The Healthcare Cost and Utilization Project (HCUP) State Databases Agency for Healthcare Research and Quality APHA CEI Session November 2006

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

State Databases State Databases

Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality

APHA CEI Session APHA CEI Session November 2006 November 2006

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Advancing Advancing Excellence in Excellence in Health CareHealth Care

Healthcare Cost and Healthcare Cost and Utilization Project (HCUP)Utilization Project (HCUP)

THE LARGEST COLLECTION OF MULTI-STATE, THE LARGEST COLLECTION OF MULTI-STATE, ALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATAALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATA

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HCUP State DatabasesHCUP State Databases

State State Ambulatory Ambulatory

Surgery Surgery Databases Databases

(SASD)(SASD)

State State Inpatient Inpatient

Databases Databases (SID)(SID)

State State Emergency Emergency Department Department Databases Databases

(SEDD)(SEDD)

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Outline of PresentationOutline of Presentation

Overview of State Database

Data Elements

Research Example

Availability and Pricing

File Structure

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State Inpatient DatabasesState Inpatient Databases

(SID)(SID)

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What are the State Inpatient What are the State Inpatient Databases (SID)?Databases (SID)?

State Inpatient State Inpatient Databases (SID)Databases (SID)

Comprehensive hospital discharge

data from states

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What Is the Source forWhat Is the Source forthe SID?the SID?

Inpatient hospital data: uniform billing data Inpatient hospital data: uniform billing data (UB-92)(UB-92)

Data organization provides data to HCUPData organization provides data to HCUP

HCUP collects and standardizes data to HCUP collects and standardizes data to create SIDcreate SID

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Advancing Advancing Excellence in Excellence in Health CareHealth Care SID File StructureSID File Structure

Range of file sizesRange of file sizes– ~ 56,000 to 3.9 million records per state~ 56,000 to 3.9 million records per state

Core set of variablesCore set of variables– Patient demographicsPatient demographics

– Expected payment sourceExpected payment source

– All listed diagnoses and proceduresAll listed diagnoses and procedures

State-specific variablesState-specific variables– Patient race/ethnicityPatient race/ethnicity

– Encrypted patient identifierEncrypted patient identifier

– Patient ZIP codePatient ZIP code

– AHA hospital identifierAHA hospital identifier

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How Do the SID Differ fromHow Do the SID Differ from State Data Files? State Data Files?

Unique attributes of the SID:Unique attributes of the SID:

Subset of data elements Subset of data elements

Value-added data elementsValue-added data elements

Uniformly codedUniformly coded across the states across the states

Data protectionData protection

Standard data quality checksStandard data quality checks

Developed for cross-state analysisDeveloped for cross-state analysis

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The SID Contains Three Types The SID Contains Three Types of Data Filesof Data Files

Core File(Patient Demographic and Clinical Info)

Charges File(Detailed Charges)

AHA Linkage File(Hospital Characteristics)

Discharge-Level Files

(One observation per discharge)

Hospital-Level Files

(One record per hospital)

Level of Files

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Core File Contains Core File Contains Patient InformationPatient Information

Contains common data elements Contains common data elements (the nucleus of the SID) and (the nucleus of the SID) and state-specific data elementsstate-specific data elements

Core File(Patient Demographic and Clinical Info)

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What Data Elements Are What Data Elements Are Included in the Core File?Included in the Core File?

Patient demographics (age, sex)Patient demographics (age, sex)

Diagnoses & procedures Diagnoses & procedures

(ICD-9-CM, DRG)(ICD-9-CM, DRG)

Expected payerExpected payer

Length of stayLength of stay

Patient dispositionPatient disposition

Admission source & typeAdmission source & type

Admission monthAdmission month

Weekend admissionWeekend admission

UB-92 Billing Form

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Some Data Elements Some Data Elements Vary by StateVary by State

Race/EthnicityRace/Ethnicity

Patient countyPatient county

Patient ZIP CodePatient ZIP Code

Severity of illness Severity of illness

BirthweightBirthweight

Procedure date (days Procedure date (days from admission)from admission)

Primary payer detailsPrimary payer details

Secondary payerSecondary payer

Detailed chargesDetailed charges

Patient identifiers Patient identifiers encryptedencrypted

Physician identifiers Physician identifiers encryptedencrypted

Physician specialtyPhysician specialty

Hospital identifier Hospital identifier unencryptedunencrypted

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Advancing Advancing Excellence in Excellence in Health CareHealth Care Standardized Data ElementsStandardized Data Elements

PAY1_X PAY1 Value Description Value Description

M Medicare 1 Medicare

D Medicaid 2 Medicaid

BBlue Cross and Blue Shield

3 Private InsuranceI, S

Other Insurance Comp; Self Ins

H HMO-PPO

P Self-pay 4 Self-pay

Z Free 5 No charge

W Workers' Comp

6 OtherC CHAMPUS

E, N Other Government

L, O Other

3, 5, A, F, G, J, K, Y Unknown . Missing

Other values .A Invalid

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Advancing Advancing Excellence in Excellence in Health CareHealth Care Standardized Data ElementsStandardized Data Elements

RACE_X RACE Value Description Value Description

1 White 1 White

2 Black 2 Black

3 Hispanic 3 Hispanic

4 Hawaiian

4Asian or Pacific

Islander

5 Chinese

6 Filipino

7 Japanese

8 Other Asian

9Other Pacific

Islander

10Native

American5 Native American

11 Mixed or Other 6 Other

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Advancing Advancing Excellence in Excellence in Health CareHealth Care Encrypted Patient IdentifiersEncrypted 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 Addition of New Variable in 2003 SID: E codes2003 SID: E codes

E Codes Identify the E Codes Identify the CauseCause of of

Injury in Hospital DataInjury in Hospital Data

External cause of injury codes (E codes) are a type External cause of injury codes (E codes) are a type of ICD-9-CM codes of ICD-9-CM codes – classify causes of injury, poisoning, or other adverse classify causes of injury, poisoning, or other adverse

effectseffects

Prior to 2003 data, E codes were coded in the ICD-Prior to 2003 data, E codes were coded in the ICD-9-CM diagnosis field, but are now included in a 9-CM diagnosis field, but are now included in a separate data fieldseparate data field

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Charges File Contains Detailed Charges File Contains Detailed Charge InformationCharge Information

Charges Charges == CostsCosts

ChargesCharges == PaymentsPayments

Charges File(Detailed Charges)

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Cost-to-Charge RatiosCost-to-Charge Ratios

The Cost-to-Charge Ratios enable conversion of charge data to cost data on the

NIS and the SID.

Hospital-Level NIS/SID Data

Apply Ratios

$ Convert Charges to

Costs

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Hospital File Allows Linking with Hospital File Allows Linking with AHA Survey of HospitalsAHA Survey of Hospitals

Not all SID include AHA linkage Not all SID include AHA linkage data elements:data elements:

Individual states decide Individual states decide

AHA Linkage File10

(Hospital Characteristics)

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HCUP Links to Other HCUP Links to Other DatabasesDatabases

ZIP Code Level Census ZIP Code Level Census

CharacteristicsCharacteristics

Health Resources and Health Resources and

Services Administration’s Services Administration’s

(HRSA) Area Resource (HRSA) Area Resource

File (ARF)File (ARF)

American Hospital Association American Hospital Association

(AHA) Annual Survey(AHA) Annual Survey

Medicare Cost ReportsMedicare Cost Reports

HCUP Databases

NIS KID

SASD SEDD

SID

AHA ID

County

ZIP Code

Medicare ID

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State Participation in SID State Participation in SID Continues to GrowContinues to Grow

0

10

20

30

40

50

1988 1998 2000 2005

# o

f st

ates

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States Releasing SID through States Releasing SID through

HCUP Central DistributorHCUP Central Distributor

ArizonaArizona CaliforniaCalifornia ColoradoColorado FloridaFlorida IowaIowa Kentucky Kentucky Maine Maine MarylandMaryland MassachusettsMassachusetts Michigan Michigan NebraskaNebraska

NevadaNevada New Jersey New Jersey New YorkNew York North Carolina North Carolina OregonOregon Rhode IslandRhode Island South CarolinaSouth Carolina Utah Utah WashingtonWashington West Virginia West Virginia WisconsinWisconsin

1990 – 2004*1990 – 2004*

* Note: Not all states participate in all years.

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SID: Availability and PricesSID: Availability and Prices

SID available for 1990 - 2004SID available for 1990 - 2004

Availability and prices vary by state and Availability and prices vary by state and yearyear

~ $20 per data-year to ~ $3,000 per data-year~ $20 per data-year to ~ $3,000 per data-year

HCUP Central Distributor

SIDSID

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The SID Supports Interesting The SID Supports Interesting Research TopicsResearch Topics

Enumeration of all hospitals and discharges Enumeration of all hospitals and discharges within market areas or stateswithin market areas or states

Investigation of questions unique to one Investigation of questions unique to one state state

Comparison of data from two or more statesComparison of data from two or more states Research of market areas or small area Research of market areas or small area

variation analysesvariation analyses Identification of state-specific trends in Identification of state-specific trends in

inpatient care utilization, access, charges, inpatient care utilization, access, charges, and outcomesand outcomes

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Advancing Advancing Excellence in Excellence in Health CareHealth Care HCUP SID DocumentationHCUP SID Documentation

http://www.hcup-us.ahrq.gov/db/state/sidhttp://www.hcup-us.ahrq.gov/db/state/siddbdocumentation.jspdbdocumentation.jsp

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State Ambulatory State Ambulatory

Surgery Databases (SASD)Surgery Databases (SASD)

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What are the State Ambulatory What are the State Ambulatory Surgery Databases (SASD)?Surgery Databases (SASD)?

State Ambulatory Surgery Databases

(SASD)

Ambulatory surgery data from

the states

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What Is the Source forWhat Is the Source forthe SASD?the SASD?

Ambulatory surgery data: Ambulatory surgery data:

Designated hospital beds; separate facilities Designated hospital beds; separate facilities with hospital affiliation includedwith hospital affiliation included

Some data from free-standing centersSome data from free-standing centers

Data organizations provides data to HCUP–Data organizations provides data to HCUP–collection varies by statecollection varies by state

HCUP collects and standardizes data to create HCUP collects and standardizes data to create SASDSASD

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Inclusion of Free-standing Inclusion of Free-standing ASCs Varies By StateASCs Varies By State

STATE HOSPITAL-BASEDASCs

FREESTANDINGASCs

Colorado Yes No

Florida Yes Yes

Kentucky Yes Yes

Maine Yes No

Maryland Yes No

Nebraska Yes No

New Jersey Yes No

New York Yes Yes

North Carolina Yes Yes

Utah Yes Yes

Wisconsin Yes Yes

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SASD File StructureSASD File Structure

Range of file sizesRange of file sizes– ~ 105,000 to 2.7 million records per state ~ 105,000 to 2.7 million records per state

Core set of variablesCore set of variables– Patient demographicsPatient demographics

– Expected payment sourceExpected payment source

– All listed diagnoses and proceduresAll listed diagnoses and procedures

State-specific variablesState-specific variables– Patient race/ethnicityPatient race/ethnicity

– Encrypted patient identifierEncrypted patient identifier

– CPT codesCPT codes

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The SASD and SID Can Provide a The SASD and SID Can Provide a More Complete Picture of CareMore Complete Picture of Care

SASD SID

The SASD can be linked to the SID for selected states

Encrypted Patient ID

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How Do the SASD Compare How Do the SASD Compare to Other Databases?to Other Databases?

Benchmarked against the American Hospital Benchmarked against the American Hospital Association (AHA) Annual Survey, the Centers for Association (AHA) Annual Survey, the Centers for Medicare and Medicaid Services (CMS) Provider of Medicare and Medicaid Services (CMS) Provider of Services (POS) file, and the SMG Freestanding Services (POS) file, and the SMG Freestanding Outpatient Surgery Center DataOutpatient Surgery Center Data

SASD provides coverage for the vast majority of SASD provides coverage for the vast majority of ambulatory surgeries performedambulatory surgeries performed

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States with Ambulatory States with Ambulatory Surgery Databases Surgery Databases

ColoradoColorado ConnecticutConnecticut FloridaFlorida GeorgiaGeorgia IowaIowa IndianaIndiana KentuckyKentucky MaineMaine MarylandMaryland MichiganMichigan MinnesotaMinnesota MissouriMissouri

NebraskaNebraska New HampshireNew Hampshire New JerseyNew Jersey New YorkNew York North CarolinaNorth Carolina OhioOhio South CarolinaSouth Carolina TennesseeTennessee UtahUtah VermontVermont WisconsinWisconsin

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SASD: Availability and PricesSASD: Availability and Prices

SASD available for 1997 - 2004SASD available for 1997 - 2004




SASDSASD

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Many Potential Applications Many Potential Applications of the SASDof the SASD

Identify state-specific trends in ambulatory Identify state-specific trends in ambulatory surgery utilization, access, charges, and surgery utilization, access, charges, and outcomesoutcomes

Conduct market area researchConduct market area research

Compare inpatient surgery data with Compare inpatient surgery data with ambulatory surgery dataambulatory surgery data

Examine complications for ambulatory Examine complications for ambulatory surgeriessurgeries

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Advancing Advancing Excellence in Excellence in Health CareHealth Care HCUP SASD DocumentationHCUP SASD Documentation

http://www.hcup-us.ahrq.gov/db/http://www.hcup-us.ahrq.gov/db/state/sasddbdocumentation.jspstate/sasddbdocumentation.jsp

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State Emergency State Emergency

Department Databases (SEDD)Department Databases (SEDD)

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What are the State Emergency What are the State Emergency Department Databases (SEDD)?Department Databases (SEDD)?

State Emergency Department

Databases (SEDD)

Emergency department data from

the states

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What is the Source forWhat is the Source forthe SEDD?the SEDD?

Emergency department data: uniform billing Emergency department data: uniform billing data (UB-92), plus additional data elements, data (UB-92), plus additional data elements, from hospital-affiliated emergency from hospital-affiliated emergency department sitesdepartment sites

Data organization provides data to HCUPData organization provides data to HCUP

HCUP collects and standardizes data to HCUP collects and standardizes data to create SEDDcreate SEDD

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The Flow of Emergency The Flow of Emergency Department VisitsDepartment Visits

Released Home/

Community

Admitted to

Inpatient Hospital

Intake Clinician TreatmentEmergency

CareComplete

SEDD

SID

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SEDD File StructureSEDD 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 The SEDD Can Provide a More Complete Picture of CareComplete Picture of Care

SEDD

The SEDD can be linked to the SID for selected states

SIDEncrypted Patient ID

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How Do the SEDD Compare How Do the SEDD Compare to Other Databases?to Other Databases?

Number of visits benchmarks well against Number of visits benchmarks well against American Hospital Association (AHA) American Hospital Association (AHA) Annual SurveyAnnual Survey

Percent of visits related to injury is similar Percent of visits related to injury is similar to the National Hospital Ambulatory Medical to the National Hospital Ambulatory Medical Care Survey (NHAMCS)Care Survey (NHAMCS)

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Some Interesting Ways to Use Some Interesting Ways to Use the SEDD for Researchthe SEDD for Research

Injury surveillance Injury surveillance

Trends in ED useTrends in ED use

Correlations between ED use and Correlations between ED use and environmental events environmental events

Emerging infectious diseases Emerging infectious diseases

Occurrence of non-fatal, preventable illness Occurrence of non-fatal, preventable illness

ED visits and re-visits for some statesED visits and re-visits for some states

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States with Emergency States with Emergency Department DatabasesDepartment Databases

ConnecticutConnecticut GeorgiaGeorgia HawaiiHawaii IndianaIndiana IowaIowa MaineMaine MarylandMaryland MassachusettsMassachusetts MinnesotaMinnesota MissouriMissouri

NebraskaNebraska New HampshireNew Hampshire New JerseyNew Jersey OhioOhio South CarolinaSouth Carolina TennesseeTennessee UtahUtah VermontVermont WisconsinWisconsin

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SEDD: Availability and PricesSEDD: Availability and Prices

SEDD available for 1999 - 2004SEDD available for 1999 - 2004




SEDDSEDD

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Advancing Advancing Excellence in Excellence in Health CareHealth Care HCUP SEDD DocumentationHCUP SEDD Documentation

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How to Obtain HCUP State-Level How to Obtain HCUP State-Level Databases throughDatabases through

the HCUP Central Distributor the HCUP Central Distributor Step 1:Step 1: Determine if the state of interest releases their data Determine if the state of interest releases their data

through the HCUP Central Distributor: through the HCUP Central Distributor:

http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsphttp://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp

Step 2:Step 2: Download application kit: Download application kit:

http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsphttp://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp

Step 3:Step 3: Obtain more information (if needed): Obtain more information (if needed):

Phone: 866-556-HCUP (4287) toll freePhone: 866-556-HCUP (4287) toll free

E-mail: E-mail: [email protected]@ahrq.gov

Step 4:Step 4: Read and sign the Data Use Agreement (DUA) Read and sign the Data Use Agreement (DUA)

Step 5:Step 5: Send order form, DUA, and payment to HCUP Send order form, DUA, and payment to HCUP

Central Distributor Central Distributor

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Availability and Prices – Availability and Prices – State DatabasesState Databases

State Databases: Availability State Databases: Availability and Prices Vary by Stateand Prices Vary by State

SID 2004SID 2004 SASD 2004SASD 2004 SEDD 2004SEDD 2004

Maryland $20Maryland $20 Maryland $20Maryland $20 Maryland $20Maryland $20

New Jersey $45New Jersey $45 New Jersey $45New Jersey $45 Massachusetts $820Massachusetts $820

Kentucky $1,520Kentucky $1,520 Kentucky $1,520Kentucky $1,520 Nebraska $1,020Nebraska $1,020

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Healthcare Cost and Healthcare Cost and Utilization Project (HCUP)Utilization Project (HCUP)

THE LARGEST COLLECTION OF MULTI-STATE, THE LARGEST COLLECTION OF MULTI-STATE, ALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATAALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATA

Documents

The Healthcare Cost and Utilization Project (HCUP) State Databases Agency for Healthcare Research and Quality APHA CEI Session November 2006