Healthcare Cost and Utilization Project (HCUP)

1. Healthcare Cost and Utilization Project (HCUP)

2. Background • Family of health care databases and related software tools • Developed through a Federal-State-Industry partnership

3. Family of databases State Inpatient Databases (SID) State Ambulatory Surgery Databases (SASD) Nationwide Inpatient Sample (NIS) Kids’ Inpatient Sample (KID) State Emergency Department Databases (SEDD) Nationwide Emergency Department Sample (NEDS)

4. HCUP databases • Contain a core set of clinical and non-clinical information found in a typical discharge abstract • Patient demographics • Diagnosis codes • Procedure codes • Discharge status • Charges for ALL PAYERS • Medicare, Medicaid, private insurance, the uninsured

5. HCUP databases, cont’d • Information from discharge abstracts are translated into a uniform format •  facilitate multi-State and national-State comparisons and analyses

6. State Inpatient Databases (SID) • Files are available beginning with data year 1990 • Contains the universe of inpatient discharge abstracts (~100%) • 44 states participate in the SID, • encompassing 95% of all U.S. community hospital discharges

7. Variations across the SIDs • http://www.hcup-us.ahrq.gov/db/state/siddist/siddistvarnote2009.jsp

8. National Inpatient Sample (NIS) • Files date back to 1988. • The largest ALL PAYER inpatient care database in the U.S. • ~8 million hospital stays • ~1,000 hospitals • 20% stratified sample of U.S. community hospitals

9. Kids’ Inpatient Sample (KID) • Data years: 1997, 2000, 2003, 2006 • The number of participating states varies by year • The only ALL PAYER inpatient care database for children in the U.S. (age < 20 years) • The 2006 KID contains a sample of • ~3 million hospital stays • ~3,500 U.S. community hospitals

10. State Emergency Department Databases (SEDD) • Files are available beginning with data year 1999. • The SEDD contains data from hospital-affiliated emergency department (ED) abstracts for visits that do not result in hospitalization. • Currently, 29 states participate in the SEDD

11. National Emergency Department Sample (NEDS) • Files are available beginning with data year 2006. • Larges ALL PAYER ED database in the U.S. • Constructed from both the SEDD and the SID to capture data both on ED visits that result in an admission, and ED visits that do not result in an admission.

12. National Emergency Department Sample (NEDS), cont’d • The NEDS contains more than 25 million unweighted records for ED visits • ~1,000 U.S. Community Hospitals • ~20% stratified sample of U.S. hospital-based EDs.

13. State Ambulatory Surgery Databases (SASD) • Files are available beginning with data year 1997. • The SASD contain data from ambulatory care encounters in hospital-affiliated (and sometimes freestanding) ambulatory surgery sites . • Currently, 29 states participate in the SEDD

14. HCUP also includes:

15. Research reports and statistics (HCUPnet, fact books, published reports) • http://www.ahrq.gov/data/hcup/ • http://hcupnet.ahrq.gov/ • REF: AHRQ Pub No. 10-P009-EF, Revised March 2011

16. Tools for use with administrative data • Clinical classification system (CCS) for each of ICD-9 and ICD-10 • Method to classify diagnosis or procedures from International Classification of Diseases ICD-9 or ICD-10 into clinically meaningful categories • http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp#download • Clinical Classifications Software (CCS) for Services and Procedures • Method for classifying Current Procedural Terminology Codes and Healthcare Common Procedure Coding System (HCPCS) codes into clinically meaningful procedure categories • Mental Health and Substance Abuse Clinical Classifications Software (CCS-MHSA) -- now integrated into the CCS (no longer a stand-alone software • Defines variables that identify general categories for mental health and substance abuse ICD-9 diagnosis in hospital discharge records.

17. Examples of single-level CCS diagnosis categories 98. Essential hypertension 99. Hypertension with complications and secondary hypertension 100. Acute myocardial infarction 101. Coronary atherosclerosis and other heart disease

18. Examples of multi-level CCS diagnosis categories     7. Diseases of the circulatory system      7.1. Hypertension        7.1.1. Essential hypertension [98]        7.1.2. Hypertension with complications and secondary hypertension [99]          7.1.2.1. Hypertensive heart and/or renal disease          7.1.2.2. Other hypertensive complications      7.2. Diseases of the heart

19. Examples of single-level CCS procedure categories     43. Heart valve procedures    44. Coronary artery bypass graft (CABG)    45. Percutaneous transluminal coronary angioplasty (PTCA)    46. Coronary thrombolysis

20. Examples of multi-level CCS procedure categories     7. Operations on the cardiovascular system      7.1. Heart valve procedures [43]      7.2. Coronary artery bypass graft [44]        7.2.1. Bypass of one coronary artery        7.2.2. Bypass of two coronary arteries        7.2.3. Bypass of three coronary arteries        7.2.4. Bypass of four coronary arteries

21. Tools for use with administrative data • Comorbidity software • Assigns variables that identify coexisting conditions on hospital discharge records using ICD-9 diagnosis codes. • Quality indicators • Measures of health care quality that utilize readily available hospital inpatient administrative data • PREVENTION QUALITY INDICATORS  identify hospital admissions that evidence suggests that could have been prevented through high-quality outpatient care • INPATIENT QUALITY INDICATORS  quality of care inside hospitals (such as inpatient mortality for medical conditions and surgical procedures) • PATIENT SAFETY INDICATORS  quality of care inside hospitals but with a focus on potentially avoidable complications and iatrogenic events. • PEDIATRIC QUALITY INDICATORS  for children age < 18 and for newborns receiving care in hospitals, identify potentially avoidable hospitalizations among children

22. Tools for use with administrative data • Procedure classes • Permit categorizing ICD-9 procedure codes into one of 4 categories: minor diagnostic, minor therapeutic, major diagnostic, and major therapeutic. • Chronic condition indicator • Chronic or not chronic • Utilization Flags • Use of procedure and services such as admission to ICU, CCU, NICU and specific diagnostic tests and therapies. • http://www.hcup-us.ahrq.gov/tools_software.jsp

23. Supplemental files • Cost-to-charge ratio files • Hospital market structure files

24. Definition of Community hospitals** (AHA) http://www.aha.org/resource/newpage.asp#registered • **Community hospitals are defined as all nonfederal, short-term general, and other special hospitals. Other special hospitals include obstetrics and gynecology; eye, ear, nose, and throat; rehabilitation; orthopedic; and other individually described specialty services. Community hospitals include academic medical centers or other teaching hospitals if they are nonfederal short-term hospitals. Excluded are hospitals not accessible by the general public, such as prison hospitals or college infirmaries.

25. Preserving confidentiality • Least sensitive core data elements included in the files • Data users agreement signed by all users • Other protections: • Masked hospital identities for certain states • IRB approval needed

26. Data Users Agreement • Signed by all users • Reporting in aggregate numbers only • No identification of individuals or institutions • No re-release of data without permission • Legal penalties for misuse of data