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

Fall 2019
Issue #60


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 e-News? Read it on the HCUP-User Support (HCUP-US) website.

News and Announcements

Now Available: Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses

The Agency for Healthcare Research and Quality (AHRQ) has released the Clinical Classifications Software Refined (CCSR) for ICD-10-CM diagnoses, which aggregates over 70,000 ICD-10-CM diagnosis codes into a manageable number of clinically meaningful categories. The categories are organized across 21 body systems, which generally follow the structure of the ICD-10-CM diagnosis chapters. This initial release of the CCSR replaces the beta version of the CCS for ICD-10-CM diagnoses and applies to all ICD-10-CM diagnosis codes valid through fiscal year 2019. It provides a means by which to identify specific clinical conditions using ICD-10-CM diagnosis codes. The CCSR for ICD-10-CM capitalizes on the specificity of the ICD-10-CM coding scheme by creating new clinical categories that did not exist in previous versions of the CCS tool and allowing ICD-10-CM codes to be classified in more than one category. The CCSR is intended to be used analytically to examine patterns of health care in terms of cost, utilization and outcomes, rank utilization by diagnoses, and risk adjust by clinical condition.

Refinements to the software include:

The CCSR for ICD-10-CM diagnoses can be downloaded from the Tools & Software section of HCUP-US.

Learn About HCUP During the September 10 and 17 Webinars—Sign Up Today!

HCUP's 2019 Fall Webinar Series will introduce and explain the HCUP Project through 2 online presentations.

September 10, 2-3 pm ET - Overview of the HCUP Databases – covers the HCUP family of databases.

September 17, 2-3 pm ET - Overview of the HCUP Products and Tools - covers the use of HCUP software tools and supplemental files to facilitate and augment research.

The 1-hour webinars are open to the public. The sessions can enhance attendees' health services and policy research with administrative hospital data. Each webinar requires separate advance registration, which is now open. Additional details on the webinars are posted on the HCUP Workshops and Webinars page.

AHRQ Hosts Sept 24 HCUP Hands-On Workshop: An In-Depth Exploration of HCUP Resources to Study Hospital Utilization for Opioid, Alcohol, and Other Substances

The 2019 HCUP Data Users' Workshop will be held in Rockville, Maryland, on September 24. This year’s intermediate-level workshop provides in-depth exposure to HCUP databases and products available to researchers, using the study topic of opioid, alcohol, and other substance. The presentations will include demonstrations of HCUPnet and Fast Stats as well as an overview of various HCUP publications on substance use. Specific examples of how to evaluate substance use-related conditions using the four HCUP nationwide databases will be discussed to help users understand which data sources are best suited to answer their research questions. Attendees will learn how to use HCUP User Support (HCUP-US) documentation to their advantage when developing analyses.

Registration for the 2019 HCUP Data User's Workshop is near capacity, but a few slots remain. For more information and workshop details, please visit the HCUP Workshops and Webinars Homepage.

Coming Soon: 2016 HCUP Nationwide Ambulatory Surgery Sample (NASS)

Later this month, the Agency for Healthcare Research and Quality (AHRQ) will release a new database, the 2016 Nationwide Ambulatory Surgery Sample (NASS). Constructed from the State Ambulatory Surgery Databases (SASD), the NASS will be an annual database of ambulatory surgery encounters. It tracks information about major ambulatory surgery encounters in hospital-owned facilities across the United States and provides information on patient characteristics, clinical diagnostic and surgical procedure codes, total charges and expected source of payment, and facility characteristics.

The NASS is the largest all-payer (including self-pay and those billed as 'no charge') ambulatory surgery database in the country. Unweighted, the 2016 NASS contains approximately 7.3 million ambulatory surgery encounters each year. Weighted, it estimates approximately 10.5 million ambulatory surgery encounters in the United States.

The 2016 NASS will be available for purchase through the HCUP Central Distributor. Sign up for the HCUP Mailing List to be notified about the release of databases, tools, and other HCUP products.

HCUP's Outstanding Article of the Year (AOTY) Award Winners Announced!

Winners of the 10th annual HCUP Outstanding AOTY Award were announced at AcademyHealth's Annual Research Meeting (ARM) Exit Disclaimer in June 2019. Each year, AHRQ recognizes researchers published in peer-reviewed journals who used HCUP databases to explore and address healthcare research topics and issues. Honored work demonstrates how HCUP has contributed to these investigations in both a clinical and a policy field. The award recipients and their articles are showcased in the Publication Spotlights section of this newsletter.

Users can find a full list of recipients from the past 10 years on the HCUP Outstanding Article of the Year Award Archive Page and gain additional information on the selection process by visiting the Award Homepage on the HCUP-US website.

Fast Stats to Introduce New Neonatal Abstinence Syndrome (NAS) topic

AHRQ will soon release new information in HCUP Fast Stats—on Neonatal Abstinence Syndrome (NAS). This new topic is a complement to the Opioid-Related Hospital Use topic in that it provides trends in rate, number, costs, and length of stay for NAS. Figures and interactive maps in the topic will show NAS rates presented overall and separately by sex, expected payer, community-level income, and rural/urban location.

Users can sign up for the HCUP Mailing List to be notified of upcoming Fast Stats releases. For additional information, please refer to the Fast Stats Frequently Asked Questions page or contact HCUP User Support.

Databases and Products

Recently Released: 2018 State Databases and Additional 2010–2013, and 2017 Databases

Since June 2019, the following State Databases have been released:

In addition, the 2016 NASS will be released in September. For database purchasing questions, please contact the HCUP Central Distributor.

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 June 2019, the following HCUP Statistical Briefs have been released:

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

Publications Using HCUP Data

HCUP Outstanding Article of the Year Award: Policy Winner:

DeCenso B, Duber HC, Flaxman AD, Murphy SM, Hanlon M. Improving Hospital Performance Rankings Using Discrete Patient Diagnoses for Risk Adjustment of Outcomes. Health Serv Res. 2018 Apr;53(2):974-90.

This study won the HCUP Outstanding Article of the Year Award in the policy category and used the 2005–2009 SID from New York to assess the changes in patient outcome prediction and hospital performance ranking when incorporating diagnoses rather than comorbidity indices as risk adjusters. The new model introduced in the study can produce fairer performance-based hospital payments by incorporating more information on patient risk. An abstract of the article is available via PubMed.

HCUP Outstanding Article of the Year Award: Clinical Winner:

Oliver J, Avraham J, Frangos S, Tomita S, DiMaggio C. The epidemiology of inpatient pediatric trauma in United States hospitals 2000 to 2011. J Pediatr Surg. 2018 Apr;53(4):758-64.

This study won the HCUP Outstanding Article of the Year Award in the clinical category and used the 2000–2011 Nationwide Inpatient Sample (NIS) to provide important updates to the epidemiology of pediatric trauma in the United States. With extensive data and careful execution, the authors used high-quality research methods to answer an important clinical question. An abstract of the article is available via PubMed.

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


Question: My research team is conducting a study on readmissions, and we came across the HCUP Nationwide Readmissions Database (NRD) as a possible resource for our analysis. Before we purchase the data, I have a few questions about the NRD that I’d like to get some answers on, in particular—


What is an index event, and how does the NRD distinguish them?

The index event is the starting point for any analysis that examines repeat hospital visits and typically is based on a combination of clinical and demographic criteria. There is no data element for index events on the NRD because index events are specific to each analysis. However, the NRD does include the necessary information for an analyst to define various types of index events. Criteria may include patient characteristics such as patient age or specific diagnoses and/or procedures. Additional information is available in the Introduction to the NRD as well as the HCUP Methods Series report on Methodological Issues when Studying Readmissions and Revisits using Hospital Administrative Data.

What are the patient linkage numbers created from in the NRD?

The NRD includes verified patient linkage numbers (HCUP data element NRD_VisitLink) that can be used to link all inpatient stays associated with the same patient. The value of NRD_VisitLink is assigned on the basis of a unique combination of the synthetic patient linkage number provided by the HCUP Partner, date of birth, and sex. No verified patient linkage number is assigned if any one of the three pieces of information is missing.

If a patient goes out of State for a readmission, will that be captured in the NRD?

The NRD is drawn from the HCUP SID containing verified patient linkage numbers that can be used to track a person across hospitals within a State. However, patients who were hospitalized in one State and readmitted or transferred to a hospital in another State cannot be tracked in the NRD. This is because patient linkage numbers are defined and coded differently in each of the SID.

What resources are available for analysts using the NRD?

The following are some of the resources available on the HCUP-US website for researchers using the NRD in their analysis:

  1. A Nationwide Readmissions Database (NRD) Tutorial that introduces users to the NRD in two parts:
  2. Detailed documentation on the NRD database can be found on the NRD Documentation Homepage at www.hcup-us.ahrq.gov/db/nation/nrd/nrddbdocumentation.jsp.

HCUP Events

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

The HCUP e-News is available online at 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