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

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

3. Advancing Excellence in Health Care 3 HCUP Tools

4. Advancing Excellence in Health Care 4 Current HCUP Tools Clinical Classifications Software (CCS) ComorbiditySoftwareProcedureClasses Cost-to-ChargeRatios AHRQ Quality Indicators (QI) Chronic/Non-ChronicIndicator

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

6. Advancing Excellence in Health Care 6 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 Clinical Classifications Software 12,000 Diagnosis Codes and 3,500 Procedure Codes Clinical Classifications ICD-9-CM Diagnosis Codes

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

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

9. Advancing Excellence in Health Care 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 CCS-MHSA Software

10. Advancing Excellence in Health Care 10 CCS Documentation http://www.hcup-us.ahrq.gov/tools_software.jsp

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

13. Advancing Excellence in Health Care 13 List of 29 Comorbidities 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 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

14. Advancing Excellence in Health Care 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. Advancing Excellence in Health Care 15 Comorbidity Software Required Data Elements Data Element Type Length Length DRGNum3 DX1 (ICD-9-CM diagnosis code) Char5 DX2 – DXn (ICD-9-CM diagnosis codes) Char5 NDX (Number of diagnosis fields) Num3

16. Advancing Excellence in Health Care 16 Download the Comorbidity Software

17. Advancing Excellence in Health Care 17 Comorbidity: Format and Analysis Program

18. Advancing Excellence in Health Care 18 Format Program Creation of Format Library for Comorbidity Groups 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. Advancing Excellence in Health Care 19 Run Format Program in SAS

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

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

22. Advancing Excellence in Health Care 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. Advancing Excellence in Health Care 23 Availability of Cost-to-Charge Files NIS NIS – 2003 – 2002 – 2001 SID SID – 2003 – 2002 – 2001 KID KID – 2003 For Most States

24. Advancing Excellence in Health Care 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. Advancing Excellence in Health Care 25 Merge HSM Variables to NIS, SID, and KID HSM Software Merge Variables from HSM File to NIS, SID, and KID HSM Measures CBSA COUNTY HSA MSA FIXED RADIUS PATFLOW RADIUS NIS KIDSID HOSPID

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

27. Advancing Excellence in Health Care 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 http://www.hcup-us.ahrq.gov/toolssoftware/procedure/procedure.jsp#download

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

29. Advancing Excellence in Health Care 29 Chronic/Non-Chronic Indicator ICD-9-CM Diagnosis Codes Chronic Non- Chronic Groups ICD-9-CM Diagnosis Codes into Chronic or Non- Chronic Categories

30. Advancing Excellence in Health Care 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. Advancing Excellence in Health Care 31 Chronic/Non-Chronic Indicator ChronicNon- Chronic Food Poisoning (ICD-9-CM 0059) Diabetes (ICD-9-CM 25000) Chronic/ Non-Chronic

32. Advancing Excellence in Health Care 32 AHRQ Quality Indicators Creates Measures of Health Care Quality Using Inpatient Administrative Data NIS KIDSID QI Software Prevention Quality Indicators Inpatient Quality Indicators Patient Safety Indicators Pediatric Indicators

33. Advancing Excellence in Health Care 33 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 Prevention Quality Indicators

34. Advancing Excellence in Health Care 34 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 Inpatient Quality Indicators

35. Advancing Excellence in Health Care 35 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 Patient Safety Indicators

36. Advancing Excellence in Health Care 36 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 Pediatric Quality Indicators

37. Advancing Excellence in Health Care 37

38. Advancing Excellence in Health Care 38 Documentation

39. Advancing Excellence in Health Care 39 Methods Series

40. Advancing Excellence in Health Care 40 Example Report: Using the HCUP NIS to Estimate Trends Exclude 1988 – 1992 data Exclude 1988 – 1992 data Use revised discharge weights Use revised discharge weights Give data elements consistent names Give data elements consistent names Beware of stratification variable changes Beware of stratification variable changes Address changes in ICD-9-CM coding Address changes in ICD-9-CM coding – DRG definitions change – Recommend AHRQ CCS

41. Advancing Excellence in Health Care 41 Research Publications

42. Advancing Excellence in Health Care 42 Access HCUP Data for Free HCUPnet

43. Advancing Excellence in Health Care 43

44. Advancing Excellence in Health Care 44 HCUP Technical Assistance Active Technical Assistance Responds to inquiries about HCUP data, products, and tools Responds to inquiries about HCUP data, products, and tools Collects user feedback and suggestions for improvement Collects user feedback and suggestions for improvement E-mail: hcup@ahrq.gov hcup@ahrq.gov Phone: (866) 290-HCUP

45. Advancing Excellence in Health Care 45 Healthcare Cost and Utilization Project (HCUP) THE LARGEST COLLECTION OF MULTI-STATE, ALL-PAYER, ENCOUNTER-LEVEL, HEALTH CARE DATA