Summer 2017, Issue #51
Contents
Missed
the last e-News? Read it on the HCUP-US Web site.
HCUP
Offers Guidance for Using ICD-10-CM/PCS Data
A new ICD-10-CM/PCS Resources section
on the HCUP User Support (HCUP-US) Web site provides information and
educational materials for researchers using the Healthcare Cost and Utilization
Project (HCUP) and other administrative databases.
The ICD-10-CM/PCS
Resources section documents key differences in the structure of HCUP
databases, provides general guidance and forewarning to users analyzing
outcomes that may be affected by the transition to the ICD-10-CM/PCS coding
system, and includes additional Web resources that may be useful to researchers.
If you have any questions or suggestions for additional Federal and State
ICD-10-CM/PCS Web resources, please contact HCUP
User Support.
2015 HCUP
State Databases—Revised Structure and New Data Elements
The HCUP State Databases are annual, calendar-year
files. The introduction of ICD-10-CM/PCS on October 1, 2015, means that the
2015 State Databases include a combination of codes:
- Nine months of the data with ICD-9-CM codes (January
1, 2015, to September 30, 2015)
- Three months of the data with ICD-10-CM/PCS (October
1, 2015, to December 31, 2015)
To alert users to this change in the data, the file
structure of the 2015 HCUP State Databases stores the first three quarters of
data with ICD-9-CM codes separately from the fourth quarter of data with
ICD-10-CM/PCS codes.
In addition, the names of diagnosis- and procedure-related data elements
under ICD-10-CM/PCS have been modified to clearly identify the new coding
scheme. ICD-10-CM/PCS information on the 2015 Nationwide Databases will be
available when the databases are released. Additional information on the 2015
State Databases is available in the ICD-10-CM/PCS Resources
section.
For questions, please contact HCUP
User Support.
Now
Available: Back Years, 2010–2012,
of the Nationwide Readmissions Database (NRD)
In April,
AHRQ released three back years of the Nationwide Readmissions Database (NRD). The NRD is now
available for data years 2010–2014. The NRD is a unique
and powerful database designed to support analyses of national readmission
rates of all payers and the uninsured. This database addresses a large gap in
health care data—the lack of nationally representative information on hospital
readmissions for all ages. Unweighted, the NRD contains data from approximately
15 million discharges each year. Weighted, it estimates roughly 35 million
discharges.
The
NRD is drawn from the State Inpatient Databases (SID). The 2010–2012 NRD were constructed from up to 22 States with
reliable, verified patient linkage numbers in the SID that could be used to
track patients across hospitals within a State, while adhering to strict
privacy guidelines.
The
2010–2012 NRD are available for purchase
through the HCUP Central
Distributor.
Additional information on the 2010–2012 NRD, such
as Summary Statistics, Load Programs, and Data Element
Availability
also are available to users on the HCUP-US Web site.
HCUP Fast
Stats Data Update
HCUP Fast Stats provides easy access
to the latest HCUP-based statistics for health information topics. Fast Stats
uses visual statistical displays in stand-alone graphs, trend figures, or
simple tables to convey complex information at a glance. Recently, this online
tool was updated to add new information to two existing topics.
- AHRQ
updated information in the Opioid-Related
Hospital Use topic. This
Fast Stats update changed the reporting of population-based rates of
opioid-related hospital use from discharge year to discharge quarter. The
update also added 2015 inpatient data for 28 States, 2015 emergency department
(ED) data for 19 States, and 2016 inpatient data for 14 States.
- AHRQ updated information in the State Trends in Hospital Use by Payer topic. This Fast Stats update
added one new State—Ohio—to the inpatient portion of this topic and four new
States—Arkansas, Massachusetts, Montana, and Wyoming—to the ED portion of this
topic. This update also included additional 2015–2016 inpatient data and 2013–2015
ED data where available.
For
additional information, please refer to the HCUP Fast Stats
Frequently Asked Questions page or contact HCUP User Support.
HCUP’s 2016 Outstanding Article of the
Year Awards
Three studies will receive the seventh annual
HCUP Outstanding
Article of the Year Award at the AcademyHealth
Annual Research Meeting. The Award honors articles published in peer-reviewed
journals in 2016 that used HCUP data to explore and address health care
research topics and issues. The award recipients will be announced during the
HCUP Overview presentation on June 26 at 9:30 a.m. C.T. Additional information
is available in the HCUP Calendar of Events.
Since 2010, the Agency for Healthcare
Research and Quality (AHRQ) has recognized exceptional research conducted using
the HCUP databases in the clinical and health policy arenas. This research
continues to enhance public conversation about health care costs, outcomes, and
trends. Over the past 7 years, the Awards have come to be recognized as a
distinguished honor among health services researchers with a variety of
clinical insights, economic interests, and policy backgrounds. AHRQ is proud of
the important work being done with HCUP data, and AHRQ staff members look
forward to future exciting research using HCUP data.
HCUP Data
Users’ Workshop on September 19
On September
19, AHRQ will sponsor a full-day, intermediate-level HCUP data users' workshop
at its headquarters in Rockville, Maryland. This workshop will teach health
services researchers and analysts how to use or improve their use of HCUP
databases and products.
Registration
information and the workshop description will be available in August on the HCUP Workshops and Webinars page.
Learn About HCUP
at September 6 and 13 Webinars
Webinars introducing researchers to HCUP will be held on September 6 and
13. On September 6, Overview of the HCUP Databases will cover an
introduction to the HCUP family of databases. On September 13, Overview of
the HCUP Products and Tools will cover the use of HCUP software tools and
supplemental files to facilitate and augment research.
The Webinars will be open to the public at no charge. Each will require
separate advance registration. Registration information and Webinar
descriptions will be available in August on the HCUP Workshops and Webinars page.
Recently
Released: 2015 State Databases and Additional 2014 Databases
Since March 2017, the following State Databases
have been released:
In
addition, the Nationwide
Readmissions Database (NRD) is now available for data years 2010–2012.
Complete
listings of available databases by year can be found in the Database Catalog on
the HCUP-US Web site. Databases can be purchased online through the HCUP Central Distributor, and aggregated national and selected State statistics can
be accessed via HCUPnet.
For
database purchasing questions, please contact the HCUP
Central Distributor.
New
HCUP Statistical Briefs Posted on HCUP-US
Since March 2017, the
following HCUP
Statistical Briefs
have been released:
-
#222 Delivery Hospitalizations Involving Preeclampsia and Eclampsia, 2005–2014
-
#223 Surgeries in Hospital-Based Ambulatory Surgery and Hospital Inpatient
Settings, 2014
To access these and other Statistical Briefs,
please visit the Statistical Briefs page on the HCUP-US Web site.
New
HCUP Methods Series Report Now Available
Since March 2017, the following Methods
Series Report has been released:
Method Series Report #2017-02:
Feasibility Report on Redesigning the Nationwide Emergency Department
Sample (NEDS) discusses
considerations for a redesign of the NEDS, evaluates the possible changes,
summarizes comparative analyses of alternative designs to external data sources,
and offers recommendations for redesigning the NEDS.
This report and other HCUP reports can be
found on the HCUP
Reports page.
Publications Using
HCUP Data
Feldman D, Swaminathan R, Geleris J, et al.
Comparison of trends and in-hospital outcomes of concurrent carotid artery revascularization
and coronary artery bypass graft surgery: the United States experience 2004 to
2012. JACC Cardiovasc Interv. 2017;10(3):286-98.
This study used the 2004–2012 National (Nationwide) Inpatient Sample
(NIS)
to examine trends in carotid endarterectomy and carotid artery stenting utilization
when performed during the same hospitalization as a coronary artery bypass
graft. In-hospital outcomes also were examined by patient age, sex, and carotid
artery disease status. The article abstract is available via PubMed.
Whitman I, Agarwal V, Nah G, et al. Alcohol abuse
and cardiac disease. J Am Coll Cardiol. 2017;69(1):13-24.
This study
uses the 2005–2009 California State Inpatient Databases (SID), State Ambulatory Surgery and Services
Databases (SASD),
and State Emergency
Department Databases (SEDD) to evaluate the relationship between alcohol abuse and
atrial fibrillation, myocardial infarction, and congestive heart failure. The
article abstract is available via PubMed.
To read additional recently published
articles featuring HCUP data, please visit the Research Spotlights page on the HCUP-US Web site.
Question:
It appears that HCUPnet has been redesigned. I have
some questions regarding this newly redesigned site’s functionality.
- Will the new HCUPnet
site have all the functionality of the archived site?
- How do I select patient
and hospital characteristics? Outcomes and measures? Previously, these options
were displayed on one screen during the step-by-step query process on the archived
site.
- For one of my queries, I
am querying several ICD-9-CM diagnosis codes. I am interested in both mean and
median costs and charges, but median does not appear to be an available option.
Is that intentional?
- In the same query of
multiple ICD-9-CM diagnosis codes, I noticed that standard errors are not
present. Is that intentional?
- I recently purchased the
Nationwide Readmissions Database (NRD) and am using HCUPnet as a point of
comparison for my results. My analysis is looking at readmission rates for
certain diagnosis-related groups (DRGs). Although my counts/rates are close,
they do not match those from HCUPnet—do you know why that might be?
Answers:
Will the new HCUPnet site have
all the functionality of the archived site?
Yes, the new, redesigned HCUPnet site will have all the functionality of the older, archived
site. AHRQ
is in the process of transferring functionality to the new site and will have most
searches available by June 15, when the archived site is retired.
AHRQ will add the remaining searches and some
additional enhancements in successive updates through the summer. Current
functionality lets you query inpatient (including readmissions), emergency
department, ambulatory surgery, and community (county) statistics, however not
all search options are possible yet. Searches for inpatient stays can be
conducted using ICD-9-CM codes, Clinical Classifications Software (CCS), DRG, major-diagnostic
category (MDC), and service line classifications; searches for other data types
may be available only by CCS or by CCS and ICD-9-CM codes. The two-way tables
option was just added to the redesigned site last month.
It is important to note that the newly redesigned
HCUPnet site will have some additional functionality that the archived site does
not offer currently. For instance, users now can select an option that displays
related diagnoses and procedures for conditions of interest.
Users are encouraged to explore HCUPnet regularly to determine
what has been added over the course of the summer. For additional information
or questions related to HCUPnet, please contact HCUP User Support.
How do I select patient and
hospital characteristics? Outcomes and measures? Previously, these options were
displayed on one screen during the step-by-step query process on the archived
site.
To obtain this information you will need to follow
a two-step process.
First, from the HCUPnet homepage, create a new analysis in which you will indicate the
type of information in which you are interested (i.e., hospital inpatient,
emergency department, or ambulatory surgery data) as well as whether you are
interested in specific diagnoses or procedures or all patients in general.
Once the results are displayed from your initial
analysis on the HCUPnet homepage, you can refine the search by using the
navigation bar on the left-hand side to make changes to your analysis. “Outcomes
and Measures” display the same options available to users on the archived as
well as some newly added options such as readmissions. Although previously
combined, “Patient Characteristics” and “Hospital Characteristics” now are two
separate options available to users, each of which includes the same options as
the archived site with new options to be added in the future.
In addition to selecting outcomes and measures or
patient/hospital characteristics, you can change your setting of care, the geographic
setting, or the year of your analysis as well as make changes to the way
diagnoses or procedures are classified or displayed.
To add an option to your query, click on the
adjacent plus sign and then submit your request. The screen then will regenerate
your results.
For one of my queries, I am querying several ICD-9-CM diagnosis codes. I
am interested in both mean and median costs and charges, but median does not
seem to be an available option. Is that intentional?
If you selected the
“Combine All Codes” option when entering your diagnoses or procedures of
choice, then yes, median charges and costs are not available measures. You
cannot obtain median values when all codes are combined because HCUPnet is
unable to calculate medians by reaggregating the medians for each individual
ICD-9-CM code. Median charges and costs statistics are available, however, if
you modify your search so that each ICD-9-CM code is queried separately. Another
option is to use a pre-aggregated classification of diagnoses, such as CCS or
DRG or alternatively, purchase the full HCUP database.
For additional
information on purchasing HCUP databases, please contact the HCUP Central Distributor.
In
the same query of multiple ICD-9-CM diagnosis codes, I noticed that standard
errors are not present. Is that intentional?
Like the option for
median costs or charges, HCUPnet is unable to calculate standard errors when
the option “Combine All Codes” is selected. This is a limitation of the way
that the data are aggregated for the Web site. To obtain this information, you
would need to purchase the full HCUP database.
It is also
important to note that in general, standard errors are not present in HCUPnet
for State-level statistics because they are often not applicable. A standard
error is a measure of the precision of a statistic. It reflects the amount that
a sample statistic’s value would fluctuate if a large number of samples
were to be drawn using the same sampling design. All the HCUP Nationwide
Databases are samples and because of this design methodology, standard errors
are provided in HCUPnet given that all nationwide statistics are weighted to be
representative of the entire U.S. population. The HCUP State Databases,
however, are not samples, they capture the universe of inpatient and outpatient
discharge records in participating HCUP States.
I
recently purchased the Nationwide Readmissions Database (NRD) and am using
HCUPnet as a point of comparison for my results. My analysis is looking at
readmission rates for certain diagnosis-related groups (DRGs). Although my
counts/rates are close, they do not match those from HCUPnet—do you know why that
might be?
The discrepancy you
describe most likely is the result of differing methodology between your
analysis and HCUPnet. In your specific analysis, you are using the NRD data
element DRG, which takes into
consideration whether a condition was present on admission (POA).
National statistics in
HCUPnet based on DRGs were created without consideration of POA (HCUP data
element DRG_NoPOA). That decision was made
because POA information is not uniformly available from all participating HCUP
Partners.
Additional discrepancies
may be the result of other varying methodology such as inclusion/exclusion
criteria or the definition of an index stay. Additional information on the
methodology used to define readmissions in HCUPnet is available at https://hcupnet.ahrq.gov/#method-readmissions or in the Introduction
to the NRD.
For a complete list of HCUP presentations and
events, visit the HCUP Events Calendar.
-
June 25–27, 2017: AcademyHealth Annual
Research Meeting (ARM)
○ Interest
Group Sessions
On
June 24, HCUP staff will present three interest group podium presentations and
one interest group poster:
▪ Changes
in Young Adult Hospital Service Demand: 2007–2014
▪ Medicare
Advantage Penetration and Hospital Costs
▪ Medicare
Advantage Penetration and Readmissions
▪ Changes
in Hospital Service Demand, Cost, and Patient Illness Severity Following Health
Reform
○ Poster
Presentations
On
June 25–26, HCUP
staff will present eight posters:
▪ Accountable
Care Organizations and Inpatient Mortality Rates
▪ Young Adult,
Health Insurance Expansions, and Hospital Services Utilization
▪ Changes
in Hospital Service Demand, Cost, and Patient Illness Severity Following Health
Reform
▪ Readmissions
Following Inpatient Treatment for Opioid-Related Conditions
▪ Effects
of Medicaid Expansion Under the Affordable Care Act on Medicaid and Uninsured Utilization
of Acute Care at Safety-Net and Nonsafety-Net Hospitals
▪ Medicare
Advantage Penetration and Hospital Costs
▪ Medicare Fee-for-Service
Spillovers on Readmissions After Implementation of the Hospital Readmissions
Reduction Program
▪ Returns
to Emergency Department, Observation, or Inpatient Care Within 30 Days After
Hospitalization, 2009–2010
to 2013–2014
○ Concurrent
Session
On
June 26 at 9:30 a.m. C.T., HCUP staff will provide an HCUP Overview and present
the winners of the AHRQ-AcademyHealth Outstanding Article of the Year Award.
Representatives will be available to provide information and answer questions.
○ Exhibit
Booth
On
June 25–27, HCUP
staff will sponsor an exhibit booth. Representatives will be available to
provide information and answer questions.
The HCUP e-News is
available online at the HCUP-US
Web site and distributed via the HCUP Mailing List.
For more information and questions regarding
the HCUP e-News, please email hcup@ahrq.gov
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