April 2005
Issue #2

Contents

News and Announcements: Information on newly released databases, reports, data elements, and tools
Notes from HCUP Partners: Updates and announcements from organizations that make HCUP possible
Publications: A sample of recent peer-reviewed journal articles that utilized HCUP data
Users´ Tech Tip: Answers to commonly asked questions when working with HCUP data
HCUP Calendar: Recent and upcoming conferences or meetings at which HCUP was/will be represented

NEWS AND ANNOUNCEMENTS

AHRQ Releases the 2004 National Healthcare Quality Report and 2004 National Healthcare Disparities Report

The Agency for Healthcare Research and Quality (AHRQ) has released the 2004 National Healthcare Quality Report (NHQR) and the 2004 National Healthcare Disparities Report (NHDR), the second set of Congressionally-mandated annual reports on the quality of health care in America. The 2004 NHQR and NHDR measure health care quality in four key areas: effectiveness, safety, timeliness, and patient centeredness. These reports use HCUP data and the AHRQ Quality Indicators (QIs), in conjunction with several other data sources. The documents include information on the effectiveness of health care, with special emphasis on the processes and outcomes of care, related to specific clinical conditions and services. These seven dimensions of clinical conditions and services include: cancer, diabetes, end-stage renal disease, heart disease, respiratory disease, nursing home care, and home health care. Three key themes were identified within the 2004 NHQR: 1) health care quality is improving, but change takes time; 2) the gap between the best possible care and actual care remains wide and is highly variable across the country; and 3) further improvement is possible using identified best practices and collaborative, focused efforts. The appendix to each report contains complete tables of national estimates by patient characteristics from the AHRQ QIs (based on HCUP databases), and, in addition, the NHQR appendix tables feature statistics by hospital characteristics. For more information or to download a copy of the 2004 NHQR and the 2004 NHDR, please refer to the AHRQ Quality Tools Website.

New Additions Made to the HCUP Methods Series for 2004 NHQR/NHDR

Four documents describing the methods used for HCUP estimates in the 2003 and 2004 National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) will be added to the HCUP Methods Series by mid-April and made available on the HCUP User Support Website (www.hcup-us.ahrq.gov). These documents will explain the methodology used for applying the AHRQ Quality Indicators to the HCUP databases and the calculations used to create national and state estimates reported in the 2003 and 2004 NHQR and NHDR. The HCUP Methods Series features a broad array of methodological information on the HCUP databases and software tools. For more information on the HCUP Methods Series, please see http://www.hcup-us.ahrq.gov/reports/methods/methods.jsp.

Economic and Health Costs of Diabetes Highlights Diabetes-Related Impacts on US Health Care

The costs of diabetes and the severity of the disease have implications for providers, policy makers, and program administrators. Economic and Health Costs of Diabetes, the first release in the HCUP Highlights series, offers information on how diabetes-related complications affect health care costs, individuals´ health status, and frequency of hospitalization in the U.S. Major findings include:

• Reducing hospital admissions for diabetes complications could save the Medicare program $1.3 billion annually and could save Medicaid $386 million a year.
• Nearly one-third of patients with diabetes were hospitalized two or more times in 2001 for diabetes or related conditions; their costs were three times higher, on average, than costs for patients with single hospital stays - $23,100 versus $8,500.
• The risk of hospitalization for cardiovascular disease was two to four times higher for women with diabetes than for women who did not have diabetes.
• African-American, other minority, and poor patients, regardless of race or ethnicity, were more likely to be hospitalized multiple times for diabetes complications than non-Hispanic white and higher income patients.

New Patient Safety Indicator Updates Now Accessible via the AHRQ Quality Indicators Website

The Agency for Healthcare Research and Quality (AHRQ) is pleased to announce a software update to the AHRQ Patient Safety Indicators (PSIs), one of the Quality Indicators (QIs) developed by the Agency. This update incorporates changes to ICD-9-CM codes and Diagnosis Related Groups (DRGs), making the available codes valid from October 1, 1994 through September 30, 2005. This new release impacts the calculation of PSI risk-adjusted rates for users wishing to compute risk-adjusted, expected, and smoothed rates based on the 2002 reference population. All PSI documentation has also been updated to reflect this change, including the ICD-9-CM major operating room procedure codes, which are now available in a separate, downloadable document. More information, as well as the updated software and documentation, is available on the AHRQ Quality Indicators Website at: http://www.qualityindicators.ahrq.gov/modules/psi_resources.aspx.

Updated Cost-to-Charge Ratio Files Added to Collection of HCUP Tools

The Cost-to-Charge ratio files for the 2001 Nationwide Inpatient Sample (NIS) and 2001 State Inpatient Databases (SID) will soon be available. HCUP databases include information on hospital charges, which reflect the total amount billed by the hospital per patient encounter; however, these charges do not reflect the actual cost of providing care. The new cost-to-charge files, developed by Bernard Freidman, Ph.D., allow HCUP data users to convert hospital charge data to cost estimates. Linking HCUP databases with the appropriate files will allow researchers to estimate an all-payer inpatient cost-to-charge ratio for nearly every hospital included in the 2001 NIS and SID. Documentation for these files and guidelines for users will soon be added to the HCUP-US Website within the relevant database information pages. The linkable files will be available by May, and can then be ordered by contacting the HCUP Central Distributor.

Back Year Data Now Available Through the HCUP Central Distributor for 1990-1994

State Inpatient Databases (SID) for 1990-1994 are now available for selected HCUP Partners through the HCUP Central Distributor. Nine states have released their data for the years 1990-1994, including: Arizona, Colorado, Florida, Iowa, Massachusetts, Maryland, New Jersey, New York, and Washington. The SID have also been released for Oregon for the years 1993 and 1994. These releases add to the depth of information available to the research community. For more information on these newly available data releases, as well as all the data available through HCUP, please contact the HCUP Central Distributor.

NOTES FROM HCUP PARTNERS

Hawaii Releases New Public Use Inpatient and Emergency Department Data

Public use data sets of inpatient and emergency department data from Hawaii are now available for licensing through the Hawaii Health Information Corporation (HHIC). Inpatient data are available for the years 1995-2003 and emergency department data are available for the years 2000-2002. These public use data sets include most of the variables collected in hospital discharge abstracts and are designed to provide general health care information to a wide spectrum of users. Considerable efforts were taken to ensure that individual patients cannot be identified from the public use data sets; patient´s age, diagnosis codes, and payers are grouped, and several data elements are encrypted under specific conditions. For more information on these data, or to obtain either of these data sets on CD-ROM, refer to http://www.hhic.org/datasets.html.

RECENT PUBLICATIONS

Kansagra SM, Curtis LH, Schulman KA. Regionalization of Percutaneous Transluminal Coronary Angioplasty and Implications for Patient Travel Distance. JAMA, October 13, 2004; 292(14):1717-23.

Using data from the 2001 HCUP State Inpatient Databases (SID) from Florida, New Jersey, and New York, the authors determined that regionalization of percutaneous transluminal coronary angioplasty (PTCA) procedures would not increase the distance most patients travel; however, further evaluation of other potential costs of regionalization policies must be completed before such policies can be recommended. The complete abstract, from which this brief description was adapted, is available online via PubMed.

Coben JH, Steiner CA, Owens P. Motorcycle-Related Hospitalizations in the United States, 2001. Am J Prev Med, December 2004; 27(5):355-62.

Using the 2001 Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP), the authors examined motorcycle-related hospitalizations in the U.S., including the demographics of patients admitted for motorcycle-related injuries, and the costs associated with resulting treatments. The researchers calculated that on average, for each day in 2001, there were about 25 new lower extremity fractures, 10 new intracranial injuries, and one new spinal cord injury resulting from motorcycle crashes. Median hospital charges for these injuries were $15,404, with total estimated hospital charges exceeding $841 million. A complete abstract is available online via PubMed.

For more publications featuring HCUP data, please consult the AHRQ Website.

USERS' TECH TIP

Trend Analyses with the Nationwide Inpatient Sample (NIS)

Researchers and policy makers use the NIS to identify, track, and analyze national trends in health care utilization, access, charges, quality, and outcomes. At present, 15 NIS databases are available-one for each year from 1988 through 2002. In total, these 15 annual NIS databases contain nearly 100 million discharge records. Several revisions were made to the NIS sample design between 1988 and 2002 that should be taken into account in most trend analyses. First, the sampling frame changed over time as more states made their data available to HCUP. For example, the 1988 NIS was drawn from a frame of eight states representing 31 percent of the U.S. population. In contrast, the 2002 NIS was drawn from a frame of 35 states representing 87 percent of the U.S. population. Second, in 1998 the sampling method changed to better reflect the cross-sectional population of hospitals. The hospital stratification variables were redefined, rehabilitation facilities were dropped from the target universe, and sampling preference was no longer given to prior-year NIS hospitals. Third, the definitions and availability of NIS database variables changed over time. For example, diagnosis and procedure codes and Diagnosis Related Groups (DRGs) changed annually. Analysts who want to use the NIS to estimate trends in patient and hospital outcomes may need to adjust for these changes. For example:

• Trend analyses should include only data from 1993 forward (i.e., exclude the 1988-1992 time span).
• A new weights file should be used for early years of the NIS (pre-1998) to account for changes in the NIS weighting strategy since 1998 (available at http://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp).
• Analysts should take into account ICD-9-CM coding revisions when classifying discharges by medical conditions or by surgical interventions over time.

HCUP CALENDAR

May 11, 2005: Society of General Internal Medicine (SGIM), 28th Annual Meeting, New Orleans, LA

HCUP and MEPS: Data as the Road Out of Chaos
This seminar will provide researchers a comprehensive overview of the design, use, advantages, limitations, and linkages of two large administrative and survey data sets maintained and distributed by the Agency for Healthcare Research and Quality (AHRQ): The Healthcare Cost and Utilization Project databases (HCUP) and the Medical Expenditure Panel Survey (MEPS). Several tools that can be applied to the databases or used to generate information about health care will also be described (e.g., CAHPS, AHRQ Quality Indicators, MEPSnet, HCUPnet). The presentation will include both didactic and interactive modules. Participants will receive detailed packets of information about HCUP, MEPS, and an assortment of tools for use with each data set.

May 14, 2005: Pediatric Academic Societies (PAS), 2005 Annual Meeting, Washington, DC

Agency for Healthcare Research and Quality: News You Can Use!
The focus of this session will be AHRQ's new mission and the implementation of that mission, including funding priorities. A portion of the session will focus on new and enhanced HCUP data and their applications for pediatric health services research.

May 22, 2005: Society for Academic Emergency Medicine (SAEM), 2005 Annual Meeting New York, NY

A Researcher's Introduction to Studying Emergency Department Visits Using MEPS, NHAMCS, and HCUP
This session will provide detailed introductions to three large, publicly available data sets sponsored by the U.S. Department of Health and Human Services, which can be used for health services research studies of emergency departments (EDs). The session will focus on the State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) from HCUP, the Medical Expenditure Panel Survey (MEPS), and the National Hospital Ambulatory Medical Care Survey (NHAMCS). This session will describe each data set in detail and will provide examples of how each can be used to conduct research on ED utilization. Participants will learn the techniques necessary to conduct research using ED encounter data and will learn how to determine which data set is most appropriate for a given research project.

June 25, 2005: 2005 Child Health Services Research Meeting, Boston, MA

HCUP: A National Information Resource to Support Children's Health Care Research and to Inform Health Care Policy and Practice
This session will provide an introduction to publicly available HCUP databases and tools that can be used for pediatric research, including the Nationwide Inpatient Sample (NIS), the Kids´ Inpatient Database (KID), and HCUPnet. In addition, panelists will present findings from HCUP studies on hospital utilization and access for a range of conditions among children and adolescents. During this session, panelists will provide an overview of the most common conditions for which children are hospitalized, an examination of pediatric heart procedures, and a report on the prevalence of mental health and substance abuse conditions among children.

June 27, 2005: 2005 AcademyHealth Annual Research Meeting, Boston, MA

HCUP: Accessing Nationwide & State Administrative Data through the Healthcare Cost and Utilization Project (HCUP)
This session will provide an introduction to HCUP data and will familiarize participants with several HCUP software tools, including HCUPnet-the free, on-line query system that provides instant access to HCUP data. Course participants will receive a CD-ROM containing valuable resources that expand on topics covered in the session, including data file descriptions, research examples that use HCUP data, information on how to access documentation, and instructions on how to obtain HCUP data and tools.

June 29, 2005: 2005 AcademyHealth Annual Research Meeting, Boston, MA

The Healthcare Cost & Utilization Project (HCUP): Data and Tools for Health Services & Policy Analyses
Adjunct meeting: Seminars in Health Services Research Methods. Seven hours, located at the John B. Hynes Veterans Memorial Convention Center, Boston, MA. This interactive, full-day seminar will present an overview of: 1) HCUP data products; 2) How to obtain the data; 3) How to access the tools; 4) The online, comprehensive technical assistance offered through AHRQ; 5) Methods of using the data (statistical program queries will be provided); and 6) The diversity of analyses that HCUP can support. Level: Intermediate. Basic understanding of administrative, inpatient, and outpatient discharge data is necessary.

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