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

Advancing Excellence in Health Care 2 Healthcare Cost and Utilization Project (HCUP) THE LARGEST COLLECTION OF MULTI-STATE, ALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATA

Advancing Excellence in Health Care 3 HCUP State Databases State Ambulatory Surgery Databases (SASD) State Inpatient Databases (SID) State Emergency Department Databases (SEDD)

Advancing Excellence in Health Care 4 Outline of Presentation Overview of State Database Data Elements Research Example Availability and Pricing File Structure

Advancing Excellence in Health Care 5 State Inpatient Databases (SID)

Advancing Excellence in Health Care 6 What are the State Inpatient Databases (SID)? State Inpatient Databases (SID) Comprehensive hospital discharge data from states

Advancing Excellence in Health Care 7 What Is the Source for the SID? Inpatient hospital data: uniform billing data (UB-92) Data organization provides data to HCUP Data organization provides data to HCUP HCUP collects and standardizes data to create SID HCUP collects and standardizes data to create SID

Advancing Excellence in Health Care 8 SID File Structure Range of file sizes Range of file sizes – ~ 56,000 to 3.9 million records per state Core set of variables Core set of variables – Patient demographics – Expected payment source – All listed diagnoses and procedures State-specific variables State-specific variables – Patient race/ethnicity – Encrypted patient identifier – Patient ZIP code – AHA hospital identifier

Advancing Excellence in Health Care 9 How Do the SID Differ from State Data Files? Unique attributes of the SID: Subset of data elements Subset of data elements Value-added data elements Value-added data elements Uniformly coded across the states Uniformly coded across the states Data protection Data protection Standard data quality checks Standard data quality checks Developed for cross-state analysis Developed for cross-state analysis

Advancing Excellence in Health Care 10 The SID Contains Three Types of 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

Advancing Excellence in Health Care 11 Core File Contains Patient Information Contains common data elements (the nucleus of the SID) and state-specific data elements Core File (Patient Demographic and Clinical Info)

Advancing Excellence in Health Care 12 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

Advancing Excellence in Health Care 13 Some Data Elements Vary by State Race/Ethnicity Race/Ethnicity Patient county Patient county Patient ZIP Code Patient ZIP Code Severity of illness Severity of illness Birthweight Birthweight Procedure date (days from admission) Procedure date (days from admission) Primary payer details Primary payer details Secondary payer Secondary payer Detailed charges Detailed charges Patient identifiers encrypted Patient identifiers encrypted Physician identifiers encrypted Physician identifiers encrypted Physician specialty Physician specialty Hospital identifier unencrypted Hospital identifier unencrypted

Advancing Excellence in Health Care 14 Standardized Data Elements PAY1_XPAY1 ValueDescriptionValueDescription MMedicare1 DMedicaid2 B Blue Cross and Blue Shield 3Private Insurance I, S Other Insurance Comp; Self Ins HHMO-PPO PSelf-pay4 ZFree5No charge WWorkers' Comp 6Other CCHAMPUS E, NOther Government L, OOther 3, 5, A, F, G, J, K, Y Unknown.Missing Other values.AInvalid

Advancing Excellence in Health Care 15 Standardized Data Elements RACE_XRACE ValueDescriptionValueDescription 1White1 2Black2 3Hispanic3 4Hawaiian 4 Asian or Pacific Islander 5Chinese 6Filipino 7Japanese 8Other Asian 9 Other Pacific Islander 10 Native American 5 11Mixed or Other6Other

Advancing Excellence in Health Care 16 Encrypted Patient Identifiers Multiple admissions by the same patient can be linked in some HCUP SID WITHIN INSTITUTIONS ACROSS INSTITUTIONS ACROSS DATABASES

Advancing Excellence in Health Care 17 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 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 Prior to 2003 data, E codes were coded in the ICD-9-CM diagnosis field, but are now included in a separate data field

Advancing Excellence in Health Care 18 Charges File Contains Detailed Charge Information Charges = Costs Charges = Payments Charges File (Detailed Charges)

Advancing Excellence in Health Care 19 Cost-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

Advancing Excellence in Health Care 20 Hospital File Allows Linking with AHA Survey of Hospitals Not all SID include AHA linkage data elements: Individual states decide AHA Linkage File 10 (Hospital Characteristics)

Advancing Excellence in Health Care 21 HCUP Links to Other Databases ZIP Code Level Census Characteristics Health Resources and Services Administration’s (HRSA) Area Resource File (ARF) American Hospital Association (AHA) Annual Survey Medicare Cost Reports HCUP Databases NISKID SASDSEDDSID AHA ID County ZIP Code Medicare ID

Advancing Excellence in Health Care 22 State Participation in SID Continues to Grow

Advancing Excellence in Health Care 23 States Releasing SID through HCUP Central Distributor States Releasing SID through HCUP Central Distributor Arizona Arizona California California Colorado Colorado Florida Florida Iowa Iowa Kentucky Kentucky Maine Maine Maryland Maryland Massachusetts Massachusetts Michigan Michigan Nebraska Nebraska Nevada Nevada New Jersey New Jersey New York New York North Carolina North Carolina Oregon Oregon Rhode Island Rhode Island South Carolina South Carolina Utah Utah Washington Washington West Virginia West Virginia Wisconsin Wisconsin 1990 – 2004* * Note: Not all states participate in all years.

Advancing Excellence in Health Care 24 SID: Availability and Prices SID available for SID available for Availability and prices vary by state and year Availability and prices vary by state and year ~ $20 per data-year to ~ $3,000 per data-year HCUP Central Distributor SID

Advancing Excellence in Health Care 25 The SID Supports Interesting Research Topics Enumeration of all hospitals and discharges within market areas or states Enumeration of all hospitals and discharges within market areas or states Investigation of questions unique to one state Investigation of questions unique to one state Comparison of data from two or more states Comparison of data from two or more states Research of market areas or small area variation analyses Research of market areas or small area variation analyses Identification of state-specific trends in inpatient care utilization, access, charges, and outcomes Identification of state-specific trends in inpatient care utilization, access, charges, and outcomes

Advancing Excellence in Health Care 26 HCUP SID Documentation us.ahrq.gov/db/state/siddbdocum entation.jsp us.ahrq.gov/db/state/siddbdocum entation.jsp

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Advancing Excellence in Health Care 29 State Ambulatory Surgery Databases (SASD)

Advancing Excellence in Health Care 30 What are the State Ambulatory Surgery Databases (SASD)? State Ambulatory Surgery Databases (SASD) Ambulatory surgery data from the states

Advancing Excellence in Health Care 31 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 Data organizations provides data to HCUP– collection varies by state HCUP collects and standardizes data to create SASD HCUP collects and standardizes data to create SASD

Advancing Excellence in Health Care 32 Inclusion of Free-standing ASCs Varies By State STATEHOSPITAL-BASED ASCs FREESTANDING ASCs Colorado YesNo Florida Yes Kentucky Yes Maine YesNo Maryland YesNo Nebraska YesNo New Jersey YesNo New York Yes North Carolina Yes Utah Yes Wisconsin Yes

Advancing Excellence in Health Care 33 SASD File Structure Range of file sizes Range of file sizes – ~ 105,000 to 2.7 million records per state Core set of variables Core set of variables – Patient demographics – Expected payment source – All listed diagnoses and procedures State-specific variables State-specific variables – Patient race/ethnicity – Encrypted patient identifier – CPT codes

Advancing Excellence in Health Care 34 The SASD and SID Can Provide a More Complete Picture of Care SASD SID The SASD can be linked to the SID for selected states Encrypted Patient ID

Advancing Excellence in Health Care 35 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 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 SASD provides coverage for the vast majority of ambulatory surgeries performed

Advancing Excellence in Health Care 36 States with Ambulatory Surgery Databases Colorado Colorado Connecticut Connecticut Florida Florida Georgia Georgia Iowa Iowa Indiana Indiana Kentucky Kentucky Maine Maine Maryland Maryland Michigan Michigan Minnesota Minnesota Missouri Missouri Nebraska Nebraska New Hampshire New Hampshire New Jersey New Jersey New York New York North Carolina North Carolina Ohio Ohio South Carolina South Carolina Tennessee Tennessee Utah Utah Vermont Vermont Wisconsin Wisconsin

Advancing Excellence in Health Care 37 SASD: Availability and Prices SASD available for SASD available for Availability and prices vary by state and year Availability and prices vary by state and year ~ $20 per data-year to ~ $3,000 per data-year HCUP Central Distributor SASD

Advancing Excellence in Health Care 38 Many Potential Applications of the SASD Identify state-specific trends in ambulatory surgery utilization, access, charges, and outcomes Identify state-specific trends in ambulatory surgery utilization, access, charges, and outcomes Conduct market area research Conduct market area research Compare inpatient surgery data with ambulatory surgery data Compare inpatient surgery data with ambulatory surgery data Examine complications for ambulatory surgeries Examine complications for ambulatory surgeries

Advancing Excellence in Health Care 39 HCUP SASD Documentation us.ahrq.gov/db/state/sasd dbdocumentation.jsp us.ahrq.gov/db/state/sasd dbdocumentation.jsp

Advancing Excellence in Health Care 40 State Emergency Department Databases (SEDD)

Advancing Excellence in Health Care 41 What are the State Emergency Department Databases (SEDD)? State Emergency Department Databases (SEDD) Emergency department data from the states

Advancing Excellence in Health Care 42 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 Data organization provides data to HCUP HCUP collects and standardizes data to create SEDD HCUP collects and standardizes data to create SEDD

Advancing Excellence in Health Care 43 The Flow of Emergency Department Visits Released Home/ Community Admitted to Inpatient Hospital Intake ClinicianTreatment Emergency Care Complete SEDD SID

Advancing Excellence in Health Care 44 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

Advancing Excellence in Health Care 45 The SEDD Can Provide a More Complete Picture of Care SEDD The SEDD can be linked to the SID for selected states SID Encrypted Patient ID

Advancing Excellence in Health Care 46 How Do the SEDD Compare to Other Databases? Number of visits benchmarks well against American Hospital Association (AHA) Annual Survey 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) Percent of visits related to injury is similar to the National Hospital Ambulatory Medical Care Survey (NHAMCS)

Advancing Excellence in Health Care 47 Some Interesting Ways to Use the SEDD for Research Injury surveillance Injury surveillance Trends in ED use Trends in ED use Correlations between ED use and environmental events Correlations between ED use and 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 states ED visits and re-visits for some states

Advancing Excellence in Health Care 48 States with Emergency Department Databases Connecticut Connecticut Georgia Georgia Hawaii Hawaii Indiana Indiana Iowa Iowa Maine Maine Maryland Maryland Massachusetts Massachusetts Minnesota Minnesota Missouri Missouri Nebraska Nebraska New Hampshire New Hampshire New Jersey New Jersey Ohio Ohio South Carolina South Carolina Tennessee Tennessee Utah Utah Vermont Vermont Wisconsin Wisconsin

Advancing Excellence in Health Care 49 SEDD: Availability and Prices SEDD available for SEDD available for Availability and prices vary by state and year Availability and prices vary by state and year ~ $20 per data-year to ~ $3,000 per data-year HCUP Central Distributor SEDD

Advancing Excellence in Health Care 50 HCUP SEDD Documentation

Advancing Excellence in Health Care 51 How to Obtain HCUP State-Level Databases through the HCUP Central Distributor Step 1: Determine if the state of interest releases their data Step 1: Determine if the state of interest releases their data through the HCUP Central Distributor: through the HCUP Central Distributor: Step 2: Download application kit: Step 2: Download application kit: Step 3: Obtain more information (if needed): Step 3: Obtain more information (if needed): Phone: HCUP (4287) toll free Step 4: Read and sign the Data Use Agreement (DUA) Step 4: Read and sign the Data Use Agreement (DUA) Step 5: Send order form, DUA, and payment to HCUP Step 5: Send order form, DUA, and payment to HCUP Central Distributor Central Distributor

Advancing Excellence in Health Care 52 Availability and Prices – State Databases State Databases: Availability and Prices Vary by State SID 2004 SASD 2004 SEDD 2004 Maryland $20 New Jersey $45 Massachusetts $820 Kentucky $1,520 Nebraska $1,020

Advancing Excellence in Health Care 53 Healthcare Cost and Utilization Project (HCUP) THE LARGEST COLLECTION OF MULTI-STATE, ALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATA