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

Slide Presentation from the AHRQ 2011 Annual Conference

The Healthcare Cost and Utilization Project (HCUP)

Slide Presentation from the AHRQ 2011 Annual 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). .

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?

Slide 7

What can you get from HCUP?

Slide 8

HCUP Supports High Impact Health Services, Policy & Clinical Research

A number of images of logos from news publications 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

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.

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

• 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

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.
• Basic quality checks.

Slide 27

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.

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)

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.

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

Slide 37

Example: Race Detail Varies by State

Slide 38

Partner State Files vs. HCUP State Files

• HCUP State Files vs. Data Files received directly from the State:

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

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

Slide 43

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

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)

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

Slide 45

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

Slide 46

What is HCUP and What Is It Not?

Slide 47

Hospital Billing Data Have Benefits and Limitations

Slide 48

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)

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).
• 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

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

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:

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

1. Chronic:
   • Ex: Diabetes.
2. 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.
    1. Prevention Quality Indicators.
    2. Inpatient Quality Indicators.
    3. Patient Safety Indicators.
    4. Pediatric Indicators.

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.

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.

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.

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.

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:
  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.

Slide 76

HCUP Supplemental Variables for Revisit Analyses by State

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.

Slide 90

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

Slide 91

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

Slide 92

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

Slide 93

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

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.

Slide 98

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

Slide 99

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

Slide 100

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

Slide 101

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

Slide 102

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

Slide 103

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

Slide 104

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

Slide 105

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

Slide 106

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

Slide 107

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

Slide 108

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

Slide 109

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

Slide 110

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

Slide 111

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

Slide 112

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

Slide 113

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

Slide 114

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

Slide 115

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

Slide 116

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

Slide 117

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

Slide 118

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

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 documents are shown.

Slide 127

HCUP Facts and Figures

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

Slide 128

Special Analysis Reports

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

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

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.

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.

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.

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.

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.

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.

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.

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

Slide 139

Healthcare Cost and Utilization Project (HCUP)

Slide 140

Questions/Comments?

Time for Questions and/or Comments.