Welcome

HCUP: Powerful Data, Meaningful Answers

 

Researcher 1: Do admission rates for preventable hospitalizations vary across the U.S.?

 

Researcher 2: What percentage of hospitalizations for children are uninsured in my state?

 

Researcher 3: What are the most common conditions treated in the Emergency Department?

 

Researcher 4: Will there be enough cases for my analysis?

 

Researcher 5: What are the latest trends in ambulatory surgery for knee injuries?

 

Researcher 6: What tools are available to help me in my research?

 

Lauren: HCUP. Powerful Data. Meaningful answers.

 

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Introduction

 

Sean: Welcome to the Healthcare Cost and Utilization Project Overview Course. My name is Sean.

 

I am a researcher who is studying a number of different health care research and policy topics. My current research interests include looking at the rise in the number of obesity-related procedures in recent years.

 

I’m not overly familiar with HCUP. I’ve heard that it’s a valuable resource. I’ve accessed publications and resources available through HCUP, and I’d like to learn about using HCUP databases and tools to support my research. My colleague, Lauren, has worked with HCUP products for years.

 

Lauren: Yes, hi, I’m Lauren. Sean, you’re right, I’ve had significant exposure to HCUP and am happy to give you an overview of the databases, software tools, and research products included in HCUP.

 

During my research career, I’ve used HCUP to support various healthcare analyses. Most recently, I used HCUP to identify trends in preventable asthma hospitalizations. There is a wealth of information available through HCUP.

 

Sean, I’ve put together a course on HCUP that I’ll share with you and anyone else interested in learning about HCUP. During this course, I’ll introduce you to the various HCUP databases and related products and help you determine if one or more of these resources can support your research interests. By the end of this course, you will:

 

Introduction/AHRQ and DHHS

 

Lauren: The Healthcare Cost and Utilization Project (HCUP) is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).

 

HCUP databases bring together the data collection efforts of state-level data organizations, hospital associations, private data organizations, and the Federal government to create a national information resource of patient-level health care data.

 

HCUP data are collected as part of AHRQ’s mission: "To improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans."

 

AHRQ is a federal agency in the Department of Health and Human Services (DHHS). The Department of Health and Human Services is the principal department for improving the health of all Americans and providing essential human services, especially for those who are least able to help themselves.

 

Other agencies within DHHS include the Agency for Toxic Substances and Disease Registry (ATSDR), the National Institutes of Health (NIH), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare and Medicaid Services (CMS), the Administration on Aging (AOA), the Food and Drug Administration (FDA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the Centers for Disease Control and Prevention (CDC), and the Administration for Children and Families (ACF).

 

Introduction/What is HCUP?

 

Lauren: HCUP provides a wealth of information to enhance your research and promote positive changes in healthcare. HCUP is a family of healthcare databases, software tools, and products that support cutting edge research. The HCUP databases include discharges for inpatient care and certain components of outpatient care, such as emergency care and ambulatory surgeries. These data are collected from community hospitals in participating states.

 

HCUP consists of a family of related databases, tools, and products.
HCUP is more than simply a set of hospital databases. HCUP also creates many software tools and a variety of publications. For more information, visit the HCUP-US Web site.

 

HCUP supports cutting edge research.
HCUP data support cutting-edge health services research and policy development. HCUP data-supported studies are published in:

HCUP also supports Congressionally-mandated reports, such as the National Health Care Disparities Report (NHDR) and the National Health Care Quality Report (NHQR).

 

HCUP captures all discharges for inpatient care and certain components of outpatient care from community hospitals in participating states.
HCUP data capture all inpatient discharges from community hospitals in participating states, as well as certain components of outpatient care (e.g., emergency care and ambulatory surgeries). Also, the HCUP state-level databases capture all discharges, making them unique and powerful. These databases are the only collection of publicly available, all-payer hospital data.

 

Introduction/Overview of HCUP Data

 

At the center of the HCUP project are the data. HCUP data are derived from hospital billing information and include both inpatient and outpatient care.

 

HCUP Inpatient Databases:

 

HCUP Outpatient Databases:

 

Introduction/Data Sources: Community Hospitals

85% of hospitals are community hospitals.

 

HCUP data are derived primarily from hospital billing information.

 

Sean: I understand that HCUP data are largely hospital and hospital affiliated data, but what types of hospitals are included? What types of hospital care are captured and how do hospitals collect all these data?

 

Lauren: The American Hospital Association (AHA) categorizes hospitals into five main categories, including:

 

The data in the HCUP databases primarily include data from non-federal community hospitals. Federal, long-term care, psychiatric, and tuberculosis hospitals are generally excluded. As you can see, the majority of hospitals in the United States are categorized as "community hospitals."

 

Examples of non-Federal community hospitals include:

 

The following hospitals are generally excluded:

 

Introduction/Data Sources: Types of Care Captured

 

Lauren: Generally, the care provided at community hospitals can be divided into three main categories: inpatient; outpatient; and ancillary services (such as pharmacy, laboratory, and radiology).

HCUP data capture records of inpatient care and certain components of outpatient care, including ambulatory surgery and emergency department information. HCUP does not capture any physician office visits data or complete pharmacy, laboratory, or radiology information.

 

Inpatient
Inpatient care is captured in the following databases:

 

Outpatient
Outpatient care is captured in the following databases:

 

Ancillary Services
Pharmacy, laboratory, and radiology information is not typically captured in the HCUP databases, although a limited amount is represented if an ICD-9-CM code exists.

 

Introduction/Data Sources: Billing Data

 

Sean: Interesting. So where does it originate and how does it get created?

 

Lauren: That’s a good question, and the easiest way to find out is to follow some patients through the process. Let’s take a look at three examples to see when data are collected.

 

Jeff is admitted to the hospital for pneumonia. After he is admitted, a patient medical record is created containing his demographic data. Because Jeff is receiving inpatient care, his treatment will be captured in the SID.

 

Jack arrives at a hospital-affiliated surgery center for outpatient eye surgery. A patient medical record is created with Jack’s demographic information. Because Jack is being treated and released on the same day for a surgical procedure, his surgery will be captured by the SASD.

 

Lizzie arrives at the emergency room with her mom after falling at the playground. A patient medical record is created with Lizzie’s demographic information. If Lizzie is admitted to the hospital because of her fall, her care will be captured by the inpatient databases. If she is not admitted, her care will be captured in the SEDD.

 

These three patients will receive care and details of that care will be added to their patient medical records. When each patient is discharged, a bill will be generated and the information included on that bill will become the basis of the HCUP databases. Read about the details of each step below.

 

Receive Care
Jeff, Jack, and Lizzie receive care, and details of this care are included in each patient’s medical record.

 

Discharge
After receiving care, each patient is discharged. On each patient medical record, a medical coder classifies the care provided in diagnosis and/or procedure codes (ICD-9-CM or CPT). A discharge summary is generated from each patient medical record for billing purposes. This discharge summary is the basis of HCUP data.

 

Bill Generated
The billing department uses the medical codes assigned by the coder to generate a hospital bill for each patient. Billing forms used by hospitals, such as the UB-92 form, include basic demographic data such as patient age and gender along with more detailed information such as the patient's diagnosis and what medical procedures were performed. Total hospital charges for patient care are also included.

 

Introduction/Contributing States

 

Lauren: These data are used for many purposes other than billing. Hospitals transmit the data to state-level Data Organizations that utilize the information for things such as public health surveillance, research, and monitoring quality, cost and access to health care.

 

The Data Organizations add additional data elements useful to researchers. The Data Organizations that participate in HCUP send their data to AHRQ for inclusion in the HCUP databases.

We call the participating states "HCUP Partners." Along with AHRQ, they put a tremendous amount of effort into creating the HCUP databases. Without their support and enthusiasm for this project, the HCUP initiative would not be possible.

 

Introduction/Comparison to Other Available Databases

 

Sean: I’ve used other federal databases such as the National Health Care Survey, the National Hospital Discharge Survey, the Medical Expenditure Panel Survey, and the Medicare Provider Analysis and Review in my research before. How are HCUP databases different from these?

 

Lauren: All of these databases are invaluable in conducting meaningful health services research, but specific databases may be more suited for certain types of analyses.

Read below to find out how these databases compare to the HCUP databases.

 

The National Health Care Survey (NHCS)
National Health Care Survey utilizes health care facility and clinician surveys, obtaining information about the facilities that supply health care, the services rendered, and the characteristics of the patients served. HCUP data include inpatient and outpatient discharge records, also called administrative data – but HCUP data are not survey-based.

 

The National Hospital Discharge Survey (NHDS)
National Hospital Discharge Survey is a national probability survey designed to meet the need for information on characteristics of inpatients discharged from non-Federal short-stay hospitals in the United States. The HCUP NIS captures hospital discharge records – but HCUP data are not survey-based.

 

The Medical Expenditure Panel Survey (MEPS)
Medicare Expenditure Panel Survey is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States. HCUP is not a survey – it is based on actual hospital discharge records. MEPS is the most complete source of data on the cost and use of health care and health insurance coverage.

 

The Medicare Provider Analysis and Review (MedPAR)
Medicare Provider Analysis and Review contains claims data for services provided to beneficiaries admitted to Medicare-certified inpatient hospitals and skilled nursing facilities. MedPAR data are limited to care for the Medicare population, while HCUP features all payers, including the uninsured.

 

Introduction/Knowledge Check

 

Sean: Okay, I’d like to take a moment to review what HCUP data are and what they aren’t before we proceed to learn about each of the HCUP databases.

 

Are these characteristics of HCUP databases? Answer yes or no for each statement listed below.

 

Select this link for the answers to the Overview Knowledge Check: Answers to Overview Knowledge Check

 

SID/What are the SID?

 

Lauren: At the center of HCUP’s inpatient data are the State Inpatient Databases (SID). Both the Nationwide Inpatient Sample (NIS) and the Kids’ Inpatient Database (KID) are derived from the SID. Data in the Nationwide Emergency Department Sample come from the SID and the SEDD.

 

It’s helpful to have an understanding of the SID if you plan to work with any of these HCUP databases.

 

The SID are a set of hospital databases that include inpatient hospitalizations in participating states. The majority of states contribute data to the SID. AHRQ processes the healthcare data from each of the participating states into uniform databases.

 

The SID include all or nearly all of the hospitalizations in each state by year; in other words, the databases are a "census" of hospitalizations by state.

 

There is variation in database formats and definitions from state to state, but HCUP processes the data into a uniform set.

 

SID/Data Sources

 

Lauren: The SID are derived from hospital billing data. This type of data is also referred to as "administrative data." To better understand what this means, let’s take a look back at the experience of one of our patients. Read the bullets below to learn what is included in the SID.

 

SID/Data Files and Elements

 

Sean: If I decided that I could use the SID in my research project, what would be included in the actual database itself?

 

Lauren: Each SID contains three types of data files: a core file containing common elements and state-specific variables, a charges file, and an AHA linkage file. The Core and Charges files are discharge-level files. The AHA Linkage file is a hospital-level file.

 

Core File: Core Data Elements

 

Core File: State-specific Data Elements

 

Charges File

 

American Hospital Association (AHA) Linkage File

 

SID/Unique Attributes

 

Sean: My understanding is that AHRQ collects data from state-level data organizations to produce the SID files. How do the HCUP SID files compare to the data files in each state?

 

Lauren: Original (or source) State data files may contain additional data elements that are not provided to HCUP. The HCUP SID contain value-added data elements and pass standard data quality checks. Most important, the HCUP SID are uniformly coded. Uniform coding occurs across states, making state-to-state comparisons much easier.

 

Read more about the key differences below.

 

Contain a Subset of Data Elements
The SID may contain a subset of data elements because states do not always submit all of the data elements that they collect.

 

Have Value-Added Data Elements
During HCUP processing, AHRQ creates and includes many value-added data elements for research, such as rural-urban indicators.

 

Pass Standard Data Quality Checks
AHRQ conducts a limited number of standard data quality checks. For example, there are checks to ensure that the diagnosis codes (such as ICD-9-CM codes) are valid. Another routine check is a "gender" check. For example, are birth diagnoses coded only for women? Are prostate surgeries coded exclusively for men?

 

Are Uniformly Coded Across States
Unlike the data files available directly from the states, the SID files are uniformly coded to make it easier for researchers to conduct state-by-state comparisons.

 

SID/Availability and Pricing

 

Lauren: The SID are updated annually, and the number of states participating in the SID continues to grow each year. Each state sets its own price for the SID.

Many of the states have agreed to allow the HCUP Central Distributor to distribute their SID. The HCUP Central Distributor handles these transactions as a service to the states—payments for the SID are returned directly to the states.

For those states that do not participate in the HCUP Central Distributor, researchers may contact the states directly to obtain a copy of their state database. However, requirements for purchase and availability vary across states.

State contact information is provided on the HCUP User Support Web site.

 

SID/Research Topics

 

Lauren: The SID can support many types of health services research. The SID are well suited for research that requires complete enumeration of hospitals and discharges within market areas or states. Researchers and policymakers use the SID to investigate questions unique to one state or to compare data from two or more states. Researchers can identify state-specific trends in health care use, access, hospital charges and costs, and outcomes. In certain states, the SID can be used to investigate race and ethnicity topics and hospital readmissions.

 

SID/Knowledge Check

 

Sean: I feel like I have a good understanding of what’s included in the SID now. Do you? Take a moment to identify what types of care would and would not be captured in the SID by answering the questions below.

 

Jane has a Cesarean section and remains in the hospital for two days. Would this record be included in the SID?

 

Madison receives routine vaccines and a check-up at her doctor’s office. Would this be captured in the SID?

 

Mark is released after receiving outpatient treatment for a broken leg. Would this record be included in the SID?

 

Helen is admitted to a hospital with pneumonia. Would the record of her hospital treatment be included in the SID?

 

Select this link for the answers to the SID Knowledge Check: Answers to SID Knowledge Check

 

SID/Summary

 

Sean: To summarize, the SID contain all of the inpatient discharge abstracts from community hospitals in participating states, translated into a uniform format to facilitate multi-state comparisons and analyses.

 

Together the SID encompass about 90 percent of all U.S. community hospital discharges.

 

The SID contain a core set of clinical and nonclinical information on all patients, regardless of payer. This includes patients covered by Medicare, Medicaid, private insurance and uninsured individuals.

 

In addition to the core set of uniform data elements common to all SID, some include other elements, such as the patient's race.

 

Lauren: And you can find additional information on the HCUP User Support Web site.

 

NIS/What is the NIS?

 

Sean: The SID sounds invaluable for investigating health issues or trends in a specific market or state, but I need national data for my research on current trends in obesity-related procedures.

 

Lauren: Don’t worry. There is an HCUP database for you. HCUP creates the Nationwide Inpatient Sample (NIS) to make it possible for researchers to conduct national and regional analyses of hospital use and the hospital charges and costs associated with inpatient care.

 

NIS/Sample Design

 

Lauren: The NIS is derived from the SID and approximates a 20% sample of community hospitals in the U.S.

 

The SID
The SID consist of all or nearly all community hospitals in each participating state. These databases are considered a “census” of all hospital discharges (not a sample).

 

Sampling
To create the NIS, a 20% stratified sample of hospitals is drawn from the SID.
The NIS approximates a 20% sample of community hospitals in the U.S. Using a stratified, random sampling design, a sample of community hospitals from the SID is selected, and 100% of those hospitals' discharges are retained.

 

Sampling Strata
Hospitals are included in the NIS sample on the basis of five hospital characteristics (referred to as “strata” in HCUP). Stratification variables include:

 

Sample Size
The NIS contains approximately 1,000 hospitals. From each selected hospital, all discharges are included; this amounts to more than 8 million observations in one data year. This large sample size allows researchers to study relatively rare diagnoses and procedures.

 

The NIS
The NIS is designed to be a nationwide representation of hospital care. Because the NIS sampling frame is not designed with “state” as a stratification variable, state-level analyses cannot be conducted. If you are interested in analyses by state, obtain the state-specific SID.

 

NIS/Comparison to the SID

 

Lauren: Let’s take a closer look at the differences between the NIS and the SID.

 

All Discharges vs. Sample
The NIS is a sample of hospitals in each region, while the SID captures all discharges from community hospitals in each state.

 

Data Elements
The NIS contains fewer data elements than the SID, but most of those variables are standardized. This allows for national estimates.

 

Value-Added Variables: Severity Measures
There are several ways to adjust for severity of illness, and use of these methods can be costly and time-consuming. HCUP has therefore added severity measures to facilitate your research. In more recent years, the NIS includes four sets of severity measures:

 

Value-Added Variables: Hospital Characteristics
The NIS also contains several hospital characteristics derived from the AHA Annual Survey Database. These include:

 

NIS/Availability and Pricing

 

Lauren: The NIS is one of the most popular HCUP databases and is released every year. It is an affordable database that is available through the HCUP Central Distributor.

 

Pricing varies by year.

 

Additional information is available on the HCUP User Support Web site.

 

NIS/Research Topics

 

Lauren: The NIS can be used to examine many important aspects of health care services and health care policy, including the use of hospital services, charges and costs for these services, medical practice variation, medical treatment effectiveness, the quality of care and patient safety, the impact of health policy changes, the diffusion of medical technology, and disparities in the use of hospital services.

 

NIS/Knowledge Check

 

Sean: The NIS seems like a good choice to study my research topic of interest, national trends in obesity-related procedures, but take a moment to identify whether the SID or the NIS would be better for some other research topics by answering the questions below.

 

Anna would like to identify differences in pneumonia hospitalizations in Maryland, as compared with Florida. Which database would Anna want to use?

 

Linda would like to identify national trends in diabetes hospitalizations. Which database would Linda want to use?

 

Tim would like to identify regional trends in hospitalizations for coronary artery bypass graft (CABG) procedures within the U.S. Which database would Tim want to use?

 

Select this link for the answers to the NIS Knowledge Check: Answers to NIS Knowledge Check

 

NIS/Summary

 

Sean: Before we move on, let’s review. The NIS is derived from the SID to allow researchers and policymakers to identify, track, and analyze national and regional trends in health care utilization, access, charges, quality, and outcomes.

 

The NIS's large sample size enables analyses of rare conditions, such as congenital anomalies; uncommon treatments, such as organ transplantation; and special patient populations, such as the uninsured.

 

The NIS is the only national hospital database with charge information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance and uninsured individuals.

 

The NIS includes hospital identifiers that permit linkages to the American Hospital Association Annual Survey of Hospitals and county identifiers that permit linkages to the Area Resource File.

 

Lauren: And as always, you can find this and more information about the NIS on the HCUP User Support Web site.

 

KID/What is the KID?

 

Lauren: Much like the NIS, the Kids’ Inpatient Database (KID) is derived from the SID. However, the purpose of the KID is to enhance research on inpatient stays for children and to enable researchers to make national estimates.

The KID is the only hospital administrative data set designed specifically to assess use of hospital services by newborns, children, and adolescents. It allows researchers to study specific conditions, procedures, and subpopulations that are sometimes difficult to analyze with other databases because children account for a relatively small proportion of hospital stays.

 

KID/Sample Design

 

Sean: Since the KID is derived from the SID, I’d imagine the creation of it is similar to that of the NIS.

 

Lauren: For the most part it is, but there are a few differences.

 

The SID
This NIS is a stratified sample of hospitals drawn from the SID. The KID is a stratified sample of pediatric discharges drawn from the SID.
Both the NIS and the KID are derived from the SID.

 

KID Strata
The KID is created from a 10% stratified sample of uncomplicated births and an 80% stratified sample of other pediatric discharges (complicated births and pediatric non-births) drawn from the SID.
Ten percent of uncomplicated in-hospital births and 80 percent of other pediatric cases from each stratum are sampled to create the KID.

 

The KID
The file structure is similar to the NIS, but with additional variables that are relevant for research on children (e.g., age in months and age in days).

 

KID/Availability and Pricing

 

Lauren: Like the NIS, the KID is affordable and available through the HCUP Central Distributor, so the purchasing process is straight forward.

It is released every three years and pricing is shown below. Like the NIS, AHRQ offers a discounted price for students.

Pricing:

 

Additional information is available on the HCUP User Support Web site.

 

KID/Research Topics

 

Lauren: There are numerous ways in which the KID can be used to support health services policy decisions and research. The KID enables studies on important topics such as the study of common and rare pediatric conditions, the impact of medical policy changes, variation in medical treatment, congenital abnormalities, and the economic burden of specific conditions. The KID is especially useful in studying rare pediatric conditions.

 

KID/Knowledge Check

 

Sean: So when would a researcher want to use the SID, the NIS, or the KID? Let’s take a look at some examples and answer the questions below.

 

Robert would like to study pediatric heart surgeries in children on a national-level. Which database(s) would Robert want to use?

 

Juliana would like to identify differences in asthma hospitalizations for children and adults on a national-level. Which database(s) would Juliana want to use?

 

James would like to identify differences in hospitalization rates of children with complications of diabetes between two neighboring states. Which database(s) would James want to use?

 

Select this link for the answers to the KID Knowledge Check: Answers to KID Knowledge Check

 

KID/Summary

 

Lauren: The KID is derived from the SID to permit researchers to study a broad range of conditions and procedures related to child health issues. Researchers and policymakers can use the KID to identify, track, and analyze national trends in health care utilization, access, charges and costs, quality, and outcomes. It is the only all-payer inpatient care database for children in the United States, and it is designed to permit research on rare pediatric conditions.

 

Sean: And let me guess… we can visit the HCUP User Support Web site to learn more about the KID?

 

Lauren: Absolutely. You can find more details on the HCUP User Support Web site.

 

SASD/What are the SASD?

 

Lauren: Now that we’ve learned about inpatient data available from HCUP, let’s take a look at available outpatient data.

 

Sean: I didn’t realize that HCUP provided outpatient data.

 

Lauren: Many researchers don’t realize that the HCUP databases include both inpatient and outpatient data. Outpatient data are available in the State Ambulatory Surgery Databases (SASD) the State Emergency Department Databases (SEDD), and the Nationwide Emergency Department Sample (NEDS).

 

We’ll discuss the SEDD and NEDS shortly. Let’s begin by taking a look at the SASD.

 

The SASD are a powerful set of databases that capture surgeries performed on the same day in which patients are admitted and released.

 

SASD/Data Sources

 

Lauren: To better understand the SASD, let’s take a look at how they are created.

 

Data Organizations
The SASD contain ambulatory surgery encounter abstracts from participating Data Organizations in each state.

 

Hospital-Affiliated Surgery Centers
All records from hospital-affiliated ambulatory surgery sites are included in the SASD. These records include information from inpatient beds that are designated as ambulatory surgery beds and separate facilities that are part of the same hospital corporation. The SASD do not contain surgeries performed in physician offices (such as some gynecological and gastro-intestinal procedures).

 

Freestanding Surgery Centers
Some of the SASD include records from both hospital-affiliated and freestanding surgery centers. Data from freestanding surgery centers vary by state. When included, these data tend to come from single specialty facilities.

 

HCUP Processes Data
The data are processed by HCUP to create uniformly formatted databases. Because of this uniform format, you can perform state-to-state comparisons and analyses.

 

SASD/Knowledge Check

 

Sean: What types of care would and would not be captured in the SASD? Answer the questions below.

 

John has a routine colonoscopy at a hospital-affiliated surgery center. Would this be captured by the SASD?

 

Mary has an elective skin biopsy performed in her physician’s office. Would this be captured by the SASD?

 

David has an elective knee arthroplasty done in a freestanding clinic. Would this be captured by the SASD?

 

Select this link for the answers to the SASD Knowledge Check: Answers to SASD Knowledge Check

 

SASD/File Structure

 

Sean: If I wanted to compare inpatient and outpatient obesity-related surgeries, would the file structure of the SASD be similar to that of the SID?

 

Lauren: Yes, let’s take a look.

 

Core Variables
The SASD contain a core set of data elements including age, gender, hospital charges, and expected payer.

 

State-Specific Variables
There are state-specific data elements in the SASD. These variables include CPT codes, patient race/ethnicity, and encrypted patient ID number. These vary by state and may or may not be available for the state(s) included in your research.

 

SASD/Availability and Pricing

 

Lauren: The SASD are updated annually, and the number of states included grows each year. Similar to the SID, each state sets its own price for the SASD, and prices can vary.

 

Many of the states have agreed to allow the HCUP Central Distributor to distribute their SASD. The HCUP Central Distributor handles these transactions as a service to the states – payments for the SASD are returned directly to the states. For those states that do not participate, researchers may contact the states directly to obtain a copy of their state database, but the process may be difficult.

 

You can find additional information on the HCUP User Support Web site.

 

SASD/Research Topics

 

Lauren: The SASD can help address a number of research topics that pertain to ambulatory surgeries. Sean could expand his research to include both inpatient and ambulatory surgery data – there has been some talk about bariatric surgeries becoming “same-day” surgeries in the near future.

 

You could use these data to identify state-specific trends in ambulatory surgery utilization, access, charges, and outcomes. You can also use it to conduct market area research or small area variation analyses. You could even use it in combination with the SID to examine complications of ambulatory surgeries that result in inpatient admissions.

 

SASD/Summary

 

Sean: To sum it all up, the SASD capture same-day surgeries that don’t require a patient to stay overnight at the hospital. The SASD contain the ambulatory surgery encounter abstracts in participating states, translated into a uniform format to facilitate multi-state comparisons and analyses.

 

They contain a core set of clinical and non-clinical information regardless of payer, including persons covered by Medicare, Medicaid, private insurance and uninsured individuals. In addition to the core set of uniform data elements common to all SASD, some include other elements, such as the patient's race.

 

Lauren: And you can find more information about the SASD on the HCUP User Support Web site.

 

SEDD/What are the SEDD?

 

Sean: Data on ambulatory surgeries are useful. Are any other types of outpatient care captured in HCUP databases?

 

Lauren: Yes, the HCUP databases capture emergency care in three databases.  The State Emergency Department Databases (SEDD) contain records of all treat and release visits to community-hospital based emergency departments in participating States.  The State Inpatient Databases (SID) include records of emergency department visits which resulted in an inpatient admission. The Nationwide Emergency Department Sample (NEDS) was constructed using records from both the SID and the SEDD.  The NEDS yields national estimates of emergency department visits

 

Let’s start by talking about the SEDD. 

 

SEDD/Data Sources

 

Lauren: The SEDD are derived from encounter abstracts and uniform billing data from hospital-affiliated emergency department sites. Visits that result in an admission to the hospital are not included in the SEDD; rather, they are included in the SID.

 

SEDD/File Structure

 

Sean: My guess is that the data elements and file structure of the SEDD are similar to that of the SID and the SASD.

 

Core Variables
The SEDD contain a core set of data elements, including patient demographics, expected payment source (including uninsured), and all-listed diagnoses and procedures.

 

State-Specific Variables
There are also state-specific data elements in the SEDD. Examples of state-specific variables include CPT codes, patient race/ethnicity, and AHA hospital identifier. Similar to the SASD, the SEDD can be linked to the SID by an encrypted patient identifier for certain states.

 

SEDD/Availability and Pricing

 

Lauren: The SEDD are released every year. Like the other state databases, the SID and the SASD, each state sets its own price for the SEDD. The cost of the SEDD varies per data set per year.

 

Many of the states have agreed to allow the HCUP Central Distributor to distribute their SEDD. The HCUP Central Distributor handles these transactions as a service to the states—payments for the SEDD are returned directly to the states. For those states that do not participate in the HCUP Central Distributor, researchers may contact the states directly to obtain a copy of their state database.

 

You can find additional information on the HCUP User Support Web site.

 

SEDD/Research Topics

 

Lauren: There are many interesting ways to use the SEDD. The SEDD can be used to examine state-specific trends in emergency department utilization, access, charges, and outcomes. Researchers can also use the SEDD to conduct market area research or small area variation analyses. The SEDD can be used to identify patterns of care for patients with various demographic and clinical characteristics and to address research topics related to injury surveillance, trends in emergency department use, correlations between ED use and environmental events, and occurrence of non-fatal, preventable illnesses. For certain states, the SEDD can be used to examine emergency department visits and re-visits.

 

Because emergency department visits that result in an admission to the hospital are not included in the SEDD, researchers who are interested in studying all visits that originate in the ED may prefer to work with both the SEDD and the SID. Studying both of these databases will provide a more complete state-level perspective by integrating outpatient and inpatient care data.  For a nationwide perspective of ED visits, researchers should use the Nationwide Emergency Department Sample, the NEDS.

 

SEDD/Knowledge Check

 

Sean: So HCUP includes three state-level databases: the SID, the SASD, and the SEDD. When would a researcher want to use one over the other, or some combination of two or three? Answer the questions below.

 

Michele is studying hospital charges associated with uninsured emergency department visits that are not hospitalized. Which database(s) would Michele want to use?

 

John is interested in researching the percentage of emergency room visits for asthma that result in hospitalization in Maryland. Which database(s) would John want to use?

 

Andrea is conducting research on the frequency of hysterectomies in a specific state. She understands that sometimes hysterectomies are performed as a same-day surgical procedure. Which database(s) would Andrea want to use?

 

Joe would like to identify serious complications resulting from outpatient surgeries that required hospitalization. Which database(s) would Joe want to use?

 

Select this link for the answers to the SEDD Knowledge Check: Answers to SEDD Knowledge Check

 

SEDD/Summary

 

Sean: So to summarize, the SEDD capture encounter information on all emergency department visits that do not result in an admission. The SEDD contain the emergency department encounter abstracts in participating states and are translated into a uniform format to facilitate multi-state comparisons and analyses.

 

They contain a core set of clinical and non-clinical information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. In addition to the core set of uniform data elements common to all SEDD, some state data include other elements, such as the patient's race.

 

Lauren: And you can find more information about the SEDD on the HCUP User Support Web site.

 

NEDS/What is the NEDS?

 

Sean: I know that the HCUP SEDD contain only ED visits that are considered treat-and-release.  I am interested in studying all ED visits—those which result in an inpatient admission to the same hospital as well as those that are treat-and-release? 

 

Lauren: HCUP creates the Nationwide Emergency Department Sample (NEDS) so that researchers can investigate emergency department utilization patterns—for both types of visits—on a national level.  The NEDS includes data on treat-and-release visits and on visits resulting in an inpatient admission to the same hospital.  The database enables national and regional analyses of emergency department utilization, charges and outcomes. 

 

NEDS/Sample Design

 

Lauren:  The NEDS, which is the largest all-payer emergency department database that is publically available in the United States is derived from the SID and the SEDD. 

 

The SID
The SID contain information on patients initially seen in the emergency room and then admitted to the same hospital. 

 

The SEDD

The SEDD capture discharge information on all the emergency department visits that do not result in an admission to that hospital—in other words, those in which the patient is treated and released.

 

Sampling
The NEDS approximates a 20% sample of hospital-based emergency departments in the U.S. Using a stratified, random sampling design, a sample of hospital-based emergency departments from States participating in both the SID and the SEDD is selected, and 100% of the emergency department visits from the selected hospital-based emergency departments are retained.

 

Sampling Strata
Hospitals are included in the NEDS sample on the basis of five hospital characteristics (referred to as “strata” in HCUP). Stratification variables include:

 

Sample Size
The NEDS contains over 950 hospital-based emergency departments. From each selected emergency department, all visits are included; this amounts to more than 25 million unweighted observations in one data year.

 

The NEDS
The NEDS is designed to be nationally representative of emergency-department care. Because the NEDS sampling frame is not designed with “state” as a stratification variable, state-level analyses cannot be conducted. If you are interested in analyses by state, obtain the state-specific SID and SEDD.

 

NEDS/Comparison to the SID and SEDD

 

Lauren: Let’s take a closer look at the differences between the NEDS and the SID and the SEDD.

 

All Discharges vs. Sample
The NEDS is a sample of hospitals-based emergency departments, while the SID captures all discharges from community hospitals in each state and the SEDD captures all treat-and-release ED visits in each state.

 

Data Elements
The NEDS contains fewer data elements than the SID and the SEDD, but most of those variables are standardized. NEDS data elements include diagnosis codes, procedure codes, discharge status from the emergency department, patient demographics, expected payment source, total hospital charges for visits that resulted in an inpatient admission, and, for many visits, total emergency department charges for emergency department visits,  Refer to the NEDS documentation available on HCUP-US for more detailed information.

 

Value-Added Variables: Hospital Characteristics
The NEDS contains hospital characteristics derived from the AHA Annual Survey Database and the Trauma Information Exchange Program database. These include:

 

Value-Added Variable: Trauma Center Designation
NEDS data on trauma center designation facilitates research on emergency department care.  A trauma center is a hospital equipped to provide comprehensive emergency medical services 24 hours a day, 365 days per year to patients suffering traumatic injuries. The NEDS distinguishes between level I, II, and III trauma centers, as designated based on criteria developed by the American College of Surgeons' Committee on Trauma.

 

NEDS/Availability and Pricing

 

Lauren: The NEDS is released every year through the HCUP Central Distributor.

 

Additional information is available on the HCUP User Support Web site.

 

NEDS/Research Topics

 

Lauren: The NEDS can be used to investigate many aspects of emergency department utilization, including quality of emergency care, difference in use of ED services in rural and urban areas, impact of health policy changes, differences in admission rates, access to care, and the use of ED services by special populations.

 

NEDS/Knowledge Check

 

Sean: Take a moment to identify whether the SID, the SEDD, the NIS or the NEDS would be better for certain research topics by answering the questions below.

 

Chris is investigating how nationwide emergency department visits that result in hospital admission differ from treat-and-release visits in terms of patient characteristics such as age, gender, or income level of their community.  Which database would Chris want to use? 

 

Jacob would like to identify regional trends in emergency department use for asthma within the U.S.  Which database would Jacob want to use?

 

Katheryn is conducting research on how treat-and-release emergency department visits for motor-vehicle accidents vary between California and New York.  Which database would Katheryn want to use?

 

Amy is interested in examining national trends in costs associated with inpatient admissions that originated in the ED and those that were routinely admitted.  Which database should Amy use in her research?

 

Select this link for the answers to the NEDS Knowledge Check: Answers to NEDS Knowledge Check

 

NEDS/Summary

 

Sean: Before we move on, let’s review. The NEDS is derived from the SID and the SEDD to allow researchers and policymakers to identify, track, and analyze national and regional trends in emergency department utilization, access, charges, quality, and outcomes.

 

The NEDS’ large sample size enables analyses of relatively uncommon disorders and procedures and special patient populations treated in the emergency department.

 

The NEDS is the largest all-payer database in the United States containing information on emergency department care.

 

Lauren: Of course, you can find this and more information about the NEDS on the HCUP User Support Web site.

 

Using HCUP Data/Benefits and Limitations

 

Lauren: Now that we’ve learned about each of databases, let’s take a closer look at the benefits and limitations of HCUP data.

 

Sean: Since HCUP databases include all discharge data from community hospitals in participating states, a large number of patients are represented, making national or regional estimates possible and allowing for the study of rare diseases.

 

Lauren: That’s true. HCUP databases also include all-payer information so groups like the uninsured can be studied. The databases have been evaluated against other sources of data to ensure accuracy. Because the databases are uniform and have been available for some time, the databases are useful for trend analysis. It is possible to link the HCUP databases to external data sources and to link them to each other. Lastly, HCUP has safeguards in place to protect the privacy of individuals, doctors, and hospitals.

 

Sean: All-payer information, benchmarking, privacy safeguards… Those benefits make a strong case for using HCUP databases. What are the limitations?

 

Lauren: The databases are derived from billing data. Some data that researchers may find useful, such as pharmacy and laboratory information, are not included. Also, as with any administrative healthcare database, there may be issues with coding accuracy. None of the HCUP databases currently include outpatient office visit data, so it’s not possible to show a complete episode of care. The data also include non-federal community hospitals. While these community hospitals account for 85% of hospitals in the U.S., HCUP does not include all hospitals. HCUP data include total charge information and not revenue or cost data. However, AHRQ has developed cost-to-charge ratios to estimate costs based on charge data. States individually decide what data elements to release.

 

Read the items below for more detail.

 

Benefits: Represent a large number of patients
Billing data are collected as part of standard hospital operations and represent the experiences of a large number of patients. The large size allows for national, regional, and state estimates and for the study of rare diseases and outcomes.

 

Benefits: Include all-payer information
All of the HCUP databases include all-payer information. This means that subpopulations often excluded from claims databases, such as the uninsured, can be studied using HCUP data.

 

Benefits: Previously benchmarked
The HCUP databases have been evaluated and benchmarked against other sources of data. For example, the number of visits in the SEDD has been compared to the AHA Annual Survey Database and the percent of injury visits has been compared to the National Hospital Ambulatory Medical Care Survey.

 

Benefits: Permit trend analysis
Multiple years of data are available for each of the HCUP databases. In the case of the NIS, we have more than 10 years of data available. Consequently, the HCUP databases are useful for trend analysis. For example, researchers are able to investigate changes that occur as a result of medical technology.

 

Benefits: Able to link to other databases
It is possible to link the HCUP databases to external data sources, such as the American Hospital Association Survey and the Area Resource File. Some HCUP databases can also be linked to one another.

 

Benefits: Safeguard individual and institutional confidentiality
HCUP has safeguards in place to protect the privacy of individual patients, physicians, and hospitals. This protection is accomplished through the Data Use Agreements and the limited release of certain data elements.

 

Limitations: Limited clinical data
The data were not originally created for research purposes. Thus, some elements that researchers may find useful are not included in the billing data, such as laboratory or pharmacy.

 

Limitations: Possibly contain medical coding inaccuracies
There may also be problems with medical coding accuracy. However, HCUP performs a limited number of edit checks on the validity of coding.

 

Limitations: Cannot show complete episode of care
None of the HCUP databases currently includes outpatient office visit data. Consequently, HCUP data cannot be used to study complete episodes of care. However, a subset of states have encrypted patient identifiers to link patients across time and setting (e.g. inpatient, ambulatory surgery and ED).

 

Limitations: Do not include all hospitals (e.g., VA or DOD hospitals)
HCUP data are based on community, non-Federal hospital data. This means that the Veteran’s Administration, Department of Defense, and Indian Health Service facilities are not represented in the HCUP databases. However, this represents < 15% of all hospitals in the US.

 

Limitations: Lack revenue or cost information
HCUP data include charge information, rather than revenue or cost data. However, AHRQ has created a methodology that can convert charges into costs. The methodology and software are available on request from the HCUP Central Distributor.

 

Limitations: Contain varying data elements depending on the state
The availability of certain data elements like physician IDs, patient race and ethnicity, and AHA hospital identifiers varies by state. Some states do not permit the release of these variables. Detailed information on state-specific restrictions can be found on the HCUP User Support Website.

 

Using HCUP Data/Which database should I use?

 

Lauren: Once you decide that the HCUP databases can help with your research, you then need to determine which of the databases will be most suited for your analysis. It is important to ask the right questions to decide whether HCUP can help address your research topic.

 

Let’s take a look at Sean’s research topic – national trends in obesity-related procedures – and determine which HCUP database will best fit his needs. Sean has already answered the first question:

 

Sean, are you looking at inpatient or outpatient data?

 

Sean: Currently, most obesity-related procedures are inpatient so I plan on focusing my research there.

 

Lauren: That eliminates outpatient databases – the SASD and the SEDD. The next question to ask is what variables you need for your analysis. We’ve talked about common data elements included in all the databases and state-specific variables that are only included when released by the states. It sounds like you’ll mainly be looking at diagnoses, procedures, and possibly patient demographics.

 

Next you’ll need to determine if you want national estimates.

 

Sean: Since I’m looking for national trends, I certainly will want national estimates. That would eliminate the SID. That leaves just the NIS and the KID, but I’m interested in adults. That eliminates the KID and leaves the NIS as the best database for my research topic.

 

Using HCUP Data/Obtaining HCUP Data

 

Sean: Once I’ve decided which databases I need for my research, how do I go about gaining access to them?

 

Lauren: We’ve talked about how you would access the HCUP databases earlier in the course.  To summarize, national databases, such as the NIS, the NEDS and the KID, are available directly through the HCUP Central Distributor. State-level databases, such as the SID, the SASD, and the SEDD, are available either through the HCUP Central Distributor or directly through the state data organization depending on the state.

 

For those states that do not participate in the HCUP Central Distributor, researchers may contact the Data Organizations in participating states directly to obtain a copy of their database.

 

Before purchasing any data files from the HCUP Central Distributor, individuals must complete the HCUP Data Use Agreement (DUA) Training Course. This training outlines important points in the DUA. After completing the training, you will receive a certification code. Use this code in your application for purchasing HCUP databases.

 

Using HCUP Data/Knowledge Check

 

Sean: I’ll be using the NIS through the HCUP Central Distributor for my research, but one of my colleagues, Jamie, is comparing hernia inpatient and outpatient surgeries in three different states. Can you help Jamie access the HCUP data that she’ll need for her research?

 

Jamie will need to use the SID and the SASD for three different states. She has checked the HCUP User Support Web site and knows that two of the states are available through the HCUP Central Distributor and one is available through the state. Who should she contact to begin this process? Choose the correct answer from the choices below.

 

What does Jamie need to submit to the HCUP Central Distributor to purchase those databases? Choose the correct answer from the choices below.

 

Select this link for the answers to the Using HCUP Data Knowledge Check: Answers to Using HCUP Data Knowledge Check

 

Using HCUP Data/Statistical Programming Software

 

Lauren: To work effectively with the HCUP databases, you will need to use a statistical software package, such as SAS, Sudaan, Stata, or SPSS. Working with these software tools requires some programming expertise. The full HCUP databases cannot be analyzed using Microsoft applications, such as Excel or Access.

 

AHRQ provides example programs in SAS, SPSS, Stata, and SUDAAN.  Example programs include database load programs, format programs, examples of statistical coding, and programs designed to help users apply the HCUP tools.

Example Programs Provided by AHRQ

 

SAS®

SPSS®

STATA®

SUDAAN®

Load Programs

Yes

Yes

 

 

Format Programs

Yes

 

 

 

Example Statistical Coding Statement

Yes

 

Yes

Yes

HCUP Tool Programs

Yes

 

 

 

 

Tools and Reports/HCUPnet Overview

 

Lauren: A convenient and valuable way to access HCUP statistics is through a free online querying system known as HCUPnet. HCUPnet provides free and immediate access to national, regional, and state-level hospital inpatient statistics based on HCUP data. HCUPnet can generate statistical output for queries based on the Nationwide Inpatient Sample (NIS), the Kids’ Inpatient Database (KID), the Nationwide Emergency Department Sample (NEDS), the State Inpatient Databases (SID) and the State Emergency Department Databases (SEDD). HCUPnet can generate output based on diagnosis and procedure codes and can cross-classify this output by select patient and hospital characteristics. You can also obtain ready-to-use national information on measures of health care quality based on the NIS using the AHRQ Quality Indicators.

 

Sean: Lauren, could I use HCUPnet to get an idea of how the number of obesity-related procedures has changed in recent years?

Lauren: Sean, let’s give it a try.

 

Tools and Reports/Using HCUPnet

 

Lauren: Here we are at the HCUPnet home page. Follow the directions to use HCUPnet to get a national perspective on how the number of obesity-related procedures has changed in the past few years. Sean will appreciate the help.

 

 

Use HCUPnet to obtain a national perspective on how the number of obesity-related procedures has changed in the past few years.

Several options exist for assessing different types of statistics available on the HCUPnet home page, such as For Children Only and State Statistics.

Because we are interested in the total number of discharges nationwide, click National and Regional Statistics from the NIS.

 

 

Now you have the choice of selecting either “Lay person, data novice” or “Researcher, medical professional.”

If you are unfamiliar with health care data, select “Lay person, data novice.” The “Researcher, medical professional” option is more versatile and will give you more flexibility.

For this example, click Researcher, medical professional to move on.

 

 

This screen asks you to select the type of query that interests you. Trend data are available for at least ten prior years. Depending on the output that you are interested in, you could also choose queries that report statistics on specific diagnoses or procedures, statistics on all US hospital stays, or a rank order of specific diagnoses or procedures.

For this query, click Trends because we are interested in seeing how the number of obesity-related procedures has changed throughout the years.

 

This screen allows you to select the types of medical codes you’d like to use to identify obesity-related surgeries – such as ICD-9-CM codes, DRGs, or CCS categories. An explanation of each of these types is presented on the right side of the page.

For this query, click Diagnosis Related Groups or DRGs.

 

Now you can input the number of the code, browse through the list of codes, or use the search function. If you didn’t know the correct DRG code, you could use the dropdown box below to browse for the correct one. For this query, we’ll use the DRG code 288.

Click Search to see if there are any matches.

 

As this screen reflects, DRG 288 is exactly what we need.

Select 288 O.R. Procedures from the search results.

 

Now that 288 O.R. Procedures for Obesity is selected, click Next on HCUPnet page to continue with the query.

 

Now you can select the outcomes and measures of interest. It is possible to select one or more other outcomes, such as length of stay and mean hospital charges and costs.

For this query, click only Number of Discharges.

 

Now that Number of Discharges is selected, click Next on HCUPnet page to continue with the query.

 

Here are the results of our query.

Take a look at the data. HCUPnet provides an online Z-test calculator to test the significance of the difference between two weighted counts, means, or percentages.

Click Z-Test Calculator at the bottom of the page.

 

 

The Z-Test Calculator is simple to use.

Let’s determine if the number of operating room procedures performed in 1997 is statistically different from the number performed in 2004.

 

 

Click Calculate to find out.

 

 

The Results box shows the Standard Error, the z Statistic, and the p Statistic based on the estimates that we entered. Our results are statistically significant.

Click the Close (or "x") button in the upper right corner of the Z-Test Calculator to return to the results.

 

 

HCUPnet produces a graph of the number of operating room procedures for obesity from 1993 to 2004.

 

Numerous other features of HCUPnet exist, but the best way to learn about this tool is to take some time to play with it. Remember that it is completely free of charge and available at the HCUP User Support Web site.

 

Tools and Reports/HCUP Tools

 

Sean: Lauren, HCUPnet seems very useful. It’s a nice way to get a feel for the HCUP data before purchasing the full files.

 

Lauren: Yes, in addition to HCUPnet, AHRQ has developed many free software tools to help researchers make the most of the HCUP data. Read about these tools below.

 

Clinical Classifications Software (CCS)

 

Chronic Condition Indicator

 

Procedure Classes Software

 

Comorbidity Software

 

Utilization Flags

 

Quality Indicators
Quality Indicators (QIs) are measures of health care quality that utilize readily available hospital inpatient administrative data:

 

Tools and Reports/HCUP Supplemental Files

 

Lauren:  Along with the various HCUP tools, AHRQ provides supplemental files for use in conjunction with the HCUP databases. 

 

Cost-to-Charge Ratios

 

Hospital Market Structure Files

 

HCUP Supplemental Files for Revisit Analysis

 

American Hospital Association Linkage Files

 

Trends Files

 

Tools and Reports/HCUP Reports

 

Lauren: AHRQ also offers a number of publications useful to researchers. I initially learned about HCUP data after seeing references in publications released by AHRQ such as the The National Healthcare Quality Report, and The National Healthcare Disparities Report. HCUP data have also been used extensively in articles published in peer-reviewed journals. Information about the latest HCUP publications and citations for journal articles based on HCUP data, tools, or products, appear on the HCUP User Support Website.

 

Congressionally Mandated Reports: The National Healthcare Quality Report and the National Healthcare Disparities Report

 

Facts and Figures

 

Statistical Briefs

 

Fact Books

 

User Support/Overview

 

Sean: Lauren, AHRQ provides so many resources for health researchers like me, but what if I need help later using HCUPnet on my own? Or what if I need specific help finding out how to purchase a database?

 

Lauren: HCUP provides user support services to help you with questions about the various HCUP products and tools. There are a number of ways to access technical assistance.

 

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

 

HCUP Online Tutorial Series

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

 

Technical Assistance – HCUP User Support
E-mail: hcup@ahrq.gov
Phone: 1-866-290-HCUP (4287)

 

HCUP Central Distributor
E-mail: hcup@s-3.com
Phone: 1-866-556-HCUP (4287)
Fax: 1-866-792-5313

 

User Support/User Support Web Site

 

Lauren: The HCUP User Support Web site is a great resource. You can use it to review extensive documentation about HCUP data, tools and products, access HCUPnet, and find a comprehensive listing of HCUP-related publications and reports.

 

User Support/Online Tutorial Series

 

Sean:  What if I’m looking for more interactive guidance on working with HCUP data?

 

Lauren:  The HCUP Online Tutorial Series provides HCUP data users with information about HCUP data and tools, and training on technical methods for conducting research with HCUP data. The courses in the HCUP Online Tutorial Series are designed to answer technical questions you may have related to HCUP data and programs, such as:

 

User Support/Technical Assistance

 

Sean: Is HCUP Technical Assistance like the technical assistance I’ve called to try to fix my computer?

 

Lauren: HCUP Technical Assistance is similar, but better! HCUP Technical Assistance is provided by senior research personnel trained in epidemiology, health services research, statistics, economics, and medicine. While they cannot provide detailed programming or analytic support, they do provide detailed, expert advice on HCUP databases and other related products. They usually respond within three business days.

 

User Support/Knowledge Check

 

Lauren: Let’s review what HCUP User Support does and what it doesn’t do. Read each statement below and determine whether or not it is provided by HCUP User Support.

Select this link for the answers to the User Support Knowledge Check: Answers to User Support Knowledge Check

 

Summary/Review

 

Sean: Thanks, Lauren. I’ve certainly learned a lot about HCUP today. Let’s review some of the key topics that we discussed.

 

HCUP Databases
HCUP databases provide a wealth of information to enhance your health care research and promote positive changes in health care. HCUP data:

Learn more about these databases on the HCUP User Support Web site.

 

Software Tools and Supplemental Files
AHRQ has developed several software tools and supplemental files to help researchers make the most of HCUP data. Detailed information about these tools is available from the HCUP User Support Web site.

 

Research Publications
HCUP data are used in numerous research publications, including many peer-reviewed journals. Citations for journal articles based on HCUP data, tools, or products appear on the HCUP User Support Web site. AHRQ-authored publications and reports that rely on HCUP data, such as Fact Books and Statistical Briefs, are also available on the User Support Web site.

 

User Support
HCUP provides user support to help address your questions about HCUP databases and tools. You can access technical assistance via phone or e-mail. Learn more about user support on the HCUP User Support Web site.

 

Summary/Feedback

 

Lauren: Thank you for completing the course! I hope that I’ve answered your questions about the HCUP project and databases.

If I haven’t, remember that HCUP provides user support and additional information online. Check the HCUP US Web site or contact technical assistance for answers to your questions.

Please take a moment to provide AHRQ with course feedback. Click the link below to e-mail us your comments:
hcup@ahrq.gov

 

Answers: Introduction/Knowledge Check

 

Are these characteristics of HCUP databases? Yes or no?

 

Good job! You've identified all of the HCUP data characteristics. The foundations of HCUP data are derived from non-Federal community hospital billing data and include inpatient care and certain components of outpatient care.

 

To return to the Overview Knowledge Check, select this link: Return to Overview Knowledge Check

 

Answers: SID/Knowledge Check

 

Jane has a Cesarean section and remains in the hospital for two days. Would this record be included in the SID?

 

Madison receives routine vaccines and a check-up at her doctor’s office. Would this be captured in the SID?

 

Mark is released after receiving outpatient treatment for a broken leg. Would this record be included in the SID?

 

Helen is admitted to a hospital with pneumonia. Would the record of her hospital treatment be included in the SID?

 

To return to the SID Knowledge Check, select this link: Return to SID Knowledge Check

 

Answers: NIS/Knowledge Check

 

Anna would like to identify differences in pneumonia hospitalizations in Maryland, as compared with Florida. Which database would Anna want to use?

 

Linda would like to identify national trends in diabetes hospitalizations. Which database would Linda want to use?

 

Tim would like to identify regional trends in hospitalizations for coronary artery bypass graft (CABG) procedures within the U.S. Which database would Tim want to use?

 

To return to the NIS Knowledge Check, select this link: Return to NIS Knowledge Check

 

Answers: KID/Knowledge Check

 

Robert would like to study pediatric heart surgeries in children on a national-level. Which database(s) would Robert want to use?

 

Juliana would like to identify differences in asthma hospitalizations for children and adults on a national-level. Which database(s) would Juliana want to use?

 

James would like to identify differences in hospitalization rates of children with complications of diabetes between two neighboring states. Which database(s) would James want to use?

 

To return to the KID Knowledge Check, select this link: Return to KID Knowledge Check

 

Answers: SASD/Knowledge Check

 

John has a routine colonoscopy at a hospital-affiliated surgery center. Would this be captured by the SASD?

 

Mary has an elective skin biopsy performed in her physician’s office. Would this be captured by the SASD?

 

David has an elective knee arthroplasty done in a freestanding clinic. Would this be captured by the SASD?

 

To return to the SASD Knowledge Check, select this link: Return to SASD Knowledge Check

 

Answers: SEDD/Knowledge Check

 

Michele is studying hospital charges associated with uninsured emergency department visits that are not hospitalized. Which database(s) would Michele want to use?

 

John is interested in researching the percentage of emergency room visits for asthma that result in hospitalization in Maryland. Which database(s) would John want to use?

 

Andrea is conducting research on the frequency of hysterectomies in a specific state. She understands that sometimes hysterectomies are performed as a same-day surgical procedure. Which database(s) would Andrea want to use?

 

Joe would like to identify serious complications resulting from outpatient surgeries that required hospitalization. Which database(s) would Joe want to use?

 

To return to the SEDD Knowledge Check, select this link: Return to SEDD Knowledge Check

 

Answers:  NEDS/Knowledge Check

 

Chris is investigating how nationwide emergency department visits that result in hospital admission differ from treat-and-release visits in terms of patient characteristics such as age, gender, or income level of their community.  Which database would Chris want to use? 

 

Jacob would like to identify regional trends in emergency department use for asthma within the U.S.  Which database would Jacob want to use?

 

Katheryn is conducting research on how potentially preventable treat-and-release emergency department visits vary between California and New York.  Which database would Katheryn want to use?

 

Amy is interested in examining national trends in costs associated with inpatient admissions that originated in the ED and those that were routinely admitted.  Which database should Amy use in her research?

 

To return to the NEDS Knowledge Check, select this link: Return to NEDS Knowledge Check

 

Answers: Using HCUP Data/Knowledge Check

 

Jamie will need to use the SID and the SASD for three different states. She has checked the HCUP User Support Web site and knows that two of the states are available through the HCUP Central Distributor and one is available through the state. Who should she contact to begin this process?

 

What does Jamie need to submit to the HCUP Central Distributor to purchase those databases?

 

To return to the Using HCUP Data Knowledge Check, select this link: Return to Using HCUP Data Knowledge Check

 

Answers: User Support/Knowledge Check

 

 

To return to the User Support Knowledge Check, select this link: Return to User Support Knowledge Check

 

Resources

 

HCUP User Support Website: http://www.hcup-us.ahrq.gov/

HCUP Databases: http://www.hcup-us.ahrq.gov/databases.jsp

HCUP Tools and Software: http://www.hcup-us.ahrq.gov/tools_software.jsp

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

HCUP News and Events: http://www.hcup-us.ahrq.gov/news.jsp

HCUP Technical Assistance: http://www.hcup-us.ahrq.gov/techassist.jsp

 

For information on obtaining the HCUP databases, please contact the HCUP Central Distributor:

 

For questions on the HCUP Data Use Agreement, please refer to the Web-based tutorial: HCUP Data Use Agreement Training.

 

To search an HCUP topic, please review the Index Page.

 

To reach HCUP User Support, please contact us via e-mail or phone:

 

This course may not be copied, photocopied, reproduced, translated, transmitted, or electronically converted in whole or in part without the prior written consent of the Agency for Healthcare Research and Quality (AHRQ), Department of Health and Human Services.

Created by Allen Communication Learning Services for the Agency for Healthcare Research and Quality (AHRQ)

Allen Communication Learning Services

We are interested in your comments and suggestions about this electronic training module.  Please contact us at hcup@ahrq.gov.