1. The Healthcare Cost and Utilization Project (HCUP) Overview Agency for Healthcare Research and Quality APHA CEI Session  November 2006

2. 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

3. Advancing Excellence in Health Care 3 HCUP Data Are Unique and Powerful 38 State Partners Representing 90% of U.S. Population 90% of Hospital Discharges in U.S. Census of Hospital Care—NOT a Sample

4. Advancing Excellence in Health Care 4 HCUP Supports High Impact Research and Policy Analyses

5. Advancing Excellence in Health Care 5 HCUP Is a Family of Databases, Tools, and Products HCUP Databases Research Publications User Support Software Tools

6. Advancing Excellence in Health Care 6 HCUP Is NOT a Black Box ?

7. Advancing Excellence in Health Care 7 Overview of HCUP Data

8. Advancing Excellence in Health Care 8 HCUP Data Mostly from Community Hospitals Typically not included in HCUP data Source: American Hospital Association (AHA), 2004 Included in HCUP data 85% (N=4,919) 15% (N=840)

9. Advancing Excellence in Health Care 9 Include these hospitals OB-GYNENTOrthopedicPediatricPublic Academic medical Centers Short-term rehabilitation Exclude these hospitals Long-term care PsychiatricAlcoholism/chemicaldependencyRehabilitation AHA definition of community hospitals: Non-Federal, short-term, general, and other specialty hospitals, excluding hospital units of other institutions (e.g., prisons) What Are Community Hospitals?

10. Advancing Excellence in Health Care 10 What Types of Care Does HCUP Inpatient State Inpatient Databases (SID) State Inpatient Databases (SID) Nationwide Inpatient Sample (NIS) Nationwide Inpatient Sample (NIS) Kids’ Inpatient Database (KID) Kids’ Inpatient Database (KID)Outpatient Emergency Room Visits State Emergency Department State Emergency Department Database (SEDD) Database (SEDD) Ambulatory Surgeries State Ambulatory Surgery State Ambulatory Surgery Database (SASD) Database (SASD) [Office Visits] [Pharmacy/Lab/Radiology] Capture [and Not]? Capture [and Not]?

11. Advancing Excellence in Health Care 11 The Foundation of HCUP Data is Billing Data Demographic Data DiagnosesProceduresCharges Billing UB-92 Form

12. Advancing Excellence in Health Care 12 Hospital Billing Data Have Benefits and Limitations Benefits Size Size Uniformity of codes Uniformity of codes Regularity of collection Regularity of collection Ease of access Ease of access All-payer All-payerLimitations Limited clinical detail Limited clinical detail Variable accuracy of coding Variable accuracy of coding No data on individuals outside hospital system No data on individuals outside hospital system

13. Advancing Excellence in Health Care 13 Current HCUP Partners Arizona Department of Health Services Arkansas Department of Health & Human Services California Office of Statewide Health Planning & Development Colorado Health & Hospital Association Connecticut Chime, Inc. Florida Agency for Health Care Administration Georgia GHA An Association of Hospitals & Health Systems Hawaii Health Information Corporation Indiana Hospital&Health Association Illinois Department of Public Health Iowa Hospital Association Kansas Hospital Association

14. Advancing Excellence in Health Care 14 Current HCUP Partners Kentucky Department for Public Health Maine Health Data Organization Maryland Health Services Cost Review Commission Massachusetts Division of Health Care Finance and Policy Michigan Health & Hospital Association Minnesota Hospital Association Missouri Hospital Industry Data Institute Nebraska Hospital Association Nevada Department of Human Resources New Hampshire Department of Health & Human Services New Jersey Department of Health & Senior Services

15. Advancing Excellence in Health Care 15 Current HCUP Partners New York State Department of Health North Carolina Department of Health and Human Services Ohio Hospital Association Office for Oregon Health Policy & Research Oregon Association of Hospitals and Health Systems (1996 data and forward) Rhode Island Department of Health South Carolina State Budget and Control Board South Dakota Association of Health Care Organizations Tennessee Hospital Association

16. Advancing Excellence in Health Care 16 Current HCUP Partners Texas Department of State Health Services Utah Department of Health Vermont Association of Hospitals and Health Systems Virginia Health Information Washington State Department of Health West Virginia Health Care Authority Wisconsin Department of Health and Family Services

17. Advancing Excellence in Health Care 17 The Making of HCUP Data Patient enters hospital Hospital sends billing data and any additional data elements to Data Organizations States store data in varying formats Billing record created AHRQ standardizes data to create uniform HCUP databases

18. Advancing Excellence in Health Care 18 38 States Contribute Data HCUP Process HCUP Uniform Data

19. Advancing Excellence in Health Care 19 KIDKID SIDSID SASDSASD NISNIS SEDDSEDD AHRQ HCUP Databases Data Use Agreement HCUP Central Distributor

20. Advancing Excellence in Health Care 20 Data Use Agreement The HCUP Data Use Agreement implements the data protections of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (Public Law 104- 191) and the Agency for Healthcare Research and Quality (AHRQ) confidentiality statute.

21. Advancing Excellence in Health Care 21 Data Use Agreement NO identification of persons – patients or doctors Hospital identifiers can be used for research, but hospitals can not be identified in any publications (directly or indirectly)

22. Advancing Excellence in Health Care 22 New Requirement: Electronic DUA Course PURPOSE OF THE COURSE Emphasize the importance of data protection  Reduce the risk of inadvertent violations  Describe your individual responsibility when using HCUP data. http://www.hcup-us.ahrq.gov/tech_assist/dua.jsp Takes 15 minutes to Complete

23. Advancing Excellence in Health Care 23 HCUP Has Five Types of Databases State Inpatient DatabasesNationwide Inpatient SampleKids’ Inpatient Database State Ambulatory Surgery Databases State Emergency Department Databases

24. Advancing Excellence in Health Care 24 HCUP Databases State Ambulatory Surgery Databases (SASD) State Inpatient Databases (SID) State Emergency Department Databases (SEDD) Nationwide Inpatient Sample (NIS) Kids’ Inpatient Database (KID)

25. Advancing Excellence in Health Care 25 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

26. Advancing Excellence in Health Care 26 How to Obtain HCUP Data through the HCUP Central Distributor Step 1: Request application kit: Step 1: Request application kit: http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp Step 2: Obtain more information (if needed): Step 2: Obtain more information (if needed): Phone: 866-556-HCUP (4287) toll free E-mail: hcup@s-3.com hcup@s-3.com Step 3: Read and sign the Data Use Agreement (DUA) Step 3: Read and sign the Data Use Agreement (DUA) Step 4: Fax or mail the order form, DUA, and payment to HCUP Central Distributor Step 4: Fax or mail the order form, DUA, and payment to HCUP Central Distributor

27. Advancing Excellence in Health Care 27 How to Learn More About HCUP General Information (or suggestions) – http://www.hcup-us.ahrq.gov/home.jsp http://www.hcup-us.ahrq.gov/home.jsp HCUP Central Distributor – E-mail: hcup@s-3.com; hcup@s-3.c – Phone: 1-866-556-HCUP (4287) HCUPnet – http://hcup.ahrq.gov/HCUPnet.asp Technical Assistance—HCUP User Support – E-mail: hcup@ahrq.gov; hcup@ahrq.gov – Phone: 1-866-290-HCUP (4287)

28. Advancing Excellence in Health Care 28 Healthcare Cost and Utilization Project (HCUP) THE LARGEST COLLECTION OF MULTI-STATE, ALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATA