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The Healthcare Cost and Utilization Project (HCUP)

The Healthcare Cost and Utilization Project (HCUP). HCUP Data Resources to Inform Research & Policy P. Hannah Davis, MS Claudia Steiner, MD, MPH Agency for Healthcare Research and Quality AHRQ Annual Conference 9-10-2012. Today’s Objectives. Project Overview The HCUP Partnership

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The Healthcare Cost and Utilization Project (HCUP)

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  1. The Healthcare Cost and Utilization Project (HCUP) HCUP Data Resources to Inform Research & Policy P. Hannah Davis, MS Claudia Steiner, MD, MPH Agency for Healthcare Research and Quality AHRQ Annual Conference 9-10-2012

  2. Today’s Objectives • Project Overview • The HCUP Partnership • The HCUP Databases • Obtaining HCUP Databases • The HCUP Tools and Products • Additional HCUP Resources

  3. What is HCUP? • HCUP is the largest collection of multi-year, all-payer data that includes inpatient and selected outpatient data that is based on the hospital billing record.

  4. What is HCUP? SID SASD SEDD NEDS NIS KID

  5. Why Do We Need AnotherHospital Data Source?

  6. What can you get from HCUP?

  7. HCUP Supports High Impact Health Services, Policy & Clinical Research

  8. Today’s Objectives • Project Overview • The HCUP Partnership • The HCUP Databases • Obtaining HCUP Databases • The HCUP Tools and Products • Additional HCUP Resources

  9. The HCUP Partnership State Federal Industry

  10. 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. 10

  11. Current HCUP State Partners Alaska State Hospital and Nursing Home Association ArizonaDepartment of Health Services Arkansas Department of Health California Office of Statewide Health Planning & Development Colorado Hospital Association Connecticut Hospital Association Florida Agency for Health Care Administration Georgia Hospital Association HawaiiHealth Information Corporation IllinoisDepartment of Public Health Indiana Hospital Association Iowa Hospital Association

  12. Current HCUP State Partners KansasHospital Association KentuckyCabinet for Health and Family Services Louisiana Department of Health and Hospitals Maine Health Data Organization Maryland Health Services Cost Review Commission Massachusetts Division of Health Care Finance and Policy Michigan Health & Hospital Association MinnesotaHospital Association Mississippi Department of Health Missouri Hospital Industry Data Institute Montana MHA – An Association of Montana Health Care Providers NebraskaHospital Association

  13. Current HCUP State Partners 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 OhioHospital Association OklahomaState Department of Health Oregon Association of Hospitals and Health Systems Oregon Office for Oregon Health Policy & Research Pennsylvania Health Care Cost Containment Council Rhode Island Department of Health South Carolina State Budget & Control Board

  14. Current HCUP State Partners South DakotaAssociation of Health Care Organizations Tennessee Hospital Association TexasDepartment of State Health Services Utah Department of Health Vermont Association of Hospitals and Health Systems VirginiaHealth Information WashingtonState Department of Health West Virginia Health Care Authority Wisconsin Department of Health Services Wyoming Hospital Association 46 States and continuing to recruit additional States to the HCUP Partnership

  15. WA MT ND VT ME NH MN OR SD ID WI MA NY MI WY RI NV OH IA PA IN CT NE UT IL NJ CO WV CA VA DE KS MO KY MD AR NC TN OK AZ NM SC GA MS AL LA TX FL HI Key: Participating Non-participating AK AK HCUP Partners Providing 2010 Inpatient Data

  16. WA MT ND VT ME MN NH OR ID WI MA SD NY MI WY RI IA PA CT NE NV OH IN UT IL NJ CO WV CA VA DE KS MO KY MD NC TN OK AZ AR NM SC GA MS AL LA TX FL HI Key: Participating Non-participating AK AK HCUP Partners Providing 2010 Emergency Department Data

  17. HI Key: Participating Non-participating AK AK HCUP Partners Providing 2010 Ambulatory Surgery Data WA MT ND VT ME MN OR NH ID WI MA NY SD MI WY RI IA PA CT NE OH NV IN UT IL NJ CO WV CA VA DE KS MO KY MD NC TN OK AZ AR NM SC GA MS AL LA TX FL

  18. WA VT MT ND ME NH MN SD OR ID WI MA NY WY MI RI NV IA PA IN OH CT NE UT IL NJ CO WV CA VA DE KS MO KY MD NC AR TN OK AZ NM SC GA MS AL LA TX FL HI AK AK Partnership: HCUP Database Participation By State Non-participating Partners Providing Inpatient Data Only Partners Providing Inpatient & Ambulatory Surgery Data Partners Providing Inpatient & Emergency Department Data Partners Providing Inpatient, Ambulatory Surgery,& Emergency Department Data

  19. Today’s Objectives • Project Overview • The HCUP Partnership • The HCUP Databases • Where does data come from? • HCUP State Databases • HCUP Nationwide Databases • Obtaining HCUP Databases • The HCUP Tools and Products • Additional HCUP Resources

  20. HCUP Has Six Types of Databases • Three state-level databases State Ambulatory Surgery Databases (SASD) State Inpatient Databases (SID) State Emergency Department Databases (SEDD) 20

  21. HCUP Has Six Types of Databases • Three nationwide databases Kids’ Inpatient Database (KID) Nationwide Inpatient Sample (NIS) Nationwide Emergency Department Sample (NEDS) 21

  22. Today’s Objectives • Project Overview • The HCUP Partnership • The HCUP Databases • Where do the data come from? • HCUP State Databases • HCUP Nationwide Databases • Obtaining HCUP Databases • The HCUP Tools and Products • Additional HCUP Resources

  23. The Foundation of HCUP Data is Hospital Billing Data Demographic Data Diagnoses Procedures Charges

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

  25. The HCUP Process • Standardized file formats and variable values • Value-added variables • Hospital characteristics • Region, Urban/rural, Teaching status, Ownership/control, Bed size • Severity Measures • APR-DRGs, APS-DRGs, Disease Staging, Comorbidity Measures • Basic quality checks

  26. Where Do We Get HCUP Data? 14% (N=769) HCUP data is mostly from community hospitals Typically not included in HCUP data 86% (N=4,985) Included in HCUP data Source: American Hospital Association (AHA), 2010

  27. 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)

  28. Today’s Objectives • Project Overview • The HCUP Partnership • The HCUP Databases • Where does data come from? • HCUP State Databases • HCUP Nationwide Databases • Obtaining HCUP Databases • The HCUP Tools and Products • Additional HCUP Resources

  29. HCUP State Databases State Inpatient Databases (SID) All inpatient hospital discharge data (including those admissions that started in the ED) from participating HCUP States State Ambulatory Surgery Databases (SASD) Ambulatory surgery data (hospital based and some freestanding) from participating HCUP States State Emergency Department Databases (SEDD) Emergency department data (treat and release) from participating HCUP States 29

  30. What Data Elements are included in the HCUP databases? Data Elements: • Patient demographics (age, sex) • Diagnoses & procedures • Expected payer • Length of stay • Patient disposition • Admission source & type • Admission month • Weekend admission

  31. AK Some Data Elements Vary by State • Race/Ethnicity • Patient county • Patient ZIP Code • Severity of illness • Birthweight • Procedure date (days from admission) • Primary payer details • Secondary payer • Detailed charges • Patient identifiers encrypted • Physician identifiers encrypted • Physician specialty • Hospital identifier unencrypted

  32. Example: Payer Detail Varies by State

  33. Example: Race Detail Varies by State

  34. Partner State Files vs. HCUP State Files • HCUP State Files vs. Data Files received directly from the State 34

  35. States Releasing Databases through HCUP Central Distributor • Vermont • Washington • West Virginia • Wisconsin • Nebraska • Nevada • New Jersey • New Mexico • New York • North Carolina • Oregon • Rhode Island • South Carolina • South Dakota • Utah • Arizona • Arkansas • California • Colorado • Florida • Hawaii • Iowa • Kentucky • Maine • Maryland • Massachusetts • Michigan Remember: Not all states participate in all years and for all databases

  36. Today’s Objectives • Project Overview • The HCUP Partnership • The HCUP Databases • Where does data come from? • HCUP State Databases • HCUP Nationwide Databases • Obtaining HCUP Databases • The HCUP Tools and Products • Additional HCUP Resources

  37. HCUP National Databases Nationwide Inpatient Sample (NIS) Inpatient hospital discharge data (including those admissions that started in the ED) from a sample of hospitals in participating HCUP States Kids’ Inpatient Database (KID) Pediatric inpatient hospital discharge data (including those admissions that started in the ED) from a sample of pediatric discharges in participating HCUP States Nationwide Emergency Department Sample (NEDS) Emergency department data (treat and release & admitted) from a sample of hospitals in participating HCUP States 37

  38. NIS is a Stratified Sample of Hospitals from the SID State Inpatient Databases (SID) N = ~ 5K hospitals ~ 36M records Nationwide Impatient Sample (NIS) N = ~ 1K hospitals ~ 8M records State is NOT included as a stratum 5 NIS Strata U.S. Region Urban/Rural Teaching Status Ownership/Control Bed Size Stratified Sample of HOSPITALS 100% of all discharges from each hospital

  39. KID is a Stratified Sample of Discharges from the SID State Inpatient Databases (SID) N = ~ 4K hospitals ~ 32M records Kids' Inpatient Database (KID) N = ~ 4K hospitals ~ 3M records State is NOT included as a stratum 3 Strata 10% stratified sample of uncomplicated BIRTHS Uncomplicated Births Complicated Births Pediatric Non-Births 80% stratified sample of other pediatric DISCHARGES 39

  40. NEDS is a Stratified Sample of Hospitals from the SEDD and SID State Inpatient Databases (SID) State Emergency Department Databases (SEDD) Nationwide Emergency Department Sample (NEDS) N = ~ 1K hospitals ~ 28M records State is NOT included as a stratum 5 NEDS Strata U.S. Region Urban/Rural Teaching Status Ownership/Control Trauma Stratified Sample of HOSPITALS 40

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

  42. What is HCUP and What Is It Not?

  43. Hospital Billing Data Have Benefits and Limitations

  44. Some Limitations Can be Addressed by Linking to Other Databases American Hospital Association (AHA) Annual Survey Health Resources and Services Administration’s (HRSA) Area Resource File (ARF) Zip Code Files from Census or Vendor Medicare Cost Reports Trauma Information Exchange Program (TIEP) AHAID SID County SASD SEDD NEDS ZIP Code NIS KID Medicare ID HCUP Databases AHAID

  45. Summary • Six types of HCUP databases • Databases are based on administrative hospital data • Available for multiple years • NIS (1988-2010) • NEDS (2006, 2007, 2008, 2009) • KID (1997, 2000, 2003, 2006, 2009) • SID (1990- 2011) • SASD (1997- 2011) • SEDD (1999-2011) • Can look at breadth of health care issues • Can be linked to external files

  46. Today’s Objectives • Project Overview • The HCUP Partnership • The HCUP Databases • Where does data come from? • HCUP State Databases • HCUP Nationwide Databases • Obtaining HCUP Databases • The HCUP Tools and Products • Additional HCUP Resources

  47. The HCUP Database Process • Processed data sent to HCUP Partners • State databases may become available to public through: • State Data Organization OR • HCUP Central Distributor 47

  48. Purchase Data through HCUP Central Distributor • Step 1: Download and complete application kit: http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp • Step 2: Obtain more information (if needed): Phone: 866-556-HCUP (4287) toll free E-mail: HCUPDistributor@ahrq.gov • Step 3:Take Data Use Agreement (DUA) on-line training and sign DUA • Step 4: Send order form, signed DUA, and payment to HCUP Central Distributor 48

  49. Pricing Informationper Data Year Nationwide Databases (NIS, KID, NEDS) • NIS: $350 (CY 2010; student price $50) $160-200 (earlier years; student price $20) • KID: $350 (CY 2009; student price $50) $200 (earlier years; student price $20) • NEDS: $500 (student price $75) State Databases (SID, SASD, SEDD) • Varies by state, database, year, and type of applicant • $35 - $3,185 49

  50. Software Requirements of Working with the Full HCUP Files MS Excel and Access are NOT GOOD Options!

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