Goal 3—Costs, Use, and Access to Health Care (continued)

Databases and Other MEPS Products

AHRQ ensures that MEPS data are readily available—consistent with privacy policies—for use in research and policymaking. MEPS data are released in a variety of ways. For example:

• Databases. MEPS produces a number of analytical databases and releases a number of databases to the public, including demographic, health care use, access, expense, and insurance coverage information for all survey participants.
• Printed data. AHRQ publishes MEPS data in tabular form on a range of topics. Printed publications include methods reports, findings, and chartbooks.
• Web site. AHRQ maintains a Web site specific to the MEPS. Databases and other MEPS products are made available to the research community and other interested audiences, and AHRQ responds promptly to inquires from MEPS users. AHRQ responds to more than 100 inquires made through the MEPS Web site each month.
• MEPSnet. AHRQ has developed a set of statistical tools to allow immediate access to MEPS micro data in a nonprogramming environment. From the MEPSnet section of the MEPS Web site, through a series of interactive queries, the most inexperienced user has the ability to generate national estimates in a few seconds. Go to http://www.meps.ahrq.gov/mepsweb/data_stats/meps_query.jsp to access this resource.
• LISTSERV® . The purpose of the MEPS LISTSERV® is to allow the free exchange of questions and answers about the use of the MEPS database. Currently, there are more than 500 subscribers to the MEPS LISTSERV®.
• Training. AHRQ conducts a series workshops—ranging in length from a few hours to several days—to educate policymakers, researchers, and other users about the range of questions that MEPS can answer and how the data can be properly used.
• Data center. AHRQ's Center for Cost and Financing Studies operates a data center to facilitate access to and use of MEPS data and answer questions from users.

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Healthcare Cost and Utilization Project

The Healthcare Cost and Utilization Project (HCUP) is a Federal-State-industry partnership to build a standardized, multi-State health data system. This long-standing collaborative endeavor has built and continues to develop and expand a family of databases and powerful, user-friendly software to enhance the use of administrative data. HCUP includes data on hospital discharges from participating States, as well as a nationwide sample of discharges from community hospitals. AHRQ has expanded HCUP beyond inpatient hospital settings to include hospital-based ambulatory surgery facilities, and a pilot effort is underway to capture information from emergency department databases.

Data from HCUP have been used to produce reports that answer questions on reasons Americans are hospitalized, how long they stay in the hospital, the procedures they undergo, how specific conditions are treated in hospitals, charges incurred for hospital stays, and the resulting outcomes.

AHRQ has made available the Kids' Inpatient Database (KID), the Nation's first comprehensive database on hospital use, charges, and outcomes focused exclusively on children and adolescents. The KID contains 1.9 million pediatric discharges representing 6.7 million pediatric discharges nationwide and data on various hospital characteristics such as region, location (urban/rural), bed size, ownership, teaching status, and children's hospital status.

FY 2002 accomplishments include increasing the number of States participating in HCUP; 29 States are HCUP partners. Four new State partners joined HCUP in FY 2002: Kentucky, North Carolina, Texas, and West Virginia. They were selected based on the diversity—in terms of geographic representation and population ethnicity—they bring to the project, along with data quality and their ability to facilitate timely processing of data.

The number of States now participating in the State Ambulatory Surgery Databases (SASD), a second group of HCUP databases, increased from 9 in FY 2000 and 13 in FY 2001 to 15 in FY 2002.

Over the past several years, AHRQ has made a concerted effort to increase the accessibility of HCUP data to researchers and other interested users. A centerpiece of this effort is HCUPnet, a free, interactive, menu-driven online service that allows easy access to national statistics and trends and selected State statistics about hospital stays.

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HCUPnet answers questions about conditions treated and procedures performed in hospitals for the population as a whole, as well as for subsets of the population such as children and the elderly. About 5,800 visits are logged each month on HCUPnet. Go to http://hcupnet.ahrq.gov/ to access HCUPnet.

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Use of HCUP Data

The HCUP databases are being used by a variety of Federal agencies and national health care organizations to examine practices and trends and guide health care decisionmaking. Examples include:

• The Centers for Disease Control and Prevention (CDC) partners with AHRQ to incorporate HCUP NIS data in relevant Morbidity and Mortality Weekly Reports (MMWR). For example, in a recent (late fall 2002) MMWR, the CDC and AHRQ used HCUP NIS (1997) data to estimate the national rates of hospital discharges for lower extremity amputation (LEA), a disabling and costly procedure, among people with and without diabetes. According to the report, the age-adjusted rates of hospital discharges among people with LEA who had diabetes were 28 times higher compared with rates among people without diabetes. This higher rate underscores the need to increase efforts to address risk factors that result in LEA among people with diabetes.
• ProMedica Health System, a large, not-for-profit health system in the Northwest Ohio and Southeast Michigan areas, used statistics in the HCUP Fact Book on Care of Women in U.S. Hospitals, 2000, for its initiative related to diversity in patient care. The statistics provide empirical data that will assist ProMedica in establishing baselines and benchmarking references.
• The National Institute of Allergy and Infectious Diseases (NIAID) in collaboration with AHRQ used the HCUP SID (1993-1999) to examine the effects of a rotavirus vaccine on hospital admissions among children. Rotavirus is a common cause of severe diarrhea among children and is responsible for half a million deaths in developing countries each year. After a previous study showed an increased risk of a serious and life-threatening complication (intussusception) following administration of rotavirus vaccine, the vaccine was withdrawn from the market. The NIAID and AHRQ analysis found no evidence of increased hospitalizations for intussusception during the period of vaccine availability, which suggests that the risk may be much lower than previously thought. This new information has implications for future vaccine policy.
• HCUP NIS and SID (2000) data will be used in preparing the first (2003) release of the National Healthcare Quality Report, a flagship project of the agency to provide national and State-level indicators of how well our health care systems are working.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) used the HCUP NIS (1988-1994) in its report on national expenditures for mental health, alcohol abuse, and other drug abuse treatment. Because HCUP is the only research database that provides hospital charge data for all types of patients, including the uninsured, it allowed a comprehensive analysis on the costs of care for a wide array of mental health-related conditions, including conditions that are relatively uncommon.
• The March of Dimes uses statistics from the online HCUP database, HCUPnet, and from the HCUP Fact Book on Hospitalizations in the United States, in developing its resource guide, Data Book for Policy Makers: Maternal, Infant and Child Health in the United States. The March of Dimes updates and publishes the Data Book every 2 years, with the next edition due out in early 2003. This reference is used by policymakers and others seeking access to national and State data on a regular basis, including information on prenatal care, infant mortality, birth defects, immunization, and trends in health insurance coverage.
• The National Association of Children's Hospitals and Related Institutions (NACHRI) supported and collaborated with AHRQ in the development of a database on children's hospitalizations, the HCUP Kids' Inpatient Database (KID), the newest addition to the family of HCUP databases. Because children's hospitalizations are relatively uncommon compared with adult stays, a database that looks specifically at children's stays allows for much more detailed and accurate analyses.
• The Blue Cross/Blue Shield Association sponsored a series of reports on rising hospital costs, one of which used the HCUP SID from 10 States to look at the impact of quality on costs. The report includes State-specific rates for a number of quality indicators. According to the study, patients in both teaching and nonteaching hospitals who had unfavorable outcomes incurred higher costs than those who had favorable outcomes. For teaching hospitals, for example, the increase in costs ranged from a low of 47 percent for urinary tract infections to a high of 119 percent for wound infections.

Nationwide Inpatient Sample (NIS). NIS is the largest all-payer inpatient database in the United States. It provides information on about 7.5 million hospital stays from about 1,000 hospitals, including data for each year from 1988-2000. In 2000, 28 States participated in the NIS.

Another means AHRQ has instituted to enhance access to HCUP data is the creation of a central distribution center for the State-level databases. Researchers and other users no longer have to contact individual States; now they can contact the HCUP Central Distributor and go one-stop shopping to obtain the data they need.

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User-Friendly Software Tools for Quality Improvement

In FY 02 AHRQ launched two modules of the AHRQ Quality Indicators (QIs), a set of quality measurement software tools that can be used with any inpatient administrative data, thus making it compatible with most data systems. The AHRQ QIs are designed for use in highlighting potential quality concerns, identifying areas that need further study and investigation, and tracking changes over time. Users include providers, purchasers, policymakers, researchers, and others at the Federal, State and local levels. The software is available free on the AHRQ Web site (http://www.qualityindicators.ahrq.gov).

The QIs are used by health care leaders to inform:

• Collective understanding of hospital outcomes, community access to care, use of care, and costs.
• Assessments of the effects of health care program and policy choices.
• Future health care policymaking.

AHRQ created the QIs in response to requests for assistance from State-level data organizations and hospital associations with inpatient data collection systems. The QIs were developed for use with information found in routine hospital administrative data, such as diagnoses and procedures, along with information on a patient's age, sex, source of admission, and discharge status.

The QIs were created by AHRQ in partnership with the University of California, San Francisco (UCSF)/Stanford Evidence-based Practice Center (EPC). Their development efforts included formal evaluation by experts in the areas of quality measurement, performance improvement, use of administrative data, and risk-adjustment, as well as feedback from various user groups.

The first two modules—the Prevention Quality Indicators (PQIs) and the Inpatient Quality Indicators (IQIs)—include a total of 45 indicators.

• Prevention Quality Indicators (PQIs). These indicators consist of "ambulatory care sensitive conditions." These are conditions for which evidence suggests that hospital admissions could have been avoided through high-quality outpatient care or illness could be less severe if the condition is treated early and appropriately. There are sixteen PQIs covering conditions such as diabetes, asthma, heart disease, pneumonia, and selected pediatric conditions. These indicators were released in early FY 2002 (November 2001).
• Inpatient Quality Indicators (IQIs). These indicators reflect quality of care inside hospitals and include inpatient mortality; use of procedures for which there are questions about overuse, underuse, or misuse; and volume of procedures for which there is evidence that a higher volume of procedures is associated with lower mortality. The IQIs include hospital and area level indicators. There are 29 indicators specific to hospital care for heart disease and surgery, hip repair, pneumonia, childbirth, and other conditions and procedures. The IQIs were released in July 2002.

Users of AHRQ QIs. The AHRQ QIs are being used by a variety of providers, purchasers, and State agencies as an integral part of quality improvement programs.

Examples of QI use include:

• Providers: The Dallas-Fort Worth Hospital Council (DFWHC) used the IQI software to generate comparative data and reports using 1999, 2000, and 2001 data. They published the hospital specific comparative information for their members as yearly trend reports in July 2002. The DFWHC also provided members with their own patient-level data for detailed evaluation and quality improvement activities.
• Purchasers: The Niagara Health Coalition used the IQI software and the New York State hospital discharge data file to generate comparative data and reports for all hospitals in the state of New York. They published these data and reports on their Web site in fall 2002.
• State agencies: The Texas Healthcare Information Council (THCIC) used the IQI software and their 2000 hospital discharge data to generate comparative data and reports for all hospitals in the State of Texas. They released their findings on their Web site at the close of fiscal year 2002.
• Federal agencies: The National Quality Forum is evaluating several AHRQ Inpatient QIs for inclusion in their initial hospital performance measurement set. The QIs are also being used for the first-ever National Healthcare Quality Report. Although the report is still in development, data from a subset of indicators from the Inpatient QIs and the Prevention QIs are being reviewed for this purpose.

Hospitals and hospital systems. AHRQ's QIs can help hospitals and hospital systems answer specific questions like these:

• How does our hospital's cesarean section rate compare with the State or the Nation?
• Do other hospitals have similar mortality rates following hip replacement?
• How does the volume of coronary artery bypass graft surgery in my hospital compare with other hospitals?

Hospital quality reports. The Healthcare Association of New York State (HANYS)—which represents more than 500 nonprofit and public hospitals, long-term care facilities, and home health agencies–has adapted AHRQ's QIs to produce annual reports for its member hospitals. The purpose of each annual report is to provide individual hospitals with comparative data on a broad range of indicators to help them target areas for improving quality of care and efficiency. The QI outcome measures provide guidance to identify areas for further examination inside each hospital, and the QI measures of access and use serve as a springboard for regional and community health initiatives. Reports prepared for hospital systems include data for each affiliated hospital, and additional comparisons are made with data from other States.

State data organizations and community health partnerships. These groups use AHRQ QIs to ask questions that provide initial feedback about clinical areas appropriate for further, more in-depth analysis, such as:

• What can the pediatric AHRQ QIs tell me about the adequacy of pediatric primary care in my community?
• How does the hysterectomy rate in our area compare with the State and national average?

State hospital associations. State hospital associations use the AHRQ QIs to do quick hospital quality and primary care access screens. Other potential users include managed care organizations, business-health coalitions, State data organizations, and others poised to begin assessments using hospital discharge data to answer questions such as:

• Can we design community interventions in areas surrounding hospitals that have high rates of diabetes-related complications?
• Which Quality Indicators can be incorporated into performance management initiatives for our member hospitals?

Federal policymakers. AHRQ QIs help these users track health care quality in the United States over time and assess whether health care quality is improving, for example:

• How does the rate of coronary artery bypass grafts vary over time and across regions of the United States?
• What is the national average for bilateral cardiac catheterization (a procedure that is not generally recommended), and how has this changed over time?

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