HCUP Reports and Features for Informing Policy
P. Hannah Davis
Manager, HCUP User Support
Agency for Healthcare Research and Quality
December 6, 2008
The Department of Health & Human Services and the AHRQ logos are located above the title of the presentation. Throughout the rest of the presentation, the AHRQ logo is located in the upper left corner and the HCUP logo in the upper right corner.
Slide 2
Healthcare Cost and Utilization Project (HCUP)
This slide has a textbox super imposed on several unidentifiable images, containing the slide title, the HCUP logo, and the following text: The largest collection of multi-year, all payer, encounter-level, health care data.
Slide 3
HCUP Partners with 40 States
This slide contains the image of another slide entitled 'The HCUP Partnership: A Voluntary Federal-State-Private Sector Collaboration.' The slide contains a color-coded map of the U.S. indicating the degree of involvement of each state in HCUP.
Slide 4
HCUP Is a Family of Databases, Tools, and Products
HCUP is comprised of HCUP databases, Software tools, Reports, and User support. This slide contains corresponding images to the components of HCUP.
Slide 5
HCUP Reports and Features Have Useful Information
• HCUP Facts and Figures (online only)
• Has national statistics on hospital stays
• Updated annually
• HCUP Statistical Briefs (online only)
• Present simple, descriptive statistics on a variety of specific, focused topics
• Produced biweekly (approx.)
• HCUP Fact Books (online and printed)
• Provides information about specific aspects of hospital care
Slide 6
This slide contains the cover of the 2006 HCUP Facts and Figures report.
Slide 7
HCUP Facts and Figures
• An annual report, updated in August
• Contains statistics on hospital based care
• Most common diagnoses, conditions, and procedures
• Costs and charges associated with hospitalizations
• Special topic - priority conditions in 2006
• Current report has 2006 data from HCUP Nationwide Inpatient Sample (NIS), and trends from 1997
• States can download software and run with own data
• Report available on HCUP-User Support website at www.hcup-us.ahrq.gov/reports
Slide 8
Overview of Hospital Utilization and Costs, 1997-2006
This slide contains a chart comparing Hospital Utilization and Costs in 1997 and 2006.
• Total discharges: 34.7 million in 1997 and 39.5 million in 2006
• Discharges per 1,000 population: 127.8 in 1997 and 131.9 in 2006
• Total days of care: 168.1 million in 1997 and 181.3 million in 2006
• ALOS: 4.8 in 1997 and 4.6 in 2006
• Avg charge per stay*: $13,800 in 1997 and $24,000 in 2006
• Average costs per stay*: $6,200 in 1997 and $8,400 in 2006
*inflation adjusted in 2006 dollars
Slide 9
Top 5 Most Frequent Principal Diagnoses, 1997-2006
This slide contains a chart listing the percent change of discharges for the top five most frequent principal CCS diagnoses in 1997 and 2006.
• All discharges: 34,679 in 1997 and 39,450 in 2006, a change of 14 percent
• Pregnancy, childbirth and newborn infants: 8,236 in 1997 and 9,252 in 2006, a change of 12 percent
• Pneumonia: 1,232 in 1997 and 1,218 in 2006, a change of negative 1 percent
• Coronary atherosclerosis (coronary artery disease): 1,407 in 1997 and 1,198 in 2006, a change of negative 15 percent
• Congestive heart failure: 991 in 1997 and 1,099 in 2006, a change of 11 percent
• Non-specific chest pain: 538 in 1997 and 857 in 2006, a change of 59 percent
Slide 10
Most Frequent Principal Diagnoses with Largest Changes, 1997-2006
This slide contains a chart listing principal CCS diagnoses with the largest changes from 1997 to 2006.
• All discharges: 34,679 in 1997 and 39,450 in 2006, a change of 14 percent
• Skin and subcutaneous tissue infections: 330 in 1997 and 597 in 2006, a change of 81 percent
• Osteoarthritis: 418 in 1997 and 735 in 2006, a change of 76 percent
• Non-specific chest pain: 538 in 1997 and 857 in 2006, a change of 59 percent
• Septicemia (blood infection): 413 in 1997 and 611 in 2006, a change of 48 percent
• Cardiac dysrhythmias (irregular heart beat): 572 in 1997 and 749 in 2006, a change of 31 percent
Slide 11
Top 5 Most Frequent Procedures, 1997-2006
This slide contains a chart listing the percent change of discharges for the top five most frequent CCS procedures in 1997 and 2006.
• All discharges w/ any procedure: 21,257 in 1997 and 24,445 in 2006, a change of 15 percent
• Blood transfusion: 1,097 in 1997 and 2,382 in 2006, a change of 117 percent
• Diagnostic cardiac catheterization, coronary arteriolgraphy: 1,461 in 1997 and 1,671 in 2006, a change of 14 percent
• Repair of obstetric laceration: 1,137 in 1997 and 1,373 in 2006, a change of 21 percent
• C-section: 800 in 1997 and 1,346 in 2006, a change of 68 percent
• Respiratory intubation and mechanical ventilation: 919 in 1997 and 1,294 in 2006, a change of 41 percent
Slide 12
Most Frequent Procedures with Largest Changes, 1997-2006
This slide contains a chart listing CCS procedures with the largest changes from 1997 to 2006.
• All discharges w/ any procedure: 21,257 in 1997 and 24,445 in 2006, a change of 15 percent
• Blood transfusion: 1,097 in 1997 and 2,382 in 2006, a change of 117 percent
• C-section: 800 in 1997 and 1,346 in 2006, a change of 68 percent
• Prophylactic vaccinations and inoculations: 567 in 1997 and 945 in 2006, a change of 67 percent
• Episiotomy: 866 in 1997 and 393 in 2006, a change of negative 55 percent
• Respiratory intubation and mechanical ventilation: 919 in 1997 and 1,294 in 2006, a change of 41 percent
Slide 13
Infants and the Elderly Disproportionally Use the Hospital
This slide contains a bar graph comparing the distribution of U.S. Population and Hospital discharges by age in 2006.
• U.S. Population
• 1-17 years old: 23 percent
• 18-44 years old: 38 percent
• 45-64 years old: 25 percent
• 65-84 years old: 11 percent
• Above 85 years old: 3 percent
• Hospital discharges
• Less than 1 year old: 12 percent
• 1-17 years old: 4 percent
• 18-44 years old: 26 percent
• 45-64 years old: 23 percent
• 65-84 years old: 27 percent
• Above 85 years old: 8 percent
Note: Bar segments representing 2 percent or less have not been labeled.
Slide 14
Top 5 Most Expensive Principal Diagnoses and Average Annual Percent Growth in Costs, 1997-2006
This slide contains a chart listing the annual percent change and cost of discharges for the top five most expensive principal CCS diagnoses in 1997 and 2006.
• All diagnoses: $216.3 billion in 1997 and $329.2 billion in 2006, an annual change of 4.8 percent
• Coronary atherosclerosis: $14.5 billion in 1997 and $17.5 billion in 2006, an annual change of 2.1 percent
• Acute myocardial infarction: $9.0 billion in 1997 and $11.8 billion in 2006, an annual change of 3.0 percent
• Congestive heart failure: $6.6 billion in 1997 and $11.2 billion in 2006, an annual change of 6.1 percent
• Liveborn: $7.8 billion in 1997 and $10.8 billion in 2006, an annual change of 3.6 percent
• Osteoarthritis: $4.6 billion in 1997 and $10.3 billion in 2006, an annual change of 9.3 percent
*Inflation adjusted in 2006 dollars
Slide 15
Most Frequent Principal Diagnoses with Largest Average Annual Percent Growth in Costs, 1997-2006
This slide contains a chart listing the principal CCS diagnoses with the largest average annual percent growth in costs from 1997 to 2006.
• All diagnoses: $216.3 billion in 1997 and $329.2 billion in 2006, an annual change of 4.8 percent
• Septicemia (blood infection): $4.0 billion in 1997 and $10.2 billion in 2006, an annual change of 10.9 percent
• Adult respiratory failure, insufficiency or arrest: $3.3 billion in 1997 and $8.1 billion in 2006, an annual change of 10.7 percent
• Non-specific chest pain: $1.6 billion in 1997 and $3.9 billion in 2006, an annual change of 10.0 percent
• Disorders of intervertebral discs and bones in spinal column (back problems): $3.4 billion in 1997 and $7.6 billion in 2006, an annual change of 9.4 percent
• Osteoarthritis: $4.6 billion in 1997 and $10.3 billion in 2006, an annual change of 9.3 percent
*Inflation adjusted in 2006 dollars
Slide 16
Some Conditions Were More Expensive Than Expected Due to Costly Technology or Intensive Care, 2006
This slide contains a scatter plot showing the average length and average charges of inpatient hospital stays for principal CCS diagnosis in 2006.
• Affective disorders: 7.3 days and $13,541
• Schizophrenia and related disorders: 11.5 days and $20,510
• Rehabilitation care: 12.6 days and $29,615
• Tuberculosis: 15.0 days and $57,537
• Heart valve disorders: 9.0 days and $105,733
• Leukemias: 14.2 days and $87,579
• Spinal cord injury: 14.00 days and $113,181
• Infant respiratory distress syndrome: 22.7 days and $106,490
• Premature birth and low birth weight: 25.7 days and $101,214
Slide 17
Public Insurance Assumed Financial Responsibility for Most Hospitalizations, 2006
This slide contains a bar graph entitled 'Percent distribution of discharges by expected primary payer, 2006.'
• Medicare: 37 percent
• Medicaid: 20 percent
• Private Insurance: 34 percent
• Uninsured**: 6 percent
• Other*: 3 percent
*Includes other payers such as Workers' Compensation, TRICARE, CHAMPUS, CHAMPVA, Title V, and other government programs
**Includes discharges classified as self-pay or no charge.
Slide 18
Public Insurance and Uninsured Grew at Highest Rates, 1997-2006
This slide contains a bar graph showing the growth in number of discharges by expected primary payer from 1997 until 2006.
• Medicaid: 36 percent
• Uninsured: 34 percent
• Medicare: 17 percent
• All Discharges: 14 percent
• Private Insurance: 0 percent
Slide 19
C-Section Rates Are Rising, 1993-2006
This slide contains two pie graphs demonstrating that the percent of vaginal and C-Section deliveries as a share of all deliveries changed from 78 and 22 respectively in 1993 to 68 and 32 respectively in 2006.
Slide 20
Lung Cancer Was the Most Common Reason for Cancer-Related Hospital Stays, 2006
This slide contains a bar graph entitled 'Most frequent hospitalizations with a principal diagnosis of cancer by gender, 2006.' The graph is based on discharge data.
• Cancer of the Pancreas: 20,000 males and 20,000 females
• Cancer of the Ovary: 40,000 females
• Cancer of the head and neck: 30,000 males and 12,000 females
• Cancer of the bladder: 32,000 males and 11,000 females
• Cancer of the Uterus: 44,000 females
• Cancer of kidney and renal pelvis: 33,000 males and 21,000 females
• Cancer of rectum and anus: 30,000 males and 24,000 females
• Leukemias: 37,000 males and 29,000 females
• Non-Hodgkin's lymphoma: 40,000 males and 29,000 females
• Cancer of prostate: 99,000 males
• Cancer of breast: 1,000 males and 119,000 females
• Cancer of colon: 65,000 males and 70,000 females
• Cancer of bronchus, lung: 107,000 males and 93,000 females
Slide 21
Changes in the Number of Cancer Hospitalizations Varied by Diagnosis, 1997-2006
This slide contains a bar graph showing the percent change of discharge from 1997 until 2006 of the following disease:
• Cancer of the liver and intrahepatic bile duct: 45
• Cancer of kidney and renal pelvis: 37
• Hodgkin's disease: 29
• Cancer of bone and connective tissue: 17
• Cancer of thyroid: 15
• Neoplasma of unspecified nature or uncertain behavior: 15
• Cancer of pancreas: 14
• Leukemia: 6
• Cancer of brain and nervous system: 3
• Cancer of bronchus, lung: -10
• Cancer of head and neck: -17
• Cancer of prostate: -17
• Cancer of bladder: -20
• Cancer of ovary: -30
• Cancer of breast: -32
• Cancer of cervix: -39
Slide 22
Asthma Hospitalizations Were Highest Among the Poor, 2006
This slide contains a bar graph entitled 'Rates of Asthma Hospitalization by Median Income of Patients' Zip code and Region, 2006.' The discharge data is measured per 100,000 persons.
In the Northeast
• $1-$37,999: 390
• $38,000-$46,999: 200
• $47,000-$61,999: 142
• Greater than $62,000: 130
In the Midwest
• $1-$37,999: 240
• $38,000-$46,999: 132
• $47,000-$61,999: 103
• Greater than $62,000: 83
In the South
• $1-$37,999: 180
• $38,000-$46,999: 142
• $47,000-$61,999: 118
• Greater than $62,000: 82
In the West
• $1-$37,999: 115
• $38,000-$46,999: 102
• $47,000-$61,999: 78
• Greater than $62,000: 67
Slide 23
HCUP Facts and Figures on HCUP User Support Website
This slide contains a screen shot of the HCUP Reports website found at http://www.hcup-us.ahrq.gov/reports.jsp.
Slide 24
HCUP Reports and Features Have Useful Information
HCUP Facts and Figures (online only)
• Has national statistics on hospital stays
• Updated annually
HCUP Statistical Briefs (online only)
• Present simple, descriptive statistics on a variety of specific, focused topics
• Produced biweekly (approx.)
HCUP Fact Books (online and printed)
• Provides information about specific aspects of hospital care
Slide 25
HCUP Statistical Briefs
This slide contains the covers of three HCUP Statistical briefs.
Slide 26
HCUP Statistical Briefs byTopic Categories
This slide contains a screen shot of the HCUP Statistical Briefs website found at http://www.hcup-us.ahrq.gov/reports/sbtopic.jsp.
Slide 27
HCUP Statistical Briefs on HCUP User Support Website
This slide contains another screen shot of the HCUP Statistical Briefs website found at http://www.hcup-us.ahrq.gov/reports/statbriefs.jsp.
Slide 28
HCUP Statistical Brief #50: Clostridium Difficile Associated Disease (CDAD)
• CDAD hospl discharges more than doubled 2001-05
• In prior 8-year period, cases increased by 74 percent
• Over two-thirds of patients with CDAD were 65 years+
• CDAD infection in NE higher than any other region
• 144 CDAD hospital stays per 100,000 population
• The West region had lowest rate
• 67 CDAD stays per 100,000 population
• NE rate 2 times higher than West
• Midwest and South rates were 69 percent and 42 percent higher than the West
• CDAD patients had lengths of stay 3 x higher than avg
• CDAD patients death rate in hospl 5 x higher than avg
Slide 29
CDAD Hospitalizations Increased Sharply, 1993-2005
This slide contains a line graph entitled 'Trends in hospital stays associated with Clostridium difficile-associated disease, 1993-2005.' While hospital stays for all-listed diagnoses increased from 85,700 to 301,200, hospital stays for Clostridium difficile-associated disease increased from 24,200 to 76,400.
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample
Slide 30
CDAD Hospitalizations by Region, 2005
This slide contains a bar graph entitled 'Rates of hospitalization with Clostridium difficile-associated disease, per 100,000 population and per 10,000 hospital discharges, by region, 2005.
Rate per 100,000 population
• Northeast: 144
• Midwest : 113
• South: 86
• West: 87
Rate per 10,000 hospital discharges
• Northeast: 102
• Midwest : 83
• South: 68
• West: 62
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample
Slide 31
HCUP Statistical Brief #62: Mental Health
• One-fifth of hospital stays had principal or secondary MH diagnoses
• 8.4 Million hospital stays involved a MH diagnosis
• Medicare and Medicaid were expected payers for 60% of MH stays
• MH hospitalizations were 2 times higher in Northeast than West
• ALOS for principal MH diagnoses was greater than for all stays (8.2 days vs 4.6 days)
• Mood disorders were the most common principal diagnosis in <65 years
• Dementia and related disorders most common 65+ years
Slide 32
Mood Disorders is Most Common MH Condition Treated in Hospitals, 2006
This slide contains a bar graph entitled 'Specific Mental Health Conditions as Principal or Secondary Diagnosis during a Hospital Stay, 2006.' It is based on discharge data.
Principal Mental Health Conditions
• Disorders Usually Diagnosed in Childhood: 3,000
• Personality Disorders: 5,000
• Impulse Control Disorders, NEC: 10,000
• Attention-deficit disorders: 16,000
• Adjustment disorders: 36,000
• Anxiety disorders: 40,000
• Dementia and other cognitive disorders: 131,000
• Schizophrenia: 381,000
• Mood disorders: 729,000
Secondary Mental Health Conditions
• Disorders Usually Diagnosed in Childhood: 29,000
• Personality Disorders: 244,000
• Impulse Control Disorders, NEC: 22,000
• Attention-deficit disorders: 130,000
• Adjustment disorders: 105,000
• Anxiety disorders: 1,310,000
• Dementia and other cognitive disorders: 1,708,000
• Schizophrenia: 452,000
• Mood disorders: 3,054,000
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2006
Slide 33
Public Insurance Is the Expected Payer for Most MH-Related Stays, 2006
This slide contains a bar graph entitled 'Government payers were billed for about 60 percent of mental health-related stays, 2006*.'
Goverrnment Payers
• Medicare
• 36.3 percent as an expected payer for stays principally for mental health
• 37.3 percent as an expected payer in all hospital stays
• Medicaid
• 26.4 percent as an expected payer for stays principally for mental health
• 19.5 percent as an expected payer in all hospital stays
Private Insurance
• 23.8 percent as an expected payer for stays principally for mental health
• 34.1 percent as an expected payer in all hospital stays
Uninsured
• 8.5 percent as an expected payer for stays principally for mental health
• 5.7 percent as an expected payer in all hospital stays
*A small portion of stays covered by other insurance programs (such as TRICARE/CHAMPUS and Title V) were not included in this figure
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2006
Slide 34
HCUP Statistical Brief #59: National Hospital Bill
• $950B for 39 million hospital stays (2006)
• Almost two-thirds of the national bill for hospital care was billed to Medicare and Medicaid
• Medicaid's most expensive conditions were related to pregnancy and care of newborn infants.
• Schizophrenia and affective disorders were among top 10 most expensive conditions.
• Among the uninsured, circulatory conditions accounted for 3 of top 5 most expensive conditions.
• Injuries accounted for 3 of top 10 most expensive conditions
Slide 35
Public Insurance Bore Responsibility for Almost Two-Thirds of National Hospital Bill, 2006
This slide contains a pie graph entitled 'Distribution of National Hospital Bill, by Primary Payer, 2006.' The national bill was $943.4 billion.
Medicare: 47.0 percent
Medicaid: 14.3 percent
Private: 30.4 percent
Uninsured: 4.6 percent
Other/Missing: 3.2
Note: "Other" insurers include Workers' Compensation, TRICARE, Title V, and other government programs.
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2006
Slide 36
HCUP Reports and Features Have Useful Information
• HCUP Facts and Figures (online only)
• Has national statistics on hospital stays
• Updated annually
• HCUP Statistical Briefs (online only)
• Present simple, descriptive statistics on a variety of specific, focused topics
• Produced biweekly (approx.)
• HCUP Fact Books (online and printed)
• Provides information about specific aspects of hospital care
Slide 37
HCUP Fact Books
This slide contains the cover images of three HCUP Fact Books.
Slide 38
HCUP Fact Book Topics
• Care of Adults with Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004 (#10)
• Ambulatory Surgery in U.S. Hospitals, 2003 (#9)
• Serving the Uninsured: Safety Net Hospitals, 2003 (#8)
• Procedures in U.S. Hospitals, 2003 (#7)
• Hospitalization in the US, 2002 (#6)
• Preventable Hospitalizations, 2000 (#5)
Slide 39
To Order an HCUP Fact Book
Email AHRQPubs@ahrq.hhs.gov
Call toll-free at 800-358-9295
Slide 40
Questions?
Comments?
Suggestions?
For information on reports, email HCUP User Support
hcup@ahrq.gov
|
