词条 | Healthcare Cost and Utilization Project |
释义 |
The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of health care databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). General InformationHCUP provides access to health care databases for research and policy analysis, as well as tools and products to enhance the capabilities of the data. HCUP databases combine the data collection efforts of state data organizations, hospital associations, private data organizations, and the federal government to create a national information resource of patient-level health care data. state organizations that provide data to HCUP are called Partners. HCUP includes multiyear hospital care (inpatient, outpatient, and emergency department) data in the United States, with all-payer, encounter-level information beginning in 1988. These databases enable research on health research and policy issues at the national, state, and local market levels, including cost and quality of health services, medical practice patterns, access to health care, and outcomes of treatments. AHRQ has also developed a set of software tools to be used when evaluating hospital data. These software tools can be used with the HCUP databases and with other administrative databases. HCUP’s Supplemental Files are only for use with HCUP databases. HCUP databases have been used in various studies on a number of topics, such as breast cancer, depression, and multimorbidity, incidence and cost of injuries, role of socioeconomic status in patients leaving against medical advice, multiple chronic conditions and disparities in readmissions, and hospitalization costs for cystic fibrosis. HCUP User Support Web Site (HCUP-US)The HCUP User Support Web site is the main repository of information for HCUP. It is designed to answer HCUP-related questions; provide detailed information on HCUP databases, tools, and products; and offer technical assistance to HCUP users. HCUP’s tools, publications, documentation, news, services, HCUP Fast Stats, and HCUPnet (the online data query system) may all be accessed through HCUP-US. HCUP-US is located at https://www.hcup-us.ahrq.gov. HCUP Overview CourseHCUP has developed an interactive online course that provides an overview of the features, capabilities, and potential uses of HCUP. The course is modular, so users can either move through the entire course or access the resources in which they are most interested. The On-line HCUP Overview Course can work both as an introduction to HCUP data and tools and a refresher for established users. HCUP Online Tutorial SeriesThe HCUP Online Tutorial Series is a set of interactive training courses that provide HCUP data users with information about HCUP data and tools, and training on technical methods for conducting research with HCUP data. The online courses are modular, so users can move through an entire course or access the sections in which they are most interested. Topics include loading and checking HCUP data, understanding HCUP’s sampling design, calculating standard errors, producing national estimates, conducting multiyear analysis, and using the nationwide readmissions database. HCUP DatabasesHCUP databases bring together data from state data organizations, hospital associations, private data organizations, and the federal government to create an information resource of patient-level health care data. HCUP’s databases date back to 1988 data files. The databases contain encounter-level information for all payers compiled in a uniform format with privacy protections in place. Researchers and policymakers can use the records to identify, track, and analyze national trends in health care use, access, charges, quality, and outcomes. HCUP databases are released approximately 6 to 18 months after the end of a given calendar year, with state databases available earlier than the national dataset. For example, 2016 state data were available beginning in 2017, and nationwide data were available beginning in July 2018. Currently there are seven types of HCUP databases: four with national- and regional-level data and three with state- and local-level data. National Databases
State Databases
HCUP Tools and SoftwareHCUP provides a number of tools and software programs that can be applied to HCUP and other similar administrative databases. HCUPnetHCUPnet is an online query system that provides health care statistics and information from the HCUP national (NIS, NEDS, KID, and NRD) and state (SID, SASD, and SEDD) databases for those states that have agreed to participate. HCUPnet can be used for identifying, tracking, analyzing, and comparing statistics on hospital inpatient stays, emergency care, and ambulatory surgery, as well as obtaining measures of quality based on the AHRQ Quality Indicators. Select statistics are available at a national- and county-level. HCUPnet can also be used for trend analysis with health care data available from 1993 forward. HCUPnet also includes a feature called hospital readmissions that provides users with some statistics on hospital readmissions within 7 and 30 days of hospital discharge. Information on calculating readmissions for HCUPnet is available in the HCUP Methods Series report. HCUP Fast StatsHCUP Fast Stats is a web-based tool that provides HCUP-based statistics for health care information topics. The following topics are available:
HCUP Fast Stats will be updated regularly (quarterly or annually, as newer data become available). Quality Indicators (QIs)The AHRQ Quality Indicators (QIs) are standardized, evidence-based measures of health care quality that use readily available hospital inpatient administrative data. AHRQ QIs can be used to highlight potential quality concerns, identify areas that need further study and investigation, and track clinical performance and outcomes over time. , , The AHRQ QIs consist of four modules measuring various aspects of quality:
Clinical Classifications Software (CCS)The Clinical Classifications Software (CCS) provides a method for classifying diagnoses or procedures into clinically meaningful categories. These can be used for aggregate statistical reporting of a variety of topics, such as identifying populations for disease- or procedure-specific studies or developing statistical reports providing information (i.e., charges and length of stay) about relatively specific conditions. , Three versions of the CCS Software are available:
The current CCS for ICD-10-CM/PCS has 285 mutually exclusive categories for diagnoses and 231 for procedures. For certain research interests, this smaller number can be more useful for presenting descriptive statistics than individual ICD-10-CM/PCS codes. Every effort was made to translate the CCS system into ICD-10-CM/PCS without making changes to the CCS assignments for diagnoses and procedures, but because of the new structure and expanded code availability this was not always possible. Because of the increased specificity of ICD-10-CM/PCS and the changes in the two code set structure, it was not possible to translate most multilevel categories to ICD-10-CM/PCS within the current structure – with the exception of the first- and second-level multilevel categories. The Beta CCS for ICD-10-CM/PCS will be updated annually.
Since fiscal year 2008, CCS for ICD-9-CM includes categories from the Mental Health and Substance Abuse Clinical Classifications Software (CCS-MHSA). These categories replace the original CCS categories for mental health and substance abuse. Specifically, the CCS single-level software includes the CCS-MHSA general categories, and the CCS multilevel software includes the CCS-MHSA specific categories. The CCS for ICD-9-CM was updated annually starting January 1980 through September 30, 2015. ICD-9-CM codes were frozen in preparation for ICD-10-CM implementation and regular maintenance of the codes has been suspended.
The CCS versions and their user guides are available for download from the HCUP-US Web site. Chronic Condition IndicatorThe Chronic Condition Indicator (CCI) facilitates health services research on diagnoses using administrative data. Two versions of the CCI software are available, CCI for ICD-9-CM and Beta CCI for ICD-10-CM. The CCI tools categorize ICD-9-CM/ICD-10-CM diagnoses codes into two classifications: chronic or not chronic. A chronic condition is defined as a condition that lasts 12 months or longer and meets one or both of the following tests: (a) it places limitations on self-care, independent living, and social interactions; and (b) it results in the need for ongoing intervention with medical products, services, and special equipment. The identification of chronic conditions is based on all 5-digit ICD-9-CM or 7-digit ICD-10-CM codes. External cause of injury codes are not classified because all injuries are assumed to not be chronic. Currently, there are approximately 14,000 diagnosis codes in version ICD-9-CM and 69,800 diagnosis codes in version ICD-10-CM. The tool also assigns diagnosis codes into one of 18 body system indicator categories, allowing users to create indicators listing which specific body systems are affected by a chronic condition. The body system indicator is based on the chapters of the ICD-9-CM/ICD-10-CM codebooks. This indicator may be useful as a means of counting the number of body systems affected by chronic conditions. Alternatively, the Clinical Classification Software (CCS) may be used in conjunction with the CCI to obtain a count of the number of relatively discrete chronic conditions. The ICD-9-CM CCI was updated annually and is valid for codes from January 1, 1980, through September 20, 2015. ICD-9-CM codes were frozen in preparation for ICD-10-CM implementation and regular maintenance of the codes has been suspended. The ICD-10-CM CCI is updated annually and is valid for codes from October 1, 2015, forward. Elixhauser Comorbidity SoftwareElixhauser Comorbidity Software assigns variables that identify comorbidities in hospital discharge records using ICD-9-CM or ICD-10-CM diagnosis coding and has been used in various analyses. Two versions of the Elixhauser Comorbidity Software are available: Beta Elixhauser Comorbidity Software for ICD-10-CM and Elixhauser Comorbidity Software for ICD-9-CM. The Beta Elixhauser Comorbidity Software for ICD-10-CM consists of two SAS computer programs for personal computers. Although the programs are written in SAS, they are distributed in ASCII so that they can be readily adapted to other programming languages. The first program, Creation of Format Library for Elixhauser Comorbidity Groups, generates a SAS format library that maps diagnosis codes into comorbidity indicators. Additional formats are created to exclude conditions that may be complications or that may be related to the principal diagnosis. The second SAS program, Creation of Elixhauser Comorbidity Variables, applies these formats to a data set containing administrative data and then creates the 29 comorbidity variables. The Elixhauser Comorbidity Software for ICD-9-CM (Version 3.7) contains a third SAS program, Creation of Elixhauser Comorbidity Index Scores, that applies the weights and creates the two indices for the Elixhauser Comorbidity Software ‒ one for in-hospital mortality and one for readmission. The Elixhauser Comorbidity Software for ICD-9-CM is based on ICD-9-CM and Medicare Severity Diagnosis-Related Group (MS-DRG) codes and valid through September 30, 2015. The Elixhauser Software for ICD-9-CM was updated annually from January 1, 1980, through September 30, 2015. The ICD-9-CM codes were frozen in preparation for ICD-10 implementation and regular maintenance of the codes has been suspended. The Beta Elixhauser Comorbidity Software for ICD-10-CM is updated annually and based on the ICD-10-CM and MS-DRG codes that are valid through September 30 of the designated fiscal year after October 1, 2015. The Elixhauser Comorbidity Software is available for download on the HCUP-US Web site. Procedure ClassesProcedure Classes facilitate research on hospital services using administrative data by identifying whether an ICD-9-CM or ICD-10-CM procedure is (a) diagnostic or therapeutic, and (b) minor or major in terms of invasiveness and/or resource use. There are two versions of Procedure Classes tools, Procedure Classes for ICD-9-CM and Beta Procedure Classes for ICD-10-PCS. The Procedure Classes can be used to categorize procedure codes into one of four broad categories:
The Procedure Classes for ICD-9-CM were updated annually from January 1, 1980, through September 30, 2015. The ICD-9-CM codes were frozen in preparation for ICD-10 implementation and regular maintenance of the codes has been suspended. The Beta Procedure Classes for ICD-10-PCS are updated annually and valid for codes from October 1, 2015, forward. Procedure Classes are available for download from the HCUP-US Web site. Utilization FlagsUtilization Flags combine information from Uniform Billing (UB-04) revenue codes and ICD-9-CM or ICD-10-PCS procedure codes to create flags—or indicators—of utilization of services rendered in health care settings such as hospitals, emergency departments, and ambulatory surgery centers. There are two types of Utilization Flags, Utilization Flags for ICD-9-CM and Beta Utilization Flags for ICD-10-CM/PCS. The Utilization Flags can be used to study a broad range of services, including simple diagnostic tests and resource-intense procedures, such as use of intensive care units. They can also be used to more reliably examine utilization of diagnostic and therapeutic services. The Utilization Flags for ICD-9-CM were updated annually from January 1, 2003, through September 30, 2015. The ICD-9-CM codes were frozen in preparation for ICD-10 implementation and regular maintenance of the codes has been suspended. The Beta Utilization Flags for ICD-10-CM/PCS are updated annually and valid for codes from October 1, 2015, forward. The Utilization Flags are available for download from the HCUP-US Web site. Surgery FlagsSurgery Flag Software consists of a SAS program and two files that include information about the classification of procedures into the broad and narrow definitions of surgeries in ICD-9-CM or CPT-based inpatient and ambulatory surgery data. Three versions of the Surgery Flag Software are available. The initial release in September 2014 is valid for ICD-9-CM codes through September 2013 and CPT codes through December 2013. A second version was released in June 2015. A third version, focusing on CPT only, was released in April 2017. This version brought the Surgery Flag software up to date for CPT codes through 2017. The software assignments are validated by certified coding specialists. The Surgery Flag Software identifies two types of surgical categories: NARROW and BROAD. NARROW surgery is based on a narrow, targeted, and restrictive definition and includes invasive surgical procedures. An invasive therapeutic surgical procedure involves incision, excision, manipulation, or suturing of tissue that penetrates or breaks the skin; typically requires use of an operating room; and requires regional anesthesia, general anesthesia, or sedation to control pain. BROAD surgery includes procedures that fall under the NARROW category but adds less invasive therapeutic surgeries and diagnostic procedures often performed in surgical settings. Users must agree to a license agreement with the American Medical Association to use the Surgery Flags before accessing the software. HCUP Supplemental FilesThe HCUP Supplemental Files augment applicable HCUP databases with additional data elements or analytically useful information that was not available when the HCUP databases were originally released. They cannot be used with other administrative databases. Cost-to-Charge Ratio Files (CCR)The Cost-to-Charge Ratio (CCR) Files are hospital-level files designed to convert the hospital total charge data to cost estimates when merged with data elements exclusively in the HCUP NIS, KID, NRD, and SID. The HCUP databases are limited to information on total hospital charges, which reflect the amount billed to the payer per patient encounter. Total charges do not reflect the actual cost of providing care or the payment received by the hospital for services provided. This total charge data can be converted into cost estimates using the CCR Files, which include hospital-wide values of the all-payer inpatient cost-to-charge ratio for nearly every hospital in the participating NIS, KID, NRD, and SID. CCR files can be used for various types of cost analyses. Cost information was obtained from the hospital accounting reports collected by the Centers for Medicare & Medicaid Services (CMS). Researchers and policy makers can use the converted cost estimates to examine a variety of topics, including use and cost of hospital services, health care cost inflation, and how the cost experiences of a given hospital or health plan compare with national or state trends. The Cost-to-Charge Ratio Files are updated annually and available for the HUCP inpatient databases beginning with 2001 data. Hospital Market Structure (HMS) FilesThe Hospital Market Structure (HMS) Files are hospital-level files designed to supplement the data elements in the NIS, KID, and SID databases. The HMS Files contain various measures of hospital market competition. These aggregate measures are meant to broadly characterize the intensity of competition that hospitals may be facing under various definitions of market area. Hospital market definitions were based on hospital locations, and in some cases, patient ZIP Codes. Hospital locations were obtained from the American Hospital Association (AHA) Annual Survey Database, Area Resource File (ARF), HCUP Historical Urban/Rural – County (HURC) file, and ArcView GIS. Patient ZIP Codes were obtained from the SID. Users can merge the data elements on the HMS Files to the corresponding NIS, KID, or SID hospitals by the hospital identification number (HOSPID). Using the merged data elements, users can include hospital market structure measures in analyses. Hospital market structure measures are generally useful for performing empirical analyses that examine the effects of hospital competition on the cost, access, and quality of hospital services. They are most useful to analysts as a secondary control variable (e.g., for assessing whether a statistical relationship exists between two variables when hospital market structure is controlled). The Hospital Market Structure Files are updated every three years. The HCUP Hospital Market Structure Files are currently available for 1997, 2000, 2003, 2006, and 2009. HCUP Supplemental Variables for Revisit AnalysesThe HCUP Supplemental Variables for Revisit Analyses allow users to track sequential visits for a patient within a state and across facilities and hospitals settings (inpatient, emergency department, and ambulatory surgery) while adhering to strict privacy guidelines. The available clinical information can determine if these sequential visits are unrelated, an expected follow-up, complications from a previous treatment, or an unexpected revisit or rehospitalization. Users must merge the supplemental files with the corresponding SID, SASD, or SEDD for any analysis. Data are available from 2003-2008 in ASCII format. Beginning with 2009 data, the revisit variables are included in the Core file of the HCUP State Databases when possible. NIS and KID Trend FilesThe NIS-Trends and KID-Trends files are available to help researchers conduct longitudinal analyses. They are discharge-level files that provide researchers with the trend weights and, in the case of the NIS-Trends, data elements that are consistently defined across data years. American Hospital Association (AHA) Linkage FilesThe American Hospital Association (AHA) Linkage Files are hospital-level files that contain a small number of data elements that allow researchers to supplement the HCUP State Databases with information from the AHA Annual Survey Databases (Health Forum, LLC © 2012). The files are designed to support richer empirical analysis where hospital characteristics may be important factors. Linkage is only possible in states that allow the release of hospital identifiers and are unique by state and year. The HCUP AHA Linkage Files for the SID, SASD, and SEDD are available starting in 2006 from the HCUP-US Web site. Nationwide Inpatient Sample (NIS) Hospital Ownership Files The NIS Hospital Ownership Files are hospital-level files designed to facilitate analysis of the NIS by hospital ownership categories. These HCUP supplemental files allow the user to identify in the 1998-2007 NIS the following three types of hospitals: government, nonfederal; private, nonprofit; and private, investor owned. HCUP News and ReportsHCUP produces material to report new findings based on HCUP data and to announce HCUP news.
See also
References
3 : United States Department of Health and Human Services|Medical databases|Databases in the United States |
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