March 2008
Issue #14

Contents

News and Announcements: Up-to-the minute information, including newly released databases and products
Recent Publications: A sample of materials, including peer-reviewed journal articles, utilizing 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

Selected 2006 HCUP State Databases Now Available!

HCUP statewide databases are released through out the year. AHRQ is now offering selected calendar year 2006 HCUP statewide databases for purchase. Currently available databases include the following:

• Statewide Inpatient Databases (SID): Arizona, California, Colorado, Florida, Hawaii, Iowa, Kentucky, Maryland, Nevada, New Jersey, New York, North Carolina, Oregon, Utah, Vermont, Washington, West Virginia, and Wisconsin



• Statewide Ambulatory Surgery Databases (SASD): California, Colorado, Iowa, Kentucky, Maryland, New Jersey, New York, North Carolina, Vermont, and Wisconsin



• Statewide Emergency Department Databases (SEDD): Arizona, California, Hawaii, Iowa, Maryland, New Jersey, Vermont, and Wisconsin.

Additional 2006 State databases will be available for purchase as the year progresses. For up-to-date release information throughout the year, please visit the HCUP Product Release Calendar on the HCUP-US Website.

In addition, HCUP is pleased to offer New York’s SASD files for 2005 as well as the following California statewide databases: SID (2003 – 2005), SASD (2005), SEDD (2005).

These and other HCUP databases are available through the HCUP Central Distributor. More information can be found on the HCUP Central Distributor page on the HCUP-US Website.

Fiscal Year 2008 Clinical Classification Software (CCS) for ICD-9-CM Update is now Available

The Clinical Classification Software (CCS) for ICD-9-CM update for Fiscal Year 2008 is now available through the HCUP Central Distributor. The CCS is a diagnosis and procedure categorization scheme that can be employed in many types of projects analyzing data on diagnoses and procedures. CCS is based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). The ICD-9-CM's array of codes—currently at over 13,600 diagnosis codes and 3,700 procedure codes—are collapsed into a smaller, more manageable number of clinically meaningful categories. For researchers interested in presenting descriptive statistics, CCS can be more useful than individual ICD-9-CM codes. For example, CCS can be used to identify populations for disease- or procedure-specific studies, or to develop statistical reports providing information (such as charges and length of stay) about relatively specific conditions.

Now included in the CCS are categories from the Mental Health Substance Abuse Clinical Classification Software (CCS-MHSA), replacing the original CCS categories for mental health and substance abuse. The integration of these two products into a single categorization scheme will allow for more specificity when identifying mental health diagnoses. The CCS single-level software includes the CCS-MHSA general categories, and the CCS multi-level software includes the CCS-MHSA specific categories. For more information on the integration, please see the 2008 Software and User’s Guide. A stand-alone version of the CCS-MHSA is available on HCUP-US for users only interested in mental health and substance abuse discharges.

The Clinical Classification Software is available for download from the Tools & Software page on the HCUP-US Website. For more information on the CCS, please visit the Clinical Classification Software page.

2007 National Healthcare Quality Report (NHQR), National Healthcare Disparities Report (NHDR), and Online State Snapshots Released

The Agency for Healthcare Research and Quality (AHRQ) released the 2007 National Healthcare Quality Report (NHQR) and the 2007 National Healthcare Disparities Report (NHDR) on March 3, 2008. Published annually, the NHQR and NHDR are part of a comprehensive effort to measure the quality of health care in the United States. The reports include a broad set of performance measures that serve as baselines and track trends in health care quality. Racial and socioeconomic health care disparities are measured nationwide, focusing on effectiveness, patient safety, timeliness, and patient centeredness. The NHDR also measures two components of access—facilitators and barriers to health care and utilization. HCUP provides the national estimates for the AHRQ Quality Indicators, which are one of the many types of measures in the reports.

In addition to the reports, state-level estimates from the NHQR are highlighted in the interactive, web-based 2007 State Snapshots, released on March 18, 2008. The State Snapshots provide State-specific statistics on health care quality, including strengths, weaknesses, and opportunities for improvement—providing public and private sector organizations the information to better understand the health care quality and disparities of their State. This year the State Snapshots include several new features: a dashboard for looking at all summary meters at a quick glance, new summary meters for Health People 2010 measures, clinical preventive services measures, and also new dials that show the context of the state’s environment (demographics, health risk, and health resources). Each of these shows the state’s position compared to all reporting states and those in the region.

For more information on the National Healthcare Quality Report (NHQR), National Healthcare Disparities Report (NHDR), and NHQR State Snapshots, please visit the Measuring Healthcare Quality Page on the AHRQ Website.

Comorbidity Software updates for Fiscal Year 2008 to be Released this Spring

HCUP is pleased to announce the upcoming release of the Comorbidity Software for Fiscal Year 2008. The Comorbidity Software, developed by Elixhauser et al., identifies comorbidities in hospital discharge records based on ICD-9-CM codes ("Comorbidity Measures for Use with Administrative Data." Medical Care, 1998;36:8-27).

The Comorbidity Software consists of two computer programs. The first, Creation of Format Library for Comorbidity Groups, generates a format library that maps diagnosis codes into comorbidity indicators. Additional formats are created to exclude conditions that may be complications or that may be related to the principal diagnosis. The second program, Creation of Comorbidity Variables, applies these formats to a data set containing administrative data.

The Fiscal Year 2008 Comorbidity Software updates will be available for download from the Tools & Software page on the HCUP-US Website in April. The software is distributed in ASCII for easy adaptation to other programming languages, such as SAS, SPSS, and Stata. For more information, please visit the Comorbidity Software page, or contact the HCUP Central Distributor by e-mail at HCUPDistributor@ahrq.gov.

Fiscal Year 2008 updates of the CCS Tool for Services and Procedures Due Out Soon

The CCS for Services and Procedures software provides a method for classifying Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes into clinically meaningful procedure categories. The procedure categories are identical to the CCS, with the addition of specific categories unique to the professional service and supply codes in CPT/HCPCS.

The CCS for Services and Procedures takes more than 9,000 CPT/HCPCS codes and 6,000 HCPCS codes and collapses them into 244 clinically meaningful categories that may be more useful for presenting descriptive statistics than individual CPT or HCPCS codes. For example, CCS for Services and Procedures can be used to identify populations for procedure-specific studies, or to develop statistical reports providing information (such as charges and length of stay) about relatively specific procedures.

HCUP anticipates that the CCS for Services and Procedures software for Fiscal Year 2008 will be available in April for download from the Tools & Software page on the HCUP-US Website. For more information, please visit the CCS for Services and Procedures page, or contact the HCUP Central Distributor by e-mail at HCUPDistributor@ahrq.gov.

More information about this and other tools that facilitate research with the HCUP and other administrative health care databases is available on the Tools & Software page on the HCUP-US Website.

New HCUP Statistical Briefs Are Now Available via the HCUP-US Website

The HCUP Statistical Briefs are short, focused reports on topics related to specific conditions, procedures, or populations. The Statistical Briefs are useful to a wide variety of audiences, including policy analysts, decision makers, media personnel, and others in need of summary facts and figures on current health care issues. Recently released Statistical Briefs include: Statistical Brief #42: The National Hospital Bill: Growth Trends and 2005 Update on the Most Expensive Conditions by Payer; Statistical Brief #43: Hospital Stays Involving Chronic Pulmonary Heart Disease, 2005; Statistical Brief #44: Gastroesophageal Reflux Disease (GERD) Hospitalizations in 1998 and 2005; Statistical Brief #45: Circumcisions Performed in U.S. Community Hospitals, 2005; Statistical Brief #46: Hospitalizations for Epilepsy and Convulsions, 2005; Statistical Brief #47: Emergency Department Visits for Adults in Community Hospitals from Selected States, 2005; and Statistical Brief #48: Violence-Related Stays in U.S. Hospitals, 2005.

HCUP Statistical Briefs can be found in the Reports section of the HCUP-US Website.

HCUP to Present a Continuing Education Program at the 2008 Medical Library Association (MLA) Annual Meeting and Exhibition

HCUP staff will present a continuing education program on May 16 at the 2008 Medical Library Association (MLA) Annual Meeting and Exhibition, which will be held at the Hyatt Regency Hotel in Chicago, Illinois, from May 16-21. This four-hour session will focus on expanding awareness of HCUP’s resources among health and medical staff librarians to better assist researchers with securing reliable health care information. A lecture offering an introduction and overview of HCUP, its databases, and the role of HCUP data in medical research will take place in the first half of the session. The second half will provide an interactive demonstration of HCUPnet, the free online query tool, and will allow time to address participant questions. At the meeting, AHRQ will also sponsor an HCUP exhibit booth that showcases a variety of HCUP-related products. Representatives will be available to answer questions about HCUP resources.

Registration and additional information for this event is available on the MLA Website.

HCUP to Offer a Didactic Session at the 2008 Society for Academic Emergency Medicine (SAEM) Annual Meeting

HCUP staff will present a didactic session on May 31 at the 2008 Society for Academic Emergency Medicine (SAEM) Annual Meeting, which will be held at the Marriott Wardman Hotel in Washington, D.C., from May 29-June 1. This two-hour lecture will provide an overview of HCUP, with a particular focus on the emergency department databases. The session will also include an interactive demonstration of the free online query tool, HCUPnet, with time allocated to address participant questions.

Registration and additional information for this event is available on the SAEM Website.

HCUP to Present an Introductory Session at the 2008 AcademyHealth Annual Research Meeting

HCUP staff will present an in-depth introduction to the HCUP databases and related products on June 10 during the 2008 AcademyHealth Annual Research Meeting, which will be held at the Marriott Wardman Park in Washington, D.C., from June 8-10. The 90-minute introductory session will also include a demonstration of HCUPnet, the free, online query system that provides instant access to national, regional, and state-level hospital inpatient statistics based on HCUP data. HCUP will also sponsor an exhibit booth at this meeting.

Registration and additional information for this event will be available on the AcademyHealth Website.

HCUP to Participate in the 2008 Council of State and Territorial Epidemiologists (CSTE) Annual Conference

HCUP staff will display two posters at the 2008 Council of State and Territorial Epidemiologists (CSTE) Annual Conference, to be held at the Adam’s Mark (soon to be Sheraton) Hotel in Denver, Colorado, from June 8-12. Representatives will be available to answer questions on the posters, entitled Hospital and Demographic Influences on the Disposition of Transient Ischemic Attacks and Using Administrative Data for Disease Surveillance. HCUP will also sponsor an exhibit booth at this meeting.

Registration and additional information for this event is available on the CSTE Website.

HCUP to Host a Workshop at the American Society of Health Economists (ASHE) 2nd Biennial Conference

AHRQ staff will be holding a half-day HCUP-MEPS introductory workshop on June 22 at the American Society of Health Economists (ASHE) 2nd Biannual Conference, to be held at Duke University in Durham, North Carolina, from June 22-25. The first part of the session will be a 90-minute introduction to HCUP databases, software, and related products, and will help familiarize participants with HCUP tools such as the Cost-to-Charge Ratio Files and Hospital Market Structure File. The presentation will also include a demonstration of HCUPnet, the free, online query tool that provides instant access to national, regional, and state-level hospital inpatient statistics based on HCUP data. The second part of the presentation will provide a general overview of the MEPS, with a description of available data files, information about online data tools, and some examples of the type of research projects the MEPS data can support. AHRQ will also sponsor an exhibit booth at this meeting.

Registration and additional information for this event is available on the ASHE Website.

HCUP to Hold a Workshop at the 2008 Emergency Medical Services for Children (EMSC) 2008 Annual Grantee Meeting

HCUP staff will present an HCUP workshop at the 2008 Emergency Medical Services for Children (EMSC) Annual Grantee Meeting on June 25, in Bethesda, MD. This 90-minute session will provide an overview of HCUP, specializing on how it relates to pediatric emergency medicine research interests. The session will also include a demonstration of HCUPnet, the free, online query system that provides instant access to national, regional, and state-level hospital inpatient statistics based on HCUP data, with time allocated to address participant questions.

Additional information for this event will be available on the EMSC Website.

Additional HCUP events are noted in the HCUP Calendar.

RECENT PUBLICATIONS

Lee JM, Okumura MJ, Freed GL, Menon RK, Davis MM. Trends in hospitalizations for diabetes among children and young adults: United States, 1993-2004. Diabetes Care, 2007 Dec; 30(12): 3035-3039.

This study uses the 1993-2004 NIS to investigate diabetes hospitalization trends for children and young adults. The findings show a 38% increase in hospitalizations over the time period, from 111,300 patients in 1993 to 166,500 in 2004 with those between the ages of 20-24 and 25-29 showing the largest increases. Hospitalization rates for those younger than 20 years in 2004 were similar to those of 1993. Gender differences were also noted, with the rate of hospitalization increasing 42% for females and 29% for males. Adjusted for inflation, the charges of diabetes hospitalizations for children and young adults rose 130% over this time period, from $1.1 billion to $2.4 billion. The article abstract is available via Pubmed.

Noskin GA, Rubin RJ, Schentag JJ, Kluytmans J, Hedblom EC, Jacobson C, et al. National trends in Staphylococcus aureus infection rates: impact on economic burden and mortality over a 6-year period (1998-2003). Clin.Infect.Dis. 2007 Nov 1;45(9):1132-1140.

This study uses the 1998-2003 NIS to analyze the trends in Staphylococcus aureus (S. aureus) infections for hospitalizations in all inpatient stays, stays involving a surgical procedure, and three specialized types of procedures (invasive cardiovascular, invasive orthopedic surgical, and invasive neurological procedures). The findings showed a drastic increase in the rate of S. aureus infections for all patient stays, surgical procedure stays, and two of the invasive surgical stays (cardiovascular and orthopedic) over the entire six year period. The rate of S. aureus in stays involving invasive neurosurgical procedures was steady between 1998 and 2000, but then increased by 11% each year until 2003. Charges for the five types of stays which involved S. aureus also increased over the time period. Despite the increase in S. aureus diagnoses, in-hospital mortality for these stays decreased significantly over the six years. The article abstract is available via Pubmed.

To access additional publications featuring HCUP data, please visit the Publications from the HCUP Databases page on the AHRQ Website.

USERS' TECH TIP

HCUPnet is a free, online query system that provides users with instant access to the largest set of publicly available, multi-year, all-payer hospital care databases. Until recently, HCUPnet only contained inpatient hospital discharge data. HCUPnet now includes emergency department (ED) data in a new pathway titled "State Statistics on All ED Visits." Based on information within the State Emergency Department Databases (SEDD) and State Inpatient Databases (SID), this option allows users to run data queries on all ED visits in the 23 participating states.

In the new HCUP ED pathway, users can obtain information on all ED visits, those ED visits that were admitted to the hospital, and those ED visits in which a patient was released home. HCUPnet provides information on several aspects of ED visits including the reasons for ED visits, procedures performed during the visit, and hospital charges for visits. Patient and hospital characteristics are also available.

HCUPnet’s step-by-step process is easy to follow. As an example, below are instructions on how to obtain information on the most common conditions treated in the ED in 2005:

1. Access HCUPnet at http://hcupnet.ahrq.gov.



2. Click on the "State Statistics on All ED Visits" link.



3. Select the type of visit of interest:
a. "ED only"—provides statistics for treat-and-release visits (i.e., visits that did not result in admission to that hospital)
b. "Only inpatient stays that originated in the ED"—provides data for ED visits that resulted in admission to that hospital
c. "All ED visits"—combines both output options for a view of all visits originating in the ED, regardless of whether the patient was released from the ED or admitted to that hospital.

For this example, select "All ED visits."


4. Select the type of query of interest:
a. "Statistics on specific diagnoses"
b. "Statistics on all emergency department visits in HCUP states"
c. "Rank order specific diagnoses"

For this example, select "Rank order of specific diagnoses" to obtain the most common diagnoses (conditions) seen in the ED.


5. Select the State and year of interest or select "Aggregate (all States combined)" and the year of interest.
   
   For this example, select "Aggregate (all states combined)" for 2005 (2006 data will be available later this year).



6. Select the type of information of interest:
a. "All emergency department visits in HCUP states"
b. "Diagnoses grouped by Clinical Classification Software (CCS)"
c. "Specific Procedures by ICD-9-CM".

For this example, select "Diagnoses grouped by Clinical Classification Software (CCS)."


7. Select how many CCS diagnosis categories should be ranked:
a. Top 10
b. Top 25
c. Top 50
d. Top 100
e. All

For this example, select "Top 10."


8. Select how to rank order conditions. Several options are available, such as ranking by number of discharges, length of stay, or charges.
   
   For this example, select "By number of discharges."



9. Select the patient and facility characteristics of interest. Several characteristics are available, such as patient age, patient gender, hospital location, and hospital bed size.
   
   For this example, select "All patients in all facilities."



10. The final screen provides the results of the query which includes information on all ED visits (shown below), as well as treat-and-release ED visits (not shown) and ED visits that resulted in a hospital stay (not shown).

State statistics - 2005 Aggregate (all States combined) - first-listed diagnosis only
All ED visits (those that resulted in admission to the hospital and those that did not)

For more information on HCUPnet and the "State ED Statistics on All Stays" feature, please visit the HCUPnet Website. Links to an overview of HCUPnet and a tutorial are available on the top right side of the Web page. Please contact HCUP Technical Assistance at hcup@ahrq.gov with any questions.

HCUP CALENDAR

Upcoming Events:

April 10, 2008: Red Cross Coalition of Disaster Education (CODE) Meeting – Red Cross Offices, Washington, D.C.

HCUP staff will present a brief overview of HCUP resources to participants of the upcoming Red Cross Coalition of Disaster Education (CODE) meeting at the Washington, D.C., Red Cross Headquarters on April 10. Because this meeting is invitation-only, attendance is limited to CODE participants.

May 16-21, 2008: Healthcare Cost and Utilization Project (HCUP): Hands-On Workshop –Medical Library Association (MLA) 2008 Annual Meeting & Exhibition, Hyatt Regency Hotel, Chicago, IL.

HCUP staff will present a four-hour continuing education program on May 16 at the 2008 Medical Library Association (MLA) Annual Meeting and Exhibition, which will be held at the Hyatt Regency Hotel in Chicago, Illinois. An interactive demonstration of the HCUPnet query tool and participant questions will follow an introduction and overview of HCUP, its databases, and the role of HCUP data in medical research. HCUP will also sponsor an exhibit booth at this conference.

May 29-June 1, 2008: Healthcare Cost and Utilization Project (HCUP): Using Administrative Data for Emergency Medicine Research – Society for Academic Emergency Medicine (SAEM) 2008 Annual Meeting, Marriott Wardman, Washington, D.C.

HCUP staff will host a two-hour didactic session on May 31 at the 2008 Society of Academic Emergency Medicine Annual Meeting, at the Marriott Wardman in Washington, D.C., on May 31. This lecture will provide an overview of HCUP, with a particular focus on emergency department databases. The session will conclude with a demonstration of the free online querying tool, HCUPnet, with time allocated to address participant questions.

June 8-10, 2008: HCUP Data for Research on Inpatient, Emergency Department, and Ambulatory Surgery Care – AcademyHealth 2008 Annual Research Meeting, Marriott Wardman, Washington Park, D.C.

HCUP staff will host an in-depth 90-minute introduction to the HCUP databases and related products on June 10 during the 2008 AcademyHealth Annual Research Meeting, to be held in Washington, D.C. The course will include a demonstration of HCUPnet—the free, online query tool that provides instant access to national, regional, and state-level hospital inpatient statistics based on HCUP data. HCUP will also sponsor an exhibit booth at this meeting.

June 8-12, 2008: Hospital and Demographic Influences on the Disposition of Transient Ischemic Attacks? and Using Administrative Data for Disease Surveillance – Council of State and Territorial Epidemiologists (CSTE) 2008 Annual Conference

HCUP staff will display two posters at the 2008 Council of State and Territorial Epidemiologists (CSTE) Annual Conference, to be held at the Adam’s Mark/Sheraton Hotel in Denver, Colorado. Representatives will be available to answer questions on the posters, entitled Hospital and Demographic Influences on the Disposition of Transient Ischemic Attacks and Using Administrative Data for Disease Surveillance, during the conference. HCUP will also sponsor an exhibit booth at this meeting.

June 22-25, 2008: Introduction to the Research Databases from the Agency for Healthcare Research and Quality (AHRQ) – American Society of Health Economists 2nd Biennial Meeting

AHRQ staff will present a half-day HCUP-MEPS introductory workshop on June 22 at the American Society of Health Economists (ASHE) 2nd Biannual Conference, to be held at Duke University in Durham, North Carolina. A 90-minute introduction to HCUP databases, software, and related products, including HCUP tools like the Cost-to-Charge Ratio Files and Hospital Market Structure File, will be presented. A demonstration of HCUPnet will also be provided, and participants will receive a free CD-ROM containing valuable resources that expand on topics covered in the session. The second part of the presentation will provide a general overview of the MEPS, its available data files, information about online data tools, and some examples of the type of research projects the MEPS data can support.

June 25, 2008: Using HCUP for Pediatric Emergency Medicine Research – Emergency Medical Services for Children (EMSC) 2008 Annual Grantee Meeting, Bethesda, MD

HCUP staff will present a 90-minute workshop at the 2008 EMSC Annual Grantee Meeting in Bethesda, MD. This presentation will provide an overview of HCUP, specializing on how it relates to pediatric emergency medicine research interests. The session will also include an interactive demonstration of our free online querying tool, HCUPnet, with time allocated to address participant questions.

Recent Events:

February 4, 2008: HCUP Exhibit: Powerful Data, Meaningful Answers – AcademyHealth 2008 National Health Policy Conference, Washington D.C.

HCUP representatives staffed an exhibit table that provided information about various HCUP resources at the 2008 AcademyHealth National Health Policy Conference on February 4, 2008, at the Capitol Hilton in Washington, D.C. This conference provided an overview of the administration and congressional health policy agendas, as well as plenary and breakout sessions for topics, such as ensuring equitable health care access, fostering better care with better value, and managing system stressors.

January 4, 2008: Healthcare Cost and Utilization Project (HCUP) Workshop—Virginia Commonwealth University School of Medicine, Richmond, VA

AHRQ staff presented a 90-minute workshop at the VCU School of Allied Health Professions on January 4, 2008, 1:00 – 2:30 pm, in Room G605, of the West Hospital Building. The session provided an in-depth overview of HCUP databases and software tools, with a focus on assisting researchers in using HCUP data and resources for their research interests. The workshop also included a demonstration of the HCUPnet, the free online query tool, with time allocated to address attendee questions.

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