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The Healthcare Cost and Utilization Project (HCUP)

The Healthcare Cost and Utilization Project (HCUP). Tools and Products Agency for Healthcare Research and Quality APHA CEI Session November 2006 . Healthcare Cost and Utilization Project (HCUP) THE LARGEST COLLECTION OF MULTI-STATE, ALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATA.

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The Healthcare Cost and Utilization Project (HCUP)

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  1. The Healthcare Cost and Utilization Project (HCUP) Tools and Products Agency for Healthcare Research and Quality APHA CEI Session November 2006

  2. Healthcare Cost and Utilization Project (HCUP) THE LARGEST COLLECTION OF MULTI-STATE, ALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATA

  3. HCUP Tools

  4. Current HCUP Tools Clinical Classifications Software (CCS) Comorbidity Software Procedure Classes Chronic/ Non-Chronic Indicator Cost-to-Charge Ratios AHRQ Quality Indicators (QI)

  5. SID NIS KID Other Administrative Databases SASD SEDD Most AHRQ HCUP Tools Can Be Applied to Any Administrative Database CCS Tools Comorbidity Procedure Classes Chronic Condition Indicator AHRQ QIs

  6. Clinical Classifications Software ICD-9-CM Diagnosis Codes 12,000 Diagnosis Codes and 3,500 Procedure Codes Clinical Classifications The CCS collapses ICD-9-CM codes into a smaller number of clinically meaningful categories that can be more useful for presenting descriptive statistics than are individual ICD-9-CM codes

  7. CCS Mapping Files The CCS Mappings are available for download on the HCUP User Support Website http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp#download

  8. SEDD SASD CCS-CPT Categories Groups CPT Codes into Clinically Meaningful Categories CPT Codes 28035-28035 29848-29848 64702-64727 65820-65855 66150-66185 66700-66761 CCS-CPT Codes CCS-CPT Software CCS 6: Decompression peripheral nerve CCS 14: Glaucoma procedures

  9. CCS-MHSA Software CCS - Mental Health and Substance Abuse (CCS-MHSA) Groups Codes into Clinically Meaningful Mental Health and Substance Abuse Categories Creates 14 MHSA diagnosis categories Some are broken into more specific diagnoses Adjustment disorders Mood disorders Anxiety disorders Personality disorders Disruptive behavior Schizophrenia Delirium, dementia Substance-related Developmental disorders Suicide Disorders in childhood Screening for MHSA Impulse control, NEC Miscellaneous

  10. CCS Documentation http://www.hcup-us.ahrq.gov/tools_software.jsp

  11. CCS Mappings – Appendix A of CCS User Guide An easy way to look at which ICD-9-CM diagnosis codes comprise each CCS category http://www.hcup-us.ahrq.gov/toolssoftware/ccs/AppendixAsingleDX.pdf

  12. Comorbidity Software Comorbidity Software 30 Comorbidity Classifications ICD-9-CM Codes, DRGs on Administrative Data The Comorbidity Software is based on the ICD-9-CM coding scheme. This software creates about 30 variables that identify major comorbidities.

  13. List of 29 Comorbidities 19. Rheumatoid arthritis/ collagen vascular diseases 20. Coagulation deficiency 21. Obesity 22. Weight loss 23. Fluid and electrolyte disorders 24. Blood loss anemia 25. Deficiency anemias 26. Alcohol abuse 27. Drug abuse 28. Psychoses 29. Depression 1. Congestive heart failure 2. Valvular disease 3. Pulmonary circulation disorders 4. Peripheral vascular disorders 5. Hypertension 6. Paralysis 7. Other neurological disorders 8. Chronic pulmonary disease 9. Diabetes w/o chronic complications 10. Diabetes with chronic complications 11. Hypothyroidism 12. Renal failure 13. Liver disease 14. Chronic Peptic ulcer disease 15. HIV and AIDS 16. Lymphoma 17. Metastatic cancer 18. Solid tumor without metastasis

  14. Example: Obesity Comorbidity #21 Obesity • ICD-9-CM codes: 2780, 27800, 27801 • Discharge does not have these DRGs: Nutrition /metabolic (296-298) or Obesity Proc (288)

  15. Comorbidity Software Required Data Elements

  16. Download the Comorbidity Software

  17. Comorbidity: Format and Analysis Program

  18. Format Program • Creation of Format Library for Comorbidity Groups The format program defines a format library that contains the diagnosis screens necessary for the comorbidity analysis. It will be used by Program 2, the comorbidity analysis program.

  19. Run Format Program in SAS

  20. Analysis Program • Creation of Comorbidity Variables The analysis program assigns to the inpatient records 0/1 indicators for the comorbidity variables of interest.

  21. Cost-to-Charge Ratios $ Hospital-Level NIS/SID Data Apply Ratios Convert Charges to Costs The Cost-to-Charge Ratios enable conversion of charge data to cost data on the NIS and the SID.

  22. Variables in the CCR Files Six variables in the Cost-to-Charge data include: • HOSPID: HCUP hospital identification number • WI_X: Wage Index, source CMS, edited • Z013: State postal code • APICC: All-payer inpatient C/C, hosp-specific • GAPICC: Group avg. all-payer inpatient C/C • YEAR: Year for linking to HCUP records

  23. Availability of Cost-to-Charge Files • NIS • 2003 • 2002 • 2001 • SID • 2003 • 2002 • 2001 • KID • 2003 For Most States

  24. Hospital Market Structure (HSM) Files The HSM Files contain various measures of hospital market competition and are available free-of-charge from the HCUP Central Distributor. http://www.hcup-us.ahrq.gov/toolssoftware/hms/hms.jsp

  25. CBSA COUNTY HSA MSA FIXED RADIUS PATFLOW RADIUS HSM Measures SID NIS KID Merge HSM Variables to NIS, SID, and KID Merge Variables from HSM File to NIS, SID, and KID HSM Software HOSPID

  26. ICD-9-CM Procedure Codes Minor Diagnostic Major Therapeutic Minor Therapeutic Major Diagnostic Procedure Classes Groups ICD-9-CM Codes into One of Four Categories to Distinguish Between Diagnostic/Therapeutic Procedures

  27. Procedure Classes Mappings The Procedure Classes Mappings are available for download on the HCUP User Support Website http://www.hcup-us.ahrq.gov/toolssoftware/procedure/procedure .jsp#download

  28. Cardiac Procedures Procedure Classes Minor Diagnostic Major Therapeutic Electrocardiogram(ICD-9-CM: 8952) CABG (ICD-9-CM: 3610) Minor Therapeutic Major Diagnostic Pacemaker(ICD-9-CM: 3778) Pericardial Biopsy(ICD-9-CM: 3724)

  29. Chronic/Non-Chronic Indicator ICD-9-CM DiagnosisCodes Non-Chronic Chronic Groups ICD-9-CM Diagnosis Codes into Chronic or Non-Chronic Categories

  30. Chronic Conditions Mappings The Chronic Conditions Mappings are available for download on the HCUP User Support Website http://www.hcup-us.ahrq.gov/toolssoftware/chronic/chronic.jsp#download

  31. Chronic/ Non-Chronic Chronic/Non-Chronic Indicator Chronic Non-Chronic Diabetes (ICD-9-CM 25000) Food Poisoning (ICD-9-CM 0059)

  32. SID NIS KID AHRQ Quality Indicators Creates Measures of Health Care Quality Using Inpatient Administrative Data Prevention Quality Indicators Inpatient Quality Indicators QI Software Patient Safety Indicators Pediatric Indicators

  33. Prevention Quality Indicators Examples of PQI Measures Diabetes Short-term Complication Admission Rate Perforated Appendix Admission Rate Diabetes Long-term Complication Admission Rate Pediatric Asthma Admission Rate Chronic Obstructive Pulmonary Disease Admission …………Rate Pediatric Gastroenteritis Admission Rate Hypertension Admission Rate Congestive Heart Failure Admission Rate Low Birth Weight Rate Dehydration Admission Rate Bacterial Pneumonia Admission Rate Urinary Tract Infection Admission Rate

  34. Inpatient Quality Indicators Examples of IQI Measures Esophageal Resection Volume Pancreatic Resection Volume Pediatric Heart Surgery Volume Abdominal Aortic Aneurysm Repair Volume Coronary Artery Bypass Graft Volume Percutaneous Transluminal Coronary Angioplasty Volume Carotid Endarterectomy Volume Esophageal Resection Mortality Rate Pancreatic Resection Mortality Rate Pediatric Heart Surgery Mortality Rate

  35. Patient Safety Indicators Examples of PSI Measures Complications of Anesthesia Death in Low-Mortality DRGs Decubitus Ulcer Failure to Rescue Foreign Body Left During Procedure Iatrogenic Pneumothorax Selected Infections Due to Medical Care Postoperative Hip Fracture Postoperative Hemorrhage or Hematoma Postoperative Physiologic and Metabolic Derangements Postoperative Respiratory Failure Postoperative Pulmonary Embolism or Deep Vein Thrombosis

  36. Pediatric Quality Indicators Examples of PDI Measures Accidental Puncture or Laceration Decubitus Ulcer Foreign Body Left During Procedure Pediatric Heart Surgery Mortality Postoperative Hemorrhage or Hematoma Postoperative Sepsis

  37. Documentation

  38. Methods Series

  39. Example Report: Using the HCUP NIS to Estimate Trends • Exclude 1988 – 1992 data • Use revised discharge weights • Give data elements consistent names • Beware of stratification variable changes • Address changes in ICD-9-CM coding • DRG definitions change • Recommend AHRQ CCS

  40. Research Publications

  41. Access HCUP Data for Free HCUPnet

  42. HCUP Technical Assistance Active Technical Assistance • Responds to inquiries about HCUP data, products, and tools • Collects user feedback and suggestions for improvement E-mail: hcup@ahrq.gov Phone: (866) 290-HCUP

  43. Healthcare Cost and Utilization Project (HCUP) THE LARGEST COLLECTION OF MULTI-STATE, ALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATA

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