Fall 2020
Issue #64

Contents

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 September 16 and 23 Webinars—Sign Up Today!

Register today for HCUP's 2020 Fall Webinar Series, which will introduce and explain the HCUP Project through two online presentations. The sessions will demonstrate how attendees' health services and policy research can be enhanced with HCUP's databases and administrative hospital data tools and products.

September 16, 2-3 pm ET - Overview of the HCUP Databases - covers a project overview, explains the HCUP Partnership, discusses the making of the HCUP State and nationwide databases, and finally reviews how to obtain and access the data as well as other HCUP resources.

September 23, 2-3 pm ET - Overview of the HCUP Products and Tools � introduces the HCUP products and tools, including the free online query tools HCUPnet and Fast Stats, explains how to add value to your data with HCUP software tools, such as the Clinical Classifications Software Refined (CCSR) for ICD-10-CM diagnoses, and supplemental files, and provides an overview of our publications and associated resources. Additional time will be dedicated to reviewing HCUP�s newest tool, the Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses.

The 1-hour webinars are open to the public. Each webinar requires separate advance registration, which is now open. Additional details on the webinars are posted on the HCUP Workshops and Webinars page.

HCUP Fast Stats Data Update

AHRQ has released new information in HCUP Fast Stats. The Neonatal Abstinence Syndrome (NAS) Among Newborn Hospitalizations topic has been updated to add one new State—Hawaii—and 2018 statistics for 42 States as well as 2017 national statistics.

For additional information, please refer to the Fast Stats Frequently Asked Questions page or contact HCUP User Support.

AHRQ Quality Indicator (QI) Software v2020 Released

AHRQ is pleased to announce that v2020 of the AHRQ Quality Indicator (QI) Software has been launched. The AHRQ QIs are measures of healthcare quality that can be used with readily available hospital inpatient administrative data to measure and track clinical performance and outcomes. The AHRQ QI modules represent aspects such as Prevention, Inpatient, Patient Safety, and Pediatric quality of care.

The new software update includes fiscal year (FY) 2020 ICD-10-CM/PCS coding updates and is backwards compatible through FY 2016. The v2020 software will calculate risk-adjusted rates based on one full year of ICD-10-CM/PCS coded all-payer 2017 HCUP State Inpatient Database (SID) data.

The software will be available for download in both SAS QI and WinQI format from the AHRQ QI website at: https://qualityindicators.ahrq.gov/Software/Default.aspx.

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

Winners of the 11th annual HCUP Outstanding AOTY Award were announced at AcademyHealth's Annual Research Meeting (ARM) in August. 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 listed below:

• Clinical Award Category Winner:
  
  • Guglielminotti J, Landau R, Li G. Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries. Anesthesiology. 2019 Jun;130(6):912-922.
• Policy Award Category Winners:
  
  • Kahn JM, Davis BS, Yabes JG, Chang CH, Hershey TB, Martsolf GR, Angus DC. Association Between State-Mandated Protocolized Sepsis Care and In-hospital Mortality Among Adults With Sepsis. JAMA. 2019 Jul 16;322(3):240-250.
  • Sakai-Bizmark R, Chang RR, Mena LA, Webber EJ, Marr EH, Kwong KY. Asthma Hospitalizations Among Homeless Children in New York State. Pediatrics. 2019 Aug;144(2):e20182769..

Users can find a full list of recipients from the past 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.

2017 National Inpatient Sample (NIS) Data on HCUPnet

Data from the 2017 National Inpatient Sample (NIS) have now been added to HCUPnet, the free, online query system that provides statistics and data tables based on HCUP data. The large sample size of the NIS is ideal for developing national and regional estimates and enables analyses of rare conditions, uncommon treatments, and special populations.

HCUPnet�s easy, step-by-step process allows users to explore many healthcare topics relating to hospital inpatient services and ED settings. Users can also generate tables and graphs on national, regional, and county-level statistics including hospital readmissions and trends on hospital and ED use in the United States.

To check out the updates and start your own query, visit HCUPnet today at https://datatools.ahrq.gov/hcupnet.

Updates to HCUP Overview Tutorial

The HCUP Overview Course Tutorial has been revised to reflect recent project updates such as the addition of the Nationwide Ambulatory Surgery Sample (NASS) and the new HCUP Fast Stats topic, Neonatal Abstinence Syndrome (NAS), National and State. The tutorial provides extensive information about HCUP data, software tools, and products. It describes where HCUP data come from, features and uses of databases and software tools, technical support, and more.

The HCUP Overview Tutorial, along with other helpful HCUP interactive courses, can be found on the HCUP Online Tutorial Series homepage.

Databases and Products

Recently Released: 2018 State Databases and Additional 2016�2017 Databases

Since July 2020, the following State databases have been released:

• State Inpatient Databases (SID)
  • 2018: District of Columbia, Georgia, Michigan, South Carolina, South Dakota
  • 2017: New York
• State Ambulatory Surgery Databases (SASD)
  • 2018: District of Columbia, Colorado, Georgia, Michigan, South Carolina
  • 2017: District of Columbia, New York
  • 2016: District of Columbia
• State Emergency Department Databases (SEDD)
  • 2018: District of Columbia, Colorado, Georgia, South Carolina
  • 2017: District of Columbia, New York
  • 2016: District of Columbia

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.

***Please note, some HCUP Central Distributor operations have been affected by the current national emergency related to COVID-19. Please refer to the notice posted on the HCUP Central Distributor for current status information.

Publication Spotlights

New HCUP Statistical Briefs Posted on HCUP-US

Since July 2020, the following HCUP Statistical Briefs have been released:

• #236 Emergency Department Visits Related to Suicidal Ideation or Suicide Attempt, 2008-2017
• #262 Medicare Advantage Versus the Traditional Medicare Program: Costs of Inpatient Stays, 2009-2017

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

HCUP Q&A

Question:: I am interested in conducting a readmission analysis using the HCUP Nationwide Readmissions Database (NRD). Before I get started, I am hoping to learn a bit more about how the NRD can be used as well as some aspects of the methodology for the NRD's design.

• Can I combine years of the NRD to analyze readmissions across years?
• Does the NRD include data elements that identify readmissions?
• How are transfers handled in the NRD?

Answers:

Can I combine years of the NRD to analyze readmissions across years?

If your intention of combining multiple years of the NRD is to follow patients over time, this currently cannot be done. Each year of the NRD should be considered as a separate sample. The patient linkage numbers (NRD_VisitLink) do not track the same patient across years of the NRD. Additionally, the hospital identifiers (HOSP_NRD) do not track the sample hospital across years of the NRD.

If your intention is to analyze trends in readmissions over time, then multiple years of the NRD can used in combination. For example, you can examine trends in readmission statistics for certain conditions or patient characteristics as long as you identify index and readmissions within a single data year. Because the stratum identifier (NRD_STARTUM) and hospital identifier (HOSP_NRD) are reassigned each year, there is no issue related to the different clustering that occurs within each data year when multiple years of the NRD are combined. However, if you wish to report statistics for each individual data year, then you will need to stratify your results by data year (YEAR).

Does the NRD include data elements that directly identifies readmissions?

No, the NRD does not include any data element that directly identifies readmissions. The NRD was designed to support many different types of readmission analyses. Analysts can use the information contained in the NRD (e.g., data elements) to define the index event and readmission specific to their topic of interest:

• Index event - the starting point for analyzing repeat hospital visits
• Readmission - a subsequent inpatient admission within a specified time period; readmission may be for a specific cause or any cause.

For additional information on using the NRD for readmission analyses, refer to the Introduction to the NRD.

How are transfers handled in the NRD?

Readmission analyses do not usually allow the hospitalization at the receiving hospital to be counted as a readmission. To eliminate this possibility, HCUP collapses the pairs of records representing a transfer into a single "combined" record in the NRD and removes the original separate discharge records from the NRD. Transfer records are defined as having all of the following characteristics:

• Discharge date of the first inpatient stay equaled the admission date of a subsequent inpatient stay.
• The first record had a discharge disposition of transfer to an acute care hospital.
• The second record was from a different hospital and had an admission source indicating a transfer.

We defined a discharge as a same-day stay if the discharge date for one inpatient stay was the same as the admission date of a second stay for the same patient (same as transfers), but there was no indication of a transfer by the discharge disposition or admission source. Same-day stays may or may not have involved different hospitals. Same-day stays may indicate that a patient was discharged too soon and then needed to be returned to the hospital on the same day. However, it was also possible that these were transfer records with an incorrect or missing discharge disposition and admission source.

We collapsed records that were part of transfers or same-day stays into a single combined record. These combined records account for about three percent of records in the NRD and are identified by the data element SAMEDAYEVENT. The value of SAMEDAYEVENT is defined as follows:

• Transfer involving two discharges from different hospitals (value 1): Discharge date of one admission equaled the admission date on another record for the same patient. There was a discharge disposition of transfer to an acute care hospital on the first record and an admission source of transfer (in) on the subsequent record; two different hospitals were involved..
• Same-day stay involving two discharges at different hospitals (value 2): The discharge date on the first inpatient stay equaled the admission date on a second inpatient stay for the same patient; two different hospitals were involved, but the coding of either the discharge disposition or admission source did not indicate a transfer.
• Same-day stays involving two discharges at the same hospital (value 3): The discharge date on the first inpatient stay equaled the admission date on a second inpatient stay for the same patient; the hospital was the same on both records.
• Same-day stay involving three or more discharges, same or different hospitals (value 4): Multiple records indicating a combination of transfers and other same-day events seem odd, but they do rarely occur in administrative data.
• Not a transfer or other same-day stay (value 0). About 97 percent of the records in the NRD did not involve transfers or same-day stays.

Please note that if a patient had a discharge disposition of transfer and an admission source that also indicated a transfer, but the discharge date of the first stay did not equal the admission date of the second stay (e.g., the patient was admitted the next day because the transfer occurred at night), the two records are not considered a transfer in the NRD.

HCUP Events

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

• September 16, 2020: Overview of the HCUP Databases Webinar
• September 23, 2020 Overview of HCUP Products and Tools Webinar
• October 24�28, 2020: American Public Health Association (APHA) 2020 Annual Meeting and Expo
  
  • Presentation
    On October 27, at 8:30 a.m., AHRQ staff will present a virtual presentation titled Black-white disparity in postpartum readmissions: Roles of clinical, community, and hospital characteristics.

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