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Why the KID should not be used to make State-level estimates
The KID is a set of pediatric hospital inpatient databases included in the HCUP family. These databases are created by AHRQ through a Federal-State-Industry partnership.
 
Why the KID should not be used to make State-level estimates


"Can I use older years of the KID that include State identifiers to do State-level estimates?"

AHRQ strongly advises researchers against using the KID to estimate State-specific statistics. Prior to 2012, State is available as a KID data element. However, these KID samples were not designed to yield a representative sample of hospitals at the State level. AHRQ recommends that researchers employ the SID for State-level estimates.

Each KID sample is drawn from the sampling frame consisting of discharge data submitted by HCUP Partners—statewide data organizations that agree to participate in the KID. Data from non-Partner States are missing completely from the sampling frame, and data from Partner States are sometimes incomplete because of different State reporting requirements, different State restrictions, or other data omissions. The KID is designed to represent hospitals and discharges nationally, including those outside the sampling frame.

To accomplish this, within each hospital sampling stratum the KID draws a sample of discharges from the sampling frame required to net a total of 10 percent of normal newborns and 80 percent of other pediatric discharges (younger than 21 years of age) nationally. The sampling strata are defined by census region (4 regions), hospital ownership (3 categories), urban-rural location, teaching status, and bed size (3 categories), with a separate category for children’s hospitals. As a result, the proportion of KID discharges in a stratum that are from a given State is unlikely to equal the State's actual proportion of discharges in that stratum. Consequently, the sample of KID discharges is unlikely to be representative of discharges in the State, and the KID sample weights will not be appropriate at the State level.

The level of this "misrepresentation" varies across the States in any given year of the KID, which further confounds State-to-State comparisons based on State-specific estimates from the KID. Moreover, for a given State the level of misrepresentation changes from year to year as States (and hospitals) enter and exit the sampling frame over time. This further confounds State-specific trends based on State-specific estimates from the KID.

Finally, because the KID was not designed to be representative at the State level, design-based estimates of standard errors are not possible, which severely hampers State-level inferences. In summary, KID State-level estimates would be very imprecise at best and biased at worst.
 

Internet Citation: Why the KID should not be used to make State-level estimates. Healthcare Cost and Utilization Project (HCUP). September 2018. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/nation/kid/kid_statelevelestimates.jsp.
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Last modified 9/21/18