These selected abstracts are from publications based on data from the Healthcare Cost and Utilization Project (HCUP), a Federal-State-industry partnership to build a standardized, multi-State health data system. HCUP is maintained by the Agency for Healthcare Research and Quality (AHRQ).
HCUP comprises a family of administrative longitudinal databases-including State-specific hospital-discharge databases and a national sample of discharges from community hospitals—and powerful, user-friendly software that can be used with both HCUP data and with other administrative databases.
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
Authors: Ball JK, Elixhauser A, Johantgen M.
Title: HCUP-3 Quality Indicators: Methods, Version 1.1: Outcome, Utilization, and Access Measures for Quality Improvement. Healthcare Cost and Utilization Project (HCUP-3) Research Note.
Publication: Rockville, MD: Agency for Health Care Policy and Research. 1998. AHCPR Publication No.
98-0035.
Date: 1998
Abstract: The value of information on health care quality has never been so widely recognized, yet many organizations lack the resources and/or expertise to build a quality information program from the ground up. Recognizing this, the Healthcare Cost and Utilization Project Quality Indicators (HCUP QIs) were initiated specifically to meet the short-term needs for information on health care quality using standardized, user-friendly methods and existing sources of data.
The indicators were designed to capitalize on the availability of administrative data on inpatient stays to produce information about: avoidable adverse outcomes (e.g., in-hospital pneumonia); utilization of specific inpatient procedures thought to be over-, under-, or misused (e.g., hysterectomy) and access to care in the community, as reflected in the hospitalizations for ambulatory-care-sensitive conditions (conditions amenable to management in an ambulatory setting, e.g. pediatric asthma).
This report provides an overview of the HCUP QI methodology and comprehensive specifications for each measure. It also illustrates a variety of potential uses of the HCUP QIs and a guide for interpreting results, using illustrations generated from the Colorado component of the HCUP State Inpatient Database and focusing on valuable information that can be derived without identifying "good" or "bad" hospitals.
By developing these tools, illustrating their use, and making them available and accessible, the authors hope to assist others in producing information on health care quality more cost effectively.
Authors: Ball JK, et al.
Title: HCUP-3 Quality Indicators: Software User's Guide, Version 1.1: Outcome, Utilization, and Access Measures for Quality Improvement. Healthcare Cost and Utilization Project (HCUP-3) Research Note.
Publication: Rockville, MD: Agency for Health Care Policy and Research. 1998. AHCPR Publication No.
98-0036.
Date: 1998
Abstract: This report is the user's guide for the HCUP QI software Version 1.1 (see above), which is provided on companion diskettes. The diskettes include software developed in two languages, SAS and SPSS, for two platforms, mainframe and personal computers. By making these tools available, we hope to assist others in producing information on health care quality more cost effectively.
Authors: Brooks JM, Dor A, Wong HS.
Title: The Impact of Physician Payments on Hospital-Insurer Bargaining in the U.S.
Publication: In: Chinitz D and Cohen J, editors. Governments and Health Care Systems. London: John Wiley and Sons, Ltd.; 1998.
Date: 1998.
Abstract: In this paper, the researchers extend their earlier work on hospital pricing, in which the bargaining between the hospital and the insurer is modeled as a Nash-bargaining process. In particular, they bring to light the relationship between the hospital-insurer bargaining process and the physician payments. The previous results indicate that competition in hospital markets leads to diminished hospital bargaining power, and that the bargaining position of hospitals has been eroding over time. Although physician payments seem to influence bargaining, these results are essentially unaffected. In addition, the payment to the attending surgeon has a negative effect on hospital bargaining power whereas the portion of the payment dedicated to ancillary physicians has a positive effect on hospital bargaining power.
Return to Citations
Return to Top
Authors: Duffy SQ, Elixhauser A, Sommers JP.
Title: Diagnosis and Procedure Combinations in Hospital Inpatient Data. Healthcare Cost and Utilization Project (HCUP-3) Research Note 3.
Publication: Rockville, MD: Agency for Health Care Policy and Research. 1996. AHCPR Publication No. 96-0047.
Date: 1996.
Abstract: This Research Note contains information on the most frequent combinations of diagnoses and procedures for hospital inpatients. It helps to answer the questions "What is this procedure used for?" and "How is this diagnosis managed?" The analysis is based on data from the 1992 Nationwide Inpatient Sample, a component of AHCPR's Healthcare Cost and Utilization Project. For each of the 100 most frequently performed principal procedures, the study lists the 5 principal diagnoses most commonly recorded on discharge abstracts of patients who had that procedures during the hospitalization. In addition, for each of the 100 most frequent diagnoses, the 5 principal procedures most commonly performed are listed. Median charges and length of stay for each diagnosis-procedure combination are also provided, along with estimates of standard errors.
Examples of findings from this Research Note include:
This information can be used as a starting point for many purposes. Medical professionals can compare their own practices with a nationwide sample. Third-party payers and managed care organizations can use this information as a starting point for examining the impact of payment policies on practice patterns. Health services researchers can use this information to generate hypotheses for future research on the treatment of specific conditions.
Return to Citations
Return to Top
Author: Elixhauser A.
Title: Clinical Classifications for Health Policy Research, Version 2: Software and User's Guide. Healthcare Cost and Utilization Project (HCUP-3) Research Note 2.
Publication: Rockville, MD: Agency for Health Care Policy and Research. 1996. AHCPR Publication No. 96-0046.
Date: 1996.
Abstract: Clinical Classifications for Health Policy Research (CCHPR) Version 2 provides a way to classify diagnoses and procedures into a limited number of categories. CCHPR aggregates individual hospital stays into larger diagnosis and procedure groups for statistical analysis and reporting. This product provides information required to use CCHPR:
CCHPR Version 2 is based on ICD-9-CM codes that are valid for January 1980 through September 1996. There is one classification scheme for diagnoses (260 categories) and one classification scheme for procedures (231 categories).
Authors: Elixhauser A, Duffy SQ, Sommers JP.
Title: Most Frequent Diagnoses and Procedures for DRGs, by Insurance Status. Healthcare Cost and Utilization Project (HCUP-3) Research Note 4.
Publication: Rockville, MD: Agency for Health Care Policy and Research. 1997. AHCPR Publication No. 97-0006.
Date: 1997.
Abstract: This Research Note contains information on the most frequent diagnoses and procedures for the top 50 diagnosis-related groups (DRGs) in the U.S. community hospitals. The analysis is based on data from the 1992 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP-3). For each of the 50 most frequent DRGs, the document lists the 5 most common principal diagnoses and the 5 most commonly performed principal procedures. Mean and median charges and length of stay for each DRG-diagnosis combination and each DRG-procedure combination are provided for all patients combined and for three patient groups defined by their insurance status: the privately insured, Medicaid, and self-pay patients.
Examples of findings from this Research Note include:
This information can be used for many purposes. Medical professionals can compare their own practices to a nationwide sample. Third-party payers and managed care organizations can use this information as a starting point for examining the impact of payment policies and insurance status on practice patterns. Health services researchers can use this information to generate hypotheses for future research on the treatment of specific conditions; the variation in resource use within DRGs; and differences in morbidity, use of services, and patterns of care by payer groups.
Authors: Elixhauser A, Johantgen M, Andrews R.
Title: Descriptive Statistics by Insurance Status for Most Frequent Hospital Diagnoses and Procedures. Healthcare Cost and Utilization Project (HCUP-3) Research Note 5.
Publication: Rockville, MD: Agency for Health Care Policy and Research. 1997. AHCPR Publication No. 97-0009.
Date: 1997.
Abstract: A number of studies have demonstrated differences in access to care, hospitalization rates, the process of care, and outcome of treatment among patients by insurance status. For example, patients with Medicaid as the primary payer or patients who are uninsured tend to:
Descriptive statistics are presented by insurance status for the top 50 diagnoses and top 50 procedures in U.S. hospitals, based on a nationwide administrative database from 1993. Results are presented for privately insured, Medicare, Medicaid, and self-pay patients; all other patients; and all patients combined. This information can be used as a starting point for more in-depth analyses aimed at assessing differences in the process of care and outcomes by insurance status.
This study employs data form the Nationwide Inpatient Sample Release 2, a component of the Agency for Health Care Policy and Research's Healthcare Cost and Utilization Project (HCUP-3). This study sample consists of 6,538,976 discharges from 913 hospitals in 17 States.
This Research Note examines differences by insurance status for a wide range of conditions from a nationwide sample of inpatients. Statistics are presented for the following measures of interest:
Authors: Elixhauser A, McCarthy E.
Title: Clinical Classifications for Health Policy Research, Version 2: Hospital Inpatient Statistics. Healthcare Cost and Utilization Project (HCUP-3) Research Note 1.
Publication: Rockville, MD: Agency for Health Care Policy and Research. 1996. AHCPR Publication No. 96-0017.
Date: 1996.
Abstract: This publication describes Version 2 of the Clinical Classifications for Health Policy Research (CCHPR), a diagnosis and procedure categorization scheme, and provides descriptive statistics for 1992 hospital inpatient stays illustrating the use of the CCHPR categories. Diagnoses and procedures for hospital stays are coded using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), an uniform and standardized coding system. ICD-9-CM consists of over 12,000 diagnosis codes and 3,500 procedure codes. Although it is possible to present descriptive statistics for individual ICD-9-CM codes, it is often helpful to aggregate codes into clinically meaningful categories that comprise similar conditions or procedures.
CCHPR Version 1 was the initial endeavor to construct such clinically meaningful categories. CCHPR Version 2 is based on the Version 1 summary diagnosis and procedure categories. The original categories were modified on the basis of clinical homogeneity, the number of discharges, and ICD-9-CM coding changes.
CCHPR categories can be employed in many types of projects analyzing data on diagnoses and procedures, such as identifying populations for disease- or procedure-specific studies; providing statistical information (such as charges and length of stay) about relatively specific conditions; defining comorbidities; and cross-classifying procedures by diagnoses to provide insight into the variety of procedures performed for particular diagnoses.
Electronic versions of CCHPR classification schemes will be available in a future HCUP-3 Research Note and can be obtained now by contacting the lead author.
Authors: Elixhauser A, Steiner CA.
Title: Hospital Inpatient Statistics, 1996. Healthcare Cost and Utilization Project, HCUP Research Note.
Publication: Rockville, MD: Agency for Health Care Policy and Research. 1999. AHCPR Publication No. 99-0034.
Date: 1999.
Abstract: This publication provides descriptive statistics for U.S. hospital inpatient stays in 1996 using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. National estimates are provided for all discharges by principal diagnosis and by principal procedure. Statistics are presented on the number of discharges, mean length of stay, mean charges, charges in quartiles (25th, 50th, and 75th percentiles), percent who died in the hospital, percent male, and mean age. The statistics in this publication can be used to assess the processes and outcomes of care for diagnoses and procedures in U.S. hospitals. For example, among the most frequent conditions are coronary atherosclerosis with over 1.4 million stays and pneumonia with over 1.2 million stays. Among the longest mean lengths of stay were those for short gestational age, low birth weight, and fetal growth retardation (23 days), infant respiratory distress syndrome (22 days), late effects of cerebrovascular disease (15 days) and paralysis (16 days) while the highest mean total charges were seen for organ transplantation ($191,000) and tracheostomy ($148,000). Diagnoses and procedures are categorized using the Clinical Classifications Software (CCS), a system for collapsing diagnosis and procedure codes into clinically meaningful categories. Electronic versions and definitions of CCS can be obtained online at: http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp
Authors: Elixhauser A, Steiner CA.
Title: Most Common Diagnoses and Procedures in U.S. Community Hospitals, 1996. Healthcare Cost and Utilization Project, HCUP Research Note.
Publication: Rockville, MD: Agency for Health Care Policy and Research. 1999. AHCPR Publication No. 99-0046.
Date: 1999.
Abstract: This publication provides information on the most frequent diagnoses and procedures for hospital inpatients. It helps to answer questions such as "What are the most common reasons for hospitalization in the United States?" "Which procedures are most frequently performed?" "For what conditions is this procedure used?" and "How is this condition treated?" The analysis is based on data for U.S. hospital inpatient stays in 1996 using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. For each of the 100 most frequently performed principal procedures, we list the 5 principal diagnoses most commonly recorded on the discharge abstract. Similarly, for each of the 100 most frequent principal diagnoses treated in hospitals, we list the 5 principal procedures most commonly performed. For each diagnosis-procedure combination, information on in-hospital mortality and mean and median length of stay and total charges is provided.
This publication can be used to evaluate the variety of diagnoses associated with a given procedure and the variations in treatment for particular diagnoses. In addition, it provides information on variations in length of stay, total charges, and in-hospital mortality among diagnosis-procedure combinations. Examples of findings from this publication include:
There are wide variations in length of stay and total charges for some conditions depending on what specific treatments are provided. Hospital charges for coronary atherosclerosis treated without an invasive procedure are, on average, $5,000, compared with $19,000 for hospitalizations during which percutaneous transluminal coronary angioplasty is performed, and $44,000 for a hospitalization during which coronary artery bypass graft is performed.
Most procedures are performed for a wide range of conditions. One third of all hysterectomies are used to treat benign neoplasm of the uterus, while prolapse of female genital organs accounts for 15 percent, endometriosis accounts for 12 percent, and menstrual disorders account for 11 percent of all hysterectomies.
The major cause of amputation of the lower extremity is diabetes mellitus, accounting for 35 percent of the reasons for amputation. Gangrene is the next most common principal diagnoses (30 percent) followed by infective arthritis and osteomyelitis (6 percent). This information can be used as a starting point for many analyses. Medical professionals can compare their own practices with a nationwide sample. Health plans and insurers can use the information as a starting point for examining the impact of payment policies on practice patterns. Health services researchers can use the information to generate hypotheses for future research on the treatment of specific conditions.
Authors: Elixhauser A, et al.
Title: Clinical Classifications for Health Policy Research: Hospital Inpatient Statistics, 1995. Healthcare Cost and Utilization Project (HCUP-3) Research Note.
Publication: Rockville, MD: Agency for Health Care Policy and Research. 1998. AHCPR Publication No. 98-0049.
Date: 1998.
Abstract: This publication provides descriptive statistics for U.S. hospital inpatient stays in 1995 using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. National estimates are provided for all discharges by principal diagnosis and by principal procedure. Statistics are presented on the number of discharges, mean length of stay, mean charges, charges in quartiles (25th, 50th, and 75th percentiles), percent who died in the hospital, percent male, and mean age. Diagnoses and procedures are categorized using the Clinical Classifications for Health Policy Research (CCHPR), a system for collapsing diagnosis and procedure codes into clinically meaningful categories. This update of the CCHPR incorporates International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding changes through September 1998.
CCHPR categories can be employed in many types of projects analyzing data on diagnoses and procedures, such as identifying populations for disease- or procedure-specific studies; providing statistical information (such as charges and length of stay) about relatively specific conditions; defining comorbidities; and cross-classifying procedures by diagnoses to provide insight into the variety of procedures performed for particular diagnoses.
Return to Citations
Return to Top
Authors: Miller MR, Elixhauser A, Zhan C, Meyer GS.
Title: Patient Safety Indicators: Using Administrative Data to Identify Potential Patient Safety Concerns.
Publication: Health Services Research 36(6) Part II: 110-132.
Date: 2001.
Abstract: Objective: To develop Patient Safety Indicators (PSI) to identify potential in-hospital patient safety problems for the purpose of quality improvement. Data Source/Study Design: The data source was 2,400,000 discharge records in the 1997 New York State Inpatient Database. PSI algorithms were developed using systematic literature reviews of indicators and hand searches of the ICD-9-CM code book. The prevalence of PSI events and associations between PSI events and patient-level and hospital-level characteristics, length of stay, in-hospital mortality, and hospital charges were examined. Principal Findings: PSIs were developed for 12 distinct clinical situations and an overall summary measure. The 1997 event rates per 10,000 discharges varied from 1.1 for foreign bodies left during procedure to 84.7 for birth traumas. Discharge records with PSI events had twofold to threefold longer hospital stays, twofold to 20-fold higher rates of in-hospital mortality, and twofold to eightfold higher total charges than records without PSI events. Multivariate logistic regression revealed that PSI events were primarily associated with increasing age (p < .001), hospitals performing more inpatient surgery (p < .001), and hospitals with higher percentage of beds in intensive care units (p < .001).
Conclusions: The PSIs provide an efficient and user-friendly tool to identify potential in-hospital
patient safety problems for targeted institution-level quality improvement efforts. Until better error-reporting systems are developed the PSIs can serve to shed light on the problem of medical errors not limited solely to mortality because of errors.
Return to Citations
Return to Top
Authors: Friedman B, Steiner CA, Scott J.
Title: Rationing of an Expensive Technology in the U.S.: Hospital Intensive Care Units in Two States.
Publication: In: Chinitz D and Cohen J, editors. Governments and Health Care Systems. London: John Wiley and Sons, Ltd.
Date: 1998.
Abstract: The primary purpose of the researchers is to test the impact of financial incentives due to broad differences in health insurance on the rationing of both admissions to ICUs and also the amount of service provided to patients admitted. The authors attempt to control for variations in patient health status in several ways. In addition, by including a large number of hospitals from two very different States, the authors can test for State and hospital-specific factors in the allocation of ICU services.
Return to Citations
Return to Top
Author: Shen JJ.
Title: Social Economic Status and Outcome of Acute Myocardial Infarction.
Publication: Conference: Health Services Research: Implications for Policy, Delivery and Practice; 1998 June 22; Washington Hilton and Towers, Washington, DC.
Date: 1998 June 22.
Abstract: Access to and quality of care for vulnerable populations have been a serious issue in health care delivery for a long time. This paper, using relatively recent information, examines the effect of patients' social economic status, measured by race, health insurance status, and range of the median income in the ZIP Code area, on risk-adjusted in hospital mortality rates of acute myocardial infarction (AMI). In addition, the average length of stay (ALOS) and average total charges (ATC) for AMI care are also compared across different levels of social economic status.
Study Design: Cross-sectional patient-level data, the Nationwide Inpatient Sample (NIS) Release 3 (1994) obtained from the Hospital Cost and Utilization Project (HCUP-3), AHCPR, are used to assess the hypothesized relationships between social economic status and AMI mortality. Mortality rates for AMI are adjusted by, with revision, employing a model developed for the California Hospital Outcomes Project (1997). Risk adjusters include demographic, clinical, organizational, and environmental factors. The measures of social economic status include race, insurance status, and median income range of the ZIP Code area. Race is categorized as white, black, Hispanic, and other ethics; Insurance status is grouped as Medicare, Medicaid, private insurance, HMO and other prepaid programs, uninsured, and other insurance programs. The range of the median ZIP Code income is classified by HCUP into eight levels. A total of 102,806 AMI discharges is included in the study. In order to have more homogenous groups of patients, analyses for Medicare patients and other patients were performed together and separated respectively.
Principal Findings: Medicaid and the uninsured AMI patients have consistently higher risk-adjusted mortality rates than these of the other patients. Compared with Medicare patients who are older, Medicaid patients show a 21 percent higher rate in hospital mortality, and the uninsured show 22 percent higher; while the privately insured patents and the prepaid-plan covered patients have 19 percent and 16 percent lower rates, respectively. Moreover, among the 42,118 non-Medicare patients, Medicaid and the uninsured patients, compared with the private insured patients, have 36 percent and 49 percent higher mortality rates; the prepaid plan covered patients show no significant difference in mortality from the privately insured. Because Medicaid and the uninsured patients have explained such an unfavorable outcome, this is further confirmed by examining the relationship between the ZIP Code median income range and the AMI mortality. The results indicate that, among the eight income levels, the risk of hospital mortality at a level for non-Medicare patients will increase 4 percent as the median income goes down one level. Among the Medicare patients, this figure is 3 percent. After adjusting the risk factors, African American patients have a lower mortality rate than white patients, while Hispanic and other ethnic patients show no difference. More significantly, for patients who are in "double jeopardy" (i.e., in either Medicaid program or uninsured and living in low median income areas), they have a 65 percent higher rate of mortality than those who are "doubly favored" (i.e., neither Medicaid beneficiaries nor uninsured and live in high median income areas). In addition, the doubly jeopardized patients have ALOS of 8.9 and the ATC of $22,412, compared with 5.8 and $20,605 for the doubly favored patients.
Social economic status significantly affects the outcome of AMI patients. Medicaid and uninsured patients are the least favored groups in measuring the risk-adjusted outcome, while there exists no significant difference between the privately insured and the alternatively prepaid groups. The lower income AMI patients have less favorable outcome measures than the higher income patients, irrespective of the type of health insurance. Race seems not to be a barrier to access to AMI care after adjusting different risk factors. The doubly jeopardized patients have much higher mortality rates, longer ALOS, and higher ATC than the doubly favored patients, which indicates the disadvantageous patients being admitted in higher severity of illness attributed by the lack of access to care.
Implications for Policy, Delivery, or Practice: Public policy officials should be concerned with the lack of access to care and select better strategies to target economically vulnerable groups who have higher risk of in-hospital mortality for quality improvement. The Government should also pay more attention to the Medicare beneficiaries who have relatively little resource and income for risk reduction.
Authors: Simonsen L, Morens DM, Elixhauser A, et al
Title: Effect of Rotavirus Vaccination Programme on Trends in Admission of Infants to Hospital for Intussusception
Publication: Lancet 358(9289):1224-29
Date: 2001 Oct 13
Abstract: The effect of Rotashield vaccination use on intussusception admissions in 10 U.S. States was investigated. We analyzed electronic databases containing 100 percent hospital discharge records for 1993-99 from 10 States, where an estimated 28 percent of the birth cohort had received Rotashield. Records of infants admitted to hospital (<365 days old) with any mention of intussusception were examined (ICD-9-CM code 560·0). Excess admissions for intussusception during the period of Rotashield availability (October 1998-June 1999) were estimated by direct comparison with the corresponding period of October 1997 to June 1998 (before Rotashield was available) and with adjustment for secular trends during 1993-98 by Poisson regression. Among infants ages 45-210 days, an increase in intussusception admissions of 1 percent (one excess admission) was estimated by direct comparison and 4 percent (4·6 excess admissions) by trend comparison, (PAR range of one excess admission in 66,000-302,000). No evidence of increased infant intussusception admissions was found during Rotashield availability.
Return to Citations
Return to Top
Author: Substance Abuse and Mental Health Services Administration.
Title: National Expenditures for Mental Health, Alcohol and Other Drug Abuse Treatment.
Publication: Rockville, MD: The National Clearinghouse for Alcohol and Drug Information Research Report. 1998. HHS Publication No. SMA 98-3255.
Date: 1998.
Abstract: Mental health, alcohol and other drug abuse (MHAOD) services are a significant sector of the health care economy. Much of this services industry consists of specialty providers who deliver care within systems apart from general health care. Tracking MHAOD treatment expenditures is essential for understanding the effect of the dynamic changes occurring in this industry, such as the spread of managed care and medical advances in treatment. The development of policies to improve the provision of cost-effective and accessible mental health and substance abuse treatment requires that we understand how MHAOD dollars are currently allocated.
The purpose of this study is to provide timely answers to the following types of questions concerning expenditures for MHAOD treatment services: How much are we spending to treat mental illness and abuse of alcohol and other drugs?
To the extent possible, researchers estimated MHAOD treatment expenditures using data and methods that the Health Care Financing Administration (HCFA) uses for estimates of national health expenditures. Thus, they relied primarily on nationally representative databases, generally with multiple years of data covering the primary study period of 1986-96. Estimates included expenditures only for formal treatment of MHAOD disorders. The substantial comorbid health costs that can result from MHAOD (for example, trauma, HIV, and other infectious diseases) and the indirect costs associated with MHAOD disorders (such as lost wages) were excluded from the estimates.
Principal Findings:
Return to Citations
Return to Top
Current as of September 2001
Send Questions & Comments to: hcup@ahrq.gov
Internet Citation:
Publications from the HCUP Database. Agency for Health Care Policy and Research, Rockville, MD. September 2001. http://www.ahrq.gov/data/hcup/hcupab.htm
Return to HCUP
Data & Surveys
AHRQ Home Page
Department of Health and Human Services Home
Page