News and Announcements

Now Available: 2017 HCUP National Inpatient Sample

The Agency for Healthcare Research and Quality (AHRQ) just released the 2017 National Inpatient Sample (NIS)! A powerful database that contains data from more than 7 million hospital inpatient records, the NIS is drawn from 47 States and the District of Columbia, covering more than 97 percent of the U.S. population. NIS data can be weighted to produce national estimates, allowing researchers and policymakers to identify, track, and analyze national trends in healthcare utilization, access, charges, quality, and outcomes. The NIS is the largest publicly available inpatient healthcare database in the United States. It includes all patients, regardless of expected payer for the hospital stay.

The 2017 NIS is an annual calendar year file with diagnosis and procedure codes reported using only the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). HCUP nationwide and State-level databases (including the 2017 NIS) are available for purchase through the HCUP Central Distributor. Earlier years of the NIS also are available.

Coming Soon: The 2017 Nationwide Readmissions Database (NRD), Nationwide Emergency Department Sample (NEDS), and Nationwide Ambulatory Surgery Sample (NASS) are scheduled to be released later this month. Users are encouraged to sign up for the HCUP Mailing List to be notified of upcoming database releases.

HCUP & the Medical Expenditure Survey (MEPS) Join Forces to Highlight Flu Burden

In October, HCUP and MEPS coordinated release of reports on influenza. The publications covered variation in influenza rates by age and various other characteristics. Highlights from the two briefs are included in the subsequent paragraphs.

HCUP Statistical Brief #253: Inpatient Hospital Stays and Emergency Department Visits Involving Influenza, 2006–2016 provides users with statistics from 10 flu seasons (2006–2007 flu season through the 2015–2016 flu season) on inpatient stays and treat-and-release ED visits (i.e., those that do not result in admission to the same hospital) using the NIS and NEDS. Select findings from the brief are listed below:

The 2014–2015 flu season appeared to be the most severe with the highest number of inpatient stays and in-hospital deaths.
Generally, the rate of influenza-related treat-and-release ED visits decreased as age increased.
Females had higher rates of influenza-related inpatient stays and treat-and-release ED visits than males.

MEPS Statistical Brief #526: Health Care Use and Expenditures for Influenza, 2016-17 presents statistics based on 2 years of pooled data (2016 and 2017) from the MEPS - Household Component (MEPS-HC) including average annual estimates of the percentage of the population treated for influenza and associated expenses. Among the findings presented, a select few are listed below:

There were approximately 3.1 million children and 5.7 million adults- a total of 8.8 million individuals of all ages- treated for flu on average per year.
In 2016-17, an annual average total of $5.2 billion (in 2017 dollars) was spent on treatment for flu for persons in the U.S. civilian noninstitutionalized population.
The overall annual mean amount paid out of pocket for influenza treatment was $75 while the overall median was $20.

To access HCUP Stat Brief #253 and others of interest, please visit the page on the HCUP-US Website. MEPS reports, such as Statistical Brief #526, can be accessed from the website homepage: www.meps.ahrq.gov/mepsweb/index.jsp.

Fast Stats New Topic Release and Data Update

HCUP Fast Stats provides easy access to the latest HCUP-based statistics for healthcare 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 a new topic—Neonatal Abstinence Syndrome (NAS) Among Newborn Hospitalizations. This new topic provides trends in NAS-related newborn hospitalizations at the national level and for 45 States and the District of Columbia, representing over 95 percent of the U.S. population. Rates of NAS per 1,000 newborn hospitalizations are presented overall as well as by sex, expected payer, community-level income, and patient location. The number of NAS newborn hospitalizations, median hospitalization cost (actual and inflation-adjusted), and median length of stay are also presented overall.

Later this month, AHRQ is planning the release of another new topic as well as new information in an existing topic.

A new topic, Hurricane Impact on Hospital Use, will be introduced that provides historical inpatient and treat-and-release emergency department (ED) utilization information from 11 U.S. hurricanes between 2005 and 2017. Supported by the Patient-Centered Outcomes Research Trust Fund (PCORTF) and created in collaboration with Office of The Assistant Secretary for Planning and Evaluation (ASPE) and the Office of the Assistant Secretary for Preparedness and Response (ASPR), this topic is designed to help HCUP users understand medical care utilization during and after past hurricanes to assist in the preparation for and deployment of medical services in future disasters. Hurricane-specific statistics on the weekly percent change in population-based rates from a pre-hurricane average rate through 7 weeks post-hurricane will be presented overall as well as for injury by age group. Counties will be grouped into classifications based on their proximity to the hurricane.
AHRQ will also release an update of State Trends in Hospital Use by Payer to include new inpatient and emergency department (ED) data. This update will add 2017-2019 inpatient data to the Inpatient Stay Trends by Payer section and 2017-2018 ED data to the Emergency Department Visits Trends by Payer section for several States.

Users can sign up for the HCUP Mailing List to be notified of upcoming Fast Stats releases. For additional information, please refer to the Fast Stats Frequently Asked Questions page or contact HCUP User Support.

Updates to HCUP Online Tutorial Series

Three HCUP Online Tutorials have been revised to reflect project updates: HCUP Overview Course, Multi-year Analysis Tutorial, and the HCUP Tools for ICD-10-CM/PCS Loading Tutorial.

The HCUP Overview Course provides extensive information about HCUP data, software tools, and products. The course describes where HCUP data come from, features and uses of databases and software tools, technical support, and more.
The Multi-year Analysis Tutorial presents solutions that may be necessary when conducting analyses that span multiple years. Errors in study results may occur when 2 or more years of data are combined. This course describes problems that may arise when using multiple years of HCUP data and provides easy solutions for addressing these issues.
The HCUP Tools for ICD-10-CM/PCS Loading Tutorial includes instructions on how to unzip (decompress) the tool, save it on the computer, and load it into a standard statistical software package for application to HCUP or other administrative databases. Users also will learn how to verify that the tool has loaded correctly. In addition, the tutorial includes information about the transition to ICD-10-CM/PCS. Although the instructions are specific to the Clinical Classifications Software (CCS) for ICD-10-PCS (beta version), they are similar to steps used for other HCUP ICD-10-CM/PCS tools.

These tutorials, along with other helpful HCUP interactive courses, can be found on the HCUP Online Tutorial Series homepage.

Now Available: The 2018 National Healthcare Quality and Disparities (QDR) Report

AHRQ recently released the 2018 National Healthcare Quality and Disparities Report (QDR). This marks the sixteenth year that AHRQ has reported on healthcare quality and disparities. The report assesses the performance of our healthcare system and identifies areas of strengths and weaknesses, as well as disparities, for access to healthcare and quality of healthcare. Quality is described in terms of six priorities: patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. The report is based on more than 250 measures of quality and disparities covering a broad array of healthcare services and settings. The reports can be accessed on the National Healthcare Quality and Disparities Report page on the AHRQ website at www.ahrq.gov/research/findings/nhqrdr/. For questions, please contact AHRQ User Support.

HCUP Tools Undergo Fiscal Year (FY) 2020 Updates

The HCUP ICD-10-CM/PCS tools are updated annually by Federal fiscal year to accommodate new or revised ICD-10-CM/PCS codes, as well as to add corrections or modifications based on new clinical guidance for the use of ICD-10-CM/PCS codes. Fiscal years are identified by the year in which the codes end. For example, FY2020 codes are valid from October 1, 2019, until September 30, 2020. The HCUP tools incorporate a versioning system that acknowledges both the Federal fiscal year and an incremented release number. Version 2020.1 of HCUP tools was released in October 2019. The codes contained in version 2020.1 will be valid for discharges from October 1, 2015, through September 30, 2020. The following HCUP tools are now valid through FY 2020:

Clinical Classifications Software Refined (CCSR) for ICD-10-CM: aggregates more than 70,000 ICD-10-CM diagnosis codes into a manageable number of clinically meaningful categories. The categories are organized across 21 body systems, which generally follow the structure of the ICD-10-CM diagnosis chapters.
Clinical Classifications Software (CCS) for ICD-10-PCS (beta version): provides a method for classifying more than 77,000 ICD-10-PCS procedure codes into clinically meaningful categories and can be used to identify populations for procedure-specific studies or to develop statistical reports about relatively specific procedures.
Procedure Classes for ICD-10-PCS (beta version): facilitates research on hospital services using administrative data by identifying whether an ICD-10-PCS procedure is (1) diagnostic or therapeutic and (2) minor or major in terms of invasiveness, resource use, or both.
Chronic Condition Indicator (CCI) for ICD-10-CM (beta version): provides users with an easy way to categorize ICD-10-CM diagnosis codes into one of two categories: chronic or not chronic. The tool also can assign ICD-10-CM diagnosis codes into 1 of 18 body system categories.
Elixhauser Comorbidity Software for ICD-10-CM (beta version): assigns variables that identify coexisting conditions on hospital discharge records.
Utilization Flags for ICD-10-PCS (beta version): reveals additional information about use of healthcare services by combining information from Uniform Bill (UB-04) revenue codes and ICD-10-PCS procedure codes to create flags, or indicators, of utilization.

Users can find these HCUP tools as well as HCUP supplemental files for research on the Tools & Software page of the HCUP-US website.

Data and Products

Recently Released: 2018 State Databases and Additional 2010 and 2015–2017 Databases

Since September 2019, the following State databases have been released:

State Inpatient Databases (SID)

2018: Oregon
2017: Arkansas
2010: Kansas

State Ambulatory Surgery and Services Databases (SASD)

2018: Oregon
2010: Kansas

State Emergency Department Databases (SEDD)

2018: Oregon
2017: Arkansas, Oregon
2016: Oregon
2015: Oregon
2010: Kansas

In addition, the 2017 NIS has been released. The 2017 NRD, NEDS, and NASS are scheduled for release later in December. For database purchasing questions, please contact the HCUP Central Distributor.

Complete listings of available databases by year can be found in the Database Catalog on the HCUP-US website. Databases can be purchased online through the HCUP Central Distributor, and aggregated national and selected State statistics can be accessed via HCUPnet.

Publications Spotlights

New HCUP Statistical Briefs Posted on HCUP-US

Since September 2019, the following HCUP Statistical Briefs have been released:

#254 Obstetric Delivery Inpatient Stays Involving Substance Use Disorders and Related Clinical Outcomes, 2016
#253 Inpatient Hospital Stays and Emergency Department Visits Involving Influenza,2006 ̶ 2016
#252 High-Volume Invasive, Therapeutic Ambulatory Surgeries Performed in Hospital-Owned Facilities, 2016

To access these and other Statistical Briefs, please visit the HCUP Statistical Briefs page on the HCUP-US website.

New HCUP Methods Series Reports Now Available

Since September 2019, the following Methods Series Reports have been released:

Methods Series Report #2019-01: Methods Applying AHRQ Quality Indicators to Healthcare Cost and Utilization Project (HCUP) Data for the 2018 National Healthcare Quality and Disparities Report (QDR) describes the preparation of the 2016 HCUP data for the 2018 QDR, the steps taken to apply the AHRQ Quality Indicators™ (QIs) to the HCUP data, and other analyses based on HCUP data that are not specific to the QIs but are developed for use in the QDR.
Method Series Report #2019-02: Population Denominator Data Sources and Data for Use with HCUP Databases (Updated with 2018 Population Data) identifies relevant sources of population data that can be used with the HCUP databases to calculate rates of hospital care events per population. This compilation includes data sources that provide nationwide population counts based on people, not hospitals, physicians, or local resources.

These reports and other HCUP reports can be found on the HCUP Reports page on the HCUP-US website.

Publications Using HCUP Data

Sears JM, Fulton-Kehoe D, Schulman BA, Hogg-Johnson S, Franklin GM. Opioid overdose hospitalization trajectories in States with and without opioid-dosing guidelines. Public Health Rep. 2019;134(5):567-76.

This study used HCUPnet to access statistics on the 2001–2014 State Inpatient Databases (SID) for Arizona, California, Colorado, Michigan, New Jersey, South Carolina, Utah, and Washington to determine whether the adoption of State-level opioid-prescribing guidelines are associated with trends in rates of opioid overdose hospitalizations, for prescription opioids, heroin, and all opioids. An abstract of the article is available via PubMed.

Dunbar P, Hall M, Gay JC, et al. Hospital readmission of adolescents and young adults with complex chronic disease. JAMA Netw Open. 2019;2(7):e197613.

This study used the 2014 Nationwide Readmissions Database (NRD) to assess variation across complex chronic diseases in the likelihood of readmission for adolescents and young adults with increasing age, because that growing population requires hospitalization to treat severe, acute health problems. An abstract of the article is available via PubMed.

To read additional recently published articles featuring HCUP data, please visit the Research Spotlights page on the HCUP-US website.

HCUP Q&A

Question: I recently heard about the release of a national database from HCUP, the NASS. My research could benefit from national ambulatory surgery statistics, but I don’t have much experience or knowledge in working with HCUP data. Can you please assist me in gathering information on the following?

What types of procedures are included in the NASS?
Does the NASS include data from all ambulatory surgery centers?
Can I use the NASS for State-level analyses as well?
How can I purchase the NASS database, and what data years are available?

Answers:

What types of procedures are included in the NASS?

The NASS is limited to encounters with at least one in-scope major ambulatory surgery on the record, performed at hospital-owned facilities. In-scope major ambulatory surgeries are defined as selected invasive, therapeutic surgical Current Procedural Terminology^®-coded procedures that typically require the use of an operating room and regional anesthesia, general anesthesia, or sedation. These surgeries are flagged as narrow in the HCUP Surgery Flags software. They also belong to a subset of CCS for Services and Procedures procedure groups with (1) a relatively high major ambulatory surgery volume, (2) a substantial share of major ambulatory surgeries performed in hospital-owned facilities, and (3) evidence of reliable reporting from SASD hospitals. For a detailed list of in-scope CCS procedure groups, see the Introduction to the NASS document on the NASS Database Documentation page.

Does the NASS include data from all ambulatory surgery centers?

The NASS is restricted to hospital-owned facilities in the HCUP SASD that perform major ambulatory surgeries. The facilities included in the NASS are further limited to community nonrehabilitation hospitals with a service type of either general acute care or children's. In other words, specialty hospitals (e.g., heart, orthopedic, women's) are not included in the current NASS design. For more details about restrictions imposed for the NASS sampling frame, see the Introduction to the NASS document on the NASS Database Documentation page.

Can I use the NASS for State-level analyses as well?

Like the other HCUP nationwide databases, the NASS cannot be used to generate State-level estimates and therefore will not be useful for State-level analyses. The NASS includes the region in which each hospital-owned facility is located but does not identify the State.

For users interested in ambulatory surgery analyses at the State-level, we recommend using the SASD. For a list of States that participate and release their SASD data through the HCUP Central Distributor, you can visit the Availability of HCUP Databases page on the HCUP-US website.

How can I purchase the NASS database, and what data years are available?

Users can purchase the NASS from the HCUP Central Distributor: www.hcup-us.ahrq.gov/tech_assist/centdist.jsp. Currently, the 2016 data year is available, and the release of the 2017 data year is planned for later this month.