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

September 2009
Issue #20


News and Announcements: Up-to-the minute information, including newly released databases and products
Recent Publications: A sample of materials, including peer-reviewed journal articles, utilizing HCUP data
Users´ Tech Tip: Answers to commonly asked questions when working with HCUP data
HCUP Calendar: Recent and upcoming conferences or meetings at which HCUP was/will be represented


It’s Here! The 2006 NEDS Now Available

AHRQ is pleased to release its newest database, the 2006 Nationwide Emergency Department Sample (NEDS). The NEDS is used to create national estimates of emergency department (ED) visits, both treat-and-release visits and those resulting in a hospital admission. The NEDS contains clinical and non-clinical information on patients, regardless of payer—including those covered by Medicare, Medicaid, private insurance, and the uninsured.

Researchers and policymakers can use its 26 million (unweighted) records for a variety of purposes, including developing performance and accountability measures, researching emergency and trauma care, gaining a better understanding of rural emergency care, and investigating the challenges of emergency mental health and substance abuse conditions.

The full 2006 NEDS database can be ordered from the HCUP Central Distributor, and a NEDS path is now available on HCUPnet—our free online query tool that provides instant access to HCUP data.

For more information on the NEDS, please visit the HCUP-US Website.

2007 NIS Released in June

The 2007 Nationwide Inpatient Sample (NIS) is now available for purchase and is included on HCUPnet. The NIS is the largest inpatient care database including all patients, regardless of payer—covering Medicare, Medicaid, privately insured, and uninsured patients.

The 2007 NIS includes data drawn from 40 States, including our newest HCUP State Partner, Wyoming. NIS data can be weighted to produce national estimates, allowing researchers and policymakers to identify, track, and analyze national trends in health care utilization, access, charges, quality, and outcomes.

With the release of the 2007 NIS, 20 years of NIS databases is available. The NIS is considered by health services researchers to be one of the most reliable and affordable databases for studying important health care topics.

The 2007 NIS and other HCUP databases can be purchased through the HCUP Central Distributor. Additional information on the NIS is available on the HCUP-US Website.

It’s Time for 2008 State Databases!

AHRQ is pleased to report that 2008 State Databases are now beginning to be released. In the past, State data were typically available 12 to 18 months following the end of a calendar year. Thanks to process improvements and strong relationships with HCUP State Partners, AHRQ has been able to begin releasing 2008 databases in half that time.

This release includes the State Inpatient Databases (SID), State Ambulatory Surgery Databases (SASD), and State Emergency Department Databases (SEDD) for selected States. Researchers and policymakers can use these State-specific HCUP databases to investigate questions unique to one State, compare data from two or more States, conduct market area research or small area variation analyses, and identify State-specific trends in utilization, access, quality, charges, and outcomes. More State databases will be released throughout the year.

The following 2008 HCUP State databases are now available:

As more 2008 State databases are released, the available databases will be listed on the HCUP Database and Product Release Calendar, and are also listed in the SID/SASD/SEDD Application Kit. These and other HCUP databases are available through the HCUP Central Distributor and selected State files can be accessed via HCUPnet.

Just Released: Updated Tools and Software for Fiscal Year 2010

Updated versions for most HCUP tools and software have recently been released. Among the updated tools are:

HCUP’s Clinical Classifications Software (CCS) for Services and Procedures tool, which classifies Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes into clinically meaningful procedure categories, is anticipated to be released in January 2010.

HCUP’s tools are available for download from the Tools & Software page on the HCUP-US Website. The CCR Files are available free-of-charge from the HCUP Central Distributor.

For information on database, tool, and publication releases, please visit the HCUP-US Online Calendar throughout the year.

HCUP Facts and Figures Now Available for 2007 Data

AHRQ has just released a new statistical report, HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2007. The report is an update and expansion of the HCUP Facts and Figures, 2006 report. The new report uses the Nationwide Inpatient Sample (NIS) database to present information about hospital care in 2007, as well as trends in care from 1997 to 2007. The featured topic this year examines the payers for hospital care.

The 2007 and earlier versions of the HCUP Facts and Figures report can be found in the Reports section of the HCUP-US Website. A description of the NIS is available on the HCUP-US Website.

Coming Soon! MONAHRQ: A Way to Input Your Data—Output Your Website

MONAHRQ, a new software tool that enables an organization to input its own hospital administrative data and generate a data-driven website, is near release. MONAHRQ analyzes, summarizes, and presents information on quality of care, preventable hospitalizations, rates of conditions and procedures, and health care utilization in a format ready for use by consumers and other decision-makers.

Any organization with hospital administrative data – such as State and local data organizations, chartered value exchanges, hospital systems, health plans, and providers – can use MONAHRQ to generate its own website for internal use or public release. Organizations will host the new tool on their own web server and populate it with their own hospital administrative data. The website generated by MONAHRQ is an interactive querying tool that users can navigate to learn about health care in their area.

AHRQ anticipates launching the tool for public use in November 2009. For more information, please contact MONAHRQ User Support at MONAHRQ@ahrq.gov, or visit the MONAHRQ page on the HCUP-US Website.

New HCUP Statistical Briefs Available on the HCUP-US Website

HCUP Statistical Briefs are short, focused reports on topics related to specific conditions, procedures, or populations. Statistical Briefs are useful to a wide variety of audiences, including policy analysts, decision-makers, media personnel, and others in need of summary facts and figures on current health care issues.

Recently-released Statistical Briefs include:

HCUP Statistical Briefs can be found in the Reports section of the HCUP-US Website.

AHRQ’s 3rd Annual Conference a Success

AHRQ hosted its 2009 Annual Conference from September 13-16 at the Bethesda North Marriott Hotel & Convention Center in Bethesda, Maryland. This year’s conference, Research to Reform: Achieving Health System Change, focused on identifying opportunities that will make lasting changes and have a transformational impact on the quality of healthcare in the U.S.

For more information on the AHRQ 3rd Annual Conference, please visit the Conference Website. We look forward to seeing you next year!

Joint HCUP and MEPS Data Users Workshop to be held September 28-29

AHRQ is sponsoring a two-day workshop on September 28-29 for health services researchers to facilitate their understanding of two AHRQ resources: the Healthcare Cost and Utilization Project (HCUP) databases and software tools and the Medical Expenditure Panel Survey (MEPS) databases.

The workshop will be held at AHRQ headquarters in Rockville, Maryland. The first day offers an overview of both data resources. The second day provides in-depth, hands-on intermediate level training on either HCUP or MEPS, depending on the registrant’s pre-selected choice.

Both the HCUP and MEPS training sessions of the workshop are full. Details about the workshop were posted on the MEPS Website. A notification was also sent via e-mail to the HCUP Mailing List.

Please check the HCUP-US Website’s Calendar of Events regularly for future training events.

Register Now for the HCUP Session at APHA’s Annual Meeting

The 137th Annual American Public Health Association (APHA) Meeting & Exposition will be held November 7-11 in Philadelphia, PA. More than 13,000 physicians, administrators, nurses, educators, epidemiologists, researchers, and related health specialists are expected to attend this meeting, which will address a range of current and emerging health science and policy topics.

An HCUP Learning Institute (LI) will take place at the conference on Saturday, November 7, from 9:00 A.M.–12:30 P.M. This HCUP session will introduce health services and policy researchers to the HCUP databases and related resources that can enhance their research studies. Additional program information is available at http://apha.confex.com/apha/137am/webprogram/CEI.html; the course number is 1003.0.

Interested APHA Annual Meeting attendees may now sign up for this session. For APHA-LI course registration information, please visit the APHA Website. A separate course registration fee is required; AHRQ has subsidized this registration fee to $50. Participants can receive CME, CNE, or CHES continuing education credits for attending APHA-LI courses. Space for the LI is limited.

HCUP will also be sponsoring a booth at this meeting. Representatives will be available throughout the conference to provide visitors with an introduction to the HCUP databases, tools, and products, and to answer questions. Conference registration information is available on the APHA Website. Advanced online registration closes October 2nd; on-site fees will be in effect following this date.

Keeping Up with HCUP: Recent Events

HCUP staff participated in a number of events this summer, including:

A complete list of recent past events for HCUP is on the HCUP Calendar. We have enjoyed meeting many HCUP users at our trainings, presentations, and exhibit booths—and look forward to meeting many more of you at our upcoming events.


Shortridge EF and Moore JR. Use of emergency departments for conditions related to poor oral healthcare: implications for rural and low-resource urban areas for three states. Journal of Public Health Management and Practice. 2009 May-Jun;15(3):238-45.

This study used the 2005 State Emergency Department Databases (SEDD) from Utah, Vermont, and Wisconsin to investigate the use of emergency departments (EDs) for conditions that might have been prevented given adequate oral healthcare. The databases were linked to an Area Resource File (ARF) to utilize the dental Health Provider Shortage Area (HSPA) variable, and specific Medicaid reimbursement and coverage policies were obtained from sources like state Medicaid websites, Medicaid representatives, and Kaiser Family Foundation’s State Health Facts division. Results indicated that, while the overall pattern of beneficiaries seeking oral healthcare in ED settings were the same for the three states, those with less generous Medicaid reimbursements in rural areas tended to seek treatment similar to the pattern of uninsured patients, while states with more generous reimbursements had beneficiaries who sought medical help in a comparable manner to patients with private insurance. The article abstract is available via Pubmed.

Etzioni DA, Beart RW Jr, Madoff RD, and Ault GT. Impact of the aging population on the demand for colorectal procedures. Diseases of the Colon & Rectum. 2009 Apr;52(4):583-90.

This study used the 2005 Nationwide Inpatient Sample (NIS) and 2005 Florida State Ambulatory Surgery Database (SASD), in conjunction with census projections, to estimate the demand for colorectal procedures over the next twenty years as the baby boom population ages. The results estimated that between 2005 and 2025, the elderly population will grow drastically (92 percent for ages 65-74 and 54 percent for ages 75 and older), while the overall population is expected to increase just 18 percent. The overall volume of procedures (both inpatient and outpatient) is projected to increase by approximately 30 percent. Colon and rectal procedures were estimated to have the greatest projected growth, with the associated diagnoses of colon cancer and rectal cancer having the most rapid growth. For outpatient procedures, hemorrhoid surgery is projected to have the largest growth. The article abstract is available via Pubmed.

To read additional recently-published articles featuring HCUP data, please visit the Research Spotlight page on the Research Spotlight page on the HCUP-US Website.


Choosing the Best HCUP Database for your Research

With the June release of the Nationwide Emergency Department Sample (NEDS), HCUP users now have even more data resources to address research questions. In this edition of the Users’ Tech Tip, we will provide some tips on deciding which databases are best suited to address your research interests.

When determining which database to use, HCUP recommends asking a few simple questions:

Can my question be addressed by hospital-based administrative data?

Make sure that your research question can be adequately addressed by hospital-based care. Individuals who do not seek inpatient, same-day surgery, and/or emergency department care at a hospital will not be represented in HCUP resources.

The foundation of HCUP data is hospital billing records. While billing data can provide a great deal of information regarding health care encounters, these data do not include information on the general prevalence of medical conditions or interventions that occur outside of the hospital setting, such as preoperative treatment, mortality following the hospitalization, or outpatient diagnostic tests. For example, when doing a study on a specific procedure, make sure that the procedure is predominantly done in the setting covered by the data available. So when using the Nationwide Inpatient Sample, focus on procedures that are primarily conducted in the inpatient setting.

Do the HCUP databases contain the data elements required for my analysis?

While the six types of HCUP databases each provide over 100 clinical and non-clinical data elements, the databases vary in the type of elements they contain. For example, some State-level databases contain variables, such as encrypted patient identifiers and patient ZIP code, that are not available in the national HCUP databases. "Patient race" is another commonly-used variable that is only available in certain HCUP databases. We caution that none of the HCUP databases capture physician office visits or complete or reliable pharmacy, laboratory, or radiology information. Even when an ICD-9-CM code exists for a particular procedure, such as chest x-rays, be aware that the data will not accurately capture minor procedures.

For a complete list of the variables available in each database, please visit the Database Documentation links on the HCUP-US Databases page.

Should I look at inpatient or outpatient data—or both?

It is important to understand if your research question can best be addressed by inpatient and/or outpatient hospital-based data. For example, certain surgical procedures are performed strictly on an inpatient basis, while others are consistently or increasingly performed in an outpatient setting. For surgical procedures that are moving to an outpatient setting, researchers may need to access both our ambulatory surgery and inpatient databases to get a complete picture of surgical care. In this case, you will not be able to calculate national estimates; your research will be limited to State-level analyses for those States that provide both inpatient and ambulatory surgery data.

Additionally, some conditions may or may not result in a hospitalization. Combining databases in States that provide both inpatient and outpatient data, or using a database like the NEDS (which includes ED visits that both result in a hospitalization and those where the patient is treated and released) will give a more complete picture of conditions and procedures.

Do I need national or State estimates?

HCUP has three types of national-level databases and three types of State-level databases. Because of the sampling methodology used to create our national databases, we do not recommend generating State-level estimates using the NIS, KID, and NEDS. While these databases include weights to allow researchers to generate national estimates from the sampled records, no weights are included for the calculation of State-level estimates. Thus, one simple question that can help guide which database is best for your analysis may be driven by the geographic unit of analysis (national, regional, State, county, etc.).

Is my research limited to children? ED encounters? Outpatient procedures?

HCUP’s more specialized databases, such as the KID and the NEDS, provide large sample sizes of stays for specific populations. Users are urged to investigate the specialized databases to see if one focuses upon a desired research population. For example, researchers interested in studying rare pediatric hospitalizations may opt to use the KID, while those interested in studying all care that began in the ED may be drawn to the NEDS.

For all of your HCUP questions, please contact HCUP User Support at hcup@ahrq.gov.


For a complete list of presentations and events, visit the HCUP Events Calendar, located on the HCUP-US Website.

Upcoming Events:

September 28-29, 2009: Joint Medical Expenditures Panel Survey (MEPS) and Healthcare Cost and Utilization Project (HCUP) Workshop, AHRQ Headquarters, Rockville, MD

AHRQ staff will sponsor a hands-on workshop for health services researchers on two useful AHRQ resources: the Healthcare Cost and Utilization Project (HCUP) and the Medical Expenditure Panel Survey (MEPS). Participants will receive information on the components and capabilities of both HCUP and MEPS products and will learn how to extract data for research purposes. Information is available on the HCUP-US Website and the MEPS Website. The HCUP session is now full, and there is a waitlist. The MEPS session still has availability.

October 15-16, 2009: National Organization of Health Data Organizations (NAHDO) 24th Annual Meeting, Alexandria, VA

HCUP will have a booth at NAHDO’s 24th Annual Conference, to be held October 15-16 at the Hilton Alexandria Old Town Hotel in Alexandria, Virginia. HCUP representatives will be available throughout the conference to provide visitors with an introduction to the HCUP databases, tools, and products. For more conference information, please visit the NAHDO Conference Website.

October 18, 2009: American Academy of Pediatrics (AAP) Annual Meeting, Washington, D.C.

HCUP staff will present a 1-hour talk from 10:45 A.M -11:45 A.M. at AAP’s 2009 Annual Meeting, to be held on October 18 at the Washington Convention Center in Washington, D.C. The presentation will focus on the value of using the HCUP databases, particularly the Kids’ Inpatient Database (KID), for pediatric research. For more conference information, please visit the AAP Conference Website.

November 7-11, 2009: American Public Health Association (APHA) 2009 Annual Meeting & Exposition, Philadelphia, PA

AHRQ is sponsoring a 3.5-hour HCUP Learning Institute at APHA’s 2009 Annual Meeting & Exposition in Philadelphia, Pennsylvania, on Saturday, November 7 from 9:00 A.M. to 12:30 P.M. The presentation will introduce health services and policy researchers to the HCUP databases and related resources that can enhance their research studies. This course will require a separate registration fee of $50. Additional program information is available at http://apha.confex.com/apha/137am/webprogram/CEI.html; the course number is 1003.0. AHRQ will also sponsor an exhibit booth during the meeting, with representatives available to provide information and answer questions. For more conference information, please visit the APHA Conference Website.


This publication and previous editions of HCUP e-News are available online at the HCUP-US Website.

HCUP e-News is distributed via the HCUP Mailing List.

For more information, or if you have any questions regarding HCUP e-News, please contact P. Hannah Davis, M.S., at hannah.davis@ahrq.hhs.gov