The Healthcare Cost and Utilization Project (HCUP) (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 10, 2008, Anne Elixhauser, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (7 MB).

Slide 1

The Healthcare Cost and Utilization Project (HCUP)

• September 10, 2008
• Anne Elixhauser, Ph.D.
  Senior Research Scientist.

Slide 2

Healthcare Cost and Utilization Project (HCUP)

• The Largest Collection of Multi-Year, All-Payer, Encounter-Level, Health Care Data.

Slide 3

The HCUP Partnership: A Voluntary Federal-State-Private Sector Collaboration

• The slide includes a map of the United States with different colors used to indicate States' participation in HCUP.
• 10 States are nonparticipating.
• 8 States are partners providing inpatient data only.
• 6 States are partners providing inpatient and ambulatory surgery data.
• 3 States are partners providing inpatient and emergency department data.
• Remaining States are partners providing inpatient, ambulatory surgery, and emergency department data.
• 39 States 90% of all discharges.

Slide 4

The Making of HCUP Data

• The slide includes a flow chart with the following elements:
  • Patient enters hospital (photo of patient in bed).
  • Billing record created (image of hospital form).
  • Hospital sends billing data and any additional data elements to Data Organizations (photo of person in laboratory coat using computer).
  • States store data in varying formats (image of U.S.A. map).
  • AHRQ standardizes data to create uniform HCUP databases (image of HCUP logo).

Slide 5

What is HCUP? And what is it not?

• Slide includes table with the following information:
• HCUP is:
  • Discharge database for health care encounters.
  • All payer, including the uninsured.
  • Hospital, ambulatory surgery, emergency department data.
  • All hospital discharges.
  • Accessible multiple ways: raw data, regular reports, on-line.
• HCUP is not:
  • A survey.
  • Specific to a single payer, e.g. Medicare.
  • Outpatient visits, pharmacy, laboratory.
  • A sample.
  • Just another database.

Slide 6

HCUP Is a Family of Databases, Tools, and Products

• Slide includes a flow chart with several arrows leading from the logo of HCUP directly to each of the following elements:
  • HCUP database (image of cylinder).
  • Research publications (image of scientific article).
  • User support (photo of person in laboratory coat using a computer).
  • Software and research tools (image of computer disk).

Slide 7

HCUP Supports High Impact Health Services, Policy, and Clinical Research

• Slide includes banners and logos for various scientific and news reporting publications.

Slide 8

HCUP Supports Federal and Non-Federal Initiatives

• Slide includes logos of various government agencies, organizations, and associations.

Slide 9

Types of HCUP Databases

• Slide includes a U.S.A. map with the following text superimposed on it.
  • State Inpatient Databases (SID).
    • Nationwide Inpatient Sample (NIS).
    • Kids' Inpatient Database (KID).
  • State Ambulatory Surgery Databases (SASD).
  • State Emergency Department Databases (SEDD).
    • Nationwide Emergency Department Sample (NEDS).

Slide 10

Purpose of the SID

• Allows state-level analysis of inpatient hospital utilization using one more States in a uniform format.

Slide 11

States Releasing SID through HCUP Central Distributor

• 1990-2006*
• Arizona
• California**
• Colorado
• Florida
• Hawaii
• Iowa
• Kentucky
• Maryland
• Massachusetts
• Michigan
• Nebraska
• Nevada
• New Jersey
• New York
• North Carolina
• Oregon
• Rhode Island
• South Carolina
• Utah
• Vermont
• Washington
• West Virginia
• Wisconsin
• * Not all States participate in all years.
• ** Special application process.

Slide 12

The SID Supports Interesting Research Topics

• Enumeration of all hospitals and discharges within market areas or States.
• Investigation of questions unique to one state.
• Comparison of data from two or more States.
• Research of market areas or small area variation analyses.
• Identification of state-specific trends in inpatient care utilization, access, charges, and outcomes.

Slide 13

Purpose of the NIS

• Allows national and regional studies of inpatient hospital utilization *
• * Not recommended for state-level analyses.

Slide 14

The NIS Is a Stratified Sample of Hospitals from the SID

• Slide includes the following elements:
• 2006 State Inpatient Databases.
  • N = 3,958 hospitals.
  • 32,114,909 records.
• 5 NIS Strata (State is NOT included as a stratum)
  • U.S. Region.
  • Urban/rural.
  • Teaching status.
  • Ownership/control.
  • Bed size.
• Stratified sample of hospitals (image of arrow pointing from NIS Strata to next element).
• 2006 Nationwide Inpatient Sample.
  • N = 1,045 hospitals.
  • 8,074,825 records.

Slide 15

Statewide Data Systems Participating in NIS

• Slide includes a table indicating which States started participating between the years of 1988-2006.
• 8 participating States in 1988.
• 38 participating States in 2006.

Slide 16

The NIS Can Be Used to Study Many Topics

• Use of and charges for hospital services.
• Medical practice variation.
• Medical treatment effectiveness.
• Quality of care and patient safety.
• Impact of health policy changes.
• Diffusion of medical technology.

Slide 17

Purpose of the KID

• Allows national and regional studies of inpatient hospital utilization and charges for children and adolescents.
• Designed for study of rare pediatric conditions.

Slide 18

The KID Is a Stratified Sample of Discharges from the SID

• Slide includes a flow chart with the following elements:
• 2006 State Inpatient Databases.
  • N = x.
  • Pediatric Discharges from x Hospitals.
• 3 Strata.
  • Uncomplicated births.
  • Complicated births.
  • Pediatric non-births.
• 10% stratified sample of uncomplicated births (image of arrow leading from strata to 2006 Kids' Inpatient Database).
• 80% stratified sample of other ped discharges (image of arrow leading from strata to 2006 Kids' Inpatient Database).
• 2006 Kids' Inpatient Database.
  • N = x.
  • Pediatric Discharges from x Hospitals.

Slide 19

Key Differences Between the 1997, 2000, 2003, and 2006 KID

• Slide includes a table comparing the statistical growth during these years for the following items:
• # HCUP States (22 in 1997; 38 in 2006).
• # Hospitals (2,521 in 1997; 3,739 in 2006).
• # Unweighted records (1.9 million in 1997; 3.1 million in 2006).
• # Weighted discharges (6.7 million in 1997; 7.6 million in 2006).

Slide 20

What Is the Source for the SASD?

• Ambulatory surgery data:
• Designated hospital beds; separate facilities with hospital affiliation included.
• Some data from free-standing centers.
• Data organizations provides data to HCUP—collection varies by state.
• HCUP collects and standardizes data to create SASD.

Slide 21

States with HCUP Ambulatory Surgery Databases

• California**
• Colorado*
• Connecticut
• Florida*
• Georgia
• Indiana
• Iowa*
• Kansas
• Kentucky*
• Maine
• Maryland*
• Michigan*
• Minnesota
• Missouri
• Nebraska*
• New Hampshire
• New Jersey*
• New York*
• North Carolina*
• Ohio
• Oklahoma
• South Carolina*
• South Dakota
• Tennessee
• Utah*
• Vermont*
• Wisconsin*
• *Data available through the HCUP Central Distributor.
• ** Special application process.
• Note: Not all States participate in all years.

Slide 22

What is the Source for the SEDD?

• Emergency department data: uniform billing data (UB-92), plus additional data elements, from hospital-affiliated emergency department sites.
• Data organization provides data to HCUP.
• HCUP collects and standardizes data to create SEDD.

Slide 23

The SEDD Can Provide a More Complete Picture of Care

• The SID and the SEDD can be combined to get a full picture of care that began in the ED.

Slide 24

States with HCUP Emergency Department Databases

• Arizona*
• California*
• Connecticut
• Florida*
• Georgia
• Hawaii*
• Indiana
• Iowa*
• Kansas
• Maine
• Maryland*
• Massachusetts*
• Minnesota
• Missouri
• Nebraska*
• New Hampshire
• New Jersey*
• New York
• Ohio
• South Carolina*
• South Dakota
• Tennessee
• Utah*
• Vermont*
• Wisconsin*
• *Data available through the HCUP Central Distributor.
• ** Special application process.
• Note: Not all States participate in all years.

Slide 25

Some Interesting Ways to Use the SEDD for Research

• Injury surveillance.
• Trends in emergency department (ED) use.
• Correlations between ED use and environmental events.
• Emerging infectious diseases.
• Occurrence of non-fatal, preventable illness.
• ED visits and re-visits for some States.

Slide 26

Coming Soon...

• Slide includes a photo of an ambulance with the following text superimposed on it: Nationwide Emergency Department Sample (NEDS).

Slide 27

HCUP ED Data

• Slide includes a flow chart with arrows from both SEDD (treat-and-release ED visits) and SID (admitted ED visits) to NEDS.
• About 84% of ED visits are treat-and-release.
• About 16% of ED visits result in a hospital stay.

Slide 28

NEDS Benchmarks Well

• Comparable to other ED sources.
• Consistent in terms of total ED visits.
• Higher percent of inpatient admissions with ED source.
• Larger amount of diagnostic and procedure information available.
• Similar for injury rates.

Slide 29

Administrative Data Have Benefits and Limitations

• Benefits:
  • Large sample size.
  • Uniformity of coding.
  • Routine, regular collection.
  • Ease of access.
  • All-payer.
  • Available at local, state, regional, national level.
• Limitations:
  • Differences in coding across hospitals.
  • No data on individuals outside of hospital system.
  • May not show complete episode of care.
  • May not include all hospitals.
  • Lack revenue information.
  • Sparse clinical details.

Slide 30

Pricing Information

• National Databases (NIS, KID).
  • $200 per data year (from CY2000 forward).
  • $20 student price.
• State Databases (SID, SASD, SEDD).
  • $20 - $3,000 per data year (varies by state).

Slide 31

HCUP Statistical Briefs

• Slide includes images of HCUP Statistical Brief #42 on The National Hospital Bill.

Slide 32

Other Statistical Briefs Include:

• Hospital stays related to depression.
• Trends in risk-adjusted mortality.
• Trends in preventable hospitalizations.
• Infections with Clostridium difficile.
• Childbirth-related stays.
• Adverse drug events.
• Admissions for traumatic brain injury.
• Bariatric surgery utilization and outcomes.
• Circumcisions.
• .

Slide 33

HCUPnet

• Slide includes an image of the HCUPnet Web site with the following text superimposed on it:
• HCUPnet is a powerful online query tool that gives you free, instant access to healthcare statistics.
• HCUPnet provides national information on hospital stays based on the Nationwide Inpatient Sample.

Slide 34

HCUPnet

• Slide includes an image of a different page on the HCUPnet Web site with this text superimposed on it:
  
  And it gives access to data from participating States from HCUP's State Inpatient Databases.

Slide 35

HCUPnet

• Slide includes an image of a different page on the HCUPnet Web site with this text superimposed on it:
  
  HCUPnet takes you through a step-by-step process to select the information you want.

Slide 36

HCUPnet

• Slide includes an image of a different page on the HCUPnet Web site with this text superimposed on it:
  
  HCUPnet provides information on:
  • Numbers of discharges.
  • Hospital LOS and charges.
  • Discharge status.
  • How patients were admitted.

Slide 37

HCUPnet

• Slide includes an image of a different page on the HCUPnet Web site with this text superimposed on it:
• Are you interested in particular patient groups? Specific hospital characteristics?

Slide 38

HCUPnet

• Slide includes an image of a different page on the HCUPnet Web site with this text superimposed on it:
• You get your results instantly.
• HCUPnet is based on aggregated statistics to speed data transfer and protect patient confidentiality.

Slide 39

HCUPnet

• Slide includes an image of a different page on the HCUPnet Web site with this text superimposed on it:
• You can request information on trends for the nation and for any participating state.

Slide 40

HCUPnet

• Slide includes an image of a different page on the HCUPnet Web site with this text superimposed on it:
• Visit HCUPnet at: http://hcupnet.ahrq.gov

Slide 41

New Interactive On-line HCUP Overview Course Available

• Slide includes an image of the HCUP Web site.
• http://www.hcup-us.ahrq.gov/overviewcourse.jsp

Slide 42

Join the HCUP E-mail List

• Slide includes an image of the HCUP Web site.
• HCUP newsletter.
• New data releases.
• New Reports.
• https://www.ahrq.gov/data/hcup/hcuplist.htm

Slide 43

Using HCUP Technical Assistance

• Slide includes a photo of a person wearing a laboratory coat and using a computer.
• Active Technical Assistance:
  • Responds to inquiries about HCUP data, products, and tools.
  • Collects user feedback and suggestions for improvement.
• E-mail: hcup@ahrq.gov
• Phone: (866) 290-HCUP