • AHAID.
  • County.
  • ZIP Code.
  • Medicare ID.
  • AHAID.

American Hospital Association (AHA) Annual Survey
Health Resources and Services Administration's (HRSA) Area Resource File (ARF)
Zip Code Files from Census or Vendor
Medicare Cost Reports
Trauma Information Exchange Program (TIEP)

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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.

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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.

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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.

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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.

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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

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Purchase Data through HCUP Central Distributor

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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

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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).
  • State Databases (SID, SASD, SEDD):
    • Varies by state, database, year, and type of applicant.
    • $35—$3,185.

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Software Requirements of Working with the Full HCUP Files

Software PackageLoad ProgramsFormat ProgramsExample Statistical CodingHCUP Tools Programs
SAS®XXXX
STATA®X XX
SPSS®X  X
SUDAAN®  X 

MS Excel® and Access® are not good options!

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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.

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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.

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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.

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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

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

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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).

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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:

  1. Minor Diagnostic:
    • Ex: Electrocardiogram.
  2. Major Diagnostic:
    • Ex: Pericardial Biopsy.
  3. Minor Therapeutic:
    • Ex: Pacemaker.
  4. Major Therapeutic:
    • Ex: CABG.

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Chronic Condition Indicator (CCI)

  • Groups ICD-9-CM diagnosis codes in Chronic or Non-Chronic Categories.

ICD-9-CM Diagnosis Codes:

  1. Chronic:
    • Ex: Diabetes.
  2. Non-Chronic:
    • Ex: Food Poisoning.

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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 ...

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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.

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AHRQ Quality Indicators

  • Creates measures of health care quality using inpatient administrative data:
    • 4 Quality Indicators.
      1. Prevention Quality Indicators.
      2. Inpatient Quality Indicators.
      3. Patient Safety Indicators.
      4. Pediatric Indicators.

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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.

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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.

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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.

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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.

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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

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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.

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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.

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HCUP Supplemental Variables for Revisit Analyses

  • There are two HCUP supplemental variables:
    1. Synthetic person-level identifiers:
      • Verified against the patient's date of birth and gender.
      • Examined for completeness (VisitLink).
    2. Timing variable determines the number of days between events for an individual (DaysToEvent):
      • Without the use of actual dates.
  • Limited to HCUP state databases with encrypted patient identifiers.
  • HCUP revisit variables can be used only with the SID, SASD, and SEDD.

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HCUP Supplemental Variables for Revisit Analyses by State

StateSIDSEDDSASD
Arizona2003-20072005-2007 
Arkansas2004-2008  
California2003-20092005-20092005-2009
Florida2004-20092005-20092004-2009
Hawaii2006-20092006-2009 
Nebraska2003-20092003-20092003-2009
Nevada2003-2007  
New York2003-2009 2003-2009
North Carolina2003-20092007-20092003-2009
Utah2003-20092003-20082003-2008
Washington2003-2009  

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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.

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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

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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

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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.

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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

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

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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.

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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:

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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.

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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.

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Image: A screen shot of the Welcome Page of H-Cupnet: http://hcup.ahrq.gov/hcup.net is shown.

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HCUPnet Demonstration

Image: A screen shot of the AHRQ HCUPnet Demonstration web site is shown.

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Image: A screen shot of the AHRQ HCUPnet welcome page is shown.

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Image: A screen shot of the AHRQ HCUPnet query page is shown.

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Image: A screen shot of the AHRQ HCUPnet select year page is shown.

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Image: A screen shot of the AHRQ HCUPnet select type of query page is shown.

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Image: A screen shot of the AHRQ HCUPnet diagnosis selection page is shown.

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Image: A screen shot of the AHRQ HCUPnet CCS category browse page is shown.

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Image: A screen shot of the AHRQ HCUPnet outcomes and measures page is shown.

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Image: A screen shot of the AHRQ HCUPnet patient and hospital characteristics page is shown.

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Image: A screen shot of the AHRQ HCUPnet results page is shown.

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Image: A screen shot of the AHRQ HCUPnet query type page is shown.

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Image: A screen shot of the AHRQ HCUPnet diagnosis or procedure selection page is shown.

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Image: A screen shot of the AHRQ HCUPnet diagnosis page is shown.

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Image: A screen shot of the AHRQ HCUPnet CCS category browse page is shown.

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Image: A screen shot of the AHRQ HCUPnet outcomes and measures page is shown.

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Image: A screen shot of the AHRQ HCUPnet results page is shown.

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Image: A screen shot of the AHRQ HCUPnet national statistics page showing a graph on total number of discharges 1993-2009 is shown.

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Image: A screen shot of the AHRQ HCUPnet welcome page is shown.

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Image: A screen shot of the AHRQ HCUPnet emergency department visit/stays page is shown.

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Image: A screen shot of the AHRQ HCUPnet query type page is shown.

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Image: A screen shot of the AHRQ HCUPnet NEDS year selection web site page is shown.

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Image: A screen shot of the AHRQ HCUPnet NEDS CCS diagnosis or procedure selection web site page is shown.

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Image: A screen shot of the AHRQ HCUPnet NEDS diagnosis web site page is shown.

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Image: A screen shot of the AHRQ HCUPnet NEDS CCS browse web site page is shown.

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Image: A screen shot of the AHRQ HCUPnet NEDS outcomes and measures web site page is shown.

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Image: A screen shot of the AHRQ HCUPnet NEDS patient and hospital characteristics selection web site page is shown.

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Image: A screen shot of the AHRQ HCUPnet NEDS 2008 national statistics web site page is shown.

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Image: A screen shot of the AHRQ HCUPnet web site page is shown.

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Image: A screen shot of the AHRQ HCUPnet indicator selection web site page is shown.

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Image: A screen shot of the AHRQ HCUPnet Prevention Quality Indicators (PQIs) web site page is shown.

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Image: A screen shot of the AHRQ HCUPnet 2007 National Quality Indicator statistics web site page is shown.

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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

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HCUP Methods Reports

  • Methodological information on the HCUP databases and software tools.

Image: A screen shot of the AHRQ HCUPnet is shown.

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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.

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Example of Using Rate Calculations

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.

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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.

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HCUP Publications

  • Statistical Briefs.
  • Annual Reports.
  • Special Analysis Reports.
  • Fact Books.

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Image: A screen shot of http://www.hcup-us.ahrq.gov/reports.jsp is shown.

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Statistical Briefs

Image: A screen shot of 3 HCUP documents are shown.

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HCUP Facts and Figures

Image: A screen shot of 3 HCUP documents are shown.

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Special Analysis Reports

State Uses of Hospital Discharge Databases to Reduce Racial and Ethnic Disparities, 2010.

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Publications Search Page on HCUP-US

  • Simple or advanced search options:
    • Data Year.
    • Database, Tool, & Product.
    • Author.
    • Title.
    • State.

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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.

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HCUP User Support Web site

http://www.hcup-us.ahrq.gov

  • 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.

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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.

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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.

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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.

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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.

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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.

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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

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Join the HCUP E-mail List

  • HCUP Newsletter, published quarterly:
    • User Tech Tips.
    • Upcoming Events.
  • New Data Releases.
  • New Reports.

http://www.ahrq.gov/legacy/data/hcup/hcuplist.htm.

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Healthcare Cost and Utilization Project (HCUP)

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Questions/Comments?

Time for Questions and/or Comments.

Page last reviewed March 2012
Internet Citation: The Healthcare Cost and Utilization Project (HCUP) (Text Version): Slide Presentation from the AHRQ 2011 Annual Conference. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/davis-steiner/index.html