Winter 2015 Issue #45
Contents
News and Announcements: Notable news from HCUP
Databases and Products: New database and product releases
Publication Spotlights: Recent works incorporating HCUP data and tools
HCUP Q&A: Answers to your HCUP questions
Now Available: HCUP Nationwide Readmissions Database (NRD)
The Agency for Healthcare Research and Quality (AHRQ) has released the Nationwide Readmissions Database (NRD), a new annual database that can be used to create estimates of national readmission rates. This database provides nationally representative information on hospital readmissions for all payers, thereby filling a large gap in health care data. The NRD uses Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) with verified patient linkage numbers. The database includes discharges from community hospitals, excluding rehabilitation and long-term acute care hospitals. It includes discharges for patients with and without repeat hospital visits and for those who have died in the hospital.
The NRD is designed to be flexible to various types of readmissions analyses. Repeat hospital visits may or may not be related. Table 1 shows the top five diagnoses related to readmissions within 30 days for 2013.
Table 1. Top Five All-Patient Readmissions Within 30 Days, National Statistics, 2013 | ||||
Rank | Diagnosis: Clinical Classifications Software category number and name | Number of all-cause 30-day readmissions | Percent readmitted within 30 days | |
1 | 2 | Septicemia | 191,156 | 18.90 |
2 | 108 | Congestive heart failure, nonhypertensive | 183,534 | 23.47 |
3 | 122 | Pneumonia | 127,601 | 15.47 |
4 | 657 | Mood disorders | 114,385 | 15.31 |
5 | 127 | Chronic obstructive pulmonary disease and bronchiectasis | 114,067 | 20.01 |
The 2013 NRD can be purchased through the HCUP Central Distributor, and select statistics can be accessed viaHCUPnet. Additional information can be found on the NRD Overview Page or by contacting HCUP User Support.
Learn About the HCUP Nationwide Readmissions Database at December 9 and 16 Webinars: Registration Now Open!
Two Webinars introducing researchers to the HCUP Nationwide Readmissions Database will be held on December 9 and 16. The first, Overview of the HCUP Nationwide Readmissions Database (NRD), covers an introduction to the NRD. The second, Utilization of the HCUP Nationwide Readmissions Database (NRD), educates users on how to produce and explore variances in rates of readmissions. The Webinars are open to the public. Registration for both Webinars opens December 2 and will close as soon as capacity has been reached. Additional details are posted on theHCUP Workshops and Webinars page.
HCUP Nationwide Readmissions Database Tutorial Recently Released
HCUP has released a new online course titled Nationwide Readmissions Database Tutorial. The tutorial was created for researchers who are interested in using the HCUP NRD to produce national readmissions estimates. The tutorial is divided into two main sections: Database Design and Using the NRD. Database Design provides background on the NRD, how it was designed, key data elements, and its limitations. Using the NRD provides sample event criteria to help researchers calculate national estimates of readmission rates using the database.
Now Available: The 2013 National Inpatient Sample (NIS)
The 2013 National Inpatient Sample (NIS) was released in October. The NIS is the largest inpatient care database in the United States. It provides data on all patients regardless of payer, so it includes patients covered by Medicare, Medicaid, private insurance, and those who are uninsured.
The NIS is a powerful database that contains data from approximately 7 million hospital stays in 47 States and the District of Columbia. NIS data can be weighted to produce national estimates, allowing researchers and policymakers to identify, track, and analyze national trends in health care utilization, access, charges, quality, and outcomes.
The 2012 NIS was redesigned to improve national estimates. The previous NIS contained all discharge records from a sample of hospitals participating in HCUP. The revised NIS contains a sample of discharge records from all hospitals participating in HCUP. The new sample strategy is expected to result in estimates with more precise statistical properties than the previous NIS design. To highlight the design change, beginning with 2012 data, AHRQ renamed the NIS from the Nationwide Inpatient Sample to the National Inpatient Sample. More information about the NIS redesign can be found in the NIS Redesign Final Report.
The 2013 NIS is available for purchase through the HCUP Central Distributor, and select statistics can be accessed viaHCUPnet.
Coming Soon: 2013 Nationwide Emergency Department Sample (NEDS)
AHRQ plans to release the 2013 Nationwide Emergency Department Sample (NEDS) later this month. The NEDS is the largest all-payer emergency department (ED) database in the United States. It contains information about geographic, hospital, patient, and visit characteristics.
The NEDS enables analyses of ED utilization patterns and yields information that supports public health professionals, administrators, policymakers, and clinicians as they make decisions regarding this critical source of care.
Once released, the 2013 NEDS will be available for purchase through the HCUP Central Distributor. Select aggregated statistics can be accessed via HCUPnet.
HCUP Fast Stats Data Update!
AHRQ has updated the first topic in HCUP Fast Stats, Effect of Medicaid Expansion on Hospital Use, to include newly received quarterly and annual inpatient data. Since its initial release in July 2015, the tool has been updated to include 2015 data (added for 7 States) and to augment 2014 data (for a total of 22 States with 2014 data). The 7 States with 2015 data are Colorado, Hawaii, Iowa, Michigan, Missouri, New Jersey, and Wisconsin.
Another update in Effect of Medicaid Expansion on Hospital Use is planned for later this month. In addition, AHRQ will release a new topic: National Hospital Utilization and Costs. This new topic includes national statistics on trends in inpatient stays, the most common diagnoses for inpatient stays, and the most common operations that occur during an inpatient stay.
For additional information, please refer to the Fast Stats Frequently Asked Questions page or contact HCUP User Support.
Updates to the HCUP Online Tutorial Series to Highlight the 2012 NIS Redesign
AHRQ is pleased to announce that two trainings from the HCUP Online Tutorial Series have been updated to account for the redesign of the 2012 NIS. The Online Tutorial Series was designed to provide data users with information about HCUP data and tools as well as training on technical methods for conducting research using HCUP databases.
- The Multi-year Analysis Tutorial presents solutions that are necessary when conducting analyses that span multiple years of the HCUP NIS, Kids’ Inpatient Database (KID), and NEDS. The tutorial was updated to account for major changes in the NIS sampling design, which occurred in 2012 to improve national estimates. In order to facilitate analysis of trends using multiple years of NIS data, AHRQ makes available the NIS Trend Weight Files to help with analysis using multiple years of NIS data prior to 2012.
- The Producing National Estimate Tutorial demonstrates how the three Nationwide Databases—the NIS, NEDS, and KID—can be used to produce national and regional estimates. The tutorial was updated to account for major changes in the NIS sampling design. Beginning with data from 2012 (after the NIS redesign), hospital weights are not included because they are no longer necessary. The NIS data from 2012 and forward should be weighted to produce discharge-level estimates only.
More information about the NIS redesign can be found in the NIS Redesign Final Report. For additional questions related to the HCUP Online Tutorial Series, please contact HCUP User Support.
HCUP Releases Neonatal and Maternal Hospital Stays Related to Substance Use Infographic
HCUP has released a new infographic, Neonatal and Maternal Hospital Stays Related to Substance Abuse, 2006–2012, which visually presents data from HCUP Statistical Brief #193: Neonatal and Maternal Hospital Stays Related to Substance Use, 2006–2012. This Statistical Brief examines the prevalence and costs of newborn and maternal inpatient hospital stays associated with substance use, including abuse of prescription drugs or use of illicit drugs or alcohol. The infographic is available on the HCUP-US Web site in PDF, JPEG, and text formats.
Recently Released: Additional State Databases
Since September 2015, the following 2014 State Databases have been released:
- State Inpatient Databases (SID)
- Arizona, Florida, Iowa
- State Ambulatory Surgery and Services Databases (SASD)
- Florida, Iowa
- State Emergency Department Databases (SEDD)
- Arizona, Florida, Iowa
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 statistics for selected States can be accessed via HCUPnet.
New HCUP Statistical Briefs Posted on HCUP-US
Since September 2015, the following HCUP Statistical Brief has been released:
- #195 Trends in Potentially Preventable Inpatient Hospital Admissions and Emergency Department Visits
- #196 Trends in Hospital Readmissions for Four High-Volume Conditions, 2009-2013
- #197 Characteristics and Quality of Inpatient Stays at Hospitals Affiliated With Health Systems, 2009-2012
To read this and other Statistical Briefs, please visit the Statistical Briefs page on the HCUP-US Web site.
New HCUP Method Series Report Now Available
Methods Series Report #2015-08: User Guide – An Examination of Expected Payer Coding in HCUP Databases (Updated for 2013 Data) presents detailed information on the expected payer codes in HCUP States and how they can be used appropriately for research purposes.
Notable Publications Using HCUP Data
Berry JG, Zaslavsky AM, Toomey SL, Chien AT, Jang J, Bryant MC, et al. Recognizing differences in hospital quality performance for pediatric inpatient care. Pediatrics 2015 Aug;136(2):251-262.
This study uses the 2009 Kid’s Inpatient Database (KID) to estimate the number of hospitals and States that have a sufficient number of pediatric hospital discharges to detect worse-than-average pediatric quality on a variety of measures. An article abstract is available via PubMed.
Haider AH, Gupta S, Zogg CK, Kisat MT, Schupper A, Efron DT, et al. Beyond incidence: Costs of complications in trauma and what it means for those who pay. Surgery 2015 Jul;158(1):96-103.
This study uses the 2008 Nationwide Inpatient Sample (NIS) to determine the mortality and attributable costs associated with the presence or absence of complications recognized by the Centers for Medicare & Medicaid Services as well as other major trauma-related complications. An article abstract is available via PubMed.
I am interested in using the new Nationwide Readmissions Database (NRD) in a research study that aims to analyze hospital readmissions. Before I get started, I have a few questions about the database.
What kind of analyses can I perform with the NRD?
As a uniform, multi-State weighted database, the NRD promotes comparative studies of health care services and supports health care policy and research on a variety of topics. These topics include the following:
- National readmission rates by diagnosis, procedure, patient demographics, or expected payment source
- Costs associated with readmissions
- Reasons for readmissions
- Impact of health policy changes
- Quality of care
- Access to care
- Utilization of health services by special populations, including the uninsured.
Can the NRD be used for national estimates of readmissions?
The NRD is designed to support national readmission analyses and cannot be used for regional, State-specific, or hospital-specific analyses. However, four hospital characteristics are included on the NRD for research analyses: hospital bed size, urban/rural location, teaching status and ownership.
How often will the NRD be released?
The NRD will be released annually.
What is the cost of the NRD?
The full price of the NRD is $500. The price of the NRD for students is $150.
How are readmissions defined in the NRD?
The criteria to determine the relationship between hospital admissions is left to the analyst using the NRD. The NRD includes discharges for patients with and without repeat hospital visits in a year and those who have died in the hospital. Repeat stays may or may not be related.
Can the NRD be linked to the American Hospital Association (AHA) hospital ID for hospital-specific analyses?
No, the NRD cannot be linked to the AHA hospital ID for hospital-specific analyses. The NRD is not designed to support analyses that are hospital-specific.
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