The Healthcare Cost and Utilization Project (HCUP)

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The Healthcare Cost and Utilization Project (HCUP)

• State Databases
• Agency for Healthcare Research and Quality
• APHA CEI Session ? November 2006

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HCUP State Databases
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Outline of Presentation
Overview of State Database

File Structure
Research Example
Data Elements
Availability and Pricing
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• State Inpatient Databases
• (SID)

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What are the State Inpatient Databases (SID)?
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What Is the Source forthe SID?

• Inpatient hospital data uniform billing data
  (UB-92)
• Data organization provides data to HCUP
• HCUP collects and standardizes data to create SID

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SID File Structure

• Range of file sizes
• 56,000 to 3.9 million records per state
• Core set of variables
• Patient demographics
• Expected payment source
• All listed diagnoses and procedures
• State-specific variables
• Patient race/ethnicity
• Encrypted patient identifier
• Patient ZIP code
• AHA hospital identifier

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How Do the SID Differ from State Data Files?

• Unique attributes of the SID
• Subset of data elements
• Value-added data elements
• Uniformly coded across the states
• Data protection
• Standard data quality checks
• Developed for cross-state analysis

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The SID Contains Three Types of Data Files
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Core File Contains Patient Information
Contains common data elements (the nucleus of
the SID) and state-specific data elements
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What Data Elements Are Included in the Core File?

• Patient demographics (age, sex)
• Diagnoses procedures
• (ICD-9-CM, DRG)
• Expected payer
• Length of stay
• Patient disposition
• Admission source type
• Admission month
• Weekend admission

UB-92 Billing Form
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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

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Standardized Data Elements
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Standardized Data Elements
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Encrypted Patient Identifiers

• Multiple admissions by the same patient can be
  linked in some HCUP SID

WITHIN INSTITUTIONS
ACROSS INSTITUTIONS
ACROSS DATABASES
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Addition of New Variable in 2003 SID E codes

• E Codes Identify the Cause of
• Injury in Hospital Data
• External cause of injury codes (E codes) are a
  type of ICD-9-CM codes
• classify causes of injury, poisoning, or other
  adverse effects
• Prior to 2003 data, E codes were coded in the
  ICD-9-CM diagnosis field, but are now included in
  a separate data field

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Charges File Contains Detailed Charge Information

• Charges Costs
• Charges Payments

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Cost-to-Charge Ratios

Hospital-Level NIS/SID Data
Apply Ratios
Convert Charges to Costs
The Cost-to-Charge Ratios enable conversion of
charge data to cost data on the NIS
and the SID.
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Hospital File Allows Linking with AHA Survey of
Hospitals
Not all SID include AHA linkage data
elements Individual states decide
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HCUP Links to Other Databases
American Hospital Association (AHA) Annual
Survey
AHA ID
Health Resources and Services Administrations
(HRSA) Area Resource File (ARF)
County
ZIP Code
ZIP Code Level Census Characteristics
Medicare ID
HCUP Databases
Medicare Cost Reports
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State Participation in SID Continues to Grow
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States Releasing SID through HCUP Central
Distributor
1990 2004

• Nevada
• New Jersey
• New York
• North Carolina
• Oregon
• Rhode Island
• South Carolina
• Utah
• Washington
• West Virginia
• Wisconsin

• Arizona
• California
• Colorado
• Florida
• Iowa
• Kentucky
• Maine
• Maryland
• Massachusetts
• Michigan
• Nebraska

Note Not all states participate in all years.
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SID Availability and Prices

• SID available for 1990 - 2004
• Availability and prices vary by state and year
• 20 per data-year to 3,000 per data-year

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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

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HCUP SID Documentation

• http//www.hcup-us.ahrq.gov/db/state/siddbdocument
  ation.jsp

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• State Ambulatory
• Surgery Databases (SASD)

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What are the State Ambulatory Surgery Databases
(SASD)?
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What Is the Source forthe SASD?

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

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Inclusion of Free-standing ASCs Varies By State
 
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SASD File Structure

• Range of file sizes
• 105,000 to 2.7 million records per state
• Core set of variables
• Patient demographics
• Expected payment source
• All listed diagnoses and procedures
• State-specific variables
• Patient race/ethnicity
• Encrypted patient identifier
• CPT codes

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The SASD and SID Can Provide a More Complete
Picture of Care
The SASD can be linked to the SID for selected
states
Encrypted Patient ID
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How Do the SASD Compare to Other Databases?

• Benchmarked against the American Hospital
  Association (AHA) Annual Survey, the Centers for
  Medicare and Medicaid Services (CMS) Provider of
  Services (POS) file, and the SMG Freestanding
  Outpatient Surgery Center Data
• SASD provides coverage for the vast majority of
  ambulatory surgeries performed

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States with Ambulatory Surgery Databases

• Colorado
• Connecticut
• Florida
• Georgia
• Iowa
• Indiana
• Kentucky
• Maine
• Maryland
• Michigan
• Minnesota
• Missouri

• Nebraska
• New Hampshire
• New Jersey
• New York
• North Carolina
• Ohio
• South Carolina
• Tennessee
• Utah
• Vermont
• Wisconsin

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SASD Availability and Prices

• SASD available for 1997 - 2004
• Availability and prices vary by state and year
• 20 per data-year to 3,000 per data-year

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Many Potential Applications of the SASD

• Identify state-specific trends in ambulatory
  surgery utilization, access, charges, and
  outcomes
• Conduct market area research
• Compare inpatient surgery data with ambulatory
  surgery data
• Examine complications for ambulatory surgeries

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HCUP SASD Documentation

• http//www.hcup-us.ahrq.gov/db/state/sasddbdocumen
  tation.jsp

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• State Emergency
• Department Databases (SEDD)

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What are the State Emergency Department Databases
(SEDD)?
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What is the Source forthe 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

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The Flow of Emergency Department Visits
Released Home/ Community
Admitted to Inpatient Hospital
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SEDD File Structure

• Range of file sizes
• 133,000 to 2.7 million records per state
• Core set of variables
• Patient demographics
• Expected payment source
• All listed diagnoses and procedures
• State-specific variables
• Patient race/ethnicity
• AHA hospital identifier
• CPT codes
• Encrypted patient identifier

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The SEDD Can Provide a More Complete Picture of
Care
The SEDD can be linked to the SID
for selected states
SEDD
Encrypted Patient ID
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How Do the SEDD Compare to Other Databases?

• Number of visits benchmarks well against American
  Hospital Association (AHA) Annual Survey
• Percent of visits related to injury is similar to
  the National Hospital Ambulatory Medical Care
  Survey (NHAMCS)

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Some Interesting Ways to Use the SEDD for Research

• Injury surveillance
• Trends in 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

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States with Emergency Department Databases

• Connecticut
• Georgia
• Hawaii
• Indiana
• Iowa
• Maine
• Maryland
• Massachusetts
• Minnesota
• Missouri

• Nebraska
• New Hampshire
• New Jersey
• Ohio
• South Carolina
• Tennessee
• Utah
• Vermont
• Wisconsin

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SEDD Availability and Prices

• SEDD available for 1999 - 2004
• Availability and prices vary by state and year
• 20 per data-year to 3,000 per data-year

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HCUP SEDD Documentation

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How to Obtain HCUP State-Level Databases through
the HCUP Central Distributor

• Step 1 Determine if the state of interest
  releases their data
• through the HCUP Central Distributor
• http//www.hcup-us.ahrq.gov/tech_assist/centdist
  .jsp
• Step 2 Download application kit
• http//www.hcup-us.ahrq.gov/tech_assist/centdist
  .jsp
• Step 3 Obtain more information (if needed)
• Phone 866-556-HCUP (4287) toll free
• E-mail HCUPDistributor_at_ahrq.gov
• Step 4 Read and sign the Data Use Agreement
  (DUA)
• Step 5 Send order form, DUA, and payment to HCUP
  
• Central Distributor

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Availability and Prices State Databases
State Databases Availability and Prices Vary by
State
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