HCUP e-News: the electronic newsletter of the Healthcare Cost and Utilization Project

Spring 2022
Issue #70


News and Announcements: Notable news from HCUP
Databases and Products: New database and product releases
Publication Spotlights: Recent works incorporating HCUP data and tools
HCUP Q&A: Answers to your HCUP questions
HCUP Events: Upcoming HCUP conferences and meetings

Missed the last HCUP e-News? Read it on the HCUP-US website.

News and Announcements

Learn About HCUP During the Spring Webinar Series�Register Today!

From April 12 to 14, the Agency for Healthcare Research and Quality (AHRQ) will host a 3-day webinar series for users interested in learning more about the Healthcare Cost and Utilization Project (HCUP). The series will begin on April 12 with the HCUP Database Overview, a presentation that will include an introduction to the HCUP family of healthcare databases and a discussion of how to obtain and access the data as well as other HCUP resources. On April 13, HCUP staff will provide an Overview of HCUP Products and Tools, which will cover the use of HCUP research tools to facilitate and augment research. This presentation will also include an overview of HCUP products that offer readily available statistics, such as HCUPnet and Fast Stats. On April 14, the series will conclude with Using the HCUP Supplemental Files. This session will provide a detailed look at select HCUP Supplemental Files, such as the Cost-to-Charge-Ratio (CCR) for Inpatient and Emergency Department Files and the American Hospital Association (AHA) Linkage Files, both of which are for use exclusively with HCUP databases.

The webinars will be 1 hour in duration and are open to the public. Each webinar requires separate advance registration. Additional details about the webinars, including registration information, are posted on the HCUP Workshops and Webinars page of the HCUP-US website.

Join Us for a Virtual HCUP Data Users' Workshop in April

AHRQ will sponsor an intermediate-level 2-day virtual Planning Your HCUP Analysis workshop on April 27�28, 2022. This virtual workshop will walk through considerations and recommendations to assist researchers in the planning of analyses that use HCUP databases and/or research tools. Attendees will learn how to determine which HCUP database best suits their analysis given their population and healthcare setting of interest. Presenters will also discuss how HCUP research tools can be used to help define conditions or procedures of interest. Additionally, guidance will be offered for decision-making related to specific outcomes of interest such as cost of care and readmissions. For participants who are not familiar with HCUP databases and research tools, we highly recommend attending the HCUP Spring Webinar Series presentations on April 12�14 or reviewing the Online HCUP Overview Course and HCUP Software Tools Tutorial prior to attending the workshop.

There is no fee to attend the workshop. Registration is now open. Additional workshop details are available on the HCUP Workshops and Webinars page.

Now Available: The 2021 National Healthcare Quality and Disparities (NHQDR) Report

AHRQ recently released the 2021 National Healthcare Quality and Disparities Report (NHQDR). This marks the nineteenth year that AHRQ has reported on healthcare quality and disparities. The report details the state of healthcare quality and disparities in the United States and identifies improvements in HIV and colon cancer care, nursing home care, and medication prescribing to older adults. It notes that the number of people covered by health insurance and those who have a usual source of healthcare has increased significantly. The report also indicates that there is more to do to address disparities in care, substance abuse, and mental health issues.

The 2021 NHQDR can be accessed on the National Healthcare Quality and Disparities Report page on the AHRQ website at www.ahrq.gov/research/findings/nhqrdr/index.html. For questions on the NHQDR, please contact AHRQ User Support.

Additional Brief Added to HCUP Findings-At-A-Glance

A new data brief from AHRQ has been added to HCUP Findings-At-A-Glance, Emergency Department and Inpatient Utilization and Cost for Pregnant Women: Variation by Expected Primary Payer and State of Residence, 2019. HCUP Findings-At-A-Glance provides a focused look at different topics across a broad range of health policy issues related to hospital use and costs. This report presents national, regional, and State-level variation of expected primary payer types among emergency department visits and inpatient hospitalizations for pregnant women in response to a congressional mandate for "research that examines the potential cost-savings to the public health system of providing a special enrollment period for pregnant individuals, as well as the impact of a special enrollment period on the private insurance market."

The following figure displays the number and aggregate cost of delivery hospitalizations by expected primary payer in the United States for 2019. The number of total delivery stays in 2019 was 3,583,224, 52.0 percent of which was attributed to private insurance, 41.5 percent to Medicaid, 3.4 percent to other (including Medicare), and 2.9 percent to self-pay/no charge. Total costs for delivery hospitalizations in 2019 amounted to $20,385.2 million dollars, 52.7 percent of which was attributed to private insurance, 41.4 percent to Medicaid, 3.4 percent to other (including Medicare), and 2.4 percent to self-pay/no charge.

Chart showing number and aggregate cost of delivery hospitalizations by expected primary payer in the United States, 2019.

Some Findings-At-A-Glance will report a one-time examination of a specific topic. Others will be updated periodically with the latest data. This data brief and others can be accessed from the Reports section of the HCUP-US website.

HCUP Outstanding Article of the Year (AOTY) Award Moves to Biennial Cycle

The HCUP Outstanding Article of the Year (AOTY) Award, sponsored by AHRQ and AcademyHealth, is moving to a biennial event. The next award recognition cycle will take place in 2023. The AOTY Award recognizes exceptional research conducted using HCUP databases in the clinical and health policy arenas. The type of research acknowledged enhances the public conversation about healthcare costs, outcomes, and trends. Over the years, the award has grown into a distinguished honor among health services researchers with a variety of clinical insights, economic interests, and policy backgrounds. A complete listing of prior winners is available on the Outstanding AOTY Award Archives page.

Additional details and deadlines for nominations for the 2023 award recognition cycle will be available this fall. More information on award eligibility and the nomination process can be found on the Outstanding AOTY Award page of the HCUP-US website.

Databases and Products

Recently Released: 2019�2020 and Additional 2018 State Databases

Since December 2021, the following State databases have been released:

Complete listings of available databases by year can be found in the Database Catalog on the HCUP-US website. Databases can be purchased online through the HCUP Central Distributor, and aggregated national and selected State statistics can be accessed via HCUPnet.

Publication Spotlights

New HCUP Statistical Briefs Posted on HCUP-US

Since December 2021, the following HCUP Statistical Briefs have been released:

To access these and other Statistical Briefs, please visit the HCUP Statistical Briefs page on the HCUP-US website.

New HCUP Methods Series Reports Available

Since December 2021, the following Method Series Reports have been released:

These and other HCUP reports can be found on the Reports page of the HCUP-US website.


Question: I would like to investigate mean costs for injury-related emergency department (ED) visits for data years 2017�2019 at the national and State levels using the Nationwide Emergency Department Sample (NEDS) and State Emergency Department Databases (SEDD). In reviewing the HCUP-US website, it looks like the HCUP Cost-to-Charge Ratio (CCR) for ED Files would be applicable for my analysis. I have a few questions before I get started:


Is there a way to identify injuries on the HCUP NEDS and SEDD?

The data element I10_INJURY is used to indicate initial encounters for injuries for both first-listed and secondary diagnoses. I10_INJURY is available for the NEDS starting with data year 2017 and for the SEDD for the 2015 and 2019+ data years. Additional injury indicators are available and include the mechanism of injury, such as fall (I10_INJURY_FALL) or motor vehicle traffic (I10_INJURY_MVT), as well as the intent of injury, such as unintentional (I10_INTENT_UNINTENTIONAL). Both mechanism and intent of injury information are determined by External Cause of Morbidity Codes and are consistent with the classification system used by the Centers for Disease Control and Prevention (CDC) and documented at www.cdc.gov/nchs/injury/injury_tools.htm.

How can the CCR for ED Files be used, and how do I obtain them?

The HCUP NEDS and SEDD contain information on total hospital charges for each ED visit record. ED visit charges represent the amount that hospitals billed for services but do not reflect how much hospital services cost or the specific amounts that hospitals received in payment. For some analyses, users may be interested in estimating how hospital charges translate into actual costs. The HCUP CCR for ED Files enable this conversion. Each file contains hospital-specific cost-to-charge ratios based on all-payer ED costs for nearly every hospital in the corresponding SEDD and NEDS.

The CCR-NEDS Files are complimentary and automatically included with download orders for the HCUP NEDS. For users working with State-level data, the CCR Files for the HCUP SEDD can be added to an order for the accompanying SEDD; they are not automatically included with the order. The CCR for ED Files are available beginning with data year 2012 for the NEDS and SEDD. A table with more details on availability is provided on the CCR for ED Files page of the HCUP-US website.

How do I link the CCR for ED Files to the NEDS and SEDD?

For the CCR-NEDS, the CCR records can be merged directly with the ED visit records in the corresponding NEDS database using the NEDS hospital identifier, HOSP_ED.

For the CCR-SEDD, users should be mindful of the different linkage options:

  1. For States that release an HCUP American Hospital Association (AHA) Linkage File, linkage between the CCR File and the SEDD is achieved in two steps: first by linking records from the CCR for SEDD File to the AHA Linkage File by the HCUP hospital identifier, HOSPID, and then by linking the resulting file to the SEDD by State (CCR for SEDD data element Z013) and the data source hospital identifier, DSHOSPID.
  2. For States that do not release an AHA Linkage File, HOSPID is included directly on their SEDD file. For these States, the data elements from the CCR File can be merged onto the SEDD by HOSPID.
  3. For States that do not include hospital identifiers, there is a modification to the linkage process described in #1 above. The linkage process between the CCR File and the SEDD is achieved in two steps. First, users must link records from the SEDD to the AHA Linkage File by the unique record identifier, KEY. Following this linkage, HOSPID can be added to the SEDD and subsequently used to link to the CCR for SEDD File.

For more information on linkage of the CCR for ED Files to the NEDS and SEDD, please review the corresponding user documentation available on the CCR for ED Files page here: www.hcup-us.ahrq.gov/db/ccr/ed-ccr/ed-ccr.jsp.

If I am using multiple years of data, can I use the most recent version of the CCR for ED Files?

The CCR Files are released for each data year and should be used with the corresponding year and database to ensure an appropriate match for the year- and database-specific hospital identifiers.

Are cost estimates able to be attributed to individual diagnoses or procedures?

No, users should be mindful that estimates of total charges or total costs reflect charges or costs incurred for the entire hospital stay or outpatient encounter. They do not reflect individual diagnoses and procedures.

According to the documentation, the CCR for ED Files are applicable for treat-and-release ED visits. What does that mean for the NEDS, which is a sample of all ED visits (including inpatient admissions that originate in the ED of the same hospital)?

You are correct that the CCR for ED Files are applicable for treat-and-release (outpatient) ED visits because they are based on outpatient charges and estimated outpatient costs. As you note, NEDS records include both treat-and-release visits from the SEDD and ED visits that result in hospital admission (from the State Inpatient Databases [SID]). Although the CCR-NEDS File can be used for both ED visit types, users should be cautious when interpreting the ED costs estimated for ED admissions. More information can be found in the User Guide for the CCR for ED Files, available on the HCUP-US website.

HCUP Events

For a complete list of HCUP presentations and events, visit the HCUP Events Calendar.

The HCUP e-News is available online on the HCUP-US website and distributed via the HCUP Mailing List.

For more information and questions regarding the HCUP e-News, please email hcup@ahrq.gov