HCUP Winter eNews, Issue #49

HCUP Winter eNews, Issue #49

Winter 2016
Issue #49

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
HCUP Events: Upcoming HCUP conferences and meetings

Missed the last e-News? Read it on the HCUP-US Web site.

News and Announcements

Now Available: The 2014 National Inpatient Sample (NIS)

The 2014 National Inpatient Sample (NIS) was released in November. The NIS is the largest inpatient care database in the United States. The NIS contains charge information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the 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. Its vast size enables analyses of infrequent conditions, uncommon treatments, and special patient populations.

The 2014 NIS is available for purchase through the HCUP Central Distributor, and select statistics can be accessed via HCUPnet.

Now Available: The 2014 Nationwide Readmissions Database (NRD)

The 2014 Nationwide Readmissions Database (NRD) was released in November. The NRD is a unique and powerful database designed to support analyses of national readmission rates for 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 2014 NRD was constructed from 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 2014 NRD is available for purchase through the HCUP Central Distributor.

Coming Very Soon: 2014 Nationwide Emergency Department Sample (NEDS)

AHRQ is releasing the 2014 Nationwide Emergency Department Sample (NEDS) in the coming days. 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 2014 NEDS will be available for purchase through the HCUP Central Distributor. Select aggregated statistics will be accessible via HCUPnet.

Kids’ Inpatient Database (KID) Planned to be Released Using 2016 Data 

Historically, the Kids’ Inpatient Database (KID) has been produced every three years beginning in 1997 and currently through 2012. Given that hospital discharge data for 2015 contains a mix of ICD-9-CM and ICD-10-CM/PCS data (the first three quarters contain ICD-9-CM data and the last quarter contains ICD‑10-CM/PCS data), the next KID will be available for 2016 and will be comprised of ICD-10-CM/PCS data only. This decision was made due to the complexities of analyzing a mixed coded data year. 

For additional information, please refer to the KID Database Documentation Page on the HCUP User Support (HCUP-US) Web site or contact HCUP User Support. 

HCUP Fast Stats Data Release and Updates! 

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 include a new topic focusing on opioid-related hospital use and to add new information to two existing topics. 

• The new topic AHRQ released is on Opioid-Related Hospital Use. The Fast Stats information provides trends in opioid-related inpatient stays and emergency department (ED) visits through 2014 at the national and State level for 43 States and the District of Columbia, representing over 95 percent of the U.S. population. Population-based rates are presented overall and separately by age group, sex, community-level income, and rural/urban location. Select statistics from this new topic are presented in HCUP Statistical Brief #219, Opioid-Related Inpatient Stays and Emergency Department Visits by State, 2009-2014. The two figures below show trends in opioid-related inpatient stays and ED visits at the national level.

• AHRQ updated information in the Effect of Health Insurance Expansion on Inpatient Stays topic. Graphic and tabular trends in the number of hospital stays for uninsured, Medicaid, Medicare, and privately insured patients before and after health insurance expansion are presented for 42 States, representing over 90 percent of the U.S. population. This Fast Stats update adds two new States—Massachusetts and Pennsylvania—and 2016 data for six States—Colorado, Georgia, Iowa, Missouri, New Jersey, and New York. This is the first HCUP data release in Fast Stats that includes ICD-10-CM clinical diagnosis coding. 
• AHRQ updated the year of information in the National Hospital Utilization and Costs topic. This topic focuses on national statistics on inpatient stays: trends, most common diagnoses, and most common operations. This Fast Stats update adds national statistics for 2014.

For additional information, please refer to the HCUP Fast Stats Frequently Asked Questions page or contact HCUP User Support.

Updates to HCUP Online Tutorial Series

Two courses in the HCUP Online Tutorial Series have been revised to reflect project updates: HCUP Overview Course and Calculating Standard Errors. Additionally, the Load and Check tutorial will be revised this month.

• The HCUP Overview Course provides a wealth of information about HCUP data, software tools, and products. The course describes where HCUP data come from, the features and uses of each database, software tools, technical support, and much more. This tutorial was updated to include information for HCUP’s newest Nationwide Database – the NRD – as well as enhancements to HCUP software tools and products, such as HCUP Fast Stats.
• The Calculating Standard Errors Tutorial provides information on how to accurately determine the precision of the estimates produced from HCUP’s Nationwide Databases. This tutorial was updated to include information on the NRD as well as to use more recent SAS code examples from the 2013 NIS.
• The Load and Check HCUP Data Tutorial provides instructions on how to unzip (decompress) HCUP data, save it on the computer, and load the data into a standard statistical software package. This tutorial will be updated soon to include information on the NRD as well as account for data purchasers being able to order HCUP Nationwide Databases online through the HCUP Central Distributor.

For additional questions related to the HCUP Online Tutorial Series, please contact HCUP User Support.

HCUP Releases New Infographic on Characteristics of Hospital Stays Involving Malnutrition

HCUP released a new infographic, Characteristics of Hospital Stays Involving Malnutrition, 2013, which visually presents data from HCUP Statistical Brief #210: Characteristics of Hospital Stays Involving Malnutrition, 2013. This Statistical Brief presents national estimates on the characteristics of malnutrition reported during nonmaternal and nonneonatal hospital inpatient stays in 2013. The infographic is available on the HCUP Infographics page in PDF, JPEG, and text formats.

Databases and Products     

Recently Released: Additional State and Nationwide Databases

The following State Databases have been released since September 2016:

• State Inpatient Databases (SID)
• 2014: Arkansas, Maryland, Minnesota, Nevada, Utah
• State Ambulatory Surgery and Services Databases (SASD)
• 2014: Maryland, Minnesota, Nevada, Utah
• State Emergency Department Databases (SEDD)
• 2013: Arkansas
• 2014: Arkansas, Maryland, Minnesota, Nevada, Utah

In addition, the 2014 National Inpatient Sample (NIS) and 2014 Nationwide Readmissions Database (NRD) have been released. The 2014 Nationwide Emergency Department Sample (NEDS) will be released in the next few days.

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.

For database purchasing questions, please contact the HCUP Central Distributor.

Publication Spotlights

New HCUP Statistical Briefs Posted on HCUP-US

Since September 2016, the following HCUP Statistical Briefs have been released:

• #210, Characteristics of Hospital Stays Involving Malnutrition, 2013
• #211, Variation in the Rate of Cesarean Section Across U.S. Hospitals, 2013
• #212, Hospital-, Health Care-, and Community-Acquired MRSA: Estimates From California Hospitals, 2013
• #213, Characteristics of Safety-Net Hospitals, 2014
• #214, Trends in Hysterectomies and Oophorectomies in Hospital Inpatient and Ambulatory Settings, 2005–2013
• #215, Trends in Hospitalizations With a Red Blood Cell Transfusion, 2000–2013
• #216, Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006–2013
• #217, Burn-Related Hospital Inpatient Stays and Emergency Department Visits, 2013
• #218, All-Cause Readmissions Following Hospital Stays for Patients With Malnutrition, 2013
• #219, Opioid-Related Inpatient Stays and Emergency Department Visits by State, 2009-2014 

These and other Statistical Briefs can be found on the HCUP Reports page. 

New HCUP Method Series Reports Now Available

Method Series Report #2016-04: Population Denominator Data for Use with the HCUP Databases (Updated with 2015 Population Data) identifies relevant sources of population data that can be used with the HCUP databases to calculate rates of hospital care events.

Method Series Report #2016-05: Identifying Observation Services in the HCUP State Databases (Updated with 2013 HCUP Data) provides information on the reporting of observation services (OS) across HCUP States using records from State Inpatient Databases (SID), State Emergency Department Databases (SEDD), and State Ambulatory Surgery Department Databases (SASD) as well as dedicated outpatient files specific to OS provided by several HCUP Partners.

Method Series Report #2016-06: Using the HCUP Databases to Study Incidence and Prevalence offers guidance for selecting measures of incidence and prevalence that are appropriate for use with HCUP data.

Method Series Report #2016-07: Challenges to Studying Patients Transferred Between Hospitals examines several potential reasons for finding incomplete transfers in the 2013 HCUP State Databases and guides users in their choice of HCUP databases when planning analysis that involves patient transfers.

Method Series Report #2016-08: State Variation in Procedure Coding in the HCUP State Emergency Department Databases describes the reporting of procedure codes in the State Emergency Department Databases (SEDD) as well as examines differences in the type and variation of procedure codes provided to HCUP.

Method Series Report #2016-09: User Guide – An Examination of Expected Payer Coding in HCUP Databases (Updated for 2014 HCUP Data) presents detailed information on the expected payer codes in HCUP States and how they can be used appropriately for research purposes.

These and other HCUP Reports can be found on the HCUP Reports page.

Publications Using HCUP Data

Adams D, Eberly M, Goudie A, et al. Rising vancomycin-resistant enterococcus infections in hospitalized children in the United States. Hosp Pediatr. 2016 Jul; 6(7): 404-11.

This study uses the 1997-2012 Kids’ Inpatient Database (KID) to analyze trends in vancomycin-resistant enterococcus (VRE) hospitalizations for children. In addition, the study focuses on the association of VRE with certain comorbid conditions as well as length of stay and cost of care. VRE are a type of bacteria called enterococci that have developed resistance to many antibiotics, especially vancomycin. An article abstract is available via PubMed.

Mannschreck D, Matsuno RK, Moriarty JP, et al. Disparities in surgical care among women with endometrial cancer. Obstet Gynecol. 2016 Sep;128(3):526-34.

This study uses the 2012–2013 National Inpatient Sample (NIS) to compare patients receiving minimally invasive surgery for the treatment of endometrial cancer and associated inpatient complications and costs against those patients receiving open surgery as well as the impact of patient race, hospital geography, and cancer volumes on disparities. An article abstract is available via PubMed.

These and other HCUP Publications can be found in the HCUP Research Spotlights and the HCUP Publications Search.

HCUP Q&A

Question: I am interested in purchasing the NRD in order to obtain information on national readmission rates. Before I purchase this database, I have a few questions:

• Do I use KEY_NRD to uniquely identify patients?
• I am specifically interested in following patients across data years. With that said, would I be able to track the same patient from the 2013 NRD in the 2014 NRD?
• The documentation mentions that a subset of States provide robust patient identifiers for infants. What are the States?
• Can I obtain readmissions data for earlier years?

Answers:

Do I use KEY_NRD to uniquely identify patients?

KEY_NRD contains a unique record identifier, not a patient identifier. KEY_NRD can be used to link separate files within the NRD, such as linking the records in the Core and Severity files in the NRD. The values for KEY_NRD are reassigned each year; also, because they are discharge record identifiers and are not patient identifiers, they cannot be used to link patient records within or across years. NRD_VisitLink is the patient linkage number in the NRD. Please note that this variable is correctly loaded as a character variable. NRD_VisitLink contains alpha numeric characters and is used as the identifier variable to link discharges for the same patient. 

I am specifically interested in following patients across data years. With that said, would I be able to track the same patient from the 2013 NRD in the 2014 NRD?

The 2013 and 2014 NRD cannot be combined to create a 24-month database. NRD_VisitLink does not track the same person from 2013 into 2014. The NRD hospital identification number (HOSP_NRD) does not track the same hospital from 2013 into 2014. Each year of the NRD must be considered as a separate sample.

The documentation mentions that a subset of States provide robust patient identifiers for infants. What are the States?

In the NRD, there are a subset of States that meet the criteria for retaining discharges for patients aged 0 years. Due to confidentiality restrictions in the design of the NRD, State names are not included in the database. We cannot provide the list of States. Please note that if you are calculating rates, the total U.S. population for patients aged 0 years should be used. The NRD weights have been constructed so that they provide national estimates of readmission for patients aged 0 years even though the data are based on a subset of States. Additional information about the design and use of the NRD can be found in the Introduction to the Nationwide Readmissions Database, which can be accessed at http://www.hcup-us.ahrq.gov/db/nation/nrd/nrddbdocumentation.jsp.

Can I obtain readmissions data for earlier years?

AHRQ is in the process of creating the back-years of the NRD for 2010 to 2012. We anticipate that these databases will be available for purchase through the HCUP Central Distributor by early Spring 2017.

If you are signed up on our HCUP Mailing List, you will be notified upon the release of databases, tools, and other HCUP products. Instructions for joining the Mailing List are available at https://subscriptions.ahrq.gov/accounts/USAHRQ/subscriber/new?topic_id=USAHRQ_65. You also can check the HCUP-US Web site Calendar for updates: http://www.hcup-us.ahrq.gov/news.jsp.

Ready-to-use information on national readmissions to the hospital within 30 days of discharge are available on HCUPnet, our free online query tool. This information is available starting in 2009. Statistics for all hospital stays are available, as well as information for various diagnostic and procedural categories such as the HCUP Clinical Classification Software (CCS).

HCUP Events

• January 30-31, 2017: National Health Policy Conference (NHPC)
• Exhibit BoothOn January 30-31, HCUP staff will sponsor an exhibit booth where representatives will be available to provide information and answer questions.

For a complete list of HCUP presentations and events, visit the HCUP Events Calendar.