HCUP Data in the National Healthcare Quality & Disparities Reports: Current Strengths and Potential Improvements

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1 HCUP Data in the National Healthcare Quality & Disparities Reports: Current Strengths and Potential Improvements Irene Fraser, Ph.D.. Director Roxanne Andrews, Ph.D. Center for Delivery, Org. and Markets Presentation to Institute of Medicine Committee on Future Directions for the National Healthcare Quality and Disparities Reports February 10, 2009

2 Outline n What is HCUP? n How are HCUP data and tools used in NHQR/DR and State Snapshots? n What are potential improvements or enhancements? n Discussion

3 The HCUP Partnership: A Voluntary Federal-State State-Private Sector Collaboration AK OR CA WA NV ID AZ UT MT WY CO NM ND SD NE TX KS OK MN IA MO WI AR LA IL MS IN TN MI AL KY OH WV SC GA PA FL VA NC VT NY ME NH MA RI CT NJ DC DE MD Legend HCUP Partner Potential Partner HI 40 states in partnership 90% of all discharges Does Not Collect Statewide Inpatient Data Not a Partner

4 HCUP Is a Family of Databases, Tools, and Products HCUP Databases Software, Tools, Measures User Support Research Publications

5 HCUP Databases State Inpatient Databases (SID) State Ambulatory Surgery Databases (SASD) State Emergency Department Databases (SEDD) Nationwide Inpatient Sample (NIS) Kids Inpatient Database (KID) Nationwide Emergency Department Sample (NEDS)

6 What is HCUP? And what is it not? HCUP is... Discharge database for health care encounters All payer, including the uninsured Hospital, ambulatory surgery, emergency department data All hospital discharges Accessible multiple ways: raw data, regular reports, on-line (HCUPnet( HCUPnet) HCUP is not... A survey Specific to a single payer, e.g. Medicare Outpatient visits, pharmacy, laboratory A sample Just another database

7 AHRQ Quality Indicators (QIs) n Developed at behest of state partners n Use existing hospital discharge data n Incorporate severity adjustment n Current modules: Inpatient, Patient Safety, Pediatric and Neonatal,, Prevention n Include composites n Growing use for reporting and P4P n NQF endorsement for 40+ so far n CMS using 9 under new Inpatient Payment rule n Evidence-based public reporting template available n 14 states use AHRQ QIs for public reporting

8 Oregon 14 States Use AHRQ QIs for Public Hospital Reporting Iowa Wisconsin (parts of state) NewYork Ohio Vermont California Utah Colorado Texas Massachusetts New Jersey Kentucky Florida

9 Study Shows Cost-effective Enhancements to Admin. Data* n Assessed impact of incrementally adding more complex clinical information n Administrative data can be improved at relatively low cost by: Adding present on admission (POA) modifiers Adding numerical lab data on admission Improved coding n AHRQ Awarded pilots in VA, FLA, MN, planning contract in WA to show proof of concept * Pine M, Jordan HS, Elixhauser A, et al. Enhancement of claims data to improve risk adjustment of hospital mortality. JAMA 2007, 267 (1): Jordan HS, Pine M, Elixhauser A, et al., Cost-effective enhancement of claims data to improve comparisons of patient safety. Journal of Patient Safety 2007, 3(2): Fry DE, Pine M, Jordan HS, et al. Combining administrative and clinical c data to stratify surgical risk. Annals of Surgery 2007 (forthcoming).

10 Preventable Hospitalization Costs: A County-level Mapping Tool n Potentially Preventable Hospitalizations cost over $30B a year. n Maps show the admission rates for health problems by county. n Calculates cost savings if admissions are reduced. n Can add information about local populations show number of persons at greatest risk for health problems in each county.

11 NEW! Portal for States, Communities, Others to Display, Analyze Data n Query paths currently in HCUPnet n Results based on AHRQ QIs n Preventable Hospitalization Costs mapping tool n New ways of presenting information Beyond tables QI Reporting Template n Other AHRQ tools? Other information? n Strategies for Improvement

12 2008 Race-Ethnicity Data Collection by HCUP States Categories Consist with OMB Standard 1997 Directive (white, black, AIAN, Asian, NHOPI) - Separate Ethnicity Question - Ethnicity Combined with Race 1977 Directive (white, black, AIAN, API) - Separate Ethnicity Question - Ethnicity Combined with Race No Hispanic coding No Hispanic, API or AIAN No Race-Ethnicity # States

13 SID Disparities Analysis File Drawn from Best States 5 Strata (same as NIS) U.S. Region 23 State Inpatient Databases, 2004 Hospitals with Good Race- Ethnicity Coding Urban/Rural B e d O w n e r s h Teaching Status S i z e O w nership/control i p / C o Bed Size n t r 40% Stratified Sample of Hospitals SID disparities analysis file N = ~ 1,900 Hospitals N = ~ 15 million dis.

14 HCUP Strengths for Use in NHRQ/NHDR and State Snapshots n National data, local drill-down down n Robust for subgroup analysis n All patients, including uninsured n Includes charge & calculated cost data n NQF-endorsed quality measures n Efficiency measures and data beginning n Timeliness good and improving n Strong data on race and ethnicity n Tools for national and local action n Technical assistance for users

15 Outline n What is HCUP? n How are HCUP data and tools used in NHQR/DR and State Snapshots? n What are potential improvements or enhancements? n Discussion

16 HCUP Data Reports National Trends, Variations HCUP Databases Data Years Prevention Quality Indicators Pediatric Quality Indicators Inpatient Quality Indicators Patient Safety Indicators 2007 NHQR Nationwide Inpatient Sample 1994, 1997, NHDR Disparities analysis file derived from 23 State Inpatient Databases

17 HCUP in the 2007 NHQR and NHDR NHQR: National Estimates using Quality Indicators n Trends (1994, ) 2004) n Current quality by population group age, gender, community income, payer, urban-rural rural n Current quality by hospital characteristics region, ownership, teaching, urban-rural, rural, bed size NHDR: National Estimates using Quality Indicators n Estimates by HCUP uniform race-ethnicity ethnicity groups White, black, Hispanic, Asian/Pacific Islanders n Estimates by race-ethnicity ethnicity by population and hospital characteristics

18 State Statistics in NHQR and State Snapshots n HCUP Partners volunteer for participation, participation growing every year n State statistics for selected QIs n Collaborate with HCUP Partners in using the State Snapshots Prepare a press release package for them, FAQs for press inquiries Challenges in Utah s Health Care report by Utah Dept of Health n

19 Efficiency Chapter- New in 2007 NHQR n National admissions and costs for aggregate PQIs Trends 1997, n Relative hospital cost efficiency index

20 Outline n What is HCUP? n How are HCUP data and tools used in NHQR/DR and State Snapshots? n What are potential improvements or enhancements? n Discussion

21 Likely Short-Term Improvements n State Statistics Add new states Add breakouts by race-ethnicity, community income for a disparities focus Work with Partners to take advantage of State Snapshots n Efficiency All-payer readmission costs in selected states by selected conditions

22 Vision for HCUP and Hybrid Data Strategy n Improve timeliness n Provide on-line all-payer market-level data on cost, quality, efficiency, price. n Add clinical detail, data links for accuracy, credibility n Expand outpatient reach (e.g. physician, episode) n Pilot cross-site site data, new data links n New tools for expanded data n Additional states,, as feasible n Develop, validate, maintain, deploy measures in priority areas n Expand data elements to align with levers of change n Tools for change

23 How HCUP/QI Improvements Could Strengthen NHQR/DR HCUP/ QI Vision Improve timeliness, clinical robustness Expand EQUIPS, other tools Add state partners Expand technical assistance and outreach NHQR/DR Improvement Data more credible, actionable Data more actionable Local data is actionable in more states Data more actionable, at national and local levels

24 Frontier in All-Payer Claims Data: Data ACROSS Sites: Hospital Data ED Data A. Surg. Data Cross-site site Data

25 How HCUP/QI Improvements Could Strengthen NHQR/DR (2) HCUP/ QI Vision Add outpatient, cross-site site data Add ED measures, episode measures Add efficiency measures Add/improve race/ethnicity data, e.g. on UB-04 Add measures on priority populations NHQR/DR Improvement Expands scope Expands scope Expands scope Improves scope,, accuracy of data on disparities Expands scope,, data on disparities

26 Outline n What is HCUP? n How are HCUP data and tools used in NHQR/DR and State Snapshots? n What are potential improvements or enhancements? n Discussion

27 us.ahrq.gov/ qualityindicators.ahrq.gov/

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