The Healthcare Cost and Utilization Project HCUP Derivative

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

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

Advancing Excellence in Health Care Nationwide Inpatient Sample (NIS) 3

Advancing Excellence in Health Care What Is the Nationwide Inpatient Sample (NIS)? State Inpatient Databases (SID) Comprehensive hospital discharge data from states 4 Nationwide Inpatient Sample (NIS)

Advancing Excellence in Health Care Purpose of the NIS n Allows national and regional studies of inpatient hospital utilization and charges* * Not recommended for state-level analyses 5

Advancing Excellence in Health Care The NIS Is a Stratified Sample of Hospitals from the SID 5 NIS Strata U. S. Region Urban/Rural Stratified Sample of Hospitals Teaching Status 2004 State Inpatient Databases Ownership/Control N = 4, 906 Hospitals 6 2004 Nationwide Inpatient Sample N = 1, 004 Hospitals Bed Size

Advancing Excellence in Health Care NIS Can NOT Be Used for State. Level Analyses 5 NIS Strata State is NOT included as a stratum U. S. Region Urban/Rural Stratified Sample of Hospitals Teaching Status 2004 State Inpatient Databases Ownership/Control N = 4, 906 Hospitals 7 2004 Nationwide Inpatient Sample N = 1, 004 Hospitals Bed Size

Advancing Excellence in Health Care The NIS Includes Some Specialty Hospitals Includes these specialty hospitals OB-GYN ENT Orthopedic Pediatric Public Academic medical centers Short-term rehabilitation 8 Excludes these specialty hospitals* Long-term care Psychiatric Alcoholism/chemical dependency Rehabilitation *Note: The NIS includes discharges for these types of care if the care was received at community hospitals.

Advancing Excellence in Health Care Differences Between SID and NIS n State Inpatient Databases (SID) – Census of hospitals – More data elements – Encrypted patient IDs in some states n Nationwide Inpatient Sample (NIS) – Sample of hospitals – Fewer data elements, but all standardized – Many value-added data elements n Severity measures 9

The NIS Has Many Value-Added Variables Advancing Excellence in Health Care n Hospital characteristics – – – Region Urban/rural Teaching status Ownership/control Bed size n Clinical Classification Software (CCS) – AHRQ clinical grouper for ICD-9 -CM codes n Median income for patient’s ZIP Code 10

Advancing Excellence in Health Care Four Sets of Severity Measures n All Patient Refined Diagnosis Related Groups (APR-DRGs) – 3 M Health Information Systems n All-Payer Severity-Adjusted Diagnosis Related Groups (APS-DRGs) – HSS, Inc. n Disease Staging – Medstat n AHRQ comorbidity measures – Elixhauser et al. , Medical Care 11

Advancing Excellence in Health Care Statewide Data Systems Participating in NIS # of Data Year States 1988 1989 -1992 1993 -1994 1995 -1996 8 11 17 19 CA, CO, FL, IA, IL, MA, NJ, WA + AZ, PA, WI + CT, KS, MD, NY, OR, SC + MO, TN 1997 -1998 1999 2000 2001 2002 2003 2004 22 24 28 33 35 37 37 + HI, UT, GA + ME, VA + KY, NC, TX, WV + MI*, MN, NE, RI, VT + NV, OH, SD [AZ not available] + AZ, IN, NH [ME not available] + AR [ME & PA not available] *MI entered HCUP partnership in 1999 and PA exited the HCUP partnership in 2004. 12

Advancing Excellence in Health Care n n NIS: Availability and Prices 2000 - 2004 1993 - 1999 1988 - 1992 Student Price (All Years) $200 per data-year $160 per data-year $322 $20 per data-year NIS HCUP Central Distributor 13

Advancing Excellence in Health Care The NIS Can Be Used to Study Many Topics n Use of and charges for hospital services n Medical practice variation n Medical treatment effectiveness n Quality of care and patient safety n Impact of health policy changes n Diffusion of medical technology 14

Advancing Excellence in Health Care Case Study: Encinosa Article Use and Costs of Bariatric Surgery and Prescription Weight-Loss Medications Encinosa WE, Bernard DM, Steiner CA, Chen CC ∙ 2005 15

Advancing Excellence in Health Care Specific Obesity-Related Research Domain Bariatric Surgeries Medical/Surgical Treatment of Obesity 16

Advancing Excellence in Health Care National Estimates of Bariatric Surgery 1998 2002 % Change 1998 -2002 Number of Surgeries 13, 386 71, 733 436 Hospital Costs (millions) $157 $948 503 Mean Cost Per Surgery $11, 705 $13, 215 12. 9 Encinosa, et al 2005 17

Advancing Excellence in Health Care HCUP NIS Documentation http: //www. hcupus. ahrq. gov/db/sta te/nisdbdocumenta tion. jsp 18

Advancing Excellence in Health Care Kids’ Inpatient Database 19

Advancing Excellence in Health Care What Is the Kids’ Inpatient Database (KID)? State Inpatient Databases (SID) Comprehensive hospital discharge data from states Kids’ Inpatient Database (KID) 20

Advancing Excellence in Health Care HCUP’s Other National Database: The KID The Kids’ Inpatient Database Allows national and regional studies of inpatient hospital utilization and charges for children and adolescents 21

Advancing Excellence in Health Care The KID Is a Stratified Sample of Discharges from the SID 3 Strata Uncomplicated Births 2003 State Inpatient Databases Complicated Births N = 6, 456, 281 Pediatric Discharges from 3, 793 Hospitals 22 Pediatric Non-Births 10% st samp ratified le of unco mplic ated births d ifie t a str of % 0 8 ple ed m sa er p es oth charg dis 2003 Kids’ Inpatient Database N = 2, 984, 129 Pediatric Discharges from 3, 438 Hospitals

Differences Between NIS and KID Advancing Excellence in Health Care State Inpatient Databases (SID) Stratified sample of hospitals pediatric discharges NIS 23 KID

Advancing Excellence in Health Care Key Differences Between the 1997, 2000, and 2003 KID 1997 2000 2003 22 27 36 2, 521 2, 784 3, 438 1. 9 million 2. 5 million 3. 0 million # Weighted discharges 6. 7 million 7. 3 million 7. 4 million Age inclusion criteria ≤ 20 years # HCUP states # Hospitals # Unweighted records 24 ≤ 18 years

Statewide Data Systems Participating in KID Advancing Excellence in Health Care Data Year 25 # of States AZ, CA, CO, CT, FL, GA, HI, IL, IA, KS, MD, MA, MO, NJ, NY, OR, PA, SC, TN, UT, WA, WI 1997 22 2000 27 + KY, ME, NC, TX, VA, WV [IL not included] 2003 36 +IL, IN, MI, MN, NE, NH, NV, OH, RI, SD, VT (ME and PA not included)

Advancing Excellence in Health Care KID: Availability and Prices n 1997, 2000, 2003 KID n Student price $200 per data-year $20 per data-year KID HCUP Central Distributor 26

Advancing Excellence in Health Care The KID Can Enable Child-Related Research n Enables studies of common and rare pediatric conditions n Permits exploration of the economic burden associated with specific child-related conditions n Allows comparisons between pediatric and adult inpatient services in conjunction with the NIS 27

Advancing Excellence in Health Care 28

Advancing Excellence in Health Care 29 Availability and Prices – National Databases Nationwide Inpatient Sample n 2000 - 2004 n 1993 - 1999 n 1988 - 1992 n Student Price $200 per data-year $160 per data-year $322 $20 per data-year Kids’ Inpatient Sample n 1997, 2000, 2003 KID n Student Price $200 per data-year $20 per data-year

Advancing Excellence in Health Care How to Obtain HCUP the NIS and the KID through the HCUP Central Distributor n Step 1: Download application kit: http: //www. hcup-us. ahrq. gov/tech_assist/centdist. jsp n Step 2: Obtain more information (if needed): Phone: 866 -556 -HCUP (4287) toll free E-mail: HCUPDistributor@ahrq. gov n Step 3: Read and sign the Data Use Agreement (DUA) n Step 4: Send order form, DUA, and payment to HCUP Central Distributor 30

Advancing Excellence in Health Care Nationwide Inpatient Sample Central Distributor Nationwide Inpatient Sample NIS 2004 Data Cost-to-Charge Ratios HCUPDistributor@ahrq. gov Phone (toll free): (866) 5564287 FAX: (866) 792 -5313 31 Documentation and Tools

Advancing Excellence in Health Care NIS 2004 Data Files Four Types of Fixed-Width ASCII Data Files n Inpatient Core File n Subsample Inpatient Core Files n Hospital Weights File n Disease Severity Measures Files 32

Advancing Excellence in Health Care NIS 2004 Documentation and Tools Files n Documentation Files: Complete file documentation, variable notes, summary statistics, record layouts, CCS/DRG labels n SAS/SPSS Source Code: load programs and library formats n Cost-to-Charge Ratio File 33

Advancing Excellence in Health Care Healthcare Cost and Utilization Project (HCUP) THE LARGEST COLLECTION OF MULTI-STATE, ALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATA 34