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HCUP Overview Presentation
A 90-minute overview of HCUP is often presented at conferences. HCUP databases and products are developed by AHRQ through a Federal-State-Industry partnership.
 
Healthcare Cost and Utilization Project (HCUP): Overview of the HCUP Databases and Resources

Select to access the presentation in PDF format (PDF file, 8.2 MB).


Slide 1

Healthcare Cost and Utilization Project (HCUP): Overview of the HCUP Databases and Resources



Healthcare Cost and Utilization Project (HCUP): Overview of the HCUP Databases and Resources
 
Slide 2

Presentation Overview

Presentation Overview
  • Project Overview
  • AHRQ and HCUP Partners
  • The Making of HCUP Data
  • HCUP State Databases
  • HCUP Nationwide Databases
  • How to Obtain HCUP Databases & Access HCUP Resources
 
Slide 3

What is HCUP?

What is HCUP?
  • HCUP is a comprehensive set of publicly available all-payer health care data.
  • Includes multiyear inpatient and outpatient data based on hospital billing records.
  • Includes:
    • HCUP Databases
    • Online Tools
    • Analytics
    • User Support
 
Slide 4

HCUP Answers Questions

HCUP Answers Questions
  • Use of hospital, ED, and ambulatory surgery services
  • Expected payer (all are included) of services
  • Age, race and area of residence of patients
  • Geography (county, State, national)
  • Clinical detail
    • Conditions/comorbidities and procedures
    • Outcomes of care
  • Cost of care
  • Care for a patient across time** (revisits/readmissions)
  • Access, quality, patient safety
  • Trends over time in all of the above
 
Slide 5

Research Using HCUP Data

Research Using HCUP Data
  • Costs of care
    • Between 2005 and 2014, the inflation-adjusted mean cost per inpatient stay increased by 12.7 percent, from $9,500 to $10,900 (2005 and 2014 NIS & HCUP Fast Stats, Stat Brief #225).
  • Patient safety
    • Half of patients with community-acquired Methicillin-resistant Staphylococcus aureus (MRSA) in California had a diagnosis of cellulitis or skin ulcers. Among patients with hospital-acquired MRSA, the largest proportion (38 percent) were diagnosed with pneumonia. (2013 SID, Stat Brief #212).
  • Access to care
    • From 2000 to 2015, the share of Medicaid among nonneonatal, nonmaternal inpatient stays for those aged 18–44 years and 45–64 years increased by 74 percent and 68 percent, respectively (2000-2015 NIS, Stat Brief #235).
  • Readmissions
    • In 2014, 14 percent of inpatient stays were readmitted within 30 days. More than one-third of these readmissions occurred within 7 days, reflecting a 7-day readmission rate of 5 percent (2014 NRD, Stat Brief #230).
 
Slide 6

Research Using HCUP Data

Research Using HCUP Data
  • Quality of Care
    • From 2010 to 2014, the rate of stays involving an adverse drug event
    • (ADE) increased the most for ADEs caused by smooth muscle and respiratory drugs (up 24 percent) and decreased the most for ADEs caused by cardiovascular drugs (down 18 percent). (2010 and 2014 SID, Stat Brief #234).
  • Geographic variation
    • The mean rate of Cesarean section (C-Section) among total and low-risk deliveries was higher for hospitals in the Northeast and South compared with those in the Midwest and West. (2013 SID, Stat Brief #211).
  • Trends in practice
    • C-section, knee arthroplasty, hip replacement, and percutaneous coronary angioplasty (PTCA) were among the five most common operating room (OR) procedures (along with circumcision) and the five OR procedures with the highest aggregate hospital costs (along with spinal fusion). (2014 NIS, Stat Brief #233).
  • Opioid-related stays
  • Nationally, from 2010 to 2015, the share of opioid-related inpatient stays and emergency department (ED) visits shifted away from private payers and no insurance and toward public payers (Medicare and Medicaid) (2010 and 2015 NIS & NEDS & HCUP Fast Stats, Stat Brief #239).
 
Slide 7

Presentation Objectives Part I

Presentation Objectives Part I
  • Project Overview
  • AHRQ and HCUP Partners
  • The Making of HCUP Data
  • HCUP State Databases
  • HCUP Nationwide Databases
  • How to Obtain HCUP Databases & Access HCUP Resources
 
Slide 8

What is the Agency for Healthcare Research and Quality (AHRQ)?

What is the Agency for Healthcare Research and Quality (AHRQ)?
  • The Agency for Healthcare Research and Quality (AHRQ) is a federal agency under the Department of Health and Human Services.
 
Slide 9

AHRQ'sMission

AHRQ's Mission
  • To produce evidence to make health care
    • safer
    • higher quality
    • more accessible
    • equitable
    • affordable
  • To work with HHS and other partners to make sure that the evidence is understood and used
 
Slide 10

The HCUP Partnership

The HCUP Partnership
  • Three-way cooperation between States, Federal government, and Industry
 
Slide 11

HCUP Data Partners

HCUP Data Partners
  • Alaska Department of Health and Social Services
  • Alaska State Hospital and Nursing Home Association
  • Arizona Department of Health Services
  • Arkansas Department of Health
  • California Office of Statewide Health Planning and Development
  • Colorado Hospital Association
  • Connecticut Hospital Association
  • Delaware Health Statistics Center & Office of Vital Statistics
  • District of Columbia Hospital Association
  • Florida Agency for Health Care Administration
  • Georgia Hospital Association
  • Hawaii Health Information Corporation
  • Illinois Department of Public Health
  • Indiana Hospital Association
  • Iowa Hospital Association
  • Kansas Hospital Association
  • Kentucky Cabinet for Health and Family Services
  • Louisiana Department of Health
  • Maine Health Data Organization
  • Maryland Health Services Cost Review Commission
  • Massachusetts Center for Health Information and Analysis
  • Michigan Health and Hospital Association
  • Minnesota Hospital Association (provides data for Minnesota and North Dakota)
  • Mississippi Department of Health
  • Missouri Hospital Industry Data Institute
  • Montana Hospital Association
  • Nebraska Hospital Association
  • Nevada Department of Health and Human Services
  • New Hampshire Department of Health & Human Services
  • New Jersey Department of Health
  • New Mexico Department of Health
  • New York State Department of Health
  • North Carolina Department of Health and Human Services
  • North Dakota (data provided by the Minnesota Hospital Association)
  • Ohio Hospital Association
  • Oklahoma State Department of Health
  • Oregon Health Authority
  • Oregon Association of Hospitals and Health Systems
  • Pennsylvania Health Care Cost Containment Council
  • Rhode Island Department of Health
  • South Carolina Revenue and Fiscal Affairs Office
  • South Dakota Association of Health Care Organizations
  • Tennessee Hospital Association
  • Texas Department of State Health Services
  • Utah Department of Health
  • Vermont Association of Hospitals and Health Systems
  • Virginia Health Information
  • Washington State Department of Health
  • West Virginia Health Care Authority
  • Wisconsin Department of Health and Family Services
  • Wyoming Hospital Association
 
Slide 12

HCUP Partners Providing Inpatient Data

HCUP Partners Providing Inpatient Data
  • A map of the United States shows those Partners that participate in HCUP by providing inpatient data. All States are participating except Idaho and Alabama.
  • HCUP data are collected on the State-level. All States that participate in HCUP provide us with inpatient data. Currently, we collect data from 48 States and the District of Columbia, representing 97% of the U.S. population and more than 97% of all hospital discharges.
 
Slide 13

HCUP Partners Providing Ambulatory Surgery & Services Data

HCUP Partners Providing Ambulatory Surgery & Services Data
  • A map of the United States shows those 49 Partners that participate in HCUP by providing ambulatory surgery and services data. States include CA, CO, CT, the District of Columbia (DC), FL, GA, HI, IA, IL, IN, KS, KY, ME, MD, MI, MN, MO, NC, ND, NE, NH, NJ, NV, NY, OH, OK, OR, PA, SC, SD, TN, TX, UT, VT, WI.
 
Slide 14

HCUP Partners Providing Emergency Department Data

HCUP Partners Providing Emergency Department Data
  • A map of the United States shows those 37 Partners that participate in HCUP by providing emergency department data. States include AR, AZ, CA, CT, the District of Columbia (DC), FL, GA, HI, IL, IN, IA, KS, KY, ME, MD, MA, MN, MO, MT, NE, NV, NH, NJ, NY, NC, ND, OH, RI, SC, SD, TN, UT, VT, WI, WY
 
Slide 15

HCUP Participation by Data Type

HCUP Participation by Data Type
  • A map of the United States that shows HCUP participation by State and data type (inpatient, emergency department, and ambulatory surgery & services combined).
 
Slide 16

Presentation Objectives Part 1

Presentation Objectives Part 1
  • Project Overview
  • AHRQ and HCUP Partners
  • The Making of HCUP Data
  • HCUP State Databases
  • HCUP Nationwide Databases
  • How to Obtain HCUP Data and Access HCUP Resources
 
Slide 17

The Foundation of HCUP Data is Hospital Billing Data

The Foundation of HCUP Data is Hospital Billing Data
  • Uniform billing forms, such as the UB-04 and the CMS 1500, are used by many hospitals and are the basis of HCUP data. These forms contain information used in the billing process. Basic demographic data, such as patient age and gender, are collected. More detailed information about the patient's hospital stay, such as the patient's diagnosis and the medical procedures performed, are also included. In addition, facility charges for patient care are included. So, when thinking about HCUP data, it's important to remember that a large portion of these data are produced for "billing" purposes and not specifically to support research or policy development. However, some States add data elements that are intended to support research and public health, not billing purposes. The addition of information on race is one example.
 
Slide 18

From Patient Hospital Visit to Administrative Record

From Patient Hospital Visit to Administrative Record
  • It is helpful to review an inpatient patient flow diagram—from the patient's perspective and from a data perspective. From a patient's perspective, a patient either makes an appointment for inpatient care, is admitted directly from a physician's office, or is transferred from another hospital or emergency department. The patient is then admitted, receives inpatient care, and is discharged.
  • For the purposes of this presentation, it is important to understand this process from a data perspective, as well. While this perspective varies by hospital, generally a patient record is created that contains demographic information about the patient, as well as medical/clinical information about his or her inpatient services. From that patient record, a discharge summary is generated and given to a medical coder. The medical coder classifies the inpatient care into ICD-10-CM/PCS diagnosis and procedure codes. The billing department then uses the medical codes assigned by the coder to generate a hospital bill, such as a UB-04 form. The foundation of HCUP data is based on this type of billing data, also known as administrative data.
 
Slide 19

The Making of HCUP Data

The Making of HCUP Data
  • Patient enters hospital
  • Billing record is created
  • Hospital sends billing data and any additional data elements to data organizations
  • States store data in varying formats
  • AHRQ standardizes data to create uniform HCUP databases
 
Slide 20

The HCUP Data Process

The HCUP Data Process
  • State data are mapped to a standardized HCUP format which allows for consistent data elements and values for comparison across States
    • Value-added variables - injury indicators, chronic condition indicators, procedure class
    • Hospital characteristics - teaching status, ownership/control, bed size
    • Diagnostic related groups and severity measures -
      • AHRQ's Clinical Classifications Software (CCS)
      • 3M's All Patient Refined DRGs (APR-DRGs)
  • Quality checks are performed
 
Slide 21

Hospitals in the U.S.

Hospitals in the U.S.
  • 88% of hospitals in the U.S. are Community Hospitals
    • 12% Non-Community Hospitals (Federal/DoD/VA/IHS), Non-Federal Psychiatric, Non-Federal Long-Term Care, etc.)
    • Source: American Hospital Association (AHA) Annual Survey, Fiscal Year 2016
    • Please visit www.aha.org/statistics/fast-facts-us-hospitals Exit Disclaimer for more information.
 
Slide 22

What Are Community Hospitals?

What Are Community Hospitals?
  • American Hospital Association Definition: Non-Federal, short-term, general, and other specialty hospitals, excluding hospital units of other institutions (e.g., prisons)
    • Included: Multi-specialty general hospitals, OB-GYN, ENT, Orthopedic, Pediatric, Public, Academic medical centers
    • Excluded: Long-term care, Psychiatric, Alcoholism/Chemical dependency, Rehabilitation DoD/VA/IHS
 
Slide 23

What are Community Hospitals?

What are Community Hospitals?
  • HCUP generally does not receive data from non-community hospitals, such as Psychiatric facilities.
  • However, if a patient is treated for a mental health condition in a community hospital, their information is included.
  • Most Frequent Principal Diagnosis per 2015 National Inpatient Sample per hundred thousand
    • Liveborn: 1,188.2 discharges
    • Septicemia (except labor): 548.8 discharges
    • Osteoarthritis: 337.2 discharges
    • Congestive Heart Failure; nonhypertensive: 294.9 discharges
    • Pneumonia (except that caused by tuberculosis or sexually transmitted disease): 275.1 discharges
    • Mood disorders: 266.2 discharges
    • Cardiac dysrhythmias: 211.0 discharges
Source: HCUPnet, Weighted national estimates from the 2015 National Inpatient Sample
 
Slide 24

HCUP Has Seven Types of Databases

HCUP Has Seven Types of Databases
  • Three State-level databases
    • State Inpatient Databases (SID)
    • State Ambulatory Surgery and Services Databases (SASD)
    • State Emergency Department Databases (SEDD)
  • Four National (Nationwide) databases
    • National (Nationwide) Inpatient Sample (NIS)
    • Kids' Inpatient Database (KID)
    • Nationwide Emergency Department Sample (NEDS)
    • Nationwide Readmissions Database (NRD)
 
Slide 25

Presentation Objectives Part I

Presentation Objectives Part I

  • Project Overview
  • AHRQ and HCUP Partners
  • The Making of HCUP Data
  • HCUP State Databases
  • HCUP Nationwide Databases
  • How to Obtain HCUP Data and Access HCUP Resources
 
Slide 26

HCUP State Databases

HCUP State Databases
  • State Inpatient Databases (SID)
    • All inpatient U.S. community hospital discharge data (including those admissions that started in the ED) from participating HCUP States
  • State Ambulatory Surgery & Services Databases (SASD)
    • Ambulatory surgery data (hospital-owned and some nonhospital-owned) and other outpatient services from participating HCUP States
  • State Emergency Department Databases (SEDD)
    • Emergency department data (treat and release) from participating HCUP States
 
Slide 27

What Data Elements are Included in the HCUP Databases?

What Data Elements are Included in the HCUP Databases?
  • Data Elements:
    • Patient demographics (e.g., age, sex, and for some States, race)
    • Diagnoses & procedures
    • Expected payment source
    • Length of stay
    • Admission type and discharge status
    • Point of origin
    • Total charges
 
Slide 28

Some Data Elements Vary by State

Some Data Elements Vary by State
  • Race/Ethnicity
  • Patient county
  • Patient ZIP Code
  • Severity of illness
  • Birth weight
  • Procedure date (days from admission to procedure)
  • Health plan details
  • Additional expected payers
  • Detailed charges
  • Patient identifiers (encrypted)
  • Physician identifiers (encrypted)
  • Physician specialty
  • Hospital identifier (unencrypted)
 
Slide 29

Example: Payer Detail Varies by State

Example: Payer Detail Varies by State
  • A screenshot shows the different values and descriptions for the variable PAY1_X and PAY1 (Standardized).
 
Slide 30

Example: Payer Detail Varies by State

Example: Race Detail Varies by State
  • A screenshot shows the different values and descriptions for the variable RACE_X and RACE (Standardized).
 
Slide 31

HCUP Files vs. Partner Files

HCUP Files vs. Partner Files

HCUP State Files vs. Data Files received directly from the State Partners
  • HCUP State Files:
    • Subset of data elements
    • Value-added data elements
    • Uniformly coded across the States
    • Standard data quality checks
    • Lag time
  • HCUP Partner-Provided Files:
    • All data elements
    • May not have some value-added elements available
    • Not uniformly coded across states
    • Variability in quality checks by state
    • More timely
 
Slide 32

2015 State and Nationwide Databases: Revised Structure

2015 State and Nationwide Databases: Revised Structure A graphic shows the transition from ICD-9-CM to ICD-10-CM/PCS on October 1, 2015. The 2015 HCUP State and Nationwide Databases (SID, SASD, SEDD, NIS, NRD, NEDS) includes a mixture of diagnosis and procedure codes from the two systems.
  • File structure changed in 2015 to separate Q1-Q3 and Q4 data
    • State databases: all file types have records split into Q1-Q3 and Q4 files
    • Nationwide databases: only file types containing DX/PR related variables are split into Q1-Q3 and Q4 files
  • AHRQ-created resources help users with transition:
    • 2015 HCUP State Databases: Change in Structure and Data Elements Caused by Transition to ICD-10-CM/PCS (PDF)
    • 2015 HCUP Nationwide Databases: Change in Structure in Data Elements (PDFs specific to NIS, NEDS, and NRD)
    • Data Innovations - ICD-10-CM/PCS Resources page: www.hcup-us.ahrq.gov/datainnovations/icd10_resources.jsp
 
Slide 33

Partners Releasing Databases Through HCUP Central Distributor

Partners Releasing Databases Through HCUP Central Distributor

  • Arizona
  • Arkansas
  • California
  • Colorado
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Iowa
  • Kansas
  • Kentucky
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Mississippi
  • Nebraska
  • Nevada
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • Oregon
  • Rhode Island
  • South Carolina
  • South Dakota
  • Utah
  • Vermont
  • Washington
  • West Virginia
  • Wisconsin
  • Remember, not all States participate in all years and for all databases.
 
Slide 34

Presentation Objectives Part I

Presentation Objectives Part I
  • Project Overview
  • AHRQ and HCUP Partners
  • The Making of HCUP Data
  • HCUP State Databases
  • HCUP Nationwide Databases
  • How to Obtain HCUP Databases & Access HCUP Resources
 
Slide 35

HCUP Nationwide Databases

HCUP Nationwide Databases
  • National (Nationwide) Inpatient Sample (NIS)
    • Inpatient discharge data for a sample of discharges from all hospitals in SID
  • Kids' Inpatient Database (KID)
    • Pediatric inpatient hospital discharge data from a sample of pediatric discharges in SID
  • Nationwide Emergency Department Sample (NEDS)
    • Emergency department data (treat and release & admitted) from a sample of hospitals in SID and SEDD
  • Nationwide Readmissions Database (NRD)
    • Inpatient discharge data from all hospitals for SID with verified patient linkage numbers
 
Slide 36

Many Potential Applications of HCUP National Databases

Many Potential Applications of HCUP National Databases
  • National and regional estimates
  • Utilization, charges, and outcomes
  • Utilization of health services by priority populations
  • Hospital care for rare conditions
  • Quality of care and patient safety
  • Impact of health policy changes
  • Access to care
 
Slide 37

Comparison of the HCUP Inpatient Databases

Comparison of the HCUP Inpatient Databases
  State Inpatient Databases National Inpatient Sample Kids' Inpatient Database Nationwide Readmissions Database
HCUP Database SID (2015) NIS (2015) KID (2012) NRD (2015)
States 46 States + DC 46 States + DC 44 27
Hospitals 4,600 4,500 4,200 2,300
Inpatient Discharges 34 million 7 million 3 million 17 million
Derived From - SID SID SID
Uses Examine State and local market area statistics on health care utilization, access, quality, patient safety, etc. Readmission analyses possible in some States. Generate national and regional estimates of health care utilization, access, quality, patient safety, etc. Generate national and regional pediatric estimates of health care statistics. Generate national estimates of all-cause and condition-specific readmissions.
 
Slide 38

State and Nationwide Database Size - Outpatient Data

State and Nationwide Database Size - Outpatient Data
  State Emergency Department Databases Nationwide Emergency Department Sample State Ambulatory Surgery and Services Databases
HCUP Database SEDD (2015) NEDS (2015) SASD (2015)
Hospitals 3,300 953 3,600
Records 93 million 31 million 17 million surgeries; 86 million other outpatient services
Derived From - SID & SEDD -
Includes All ED visits in a given State that do not result in an admission Sample of hospital-based EDs with ED admissions and ED outpatient visits Encounter-level data for ambulatory surgeries and other outpatient services from hospital-owned facilities
 
Slide 39

NIS is a Stratified Sample of Discharges from the SID

NIS is a Stratified Sample of Discharges from the SID
  • State Inpatient Databases (SID)
    • Approximately 5,500 hospitals
    • Approximately 34 million records
    • Strata
      • Ownership/Control
      • Bedsize
      • Teaching Status
      • Urban/Rural Location
      • U.S. Division
  • Stratified Sample of Discharges
    • Within strata sort by hospital, DRG, and admission month and select 1 in 5 records
    • **State not included in the stratum
  • National Inpatient Sample (NIS)
    • Approximately 4,500 hospitals
    • Approximately 7 million records
Statistics listed from 2015 data year
 
Slide 40

Comparing SID with NIS

Comparing SID with NIS
  SID NIS
Linkage to AHA Annual Survey Data Yes, for some States Only 2011 and prior years
Revisit analyses Yes, for some States Not applicable
Uniformity of coding State-specific data elements and detailed coding Common data elements and HCUP uniform coding
Level of analysis available State, local market area, and community statistics Generate national and regional estimates
 
Slide 41

KID is a Stratified Sample of Discharges from the SID

KID is a Stratified Sample of Discharges from the SID
  • State Inpatient Databases (SID)
    • Approximately 4,380 hospitals
    • Approximately 34.3 million records
    • Strata
      • Uncomplicated Births
      • Complicated Births
      • Pediatric Non-Births
  • Stratified Sample of Discharges
    • 10% uncomplicated births
    • 80% pediatric discharges
    • **State not included in the stratum
  • KIDs' Inpatient Database (KID)
    • Approximately 4,000 hospitals
    • Approximately 3 million records
Statistics listed from 2012 data year
 
Slide 42

KID Planned for Release Using 2016 Data

KID Planned for Release Using 2016 Data

NEDS
  • Historically, the KID has been produced every three years beginning in 1997 and currently through 2012.
  • Given that hospital discharge data for 2015 contains a mix of ICD-9-CM and ICD-10-CM/PCS data, the next KID will be available for the 2016 data year and will be comprised of ICD-10-CM/PCS data only.
  • This decision was made due to the complexities of analyzing a mixed coded data year.
 
Slide 43

HCUP NEDS Data

HCUP NEDS Data

NEDS
  • SEDD: Treat-and-Release ED Visits
    • Approximately 77% of ED visits are treat-and-release
  • SID: Admitted ED Visits
  • NEDS:
    • Approximately 14% of ED visits result in a hospital stay
Statistics listed from 2015 data year
 
Slide 44

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

NEDS is a Stratified Sample of Hospitals from the SEDD and SID
  • State Inpatient Databases (SID) and State Emergency Department Databases (SEDD)
    • Strata
      • U.S. Region
      • Urban/Rural Location
      • Teaching Status
      • Ownership/Control
      • Trauma center
  • Stratified Sample of Hospitals
    • **State not included in the stratum
  • Nationwide Emergency Department Sample (NEDS)
    • Approximately 950 hospitals
    • Approximately 31 million ED visits
o• Statistics listed from 2015 data year
 
Slide 45

NRD is Constructed from SID with Verified Patient Linkage Numbers

NRD is Constructed from SID with Verified Patient Linkage Numbers
  • State Inpatient Databases (SID)
    • Hospital and Patient Exclusions
    • Strata
      • U.S. Region
      • Urban/Rural Location
      • Teaching Status
      • Size
      • Ownership/Control
      • Patient Characteristics (age and sex)
  • All Discharges (after exclusions)
  • Nationwide Readmissions Database (NRD)
    • Approximately 2,000 hospitals
    • Approximately 17 million records
Statistics listed from 2015 data year
 
Slide 46

NIS, NEDS, KID, NRD: Must be Weighted to Produce National and Regional Estimates

NIS, NEDS, KID, NRD: Must be Weighted to Produce National and Regional Estimates
  • An illustration shows the four nationwide databases (NIS, NEDS, KID, and NRD) can be weighted using the data element DISCWT to produce national and regional estimates.
 
Slide 47

NEDS:  Must be Weighted to Produce National and Regional Estimates

NEDS: Must be Weighted to Produce National and Regional Estimates
  • An illustration shows that the NEDS can be weighted using the data element HOSPWT to produce national and regional estimates of emergency departments.
 
Slide 48

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

What Types of Care Are and Are Not Captured by HCUP?
  • Included in HCUP:
    • Inpatient Care
      • State Inpatient Databases (SID)
      • National (Nationwide) Inpatient Sample (NIS)
      • Kids' Inpatient Database (KID)
      • Nationwide Readmissions Database (NRD)
    • Emergency Department
      • State Emergency Department Databases (SEDD)
      • Nationwide Emergency Department Sample (NEDS)
    • Ambulatory Surgery and Services
      • State Ambulatory Surgery and Services Databases (SASD)
    • Other Non-Emergent Outpatient Services
      • State Ambulatory Surgery and Services Databases (SASD)
    • Not Included in HCUP
      • Physician office visits
      • Pharmacy
      • Labs/Radiology
 
Slide 49

Some Limitations Can be Addressed by Linking to Other Databases

Some Limitations Can be Addressed by Linking to Other Databases
  • HCUP State databases can be linked to other databases, including:
    • American Hospital Association (AHA) Annual Survey
    • The Health Resources and Services Administration (HRSA) Area Health Resource File (AHRF)
    • Zip Code Files from Census or Vendor
    • Medicare Cost Reports
    • Trauma Information Exchange Program (TIEP)
 
Slide 50

Key HCUP Design Features

Key HCUP Design Features
  • HCUP is:
    • A family of discharge databases for health care encounters
    • All payer, including the uninsured
    • Hospital, ambulatory surgery, emergency department data
    • All hospital discharges
    • Accessible multiple ways: raw data, regular reports, online
  • HCUP is Not:
    • A survey
    • Specific to a single payer, e.g. Medicare
    • Office visits, pharmacy, laboratory, radiology
    • Hospital claims
    • Only a database - it includes additional tools and resources
 
Slide 51

Hospital Billing Data Have Benefits and Limitations

Hospital Billing Data Have Benefits and Limitations
  • Benefits
    • Large number of records
    • Uniformity in coding
    • Regular, routine collection
    • Ease of Access
    • All payers, including the uninsured
    • Available at local, State, regional, and national level
    • Supplemental files available to facilitate research
  • Limitations
    • Limited clinical details
    • Lack reimbursed claims information
    • Does not include all hospital types (e.g., VA and DoD)
    • Does not show complete episode of care
    • No data on individuals outside of the hospital system
    • Cannot link national databases to external sources
    • Differences in coding across hospitals
 
Slide 52

Summary

Summary
  • Seven types of HCUP databases
  • Databases are based on administrative hospital data: inpatient, emergency department, and ambulatory surgery and services
  • Available for multiple years
    • Nationwide
      • NIS (1988-2015)
      • NEDS (2006-2015)
      • KID (1997, 2000, 2003, 2006, 2009, 2012)
      • NRD (2010-2015)
    • State
      • SID (1990-2016)
      • SASD (1997-2016)
      • SEDD (1999-2016)
    • Can look at breadth of health care issues
    • Can be linked to external files
Find out more on HCUP-US! www.hcup-us.ahrq.gov/
 
Slide 53

Presentation Objectives Part I

Presentation Objectives Part I
  • Project Overview
  • AHRQ and HCUP Partners
  • The Making of HCUP Data
  • HCUP State Databases
  • HCUP Nationwide Databases
  • How to Obtain HCUP Databases & Access HCUP Resources
 
Slide 54

The HCUP Database Process

The HCUP Database Process
  • Processed data sent to HCUP Partners
  • State Databases become available to the public through the HCUP Central Distributor
  • Nationwide Databases become available for download through the HCUP Central Distributor
 
Slide 55

How to Purchase HCUP Data

How to Purchase HCUP Data
  • HCUP Central Distributor: www.hcup-us.ahrq.gov/tech_assist/centdist.jsp
  • Visit the HCUP Central Distributor.
  • The Central Distributor provides one stop shopping for purchasing many of the State Databases, as well as the Nationwide Databases.
  • Not all data elements are available from every Partner Organization, and not all Partner Organizations make their data available through the Central Distributor.
  • Some Partner Organizations may place additional restrictions on the sale of their data.
 
Slide 56

Purchase Data Online Through the HCUP Central Distributor

Purchase Data Online Through the HCUP Central Distributor
  • Step 1: Take Data Use Agreement (DUA) online training
  • Step 2: Login or register for an account
  • Step 3: Create your profile under "My Account"
  • Step 4: Submit online order and complete further instructions listed on the "Thank You" page
  • Step 5: Download Nationwide databases online or receive delivery of State databases through the mail.
  • For assistance, contact the HCUP Central Distributor:
 
Slide 57

Additional Requirement: Electronic Data Use Agreement (DUA) Course

Additional Requirement: Electronic Data Use Agreement (DUA) Course
  • Purpose of the Course:
  • Emphasize the importance of data protection
  • Reduce the risk of inadvertent violations
  • Describe your individual responsibility when using HCUP data
  • Takes 15 minutes to complete
  • www.hcup-us.ahrq.gov/tech_assist/dua.jsp
 
Slide 58

Pricing Information per Data Year

Pricing Information per Data Year
  • Nationwide Databases (NIS, KID, NEDS, NRD)
    • NIS: $625 beginning 2016, student price $125
    • KID: $350 beginning 2009, student price $50
    • NEDS: $750 beginning 2014, student price $150
    • NRD: $1,000 beginning 2015, student price $200
  • State Databases (SID, SASD, SEDD)
    • Varies by state, database, year, and type of applicant
    • $50 - $3,200
  • Funds for State data sales returned to HCUP Partners
 
Slide 59

Software Requirements of Working with the Full HCUP Files

Software Requirements of Working with the Full HCUP Files
  • Software Package:
    • SAS
      • Load programs
      • Format programs
      • Example Statistical Coding
      • HCUP Tools and Programs
    • STATA
      • Load programs
      • Example Statistical Coding
      • HCUP Tools and Programs
    • SPSS
      • Load programs
      • HCUP Tools and Programs
    • SUDAAN
      • Example Statistical Coding
Microsoft Excel and Access are NOT GOOD Options!
 
Slide 60

HCUP User Support Web Site

HCUP User Support Web Site
  • Find detailed information on HCUP databases, tools, and products
  • Access HCUPnet, HCUP Fast Stats, the Central Distributor, Online Tutorials, and more
  • Find comprehensive list of HCUP-related publications and database reports
  • Access technical assistance
  • Visit us at: www.hcup-us.ahrq.gov
 
Slide 61

HCUP-US for Database Documentation

HCUP-US for Database Documentation
  • Screenshot of the Databases page, showing where you can access documentation for Nationwide HCUP Databases and State-Specific HCUP Databases.
  • www.hcup-us.ahrq.gov/databases.jsp
 
Slide 62

Presentation Objectives Part II

Presentation Objectives Part II
  • Tools & Software
  • Supplemental Files
  • HCUPnet Overview
  • HCUP Fast Stats
  • Publications and Publication Search
  • How to Access HCUP Resources
 
Slide 63

Value-Added Clinical and Quality Measurement Tools

Value-Added Clinical and Quality Measurement Tools
  • Clinical Classifications Software (CCS)*ˆ
  • Procedure Classes*ˆ
  • Chronic Condition Indicator*ˆ
  • Elixhauser Comorbidity Software*ˆ
  • Utilization Flags*ˆ
  • Surgery Flags*
  • AHRQ Quality Indicatorsˆ
    • Prevention Quality Indicators
    • Inpatient Quality Indicators
    • Patient Safety Indicators
    • Pediatric Quality Indicators
*Available on most HCUP databases through September 30, 2015
ˆAvailable for ICD-9-CM and ICD-10-CM/PCS
 
Slide 64

Clinical Classifications Software (CCS) for ICD-9-CM

Clinical Classifications Software (CCS) for ICD-9-CM
  • Clusters diagnosis and procedure codes into categories
    • >14,000 diagnoses codes into 285 categories
    • >3,900 procedure codes into 231 categories
  • Useful for presenting descriptive statistics and understanding patterns
  • CCS for ICD-9
    • ICD-9-CM Codes (CCS 2: Septicemia): 0031 0202 0223 0362 0380 0381 03810 03811 03819 0382 0383 03840 03841 03842 03843 03844 03849 0388 0389 0545 449 7907
    • ICD-9-CM Codes (CCS 6: Hepatitis): 0700 0701 0702 07020 07021 07022 07023 0703 07030 07031 07032 07033 0704 07041 07042 07043 07044 07049
 
Slide 65

Clinical Classifications Software (CCS)

Clinical Classifications Software (CCS)
  • CCS for ICD-9-CM
    • Single-level and Multi-level
    • Valid through FY 2015
  • Beta CCS for ICD-10-CM/PCS
    • Single-level and first and second multi-level categories only
    • Valid through FY 2018
  • CCS for Mortality Reporting
    • Codes are valid through December 2009
  • CCS for Services and Procedures
    • Classifies CPT/HCPCS codes
    • Valid through December 2018
 
Slide 66

Procedure Classes 1-4

Procedure Classes
  • Groups procedure codes into one of four categories
    • Beta Procedure Classes for ICD-10-PCS
      • Valid through FY 2018
      • More than 71,900 procedure codes!
    • Procedure Classes for ICD-9-CM
      • Valid through FY 2015
      • Approximately 4,000 procedure codes
  • Major procedures defined as OR procedures (DRGs)
  • ICD-10-PCS or ICD-9-CM Procedure Codes
    1. Minor Diagnostic (ex: Electrocardiogram)
    2. Minor Therapeutic (ex: Pacemaker)
    3. Major Diagnostic (ex: Pericardial Biopsy)
    4. Major Therapeutic (ex: CABG)
 
Slide 67

Chronic Condition Indicator (CCI)

Chronic Condition Indicator (CCI)
  • Groups diagnosis codes into Chronic or Non-Chronic Categories
    • Beta CCI for ICD-10-CM diagnosis codes valid through FY 2018
    • CCI for ICD-9-CM diagnosis codes valid through FY 2015
  • ICD-10-CM or ICD-9-CM Diagnosis Codes
    1. Chronic (ex: Diabetes)
    2. Non-Chronic (ex: Food Poisoning)
 
Slide 68

Elixhauser Comorbidity Software (New)

Elixhauser Comorbidity Software (New)
  • Creates indicator flags for 29 major comorbidities
    • Elixhauser Comorbidity Software Version 3.7 for ICD-9-CM diagnoses codes valid through FY 2015
    • Beta Elixhauser Comorbidity Software Version 2018.1 for ICD-10-CM diagnosis codes valid through FY 2018
  • ICD-10-CM or ICD-9-CM Codes, DRGs on Administrative Data
    • Elixhauser Comorbidity Software
    • Comorbidity Variables
      • Valvular disease
      • Pulmonary circulation disorders
      • Peripheral vascular diagnoses
      • Hypertension
      • Paralysis
      • Liver disease...
 
Slide 69

Index for Elixhauser Comorbidity Software

Index for Elixhauser Comorbidity Software
  • Two indices based on Elixhauser Comorbidity Software now available on HCUP-US
    • Applies weights to inpatient records and creates the two indices for the software
      • One for in-hospital mortality and
      • One for Readmission
    • The resulting index score(s) can be used in analyses in place of the 29 individual measures.
  • Elixhauser Comorbidity Version 3.7 is available for ICD-9-CM data only
 
Slide 70

Utilization Flags

Utilization Flags
  • Reveals additional information about the use of health care services
  • Primarily uses UB-04 revenue codes, augmented with ICD-9-CM and ICD-10-PCS procedure codes
  • Two versions available:
    • Utilization Flags for ICD-9-CM valid through December 2014
    • Utilization Flags for ICD-10-PCS valid through FY 2018
  • UB-04 codes + ICD-9-CM and ICD-10 PCS procedure codes
    • Emergency Room
    • Observation Services
    • Intensive Care Unit
    • Renal Dialysis
    • CT Scan...
 
 
Slide 71

30 Utilization Flags

30 Utilization Flags
  • Screen shot of the 30 Utilization Flags.
  • There are not ICD-9-CM codes and ICD-10 PCS codes for all services. Concern exists that some diagnostic procedures may be under-reported.
 
 
Slide 72

Surgery Flags

Surgery Flags
  • Identifies encounters for surgical procedures in ICD-9-CM or CPT-based inpatient and ambulatory surgery data
  • Valid for codes through December 2015
    1. Narrow
      • Invasive therapeutic surgical procedure involving incision, excision, manipulation, or suturing of tissue that penetrates or breaks the skin
      • Typically requires use of an operating room
      • Requires regional anesthesia, general anesthesia, or sedation to control pain
    2. Broad
      • Includes all narrowly defined surgical procedures as well as a broader group of diagnostic and less invasive therapeutic surgeries
    3. Neither Broad nor Narrow
      • Example: Use of endoscopes for diagnostic purposes only and for which nothing was removed
 
 
Slide 73

Use of HCUP Tools with 2015 ICD-10-CM/PCS Data

Use of HCUP Tools with ICD-10-CM/PCS Data
  • Users are advised to visit the HCUP-US Tools & Software page regularly to ensure they have the most recent version of the HCUP tools downloaded and applied to their data.
  • For the 2015 HCUP State Databases, users should use caution with the tools-based data elements present on Q4 data.
  • A new HCUP Tools Loading Tutorial is available to assist users in the download and use of HCUP Tools.
 
 
Slide 74

AHRQ Quality Indicators

AHRQ Quality Indicators
  • Creates measures of health care quality using inpatient administrative data
    • Four Quality Indicators modules:
      1. Prevention Quality Indicators (PQIs)
      2. Inpatient Quality Indicators (IQIs)
      3. Patient Safety Indicators (PSIs)
      4. Pediatric Indicators (PDIs)
 
 
Slide 75

Presentation Objectives Part II

Presentation Objectives Part II
  • Tools & Software
  • Supplemental Files
  • HCUPnet Overview
  • HCUP Fast Stats
  • Publications and Publication Search
  • How to Access HCUP Resources
 
 
Slide 76

HCUP Supplemental Files Can Only be Applied to HCUP Databases

HCUP Supplemental Files Can Only be Applied to HCUP Databases
  • Cost-to-Charge Ratio (CCR) Files
  • Hospital Market Structure (HMS) Files
  • Supplemental Variables for Revisit Analyses
  • Trend Weights Files (NIS & KID)
  • American Hospital Association (AHA) Linkage Files
 
 
Slide 77

Charges vs. Costs

Charges vs. Costs
  • Charges: What the hospital charged for care (includes charge BEFORE discount)
  • Costs: What it cost the hospital to provide the care
HCUP Databases include CHARGE information. COST information can be estimated by applying the cost-to-charge ratio supplemental file to the data of select databases
 
 
Slide 78

Cost-to-Charge Ratio (CCR) Files

Cost-to-Charge Ratio (CCR) Files
  • Enable conversion of charge data to cost data on the SID, NIS, KID, and NRD
  • Hospital Level data:
    • Apply Ratios
    • Convert Total Charges to Costs
 
 
Slide 79

Hospital Market Structure (HMS) Files

Hospital Market Structure (HMS) Files
  • Contain various measures of hospital market competition
  • Allow users to broadly characterize the intensity of competition that hospitals face
    • Using various definitions of market area
 
 
Slide 80

HCUP Supplemental Variables for Revisit Analyses

HCUP Supplemental Variables for Revisit Analyses
  • Allows linkage across settings and time
    • Hospital readmissions
    • ED visits following hospital discharge
    • Inpatient hospitalizations following ambulatory surgery visits
  • Adheres to strict privacy guidelines
 
 
Slide 81

HCUP Supplemental Variables for Revisit Analyses

HCUP Supplemental Variables for Revisit Analyses

  • There are two HCUP supplemental variables:
    1. Synthetic person-level identifier (VisitLink)
      • Verified against the patient's date of birth and sex
      • Examined for completeness
    2. Timing variable determines the number of days between events for an individual (DaysToEvent)
      • Without the use of actual dates
  • HCUP revisit variables are to be used exclusively with the SID, SASD, and SEDD (not Nationwide Databases) for States with encrypted patient identifiers
  • Revisit Variables are only available in one nationwide HCUP database - the Nationwide Readmissions Database (NRD) (NRD_VisitLink and NRD_DaysToEvent)
  • Select national revisit statistics are also available on HCUPnet
 
 
Slide 82

Additional HCUP Supplemental Files

Additional HCUP Supplemental Files
  • Trend Weights Files (NIS & KID)
    • Discharge-level files that provide trend weights and data elements that are consistently defined across data years
  • AHA Linkage Files
    • Enable researchers to link hospital identifiers in some State Databases to the AHA Annual Survey Databases
  • www.hcup-us.ahrq.gov/tools_software.jsp
 
 
Slide 83

Presentation Objectives Part II

Presentation Objectives Part II
  • Tools & Software
  • Supplemental Files
  • HCUPnet Overview
  • HCUP Fast Stats
  • Publications and Publication Search
  • How to Access HCUP Resources
 
 
Slide 84

HCUPnet: Quick, Free Access to HCUP Statistics

HCUPnet: Quick, Free Access to HCUP Statistics
  • Free online query system
  • Users generate tables and figures of outcomes by diagnoses and procedures
  • Data can be cross-classified by patient and hospital characteristics
  • Can produce county-level statistical maps
  • Recently redesigned
  • www.hcupnet.ahrq.gov
 
 
Slide 85

HCUPnet Can Answer a Variety of Questions

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 U.S. hospitals?
  • What is the trend in hospitalizations for depression?
  • Will there be a sufficient number of cases to do my analysis?
  • How do my estimates and calculations compare with HCUPnet (validation)?
 
 
Slide 86

Examples of What HCUPnet Provides...

Examples of What HCUPnet Provides...
  • Step-by-step queries on:
    • Hospital inpatient data (SID, NIS, KID, NRD)
    • Emergency department (ED) data (SID, SEDD, NEDS)
    • Ambulatory surgery (AS) data (SASD)
    • Community-level statistics
  • Specialized queries by:
    • Overall inpatient stays
      • Select conditions or procedures
    • Overall ED visits
      • Select conditions or procedures
    • Overall AS encounters
      • Select conditions or procedures
    • County-level, regional, or U.S.-Mexico border State statistics
  • Ready-to-use statistics:
    • Trends in inpatient stays
    • Related conditions and procedures
    • Readmissions (NRD)
    • Trends in ED visits
    • Percent of patients admitted versus discharged from the ED (i.e., treat-and-release)
    • Percent of cases treated in the inpatient versus AS settings
    • Inpatient stays for alcohol and other drugs
 
 
Slide 87

How does HCUPnet Work?

How does HCUPnet Work?
  • Step 1: What kind of data are you looking for?
  • Step 2: Do you want information on a specific diagnosis or procedure?
  • Step 3: Create your analysis
  • Step 4: View and update your data results in real time
  • Step 5: View your results in detailed graphs
  • Step 6: Export your data for future use
 
 
Slide 88

HCUPnet Versus Full HCUP Databases

HCUPnet Versus Full HCUP Databases
    • HCUPnet Can Produce
      • Simple statistics
      • Simple size calculations
      • Trends analyses
      • Rank order of diagnoses and procedures
      • Z-test calculator for significance testing
      • Validation of results obtained from the HCUP databases
    • HCUP Databases Can Produce
      • Simple statistics
      • More complicated queries
      • Sample size calculations
      • Trends Analyses
      • Rank order of diagnoses and procedures
 
 
Slide 89

Presentation Objectives Part II

Presentation Objectives Part II
  • Tools & Software
  • Supplemental Files
  • HCUPnet Overview
  • HCUP Fast Stats
  • Publications and Publication Search
  • How to Access HCUP Resources
 
 
Slide 90

HCUP Fast Stats

HCUP Fast Stats
  • Screenshot from HCUP Fast Stats homepage.
  • HCUP Fast Stats provides easy access to the latest HCUP-based statistics for health information topics.
  • Uses visual statistical displays in stand-alone graphs, trend figures, or simple tables to convey complex information at a glance.
  • Information will be updated regularly (quarterly or annually, as newer data become available).
  • www.hcup-us.ahrq.gov/faststats/landing.jsp
 
 
Slide 91

HCUP Fast Stats- State Trends in Inpatient Stays by Payer

HCUP Fast Stats- State Trends in Inpatient Stays by Payer
  • Screenshot of HCUP Fast Stats homepage for the State Trends in Inpatient Stays by Payer topic.
 
 
Slide 92

HCUP Fast Stats- State Trends in Emergency Department Visits by Payer

HCUP Fast Stats- State Trends in Emergency Department Visits by Payer
  • Screenshot of HCUP Fast Stats homepage for the State Trends in Emergency Department Visits by Payer topic.
 
 
Slide 93

HCUP Fast Stats - National Hospital Utilization and Costs

HCUP Fast Stats - National Hospital Utilization and Costs
  • Screenshots of statistics generated from the HCUP Fast Stats National Hospital Utilization and Costs topic.
  • Includes information on trends in inpatient stays, the most common diagnoses for inpatient stays, and the most common operations during inpatient stays.
 
 
Slide 94

HCUP Fast Stats - Opioid-Related Hospital Use (New)

HCUP Fast Stats - Opioid-Related Hospital Use (New)
  • Opioid-Related Hospital Use, provides information on opioid-related inpatient stays and ED visits overall and by age group, sex, community-level income, and rural/urban location. Trends are presented graphically as population-based rates for the U.S. and by State.
  • Screenshots of statistics generated from the HCUP Fast Stats Opioid-Related Hospital Use topic.
 
 
Slide 95

Presentation Objectives Part II

Presentation Objectives Part II
  • Tools & Software
  • Supplemental Files
  • HCUPnet Overview
  • HCUP Fast Stats
  • Publications and Publication Search
  • How to Access HCUP Resources
 
 
Slide 96

HCUP Publications

HCUP Publications
  • Statistical Briefs
  • Methods Series Reports
  • Screenshot of HCUP Statistical Brief and Methods Series Report
 
 
Slide 97

Statistical Briefs

Statistical Briefs
  • Screenshot of three HCUP statistical briefs.
 
 
Slide 98

HCUP Methods Reports

HCUP Methods Reports
  • Screenshot of five HCUP Methods Reports.
  • Methodological information on the HCUP databases and software tools.
 
 
Slide 99

HCUP-US for HCUP Reports and Publications Search

HCUP-US for HCUP Reports and Publications Search
  • Screenshot of the Reports page, showing where you can access Statistical Briefs, HCUP Methods Series reports, and HCUP Publications.
  • www.hcup-us.ahrq.gov/reports.jsp
 
 
Slide 100

Publications Search Page on the HCUP-US Web Site

Publications Search Page on the HCUP-US Web Site
  • Simple or advanced search options
    • Data Year
    • Database, Tool, and Product
    • Author
    • Title
    • State
  • More than 6,000 publications use HCUP data or products
 
 
Slide 101

Presentation Objectives Part II

Presentation Objectives Part II
  • Tools & Software
  • Supplemental Files
  • HCUPnet Overview
  • HCUP Fast Stats
  • Publications and Publication Search
  • How to Access HCUP Resources
 
 
Slide 102

Visit HCUP's Virtual Exhibit Booth

Visit HCUP's Virtual Exhibit Booth
  • The HCUP Virtual Exhibit Booth provides materials typically offered at the HCUP conference exhibit booths
  • Includes brochures, participation maps, an overview presentation of HCUP, and additional information that provides general project information
  • www.hcup-us.ahrq.gov/news/exhibit_booth.jsp
 
 
Slide 103

Interactive Online HCUP Tutorial and Training Courses

Interactive Online HCUP Tutorial and Training Courses
  • HCUP Overview Course
  • Producing National HCUP Estimates
  • Load and Check HCUP Data
  • HCUP Tools Loading NEW
  • Multi-Year Analysis
  • Nationwide Readmissions Database (NRD)
 
 
Slide 104

Using HCUP Technical Assistance

Using HCUP Technical Assistance
  • Active Technical Assistance
    • Responds to inquiries about HCUP data, products, and tools
    • Collects user feedback and suggestions for improvement
  • E-mail: hcup@ahrq.gov
 
 
Slide 105

HCUP-US for Technical Assistance

HCUP-US for Technical Assistance
 
 
Slide 106

Join the HCUP E-mail List

Join the HCUP E-mail List
 
 
Slide 107

Healthcare Cost and Utilization Project (HCUP)

Healthcare Cost and Utilization Project (HCUP)
  • Screenshot of the HCUP logo
 
 
Slide 108

Questions/Comments?

Questions/Comments?
 

Internet Citation: HCUP Overview Presentation. Healthcare Cost and Utilization Project (HCUP). November 2018. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/news/exhibit_booth/hcup_90_min_pres.jsp.
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Last modified 11/5/18