The Healthcare Cost and Utilization Project (HCUP)

1
The Healthcare Cost and Utilization Project (HCUP)

• Tools and Products
• Agency for Healthcare Research and Quality
• APHA CEI Session? November 2006

2
(No Transcript)
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
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.
jspdownload
8
CCS-CPT Categories
Groups CPT Codes into Clinically Meaningful
Categories
CPT Codes 28035-28035 29848-29848 64702-64727 65
820-65855 66150-66185 66700-66761
CCS-CPT Codes
CCS-CPT Software
CCS 6 Decompression peripheral nerve
CCS 14 Glaucoma procedures
9
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/Appe
ndixAsingleDX.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
Data Element Type Length
DRG Num 3
DX1 (ICD-9-CM diagnosis code) Char 5
DX2 DXn (ICD-9-CM diagnosis codes) Char 5
NDX (Number of diagnosis fields) Num 3
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
Merge HSM Variables to NIS, SID, and KID
Merge Variables from HSM File to NIS, SID, and KID
HSM Software
HOSPID
26
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/procedu
re/procedure .jspdownload
28
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.jspdownload
31
Chronic/Non-Chronic Indicator
Chronic
Non-Chronic
Diabetes (ICD-9-CM 25000)
Food Poisoning (ICD-9-CM 0059)
32
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
(No Transcript)
38
Documentation
39
Methods Series
40
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

41
Research Publications
42
Access HCUP Data for Free
HCUPnet
43
(No Transcript)
44
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_at_ahrq.gov
• Phone (866) 290-HCUP

45
(No Transcript)