HCUP Data for Healthcare Research
The Healthcare Cost and Utilization Project (HCUP)
Anne Elixhauser, Ph.D.
Claudia Steiner, M.D., M.P.H.
AcademyHealth
y
Annual Research Meeting
g
June 28, 2010
Texth
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
Texth
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
Texth
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
H
AHRQ – Agency within DHHS
7
Healthcare Cost and Utilization
Project (HCUP)
THE LARGEST COLLECTION OF MULTI
MULTI--YEAR,
ALL--PAYER, ENCOUNTERALL
ENCOUNTER-LEVEL:
INPATIENT
EMERGENCY DEPARTMENT
AMBULATORY SURGERY
8
HOSPITAL--BASED ADMINISTRATIVE DATA
HOSPITAL
HCUP is a Family of
Databases,
Databases Tools & Products
SID
SEDD
NIS
NEDS
SASD
KID
HCUP Databases
Research Products
9
User Support
Research Publications
HCUP Partners Providing 2009
Inpatient Data
WA
MT
ND
VT
ME
MN
OR
NH
ID
WY
WI
SD
RI
PA
IA
NE
NV
UT
IL
IN
KS
AZ
MO
OK
NM
AR
NJ
AK
AK
WV VA
KY
NC
TN
DE
MD
SC
MS AL
TX
CT
OH
CO
CA
MA
NY
MI
GA
LA
FL
HI
Key:
Participating
a c pa g
Non-participating
HCUP Partners Providing 2009
Emergency Department Data
WA
MT
VT
ND
ME
MN
OR
ID
NH
WI
SD
WY
RI
PA
IA
NE
NV
UT
IL
IN
KS
AZ
MO
OK
NM
NJ
AK
AK
WV VA
KY
NC
TN
AR
DE
MD
SC
MS AL
TX
CT
OH
CO
CA
MA
NY
MI
GA
LA
FL
HI
Key:
Participating
a c pa g
Non-participating
HCUP Partners Providing 2009
Ambulatory Surgery Data
WA
MT
ND
VT
ME
MN
OR
NH
ID
WY
WI
SD
RI
PA
IA
NE
NV
UT
IL
IN
KS
AZ
MO
OK
NM
NJ
AK
AK
WV VA
KY
NC
TN
AR
DE
MD
SC
MS
TX
CT
OH
CO
CA
MA
NY
MI
AL
GA
LA
FL
HI
Key:
Participating
a c pa g
Non-participating
HCUP Database Participation
2009 Data Year
WA
MT
VT
ND
ME
MN
OR
NH
ID
WY
WI
SD
RI
IA
NE
NV
PA
UT
IL
IN
KS
AZ
OK
NM
NJ
MO
TX
NC
TN
DE
MD
SC
MS
AK
AK
WV VA
KY
AR
CT
OH
CO
CA
MA
NY
MI
AL
GA
LA
FL
HI
Key:
N
Non-participating
ti i ti
Partners Providing
Inpatient Data Only
Partners Providing
I
Inpatient
ti t & Ambulatory
A b l t
Surgery Data
Partners Providing Inpatient
&E
Emergency Department
D
t
t
Data
Partners Providing
Inpatient, Ambulatory Surgery,
& Emergency Department
Data
Current HCUP Partners
Arizona Department of Health Services
Arkansas Department of Health
California Office of Statewide Health Planning & Development
Colorado Hospital Association
Connecticut Integrated Health Information (Chime, Inc.)
Florida Agency for Health Care Administration
g Hospital
p
Association
Georgia
Hawaii Health Information Corporation
Illinois Department of Public Health
Indiana Hospital & Health Association
Iowa Hospital Association
Kansas Hospital Association
14
Current HCUP Partners
Kentucky Cabinet for Health and Family Services
Louisiana Department of Health and Hospitals
Maine Health Data Organization
Maryland Health Services Cost Review Commission
y
Massachusetts Division of Health Care Finance and Policy
Michigan Health & Hospital Association
Minnesota Hospital Association
Missouri Hospital Industry Data Institute
Nebraska Hospital Association
Nevada Division of Health Care Financing and Policy,
Department of Health and Human Services
New Hampshire Department of Health & Human Services
15
Current HCUP Partners
New Jersey Department of Health and Senior Services
New Mexico Health Policy Commission
New York State Department of Health
North Carolina Department of Health and Human Services
Ohio Hospital Association
Oklahoma Health Care Information Center for Health Statistics
Oregon Association of Hospitals and Health Systems
Pennsylvania
Penns l ania Health Care Cost Containment Council
Co ncil
Rhode Island Department of Health
South Carolina State Budget & Control Board
South Dakota Association of Health Care Organizations
Tennessee Hospital Association
16
Current HCUP Partners
T
Texas
D
Department
t
t off State
St t Health
H lth Services
S i
Utah Department of Health
Vermont Association of Hospitals and Health Systems
Virginia Health Information
Washington State Department of Health
West Virginia Health Care Authority
Wisconsin Department of Health and Family Services
Wyoming Hospital Association
Continuing to recruit additional
States to join the HCUP
Partnership!
17
Overview of HCUP Data
18
The Core of HCUP: HospitalHospital-Based
IP ED,
IP,
ED AS Databases
SID
SEDD
NIS
NEDS
SASD
KID
Inpatient, Emergency Department, and
Ambulatory Surgery Databases Based on
Hospital Billing Data
19
HCUP Data Mostly from
Community Hospitals
Typically
not
included
in HCUP
data
14% (N=811)
(N 811)
Community
86%
(N=4,897)
Included in HCUP
data
Federal
Other/LTC
20
Source: American Hospital Association (AHA), 2007
What Are Community
y Hospitals?
p
AHA definition
d fi iti
off community
it hospitals:
h
it l NonNon
N -Federal,
F d
l shortshort
h t-term,
t
general, and other specialty hospitals, excluding hospital units
of other institutions ((e.g.,
g , prisons)
p
)
Include these hospitals
Multi--specialty general hospitals
Multi
OB--GYN
OB
ENT
Orthopedic
P di t i
Pediatric
Public
A d i medical
Academic
di l centers
t
21
Exclude these hospitals
Long--term care
Long
Psychiatric
Alcoholism/Chemical
dependency
Rehabilitation
DoD / VA / IHS
What Types of Care Are and Are Not
Captured by HCUP?
Inpatient
State Inpatient Databases (SID)
Nationwide Inpatient Sample (NIS)
Kids’ Inpatient Database (KID)
ED and Ambulatory Surgery
Emergency Room Visits
State Emergency Department
Database ((SEDD))
Nationwide Emergency Department
Database Sample (NEDS)
Ambulatory Surgeries
State Ambulatory Surgery
Database (SASD)
[Physician Office Visit]
22
[Pharmacy/Lab/Radiology]
From Patient Hospital Visit to HCUP
Record
ED Visit
S h d l d Admission
Scheduled
Ad i i
Transfer
Reception
Admit
Provide
Care
Discharge
Patient Perspective
Data Perspective
Patient
Record
Patient
Record
Discharge
Summary
Medical
Coder
23
Billing
Dept
Bill Generated
The Foundation of HCUP Data is
Hospital Billing Data
Demographic
Data
Diagnoses
Di
Procedures
24
Charges
The Making of HCUP Data
Billing
record
created
Patient enters
hospital
AHRQ
standardizes data
to create uniform
HCUP databases
25
States store data
in varying formats
Hospital sends
billing data and any
additional
dditi
l data
d t
elements to
Data Organizations
Value of HCUP Processing
 Basic quality checks
 Standardization of file formats and variable
values
 Value
Value--added variables
– Hospital characteristics
 Region, Urban/rural, Teaching status,
Ownership/control, Bed size
– Severity Measures
 APR
APR--DRGs,
DRGs APSAPS-DRGs,
DRGs Disease Staging
Staging,
26
Comorbidity Measures
The HCUP Database Process
AHRQ HCUP
Databases
HCUP Central
Distributor
SIGN
Sign DUA
DUA
NIS
SID
27
SEDD
SASD
KID
NEDS
Why Do We Need Another Hospital
Data
D t S
Source?
?
Hospital Data Source
National Hospital Discharge Survey
(NHDS) National Hospital Ambulatory
Care Survey (NHAMCS)
Description
Hospital inpatient, ED, and outpatient
samples
Centers for Disease Control and Prevention (CDC)
Medical Expenditure Panel Survey
(MEPS)
Agency for Healthcare Research and Quality (AHRQ)
Medicare Provider Analysis
y
and Review
(MedPAR)
Centers for Medicare and Medicaid Services (CMS)
28
Health care surveys that provide
information about health care use
and costs
Collection of hospital Medicare
claims
What is HCUP and
What Is It Not?
HCUP is...
HCUP is NOT
NOT...
...
Discharge database for health care
encounters
A survey
All payer
payer, including the uninsured
Specific
p
to a single
g
payer, e.g. Medicare
Hospital, ambulatory surgery, emergency
d
department
t
t data
d t
Office visits, pharmacy,
l b
laboratory,
t
radiology
di l
All hospital discharges
Only a sample
Accessible multiple ways: raw data, regular
reports, onon-line
Just another database
29
Hospital Billing Data Have
Benefits and Limitations
Benefits

Large sample size

Uniformity of coding

Routine,, regular
g
collection

Ease of access

All--payer
All


30
Limitations

Differences in coding
across hospitals

No data on individuals
outside
t id off hospital
h
it l
system

May not show complete
episode of care
Available at local, state,
regional, national level

May not include all
hospitals
Supplemental files
available
il bl

Lack revenue information

Limited clinical details
Some Limitations Can be Addressed
by Linking to Other Databases
American Hospital Association
(AHA) Annual Survey
SID
SEDD
NIS
NEDS
SASD
KID
HCUP
Databases
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)
31
HCUP Has Six Types
yp of Databases
State Inpatient
Databases (SID)
Nationwide
N
ti
id Inpatient
I
ti t
Sample (NIS)
32
State Emergency Department
Databases (SEDD)
State Ambulatory Surgery
Databases (SASD)
Nationwide Emergency
Department Sample
(NEDS)
Kid ’ Inpatient
Kids’
I
ti t Database
D t b
(KID)
HCUP State Databases
(SID,
(SID SEDD,
SEDD SASD)
33
HCUP State Databases
SID
SEDD
SASD
34
All inpatient hospital discharge
data (including those admissions
that started in the ED) from
participating HCUP States
Emergency department data
(treat and release) from
participating HCUP States
Ambulatory surgery data (hospital
based and some freestanding)
from participating HCUP States
What is the Source for
th SID
the
SID, SEDD
SEDD, and
d SASD?
Uniform billing data (UB(UB-04, CMS 1500)
 Data organization provides data to HCUP
 Data is a census of all discharges
g from
community hospitals
 HCUP collects and standardizes data to create
databases
35
Databases Contain Several Types
off Data
D t Fil
Files
Core File
(Patient Demographic and Clinical Info)
Charges File
In all
State--level
State
files
(Detailed Charges)
Diagnosis and Procedure
Groups
Disease Severity Measures
36
In some
State--level
State
files
What Data Elements Are Included
in the Core File?
UB--04 or CMS 1500 Billing
UB
Forms
Patient demographics
(age,
( g , sex))
Diagnoses & procedures
(ICD--9-CM,
(ICD
CM DRG)
Expected payer
Length of stay
Patient disposition
Admission source & type
Admission month
Weekend admission
37
Some Data Elements
Vary by State
 Race/Ethnicity
 Secondary payer
 Patient county
 Detailed charges
 Patient ZIP Code
 Patient identifiers
 Severity of illness
 Birthweight
 Procedure date (days
from admission)
 Primary
Pi
payer details
d t il
38
encrypted
yp
 Physician identifiers
encrypted
 Physician specialty
 Hospital identifier
unencrypted
Example: Payer Detail Varies by
State
PAY1_X
PAY1 X
PAY1 (Standardized)
Value
Description
Value
Description
M
Medicare
1
Medicare
D
Medicaid
2
Medicaid
B
Blue Cross and
Blue Shield
I, S
Other Insurance
Comp; Self Ins
3
Private Insurance
H
HMO
HMO--PPO
P
SelfS lf-pay
Self
4
SelfS lf-pay
Self
Z
Free
5
No charge
W
Workers' Comp
C
CHAMPUS
E, N
Other Government
6
Other
L, O
Other
3, 5, A, F, G, J, K, Y
Unknown
39 Other values
Missing
A
Invalid
Example: Race Detail Varies by
State
RACE_X
RACE X
Value
40
Description
RACE
Value
Description
1
White
1
White
2
Black
2
Black
3
Hispanic
3
Hispanic
4
H
Hawaiian
ii
5
Chinese
6
Filipino
4
Asian
A
i
or Pacific
P ifi
Islander
7
Japanese
8
Other Asian
9
Other Pacific
Islander
10
Native
American
5
Native American
11
Mixed or Other
6
Other
Software Requirements of
Working with the Full HCUP Files
Load
Programs
Format
Programs
Example HCUP Tools
Statistical Programs
Coding
MS Excel and Access are NOT GOOD Options!
41
States Releasing State Databases
through
HCUP Central
C t l Distributor
Di t ib t
1990 – 2008
2008*













42
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
Sout
Ca o a
South Dakota
Utah
Vermont
Washington
West Virginia
Wisconsin
* Not all states participate in all years and for all databases.
HCUP State Files vs. Data Files
Received Directly from the State
HCUP State Files
Partner State Files
Subset of data elements
All data elements
Value--added data elements
Value
May not have same valuevalueadded elements
Uniformly coded across the Not uniformly coded across
states
t t
states
t t
43
Standard data quality
checks
Variability in quality checks
by state
L titime
Lag
M
More
titimely
l
HCUP National Databases
(NIS,
(NIS KID,
KID NEDS)
44
HCUP National Databases
NIS
Inpatient hospital discharge data
(including those admissions that started in
the ED)) from a sample
p of hospitals
p
in
participating HCUP States
KID
Pediatric inpatient hospital discharge data
(including those admissions that started in
the ED)) from a sample
p of p
pediatric
discharges in participating HCUP States
NEDS
45
Emergency department data (treat and
release & admitted) from a sample of
hospitals in participating HCUP States
HCUP National Databases are
Sampled from State Databases
State Emergency
Department Databases
State Inpatient
Databases
NIS
46
KID
NEDS
NIS is a Stratified Sample of
Hospitals from the SID
5 NIS Strata
State is NOT
included as a
stratum
U.S. Region
Urban/Rural
U b /R
l
Stratified
Sample of
Hospitals
Teaching Status
S
State
Inpatient
I
i
Databases
Ownership/Control
Ownership/Contr
N = ~ 4K hospitals
47
~ 32M records
N i
Nationwide
id Inpatient
I
i
Sample
N = ~ 1K h
hospitals
it l
Bed Size
~ 8M records
KID is a Stratified Sample of
Di h
Discharges
from
f
the
th SID
3 Strata
State is NOT
included as a
stratum
Uncomplicated
Births
State Inpatient
p
Databases
Complicated Births
N = ~ 4K hospitals
48
~ 6M records
p
Kids’ Inpatient
Database
N = ~ 4K h
hospitals
it l
Pediatric
Non--Births
Non
~ 3M records
KID--Specific
KID
p
Variables
 Age in days (AGEDAY)
 Birth weight in grams (BWT)
 Birth
t diagnosis
d ag os s (HOSPBRTH)
OS
)
 National Association of Children’s Hospitals and
R l d IInstitutions
Related
i i
(NACHRI) h
hospital
i l type
(NACHTYPE)
 Normal, uncomplicated birth in hospital
(UNCBRTH)
49
HCUP NEDS Data
SEDD
SID
Treat--andTreat
and-Release ED Visits
About 84% of ED
visits are treattreatand--release
and
50
NEDS
Admitted ED Visits
About 16% of ED
visits result in a
hospital stay
NEDS is a Stratified Sample of
Hospitals from the SEDD and SID
5 NEDS Strata
U.S. Region
Urban/Rural
U b /R
l
Si il to the
Similar
h NIS and
d
KID Strata: State is NOT
included as a stratum
Stratified
Sample of
Hospitals
Teaching Status
SEDD & SID
Ownership/Control
N = ~ 2K HospitalHospitalbased EDs
51
~ 64M ED visits
NEDS
N = ~ 1K HospitalHospitalbased EDs
Trauma
~ 26M ED visits
NEDS--Specific Variables
NEDS
 Type of ED event:
event: treated and released, admitted
to the same hospital, transferred, died (EDEVENT)
 Disposition of patient from ED (DISP_ED)
 Died
Di d iin th
the ED
ED: di
died
d iin th
the ED
ED, di
died
d iin th
the h
hospital,
it l
did not die (DIED_VISIT
DIED_VISIT))
 Diagnosis reported on record indicates self harm
(INTENT_SELF_HARM
INTENT_SELF_HARM)
_
_
)
 Trauma center level I, II, or III (HOSP_TRAUMA)
 HCUP ED hospital
h
it l identifier
id tifi (HOSP_ED)
HOSP ED)
52
Databases Contain Several Types
off Data
D t Fil
Files
Core File
NIS KID,
NIS,
KID NEDS
Hospital Weights File
Diagnosis and Procedure
Groups
NIS KID
NIS,
Disease Severity Measures
Supplemental ED File
Supplemental Inpatient File
53
NEDS
NIS, NEDS, KID:
Must be Weighted to Produce
N ti
National
l and
d Regional
R i
l Estimates
E ti t
NIS
NEDS
KID
54
D
I
S
C
W
T
NIS, NEDS, KID:
Must be Weighted to Produce
N ti
National
l and
d Regional
R i
l Estimates
E ti t
NIS
NEDS
55
H
O
S
P
W
T
Types of Research the National
Databases Can Support

Utilization and cost of hospital inpatient, ED,
and ambulatory care






56
Trends in healthcare utilization and costs
Q li off care
Quality
Impact of health policy changes
Diffusion of medical technology
Medical practice variation
Medical treatment effectiveness
Recap:
p Use of HCUP Databases
Benefits

Large sample size

Uniformity
y of coding
g

Routine, regular collection

Ease of access

All--payer
All

Available at local,, state,,
regional, national level

57
Supplemental files available
Limitations

Differences in coding across
hospitals

No data on individuals outside
of hospital system

May not show complete
episode of care

May not include all hospitals

Lack revenue information

Limited clinical details

ED data do not contain
information on time to triage,
g
time to treatment, time to
disposition, etc.
How to Obtain HCUP Data &
Access HCUP Resources
58
Database Summary
 Six types of HCUP databases
 Databases are based on administrative hospital data
 Available for multiple years
–
–
–
–
–
–
NIS (1988(1988-2008)
NEDS (2006, 2007)
KID (1997, 2000, 2003, 2006)
SID (1990
(1990--2008)
SASD (1997(1997-2008)
SEDD (1999(1999-2008)
 Can look at breadth of healthcare issues
 Can be linked to external files
59
Obtain HCUP Data –
Two Methods
HCUP Central Distributor
www.hcup--us.ahrq.gov/
www.hcup
tech_assist/centdist.jsp
assist/centdist.jsp
j p
HCUP Partner States
www.hcupwww.hcupus.ahrq.gov/partners.jsp
60
How to Obtain HCUP Data through
the HCUP Central Distributor
 Step 1: Download and complete application kit:
http://www.hcup--us.ahrq.gov/tech_assist/centdist.jsp
http://www.hcup
 Step 2: Obtain more information (if needed):
Phone: 866866-556
556--HCUP (4287) toll free
E-mail: HCUPDistributor@ahrq.gov
 Step 3: Take Data Use Agreement (DUA) onon-line training
and sign DUA
 Step 4: Send order form, signed DUA, and payment to
HCUP Central Distributor
61
Additional Requirement
Requirement::
Electronic DUA Course
PURPOSE OF THE
COURSE
Takes 15 minutes to Complete
• Emphasize the
importance of data
protection
 Reduce the risk of
inadvertent violations
 Describe your
individual
responsibility when
using HCUP data
62
http://www.hcup--us.ahrq.gov/tech_assist/dua.jsp
http://www.hcup
Pricing Information
per Data
D t Y
Year
National Databases (NIS,
(NIS KID
KID, NEDS)
–
–
–
NIS: $350 (CY2008(CY2008-2007; student price $50), $200
(CY2000--CY2006; student price $20)
(CY2000
KID: $200 (student price $20)
NEDS: $500 (student price $75)
NIS
KID
NEDS
State Databases (SID, SASD, SEDD)
–
$35 - $3,000
$3 000 ((varies
i b
by state)
t t )
SID
63
SASD
SEDD
HCUP is a Family of
Databases,
Databases Tools & Products
SID
SEDD
NIS
NEDS
SASD
KID
HCUP Databases
Research Products
64
User Support
Research Publications
HCUP Provides Many
Research Products






Software Tools
Supplemental
pp
Files
Online Tools
Methods Reports
Statistical Briefs
Publications using HCUP Data
– with search feature
65
Most HCUP Tools can be applied
to any Administrative Database
Clinical Classification
Software
SID
NEDS
NIS
KID
SEDD
SASD
Procedure Classes
Chronic Condition
Indicator
d cato
Comorbidity
Other
Administrative
atabases
Databases
66
Utilization Flags
AHRQ QIs
Most Tools Based On Medical
Coding Classifications
 ICD
ICD--9-CM (ICD(ICD-10
10--CM soon)
 CPT
 HCPCS
 DRGs
 MDC
 CCS
67
ICD--9-CM
ICD
 ICD
ICD--9-CM Diagnosis
g
Codes
 ICD
ICD--9-CM Procedure
Codes
 Included in both
i
inpatient
ti t and
d outpatient
t ti t
databases
68
Common Procedural Coding
S t
System
– CPT & HCPCS
CPT
HCPCS
Local Codes
69
http://www.hcup--us.ahrq.gov/tools_software.jsp
http://www.hcup
70
Clinical Classifications Software
(CCS) for ICDICD-9-CM
Groups ICDICD-9-CM codes into clinically
meaningful categories
CCS for
ICD--9-CM
ICD
ICD-9-CM
ICDCodes
NEDS
NIS
KID
SID
SEDD
SASD
71
0031 0202 0223 0362
0380 0381 03810
03811 03819 0382
0383 03840 03841
03842 03843 03844
03849 0388 0389 0545
449 7907
0700 0701 0702 07020
07021 07022 07023
0703 07030 07031
07032 07033 0704
07041 07042 07043
07044 07049 0705
07051 07052 07053
07054 07059 0706
07070 07071 0709
57140 57141 57149
5731 5732 5733
CCS
Codes
CCS 2:
p
Septicemia
CCS 6:
Hepatitis
Clinical Classification Software
(CCS) for Services and Procedures
9,000
CPT/HCPCS
codes and 6,000
HCPCS codes
72
244 Mutually
Exclusive
Clinical
Classifications
The CCS collapses CPT codes into a
smaller number of clinicallyclinically-meaningful
categories that can be more useful for
presenting descriptive statistics than are
individual CPT or HCPCS codes
What Codes Are Used in HCUP
Data Files
DETAILED CODES
ICD-9-CM
ICD- Diagnosis Codes
- Procedure Codes
CPT
HCPCS
Inpatient
Databases
ICD--9-CM
ICD
DRG
MDC
KID
NEDS
ICD--9-CM
ICD
CPT
HCPCS
73
NIS
CCS
Outpatient
GROUPED CODES Databases
DRG
MDC
CCS
SID
CCS
SASD
SEDD
Procedure Classes
ICD-9-CM
ICDP
Procedure
d
Codes
Minor
Diagnostic
Major
Therapeutic
Minor
Therapeutic
Major
Diagnostic
Groups
p ICD
ICD--9-CM Codes into One of Four Categories
g
to
Distinguish Between Diagnostic/Therapeutic Procedures
74
Chronic Condition Indicator ((CCI))
ICD-9-CM
ICDDiagnosis
Codes
Chronic
75
Non--Chronic
Non
Groups ICD
ICD--9-CM Diagnosis Codes into
Chronic or NonNon-Chronic Categories
Comorbidity
y Software
Comorbidity
Software
ICD--9-CM Codes,
ICD
DRGs on
Administrative Data
29 Comorbidity
Classifications
The Comorbidity Software is based on the
ICD--9-CM coding scheme. Creates 29
ICD
variables that identify major comorbidities.
76
* Elixhauser et al., Medical Care, 1998
Appends Indicator Flags for
Each Comorbidity














77
Congestive
g
heart failure
Valvular disease
Pulmonary circulation disorders
P i h
Peripheral
l vascular
l disorders
di
d
Hypertension (uncomplicated and complicated)
Paralysis
Other neurological disorders
Chronic p
pulmonary
y disease
Diabetes without chronic complications
Diabetes with chronic complications
29 flags
H
Hypothyroidism
th
idi
created and
Renal failure
appended to
Liver disease
each
h record
d
Chronic peptic ulcer disease
Appends Indicator Flags for
Each Comorbidity












78
 Drug
g abuse
HIV and AIDS
 Psychoses
Lymphoma
 Depression
Metastatic cancer
Solid tumor without metastasis
Rheumatoid arthritis/collagen
vascular
l diseases
di
Coagulation deficiency
Obesity
Weight loss
Fluid and electrolyte disorders
Blood loss anemia
Deficiency anemia
Alcohol abuse
Utilization Flags
R
Reveals
l additional
dditi
l information
i f
ti about
b t
use of health care services
Utilization Flag
Software
SID
ICD-9-CM
ICDcodes
+
SEDD
SASD
79
UB-04
UBcodes
Emergency
Room
Chest
X-ray /
CT Scan
I t
Intensive
i
Care Unit
30 Utilization Flags
There are not
ICD--9-CM codes
ICD
for all services.
Concern exists
that some
diagnostic
procedures may
be under
under-reported
80
AHRQ Quality Indicator Software
Creates Measures of Health Care Quality
Using
g Inpatient
p
Administrative Data
Prevention Quality
Indicators
QI Software
SID
NIS
KID
81
Inpatient Quality
I di t
Indicators
Patient Safety
Indicators
P di t i IIndicators
Pediatric
di t
Prevention Quality Indicators (PQI)
Examples of PQI Measures
Admission rates for:
 Diabetes
Di b t LongLong
L
-term
t
Complications
C
li ti
 Diabetes ShortShort-term Complications
 Pediatric Asthma
 Chronic Obstructive Pulmonary
Disease
 Pediatric Gastroenteritis
 Hypertension
82
Inpatient Quality Indicators (IQI)
Examples
p
of IQI
Q Measures
Mortality – medical conditions
 AMI
 Pneumonia
Mortality – procedures
 Hip replacement
HospitalH
Hospital
it l-level
l
l utilization
tili ti
 C-section
Area--level utilization
Area
 Hysterectomy
Volume
83
 Abdominal aortic aneurysm repair
Patient Safety Indicators (PSI)
Examples of PSI Measures
 Foreign Body Left During Procedure
 Iatrogenic Pneumothorax
 Central Venous Catheter Blood Stream
Infection
 Postop Hip Fracture
 Postop Hemorrhage or Hematoma
 Postop Physiologic and Metabolic
Derangements
 Death among surgical inpatients
84
Pediatric Quality Indicators (PDI)
Examples of PDI Measures
Accidental Puncture or Laceration
Decubitus
D
bit Ulcer
Ul
Foreign Body Left During Procedure
Pediatric Heart Surgery Mortality
Postop Hemorrhage or Hematoma
Postop Sepsis
85
w
http://www.qualityindicators.ahrq.gov
www.qualityindicators.ahrq.gov/
86
HCUP Supplemental Files can only be
applied to HCUP Databases
Cost--to
Cost
to--Charge Ratios
Hospital Market
SID
NEDS
NIS
KID
NIS Hospital Ownership
SEDD
SASD
American Hospital Association
(AHA) Linkage
Revisit Analyses
NIS Trends
KID Trends
87
Cost--to
Cost
to--Charge Ratio Files
$
Hospital-Level
HospitalNIS/SID Data
Apply Ratios
Convert Charges to
Costs
The CostCost-to
to--Charge
g Ratio Files enable
conversion of charge data to cost data on the
NIS, KID, and SID
88
Charges vs. Costs vs. Price
Charges
Costs
What the hospital charged for the care
(includes charge BEFORE discount)
discount)
What it cost the hospital to provide the
care
Price
What the insurer/individual paid for the
(Payment) care (includes negotiated/discounted charges)
charges)
HCUP Databases include CHARGE information
COST information can be estimated
89
Hospital Market Structure (HMS)*
Files
The HMS Files contain
measures of hospital
market competition.
Available free
free--of
of--charge
from the HCUP Central
Distributor.
*Wong and Mutter,
Review of Industrial
Organization,
O
i ti
2005
90
HCUP Supplemental Files for
Revisit Analyses
The HCUP Supplemental
Files for Revisit Analyses
are dischargedischarge-level files
designed to facilitate
analyses
y
that need to
track patients across time
and hospital settings in
the SID, SASD, and SEDD
91
HCUP Databases
can be combined to provide a more
complete picture
SID
SASD
92
SEDD
Researchers can link or combine the
HCUP databases to track patients across
time and settings
The SASD and SID
can be linked
SASD
+
SID
The SASD can be used with the SID for
selected states to:
• get a complete picture of same day versus
inpatient surgeries
93
• follow patients from ambulatory surgery
setting to inpatient setting
The SEDD and SID
can be linked
The SID and the SEDD can be combined to:
• assess all care delivered in both settings
• track ED visits following hospital discharge
SEDD
94
+
SID
Additional HCUP Supplemental
Files
 Trends Files (NIS & KID)
– Discharge
Dischargeg -level files that p
provide the data user
with trend weights and data elements that are
consistently defined across data years
 NIS Hospital Ownership File
– Hospital
Hospital--level files designed to facilitate analysis
off the
th NIS by
b hospital
h
it l ownership
hi categories
t
i
 AHA Linkage Files
– Enable researchers to link hospital identifiers in
some State databases to the AHA Annual Survey
Databases
95
Online Tools
 MONAHRQ
– A web
web--based software tool that enables
organizations to input their own hospital
administrative data and generate a datadata-driven
website
 HCUPnet
– Free, interactive online query system
– http://hcup.ahrq.gov/hcupnet
96
Key features of
Currently
y based on
hospital discharge data
Host user downloads
MONAHRQ software from
AHRQ website
Software
www.monahrq.ahrq.gov
• Internally to better
understand own data and to
answer questions
• To member organizations,
organizations,
e g through a password
e.g.,
protected site
97
• Publicly to provide
information to the
community
Host user makes
website
available
Host user
applies
software
to own
data
locally
Host user
creates local
website on
their own
server
HCUPnet: Quick, free access to
HCUP Data
 Free, interactive online query system
 Users
U
generate
t ttables
bl off outcomes
t
by
b
diagnoses and procedures
 Data can be crosscross-classified by patient and
hospital characteristics
99
HCUPnet can answer a variety of
questions
 What percentage of hospitalizations for children
are uninsured, by state?
 What are the most expensive conditions treated
in
i U.S.
US h
hospitals?
it l ?
 What is the trend in admissions for depression?
 Will there be sufficient cases to do my analysis?
 How do my estimates compare with HCUPnet
((validation)?
)
100
http://hcupnet ahrq gov
http://hcupnet.ahrq.gov
101
H
H
H
H
H
H
H
H
H
H
H
H
h
H
H
H
H
H
H
H
H
H
H
H
H
h
H
H
H
H
H
H
H
H
H
H
H
H
h
HCUPnet Capabilities
HCUPnet...
HCUPnet
...
CAN PRODUCE...
Simple statistics
Sample size calculations
Trends information
Rank ordering of diagnoses
and procedures
Significance testing
112
CANNOT PRODUCE…
More complicated queries
Multivariate analyses
Statistics involving certain
variables
Statistics that may violate
confidentiality (patient
(patient--,
provider--, hospitalprovider
hospital-level data)
HCUP is a Family of
D t b
Databases,
Tools
T l & Products
P d t
SID
SEDD
NIS
NEDS
SASD
KID
HCUP Databases
Research Products
113
User Support
Research Publications
HCUP Methods Reports
Methodological information on the HCUP
databases and software tools
114
HCUP Methods Reports
Population Denominator
Data for Use with the
HCUP Databases
(Updated with 2009
Population Data)
Barrett M
M, Hunter K
K,
Coffey R, Levit K.
April 12
12, 2010
115
http//www.hcup--us.ahrq.gov/reports/methods.jsp
http//www.hcup
Percentage of discharges by region
40%
33%
30%
25%
26%
20%
17%
10%
0%
Northeast
116
Midwest
South
West
Does the South have the highest prevalence of
CDAD hospital stays?
CDAD rates using a population
denominator
Rate perr 10,000 populatiion
R
15
14.9
12.4
12
Region Population Count
Northeast 54,917,435
Midwest
66,414,030
South
109,596,119
West
70,072,384
9.6
9
7.7
6
3
0
Northeast
117
Midwest
South
West
HCUP Publications
 Statistical Briefs
 Fact
F t Books
B k
 Annual
ua Reports
epo ts
118
119
Statistical Brief Topics
 More than 90 briefs posted – a new brief
posted every two to three weeks:
– Ambulatory Surgeries
– Rural Hospitalizations
– Motor Vehicle Accidents
– Childbirth
– Brain Cancer
120
HCUP Facts and Figures
121
New: Publications Search Page
on HCUPHCUP-US
 Simple or advanced search options
– Data Year
– Database, Tool, & Product
– Key Word
– Publication Type
yp
– Author
– Title
Titl
– State
122
HCUP Supports High Impact Health
Services,
Services Policy & Clinical Research
123
HCUP is a Family of
D t b
Databases,
Tools
T l & Products
P d t
SID
SEDD
NIS
NEDS
SASD
KID
HCUP Databases
Research Products
124
User Support
Research Publications
HCUP User Support Website

Find detailed information on
HCUP databases, tools, and
products

Access HCUPnet

Find comprehensive listing of
HCUP--related publications,
HCUP
database reports, and fact
books
http://www.hcup--us.ahrq.gov
http://www.hcup

Access technical assistance
125
Using HCUP Technical Assistance
Active Technical Assistance
 Responds to inquiries about
HCUP
CU da
data,
a, p
products,
oduc s, a
and
d tools
oo s
 Collects user feedback and
suggestions for improvement
E-mail
mail:: hcup@ahrq.gov
hcup@ahrq gov
126
Interactive On
On--line HCUP Overview
Course Available
http://www.hcup--us.ahrq.gov/overviewcourse.jsp
http://www.hcup
127
Additional HCUP Online Courses
Courses::
Methods Focus
 Now
N
available
available:
il bl :
– HCUP Sample Design
Tutorial
 Coming
g soon:
– Loading and Checking
HCUP Data Files
– Producing National
Estimates with HCUP
Data
– And more
more…
…
http://www.hcup--us.ahrq.gov/tech_assist/tutorials.jsp
128 http://www.hcup
Join the HCUP Email List
HCUP
Newsletter
♦
New Data
Releases
♦
New
Reports
http://www.ahrq.gov/data/hcup/hcuplist.htm
129
HCUP 20th Anniversary!
130
Healthcare Cost and
Utilization Project (HCUP)
THE LARGEST COLLECTION OF MULTIMULTI-YEAR,
YEAR
ALL--PAYER, ENCOUNTERALL
ENCOUNTER-LEVEL, HEALTH CARE DATA
131
Questions/Comments?
Time for Questions
and/or Comments
132