Summer 2017, Issue #51
Contents
News and Announcements
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.
Data and Products
Recently Released: 2015 State Databases and Additional 2014 Databases
Since March 2017, the following State Databases have been released:
- State Inpatient Databases (SID)○ 2014: Massachusetts
○ 2015: Arizona, Iowa, Nebraska, and Wisconsin - State Ambulatory Surgery and Services Databases (SASD)○ 2015: Nebraska and Wisconsin
- State Emergency Department Databases (SEDD)○ 2014: Massachusetts
○ 2015: Arizona, Nebraska, and Wisconsin
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.
Publications Spotlights
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.
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.
HCUP Q&A
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/#
HCUP Events
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 SessionsOn 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 PresentationsOn 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 SessionOn 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 BoothOn June 25–27, HCUP staff will sponsor an exhibit booth. Representatives will be available to provide information and answer questions.
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