Methods

Authors: Steiner CA, Elixhauser A, and Schnaier J.
Title: The Healthcare Cost and Utilization Project: An Overview.
Publication: Effective Clinical Practice 5(3):143-51.
Date: 2002.
Abstract: Healthcare Cost and Utilization Project (HCUP)—a family of databases including the State Inpatient Databases (SID), the Nationwide Inpatient Sample (NIS), the Kids' Inpatient Database (KID), and the outpatient databases State Ambulatory Surgery Data (SASD) and State Emergency Department Data (SEDD). Multistate, inpatient (SID, NIS, KID) and outpatient (SASD, SEDD) discharge records on insured and uninsured patients. Partnership between the Agency for Healthcare Research and Quality (AHRQ) and public and private statewide data organizations. Selected data elements from inpatient and outpatient discharge records, including patient demographic, clinical, disposition and diagnostic/procedural information; hospital identification (ID); facility charges; and other facility information. Varies by database: NIS 1988-2000; SID 1995-2000; KID 1997 and 2000; SASD 1995-2000; and SEDD in pilot phase. Future data years anticipated for all datasets and back years for SID and SASD. UNITS OF ANALYSIS: Patient (in states with encrypted patient identification), physician, market, and state. Quality assessment, use and cost of hospital services, medical treatment variations, use of ambulatory surgery services, diffusion of medical technology, impact of health policy changes, access to care (inference), study of rare illness or procedures, small area variations, and care of special populations. Largest collection of all-payer, uniform, state-based inpatient and ambulatory surgery administrative data. Lacks clinical detail (e.g., stage of disease, vital statistics) and laboratory and pharmacy data. Ability to track patients across time and setting varies by state. Access available to all users who sign and abide by the Data Use Agreement. Application kits available at www.ahrq.gov/data/hcup. HCUPnet, an online interactive query tool, allows access to data without purchase (http://hcupnet.ahrq.gov/).

Authors: Encinosa W, Seldon T.
Title: Designing Employer Health Benefits for Heterogeneous Workforces: Risk Adjustment and Its Alternatives.
Publication: Inquiry 38:270-9.
Date: Fall 2001
Abstract: Many health economists recommend that employers provide employees with a risk-adjusted choice among competing health insurance plans. Formal risk adjustment is, however, rarely if ever used by employers. This paper examines a range of health benefit design options that are available to employers, focusing attention not only on risk adjustment but also on its alternatives. We argue that while formal risk adjustment is rare, employers commonly use strategies that accomplish some of the same objectives and at less cost.

Authors: Brach C, Sanches L, Young D, et al.
Title: Wrestling with typology: Penetrating the "black box" of managed care by focusing on health care system characteristics.
Publication: Med Care Res Rev 57(Suppl 2):93-115.
Date: 2000.
Abstract: The health care system has undergone a fundamental transformation, undermining the usefulness of the typology of HMO, IPA, PPO, etc. The authors present a new approach to studying the health care system. In matrix form, they have identified a set of organizational and delivery characteristics with the potential to influence outcomes of interest, such as access to services, quality, health status and functioning, and cost. The matrix groups the characteristics by domain (financial features, structure, care delivery and management policies, and products) and by key roles in the health care system (sponsor, plan, provider intermediary organization, and direct services provider). The matrix is a tool for researchers, administrators, clinicians, regulators and policy makers, and data collectors. It suggests a new set of players to be studied; emphasizes the relationships among the players; and provides a checklist of independent, control, and interactive variables to be included in analyses.
Availability: AHRQ Publication No. 01-R014 is available from the AHRQ Publications Clearinghouse.

Authors: Elixhauser A, Leidy NK, Halpern M.
Title: Cost and outcome implications for prevention.
Publication: In: Weiss KB, Buist AS, Sullivan SD. Asthma's Impact on Society: The Social and Economic Burden. New York: Marcel Dekker, Inc.
Date: 2000
Abstract: This chapter examines the health and economic implications of interventions aimed at the primary prevention of asthma. Research into these areas is a relatively recent phenomenon; many of the conclusions about the effectiveness of preventive interventions are speculative. This chapter provides alternative typologies of prevention for asthma and provides a conceptual framework for evaluating the costs and outcomes of interventions for the primary prevention of asthma.

Author: Hellinger FJ, Fleishman JA.
Title: Estimating the national cost of treating people with HIV disease: Patient, payer, and provider data.
Publication: Journal of Acquired Immune Deficiency Syndrome 24(2):182-8.
Date: 2000
Abstract: Existing estimates of the national cost of treating all people with HIV disease use data from a sample of people with HIV disease to extrapolate the cost of treating all people with HIV disease (patient-based approach). This study derives estimates using two novel approaches (i.e., payer-based and provider-based) and compares these with existing estimates. The data sources include the Health Insurance Association of American and the American Council of Life Insurance 1996 HIV survey, the 1996 State Inpatient Databases (SID) maintained by the Agency for Healthcare Research and Quality, and the IMS America Ltd. survey of independent and chain drugstores. The authors found that the cost of treating all people with HIV disease in 1996 was between $6.7 and $7.8 billion, and the average annual cost of treating a person with HIV disease was between $20,000 and $24,700. They concluded that analysts should derive estimates of the cost of treating people with HIV disease using several different approaches.
Availability: AHRQ Publication No. 00-R058 is available from the AHRQ Publications Clearinghouse.

Authors: Elixhauser A, Halpern M.
Title: Economic evaluations of pancreatic and gastric cancer.
Publication: Hepato-Gastroenterology 46:1206-13.
Date: 1999
Abstract: The total cost of cancer care in the United States is about $146 billion, of which pancreatic cancer comprises $2.6 billion (1.8 percent of the total) and gastric cancer comprises $1.8 billion (1.3 percent). The authors have reviewed published studies presenting economic analysis of treatment or followup for patients with pancreatic or gastric cancer. Relatively few studies report on economic evaluations of pancreatic cancer care. There are also few economic studies for gastric cancer, although the authors identified three cost-effectiveness analyses. In general, economic analyses in these areas are relatively unsophisticated, relying on charge data or simple multipliers (e.g., average cost per day in the hospital multiplied by days in the hospital), and are often limited to in-hospital costs (particularly studies for pancreatic cancer). A wide range of costs are included in these studies and a variety of methodologies for assigning costs are used, making comparisons between studies difficult. Future health economics research in this area should evaluate the costs and effectiveness of alternative practice patterns for gastric and pancreatic cancer; conduct additional cost-effectiveness analyses of chemotherapeutic interventions; consider quality of life, survival, stage at diagnosis, patient-borne costs, and complications of therapy; and take advantage of administrative data from large populations.

Authors: Elixhauser A., Leidy N, Meador K, et al.
Title: The relationship between memory performance, perceived cognitive function, and mood in patients with epilepsy.
Publication: Epilepsy Research 37:13-24.
Date: 1999
Abstract: The low correlations between memory performance and subjective memory may be attributable to disparities between tasks in neuropsychological tests and cognitive experiences of day-to-day living. This study evaluated the relationship between everyday memory performance, perceived cognitive functioning, and mood among patients with epilepsy. For the study, 138 patients were recruited from 3 epilepsy centers in the U.S. Everyday memory performance was measured using the Rivermead Behavioural Memory Test (RBMT). Questionnaires assessed perceived cognitive function (cognitive domain, Quality of Life in Epilepsy Inventory, QOLIE-89) and mood (Profile of Moods States, POMS). Memory performance scores were weakly correlated with perceived cognitive functioning (r = 0.22, p<0.01). Perceived cognitive functioning was strongly correlated with mood (r = -0.75, p<0.0001). Multiple regression analysis indicated memory performance (RBMT) and mood (POMS) were independent predictors of perceived cognitive functioning (p<0.02); however, the explained variance for RBMT and POMS combined (R2=0.58) was only slightly higher than the predictive value for the POMS score alone (R2=0.56). Memory performance tests provide qualitatively different information than patients' self-reported cognitive difficulties, thus it is important to assess memory performance, perceived cognitive function, and mood separately because the constructs are related but not redundant.

Authors: Elixhauser A, Steiner CA.
Title: Hospital inpatient statistics, 1996
Publication: Rockville (MD): AHCPR.
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). 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.
Availability: AHCPR Publication No. 99-0034 is available from the AHRQ Publications Clearinghouse.

Authors: Elixhauser A., Leidy N, Meador K, et al.
Title: Evaluation of the Rivermead Behavioural Memory Test in patients with epilepsy.
Publication: Epilepsy Research 37:13-24.
Date: 1999
Abstract: The low correlations between memory performance and subjective memory may be attributable to disparities between tasks in neuropsychological tests and cognitive experiences of day-to-day living. This study evaluated the relationship between everyday memory performance, perceived cognitive functioning, and mood among patients with epilepsy. For the study, 138 patients were recruited from 3 epilepsy centers in the U.S. Everyday memory performance was measured using the Rivermead Behavioural Memory Test (RBMT). Questionnaires assessed perceived cognitive function (cognitive domain, Quality of Life in Epilepsy Inventory, QOLIE-89) and mood (Profile of Moods States, POMS). Memory performance scores were weakly correlated with perceived cognitive functioning (r = 0.22, p<0.01). Perceived cognitive functioning was strongly correlated with mood (r = -0.75, p<0.0001). Multiple regression analysis indicated memory performance (RBMT) and mood (POMS) were independent predictors of perceived cognitive functioning (p<0.02); however, the explained variance for RBMT and POMS combined (R2=0.58) was only slightly higher than the predictive value for the POMS score alone (R2=0.56). Memory performance tests provide qualitatively different information than patients' self-reported cognitive difficulties, thus it is important to assess memory performance, perceived cognitive function, and mood separately because the constructs are related but not redundant.

Authors: Leidy NK, Elixhauser A, Vickrey B, et al.
Title: Seizure frequency and the health-related quality of life of adults with epilepsy.
Publication: Neurology 53:162-66.
Date: 1999
Abstract: This article compares the health-related quality of life (HRQL) of a non-surgical sample of adults with epilepsy to that of age and gender-equivalent norms, and analyzes the relative importance of seizure frequency, time since last seizure, gender, and comorbidity on HRQL in the epilepsy sample. The study, using data from 139 adults with epilepsy from 3 U.S. centers, found that seizure-free adults can attain HRQL levels comparable to those of the general population. As seizure frequency increases, patients report more impaired HRQL, regardless of time since last seizure, gender, and comorbid status. Potential for difficulties in HRQL should be considered in clinical assessment and in evaluating treatment outcomes.

Authors: Schmier J, Elixhauser A, Halpern M.
Title: Health related quality of life evaluations in pancreatic and gastric cancer.
Publication: Hepato-Gastroenterology 46:1998-2004.
Date: 1999
Abstract: This review addresses the state of the literature on health-related quality of life (HRQL) assessment among patients with cancers of the pancreas and stomach. The authors first briefly review the epidemiology of these cancers. They examine the concept of HRQL and the degree to which it has been measured among these patient groups. The impact of gastric and pancreatic cancers on HRQL is described, including the domains that these conditions are most likely to impact. The effect of different treatments on HRQL is considered, including surgical procedures, pharmacological and non-pharmacological therapies, and procedures for symptom palliation. Based on their findings and on the limited quantity and quality of the body of literature, the authors make suggestions for further research in the area.

Authors: Carman K, Short P, Farley D, et al.
Title: Early lessons from CAHPS®: Demonstrations and evaluations.
Publication: Med Care 37(3 Suppl):MS97-MS105.
Date: 1999
Abstract: The main goal of the Consumer Assessments of Health Plans (CAHPS®) survey is to develop an integrated set of tested, standardized surveys to obtain meaningful information from health plan enrollees about their experiences. The CAHPS® project benefits from the complementary strengths of psychometric and cognitive testing. The CAHPS® team conducted 150 cognitive interviews across 3 organizations, in different geographic locations, using multiple interview methods with different consumer populations. This article explains how cognitive testing was used in the CAHPS® survey development process and shares the main findings across the cognitive interviews.

Authors: Harris-Kojetin L, Fowler F, Schnaier J, et al.
Title: The use of cognitive testing for developing and evaluating CAHPS® survey items.
Publication: Med Care 37(3 Suppl):MS10-MS21.
Date: 1999
Abstract: The main goal of the Consumer Assessments of Health Plans (CAHPS®) survey is to develop an integrated set of tested, standardized surveys to obtain meaningful information from health plan enrollees about their experiences. The CAHPS® project benefits from the complementary strengths of psychometric and cognitive testing. The authors found that cognitive testing was integral in developing and refining the CAHPS® instrument. The cognitive testing findings contributed to an improved instrument that should capture consumers' health care and plan experiences with less response error than one not subjected to such testing.

Authors: Leidy N, Elixhauser A, Rentz AM, et al.
Title: Telephone validation of the Quality of Life in Epilepsy Inventory-89 (QOLIE-89).
Publication: Epilepsia 40(1):97-106.
Date: 1999
Abstract: This study assesses the psychometric properties of the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) administered via telephone and to compare these properties with data gathered through self-administration. Results of this study indicate telephone interview is a viable option for evaluating health-related quality of life (HRQL) in persons with epilepsy and support the reliability and validity of the QOLIE-89 regardless of method of administration.

Authors: Schnaier J, Sweeny S, Williams W, et al.
Title: Special issues addressed in the CAHPS® survey of Medicare managed care beneficiaries.
Publication: Med Care 37(3 Suppl):MS69-MS78.
Date: 1999
Abstract: This article describes the process through which the Medicare Managed Care plan (MMC) survey was developed and examines issues in using this survey with Medicare beneficiaries that have implications for all CAHPS® surveys. These implications include the ability of Medicare beneficiaries to use MMC navigational features, whether access measures are meaningful for this population, and whether beneficiaries' familiarity with managed care influences their health plan assessments.

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