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On December 5, 2008, Hannah Davis gave a presentation on HCUP Reports at the Using Administrative Data to Answer State Policy Questions Intensive Workshop that can help inform policy. This is the text version of the event's slide presentation. Please select the following link to access the slides: (PowerPoint® File, 2.5 MB).
Slides: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | 39 | 40
Slide 1: HCUP Reports and Features for Informing Policy
P. Hannah Davis
Manager, HCUP User Support
Agency for Healthcare Research and Quality
December 6, 2008
On the top of the slide are the logos for the Department of Health & Human Services and the AHRQ logo. The Department of Health & Human Services logo is an artistic image of an eagle with the outlined profile of faces. The AHRQ logo reads, "AHRQ — Agency for Healthcare Research and Quality: Advancing Excellence in Health Care, www.ahrq.gov."
This presentation uses a template with a blue background and a header with the AHRQ and Department of Health & Human Services logos on the left and the HCUP logo on the right.
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Slide 2: Healthcare Cost and Utilization Project (HCUP)
Screen shot of the HCUP logo and beneath it are the words: "The largest collection of multi-year, all-payer, encounter-level, health care data."
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Slide 3: HCUP Partners with 40 States
The HCUP Partnership: A Voluntary Federal-State-Private Sector Collaboration
This slide contains a map of the United States, indicating the level of HCUP participation of each state. A total of 40 states participate in HCUP and provide 90 percent of all discharges.
Nonparticipant States: AK, NM, ID, MT, ND, LA, MS, AL, PA, DE
Partner States providing inpatient data only: WA, OR, NV, WY, TX, AR, IL, WV, VA, RI
Partner States providing inpatient and ambulatory surgery data: CO, OK, MI, KY, NC
Partner States providing inpatient and emergency department data: HI, AZ, MA
Partner States providing inpatient, ambulatory surgery, and emergency department data: CA, UT, SD, NE, KS, MN, IA, MO, WI, IN, OH, TN, SC, GA, FL, MD, NJ, NY,
CT, VT, NH, ME
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Slide 4: HCUP Is a Family of Databases, Tools, and Products
Screen shot of a diagram showing the HCUP family of products and services, including: HCUP databases, software tools, reports, and user support.
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Slide 5: HCUP Reports and Features Have Useful Information
- HCUP Facts and Figures (online only)
- Has national statistics on hospital stays.
- Updated annually.
- HCUP Statistical Briefs (online only)
- Present simple, descriptive statistics on a variety of specific, focused topics.
- Produced biweekly (approx.).
- HCUP Fact Books (online and printed)
- Provides information about specific aspects of hospital care.
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Slide 6: HCUP Facts and Figures, 2006
An image of the cover of the AHRQ publication HCUP Facts and Figures, 2006: Statistics on Hospital-Based Care in the United States.
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Slide 7: HCUP Facts and Figures
- An annual report, updated in August.
- Contains statistics on hospital based care:
- Most common diagnoses, conditions, and procedures.
- Costs and charges associated with hospitalizations.
- Special topic - priority conditions in 2006.
- Current report has 2006 data from HCUP Nationwide Inpatient Sample (NIS), and trends from 1997.
- States can download software and run with own data.
- Report available on HCUP-User Support website at http://www.hcup-us.ahrq.gov/reports.jsp.
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Slide 8: Overview of Hospital Utilization and Costs, 1997-2006
| U.S. Community Hospitals |
1997 |
2006 |
| Total discharges (millions) |
34.7 |
39.5 |
| Discharges per 1,000 population |
127.8 |
131.9 |
| Total days of care (millions) |
168.1 |
181.3 |
| ALOS |
4.8 |
4.6 |
| Average charge per stay* |
$13,800 |
$24,000 |
| Average costs per stay* |
$6,200 |
$8,400 |
* Inflation adjusted in 2006 dollars.
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Slide 9: Top 5 Most Frequent Principal Diagnoses, 1997-2006
| Principal CCS Diagnosis |
Discharges (in thousands) |
% Change |
| 1997 |
2006 |
1997-2006 |
| All discharges |
34,679 |
39,450 |
14 |
Pregnancy, childbirth and
newborn infants |
8,236 |
9,252 |
12 |
| Pneumonia |
1,232 |
1,218 |
-1 |
Coronary atherosclerosis
(coronary artery disease) |
1,407 |
1,198 |
-15 |
| Congestive heart failure |
991 |
1,099 |
11 |
| Non-specific chest pain |
538 |
857 |
59 |
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Slide 10: Most Frequent Principal Diagnoses with Largest Changes, 1997-2006
| Principal CCS Diagnosis |
Discharges (in thousands) |
% Change |
| 1997 |
2006 |
1997-2006 |
| All discharges |
34,679 |
39,450 |
14 |
Skin and subcutaneous
tissue infections |
330 |
597 |
81 |
| Osteoarthritis |
418 |
735 |
76 |
| Non-specific chest pain |
538 |
857 |
59 |
| Septicemia (blood infection) |
413 |
611 |
48 |
Cardiac dysrhythmias
(irregular
heart beat) |
572 |
749 |
31 |
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Slide 11: Top 5 Most Frequent Procedures, 1997-2006
| All-Listed CCS Procedures |
Discharges
(in thousands) |
% Change |
| 1997 |
2006 |
1997-2006 |
| All discharges w/any procedure |
21,257 |
24,445 |
15 |
| Blood transfusions |
1,097 |
2,382 |
117 |
Diagnostic cardiac catheterization,
coronary arteriolgraphy |
1,461 |
1,671 |
14 |
| Repair of obstetric laceration |
1,137 |
1,373 |
21 |
| C-section |
800 |
1,346 |
68 |
Respiratory intubation and
mechanical ventilation |
919 |
1,294 |
41 |
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Slide 12: Most Frequent Procedures with Largest Changes, 1997-2006
| All-Listed CCS Procedures |
Discharges (in thousands) |
% Change |
| 1997 |
2006 |
1997-2006 |
| All discharges w/any procedure |
21,257 |
24,445 |
15 |
| Blood transfusions |
1,097 |
2,382 |
117 |
| C-section |
800 |
1,346 |
68 |
Prophylactic vaccinations
and inoculations |
567 |
945 |
67 |
| Episiotomy |
866 |
393 |
-55 |
Respiratory intubation and
mechanical ventilation |
919 |
1,294 |
41 |
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Slide 13: Infants and the Elderly Disproportionately Use the Hospital
Bar chart showing the distribution of U.S. Population and Hospital Discharges by Age, 2006
| Age Range |
U.S. Population |
Discharges |
| <1 |
<2% |
12% |
| 1-17 |
23% |
4% |
| 18-44 |
38% |
26% |
| 45-64 |
25% |
23% |
| 65-84 |
11% |
27% |
| 85+ |
<2% |
8% |
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Slide 14: Top 5 Most Expensive Principal Diagnoses and Average Annual Percent Growth in Costs, 1997-2006
| Principal CCS Diagnosis |
Total Hospital Costs*
(in billions) |
% Annual Change |
| 1997 |
2006 |
1997-2006 |
| All diagnoses |
$216.3 |
$329.2 |
4.8 |
| Coronary atherosclerosis |
14.5 |
17.5 |
2.1 |
| Acute myocardial infarction |
9.0 |
11.8 |
3.0 |
| Congestive heart failure |
6.6 |
11.2 |
6.1 |
| Liveborn |
7.8 |
10.8 |
3.6 |
| Osteoarthritis |
4.6 |
10.3 |
9.3 |
* Inflation adjusted in 2006 dollars.
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Slide 15: Most Frequent Principal Diagnoses with Largest Average Annual Percent Growth in Costs, 1997-2006
| Principal CCS Diagnosis |
Total Hospital Costs*
(in billions) |
% Annual Change |
| 1997 |
2006 |
1997-2006 |
| All diagnoses |
$216.3 |
$329.2 |
4.8 |
| Septicemia (blood infection) |
4.0 |
10.2 |
10.9 |
| Adult respiratory failure, insufficiency or arrest |
3.3 |
8.1 |
10.7 |
| Non-specific chest pain |
1.6 |
3.9 |
10.0 |
| Disorders of intervertebral discs and bones in spinal column (back problems) |
3.4 |
7.6 |
9.4 |
| Osteoarthritis |
4.6 |
10.3 |
9.3 |
* Inflation adjusted in 2006 dollars.
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Slide 16: Some Conditions Were More Expensive Than Expected Due to Costly Technology or Intensive Care, 2006
This slide contains a scatter plot showing the average length and average charges of inpatient hospital stays for principal CCS diagnosis in 2006.
- Affective disorders: 7.3 days and $13,541
- Schizophrenia and related disorders: 11.5 days and $20,510
- Rehabilitation care: 12.6 days and $29,615
- Tuberculosis: 15.0 days and $57,537
- Heart valve disorders: 9.0 days and $105,733
- Leukemias: 14.2 days and $87,579
- Spinal cord injury: 14.00 days and $113,181
- Infant respiratory distress syndrome: 22.7 days and $106,490
- Premature birth and low birth weight: 25.7 days and $101,214
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Slide 17: Public Insurance Assumed Financial Responsibility for Most Hospitalizations, 2006
Bar chart entitled: Percent Distribution of Discharges by Expected Primary Payer, 2006. The percentages are:
Medicare: 37%
Medicaid: 20%
Private Insurance: 34%
Uninsured: 6%
Other: 3%
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Slide 18: Public Insurance and Uninsured Grew at Highest Rates, 1997-2006
Bar chart entitled: Growth in Number of Discharges by Expected Primary Payer, 1997-2006. The percent growth is shown as:
Medicaid: 36%
Uninsured: 34%
Medicare: 17%
All Discharges: 14%
Other: 4%
Private Insurance: 0%
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Slide 19: C-Section Rates Are Rising, 1993-2006
Pie chart comparing the number of vaginal and C-Section deliveries as a share of all deliveries, 1993 and 2006. In 1993 78% of all deliveries were vaginal and 22% C-Section. In 2006 68% of all deliveries were vaginal, and 32% were c-section.
Slide 20: Lung Cancer Was the Most Common Reason for Cancer-Related Hospital Stays, 2006
Bar chart entitled: Most Frequent Hospitalizations with a Principal Diagnosis of Cancer by Gender, 2006. The data are shown below in tabular form.
| Cancer type |
Discharges in Thousands |
| Male |
Female |
| Pancreas |
20 |
20 |
| Ovary |
N/A |
40 |
| Head and neck |
30 |
12 |
| Bladder |
32 |
11 |
| Uterus |
N/A |
44 |
| Kidney and renal pelvis |
33 |
21 |
| Rectum and anus |
30 |
24 |
| Leukemias |
37 |
29 |
| Non-Hodgkin's lymphoma |
40 |
29 |
| Prostate |
99 |
N/A |
| Breast |
1 |
119 |
| Colon |
65 |
70 |
| Bronchus, lung |
107 |
93 |
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Slide 21: Changes in the Number of Cancer Hospitalizations Varied by Diagnosis, 1997-2006
Bar chart showing the percent change in discharges from 1997-2006 by cancer diagnosis. The percentages are as follows:
| Cancer Type |
Percent Change |
| Liver and intrahepatic bile duct |
45% |
| Kidney and renal pelvis |
37% |
| Hodgkin's disease |
29% |
| Bone and connective tissue |
17% |
| Thyroid |
15% |
| Neoplasms of unspecified nature or uncertain behavior |
15% |
| Pancreas |
14% |
| Leukemias |
6% |
| Brain and nervous system |
3% |
| Bronchus, lung |
-10% |
| Head and neck |
-17% |
| Prostate |
-17% |
| Bladder |
-20% |
| Ovary |
-30% |
| Breast |
-32% |
| Cervix |
-39% |
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Slide 22: Asthma Hospitalizations Were Highest Among the Poor, 2006
Bar chart entitled: Rates of Asthma Hospitalization by Median Income of Patients' Zip Code and Region, 2006. It shows the discharges per 100,000 population. The totals are as follows:
| Region |
$1-37,999 |
$38,000-46,999 |
$47,000-61,999 |
$62,000+ |
| Northeast |
390 |
200 |
142 |
130 |
| Midwest |
240 |
132 |
103 |
83 |
| South |
180 |
142 |
118 |
82 |
| West |
115 |
102 |
78 |
67 |
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Slide 23: HCUP Facts and Figures on HCUP User Support Website
Screen shot of the reports page on the HCUP Web site.
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Slide 24: HCUP Reports and Features Have Useful Information
- HCUP Facts and Figures (online only)
- Has national statistics on hospital stays.
- Updated annually.
- HCUP Statistical Briefs (online only)
- Present simple, descriptive statistics on a variety of specific, focused topics.
- Produced biweekly (approx.).
- HCUP Fact Books (online and printed)
- Provides information about specific aspects of hospital care.
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Slide 25: HCUP Statistical Briefs
Image of the covers of several HCUP statistical briefs.
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Slide 26: HCUP Statistical Briefs by Topic Categories
Screen shot of the front page for the HCUP Statistical Briefs Web site by topic category.
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Slide 27: HCUP Statistical Briefs on HCUP User Support Website
Screen shot of the HCUP Statistical Briefs Web site showing a listing of the Statistical Briefs by report number.
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Slide 28: HCUP Statistical Brief #50: Clostridium Difficile Associated Disease (CDAD)
- CDAD hospital discharges more than doubled 2001-05.
- In prior 8-year period, cases increased by 74 percent.
- Over two-thirds of patients with CDAD were 65 years+.
- CDAD infection in NE higher than any other region:
- 144 CDAD hospital stays per 100,000 population.
- The West region had lowest rate:
- 67 CDAD stays per 100,000 population.
- NE rate 2 times higher than West.
- Midwest and South rates were 69 percent and 42 percent higher than the West.
- CDAD patients had lengths of stay 3 x higher than average.
- CDAD patients death rate in hospital 5 x higher than average.
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Slide 29: CDAD Hospitalizations Increased Sharply, 1993-2005
A line graph entitled: Trends in hospital stays associated with Clostridium difficile-associated disease, 1993-2005. The number of discharges with CDAD as the principal diagnosis increased steadily from about 24,000 in 1993 to 76,000 in 2005. The number of discharges with CDAD among all listed diagnoses increased steadily from about 86,000 in 1993 to 149,000 in 2001, followed by a sharp increase to about 193,000 in 2002 and ending around 301,000 in 2005. Source: HCUP Nationwide Inpatient Sample.
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Slide 30: CDAD Hospitalizations by Region, 2005
A bar chart entitled: Rates of hospitalization with Clostridium difficile-associated disease, per 100,000 population and per 10,000 hospital discharges, by region, 2005. The data are as follows:
| Region |
Rate per 100,000 population |
Rate per 10,000
hospital discharges |
| Northeast |
144 |
102 |
| Midwest |
113 |
83 |
| South |
96 |
68 |
| West |
67 |
62 |
Based on all-listed diagnoses. Source: HCUP Nationwide Inpatient Sample.
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Slide 31: HCUP Statistical Brief #62: Mental Health
- One-fifth of hospital stays had principal or secondary MH diagnoses.
- 8.4 Million hospital stays involved a MH diagnosis.
- Medicare and Medicaid were expected payers for 60% of MH stays.
- MH hospitalizations were 2 times higher in Northeast than West.
- ALOS for principal MH diagnoses was greater than for all stays (8.2 days vs 4.6 days).
- Mood disorders were the most common principal diagnosis in <65 years.
- Dementia and related disorders most common 65+ years.
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Slide 32: Mood Disorders is Most Common MH Condition Treated in Hospitals, 2006
Bar graph entitled: Specific Mental Health Conditions as Principal or Secondary Diagnosis during a Hospital Stay, 2006.
| Diagnosis |
Principal MH Conditions
(discharges in thousands) |
Secondary MH Conditions
(discharges in thousands) |
| Disorders usually diagnosed in childhood |
3 |
29 |
| Personality disorders |
5 |
244 |
| Impulse control disorders, NEC |
10 |
22 |
| Attention-deficit disorders |
16 |
130 |
| Adjustment disorders |
36 |
105 |
| Anxiety disorders |
40 |
1,310 |
| Dementia and other cognitive disorders |
131 |
1,708 |
| Schizophrenia |
381 |
453 |
| Mood disorders |
729 |
3,054 |
s HCUP Nationwide Inpatient Sample.
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Slide 33: Public Insurance Is the Expected Payer for Most MH-Related Stays, 2006
Bar graph entitled: Government payers were billed for about 60 percent of mental health-related stays, 2006.
| Insurance Type |
Expected payer for stays principally for mental health |
Expected payer in all hospital stays |
| Medicare |
36.3% |
37.3% |
| Medicaid |
26.4% |
19.5% |
| Private Insurance |
23.8% |
34.1% |
| Uninsured |
8.5% |
5.7% |
A small portion of stays covered by other insurance programs (such as TRICARE/CHAMPUS and Title V) were not included in this figure. Source: HCUP Nationwide Inpatient Sample.
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Slide 34: HCUP Statistical Brief #59: National Hospital Bill
- $950B for 39 million hospital stays (2006).
- Almost two-thirds of the national bill for hospital care was billed to Medicare and Medicaid.
- Medicaid's most expensive conditions were related to pregnancy and care of newborn infants.
- Schizophrenia and affective disorders were among top 10 most expensive conditions.
- Among the uninsured, circulatory conditions accounted for 3 of top 5 most expensive conditions.
- Injuries accounted for 3 of top 10 most expensive conditions.
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Slide 35: Public Insurance Bore Responsibility for Almost Two-Thirds of National Hospital Bill, 2006
Pie chart entitled: Distribution of the National Hospital Bill by Primary Payer, 2006. The total national bill is $943.4 billion. The payer proportions are as follows:
Medicare: 47.0%
Medicaid: 14.3%
Private Insurance: 30.4%
Uninsured: 4.6%
Other/Missing: 3.2%
“Other” insurers include Workers' Compensation, TRICARE, Title V, and other government programs. Source: HCUP Nationwide Inpatient Sample.
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Slide 36: HCUP Reports and Features Have Useful Information
- HCUP Facts and Figures (online only)
- Has national statistics on hospital stays.
- Updated annually.
- HCUP Statistical Briefs (online only)
- Present simple, descriptive statistics on a variety of specific, focused topics.
- Produced biweekly (approx.).
- HCUP Fact Books (online and printed)
- Provides information about specific aspects of hospital care.
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Slide 37: HCUP Fact Books
The front covers of 3 different HCUP fact books.
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Slide 38: HCUP Fact Book Topics
- Care of Adults with Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004 (#10).
- Ambulatory Surgery in U.S. Hospitals, 2003 (#9).
- Serving the Uninsured: Safety Net Hospitals, 2003 (#8).
- Procedures in U.S. Hospitals, 2003 (#7).
- Hospitalization in the US, 2002 (#6).
- Preventable Hospitalizations, 2000 (#5).
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Slide 39: To Order an HCUP Fact Book
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Slide 40: Questions? Comments? Suggestions?
Questions?
Comments?
Suggestions?
For information on reports, email HCUP User Support hcup@ahrq.gov
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