Data Sources—Agency for Healthcare Research and Quality (AHRQ)
2008 National Healthcare Quality and Disparities Reports
Healthcare Cost and Utilization Project (HCUP)
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ).
Mode of Administration
HCUP databases bring together the data collection efforts of State government data organizations, hospital associations, private data organizations, and the Federal Government to create a national information resource of discharge-level health care data.
HCUP includes a collection of longitudinal hospital care data, with all-payer, discharge-level information beginning in 1988. Two HCUP discharge datasets were used in this report:
- The HCUP Nationwide Inpatient Sample (NIS) is a nationally stratified sample of hospitals (with all their discharges) from States that contribute data to the NIS. Weights are used to develop national estimates. The 2005 NIS contains data for nearly 8 million discharges from 1,054 hospitals located in 37 States, approximating a 20% stratified sample of U.S. community hospitals.
- The 2005 HCUP Statewide Inpatient Databases (SID) include all hospitals (with all their discharges) from 37 participating States. In aggregate, the SID represent almost 85% of all U.S. hospital discharges, totaling more than 32 million inpatient discharge abstracts.
SID Disparities Analysis File
A special disparities analysis file was created from SID data to provide national estimates for the National Healthcare Disparities Report. It consists of weighted records from a sample of hospitals from 23 States participating in HCUP that have high-quality race/ethnicity data, including: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, VT, and WI. In 2005, the 23 States accounted for 60% of U.S. hospital discharges (based on the American Hospital Association [AHA] Annual Survey), about 60% of White and African Americans in the Nation, and more than 80% of Asians and Pacific Islanders and Hispanics.
The HCUP databases maintain the combined categorization of race/ethnicity categories, resulting in the categories of Hispanic of all races and non-Hispanic African Americans, Asian and Pacific Islanders, and Whites. Not all States collect race and ethnicity data uniformly; when a State and its hospitals collect Hispanic ethnicity separately from race, HCUP uses Hispanic ethnicity to override any other race category.
Community hospitals from the 23 States were sampled to approximate a 40% stratified sample of U.S. community hospitals, with stratification based on 5 hospital characteristics: geographic region, hospital ownership, urbanized location, teaching status, and bed size. Hospitals were excluded from the sampling frame if the coding of patient race was suspect. Once the 40% sample was drawn, discharge-level weights were developed to produce national-level estimates when applied to the SID disparities analysis file. The final SID disparities analysis file included about 15 million hospital discharges from almost 1,900 hospitals. The SID disparities analysis file employed the same sampling and weighting strategy used for the NIS, except for the differences described here. The SID disparities analysis file used the same imputation procedures described for the NIS for race/ethnicity data, as well as for missing age, gender, ZIP Code, and payer data. For information on imputation procedures, access: Coffey R, Barrett M, Houchens R, et al. Methods applying AHRQ Quality Indicators to Healthcare Cost and Utilization Project (HCUP) data for the Sixth (2008) National Healthcare Quality Report. HCUP Methods Series Report # 2008-05. Online October 23, 2008. Rockville, MD: Agency for Healthcare Research and Quality; 2008. Available at: http://www.hcup-us.ahrq.gov/reports/methods.jsp.
The HCUP NIS and SID contain more than 100 clinical and nonclinical data variables, including age, gender, race, ethnicity, length of stay, discharge status, source of payment, total charges, hospital size, ownership, region, teaching status, diagnoses, and procedures.
The NHQR and NHDR measures that use HCUP data are based on AHRQ Quality Indicators (QIs), a set of algorithms that may be applied to hospital administrative data to quantify quality issues among inpatient populations. There are four categories of Quality Indicators:
- Inpatient Quality Indicators (IQIs) reflect quality of care in hospitals and currently include 15 mortality indicators for conditions or procedures for which mortality can vary from hospital to hospital; 11 utilization indicators for procedures for which utilization varies across hospitals or geographic areas; and 6 volume indicators for procedures for which outcomes may be related to the volume of procedures performed.
- Prevention Quality Indicators (PQIs) identify hospital admissions for 14 ambulatory care-sensitive conditions, which evidence suggests could have been avoided, in part, through high-quality outpatient care.
- Patient Safety Indicators (PSIs) reflect potential inpatient complications and other patient safety concerns following surgeries, other procedures, and childbirth. There are 27 measures in the most recent version of the PSI software.
- Pediatric Quality Indicators (PDIs) examine 18 conditions that pediatric patients experience within the health care system that may be preventable by changes at the system or provider level. In earlier versions of the QI software, some PDI measures were part of the IQI, PSI, and PQI modules.
Any person, U.S. citizen or foreign, using non-Federal, nonrehabilitation, community hospitals in the United States as defined by AHA.
AHA defines community hospitals as “all non-Federal, short-term, general, and other specialty hospitals, excluding hospital units of institutions.” Included among community hospitals are specialty hospitals, such as obstetrics-gynecology, ear-nose-throat, short-term rehabilitation, orthopedic, and pediatric institutions. Also included are public hospitals and academic medical centers. The NIS and analyses of the SID for this report excluded short-term rehabilitation hospitals (beginning with 1998 data), long-term hospitals, psychiatric hospitals, and alcoholism/chemical dependency treatment facilities.
Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the AHA Annual Survey Database (Health Forum, LLC, 2007).
Age, gender, race, insurance coverage, median household income of the patient's ZIP Code, urbanized location, region of the United States.
National, four U.S. Census Bureau regions, States (for States participating in SID that agree to the release).
Agency home page: http://www.ahrq.gov.
Data system home page: http://www.ahrq.gov/data/hcup.
AHRQ Quality Indicators: http://www.qualityindicators.ahrq.gov.
Use of AHRQ Quality Indicator Software in Generating NHQR Tables
The following AHRQ QI software versions were used to generate the HCUP tables in this report: IQI Version 3.1; PQI Version 3.1; PSI Version 3.1; and PDI Version 3.1. For more information, see the methods section for each quality report, available at http://www.qualityindicators.ahrq.gov.
For detailed information about each measure, see the individual guides to the quality indicators listed below, available from the archives at http://www.qualityindicators.ahrq.gov.
Inpatient Quality Indicators (IQIs)
AHRQ Quality Indicators—Guide to Inpatient Quality Indicators: Quality of Care in Hospitals—Volume, Mortality, and Utilization, Version 3.1. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Available at: http://www.qualityindicators.ahrq.gov/downloads/iqi/iqi_guide_v31.pdf. (Plugin Software Help)
Prevention Quality Indicators (PQIs)
AHRQ Quality Indicators—Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions, Version 3.1. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Available at: http://www.qualityindicators.ahrq.gov/downloads/pqi/pqi_guide_v31.pdf. (Plugin Software Help)
Patient Safety Indicators (PSIs)
AHRQ Quality Indicators—Guide to Patient Safety Indicators, Version 3.1. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Available at: http://www.qualityindicators.ahrq.gov/downloads/psi/psi_guide_v31.pdf. (Plugin Software Help)
Pediatric Quality Indicators (PDIs)
Measures of pediatric health care quality based on hospital administrative data: the Pediatric Quality Indicators. Rockville, MD: Agency for Healthcare Research and Quality; 2006. Available at: http://www.qualityindicators.ahrq.gov/downloads/pdi/pdi_measures_v31.pdf. (Plugin Software Help)
Sources of HCUP Data
Arizona Department of Health Services
Arkansas Department of Health
California Office of Statewide Health Planning and Development
Colorado Hospital Association
Florida Agency for Health Care Administration
Georgia Hospital Association
Hawaii Health Information Corporation
Illinois Department of Public Health
Indiana Hospital Association
Iowa Hospital Association
Kansas Hospital Association
Kentucky Cabinet for Health and Family Services
Maine Health Data Organization
Maryland Health Services Cost Review Commission
Massachusetts Division of Health Care Finance and Policy
Michigan Health and Hospital Association
Minnesota Hospital Association
Missouri Hospital Industry Data Institute
Nebraska Hospital Association
Nevada Department of Health and Human Services
New Hampshire Department of Health & Human Services
New Jersey Department of Health and Senior Services
New York State Department of Health
North Carolina Department of Health and Human Services
Ohio Hospital Association
Oklahoma State Department of Health
Oregon Association of Hospitals and Health Systems
Rhode Island Department of Health
South Carolina State Budget and Control Board
South Dakota Association of Healthcare Organizations
Tennessee Hospital Association
Texas Department of State Health Services
Utah Department of Health
Vermont Association of Hospitals and Health Systems
Virginia Health Information
Washington State Department of Health
West Virginia Health Care Authority
Wisconsin Department of Health and Family Services
State sources listed above may not participate in all years or in all HCUP databases.
Medical Expenditure Panel Survey (MEPS)
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ); and Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).
Mode of Administration
MEPS comprises three component surveys: the Household Component (HC), the Medical Provider Component (MPC) and the Insurance Component (IC). The MEPS HC, the core survey, is an interviewer-administered computer-assisted personal interview household survey. The data for the NHQR and NHDR are primarily from the following sections of the 2001 and 2005 MEPS HC:
- Self-Administered Questionnaire (SAQ). This self-administered paper questionnaire collects a variety of health and health care quality measures for adults. The health care quality measures in the SAQ were taken from the health plan version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®), an AHRQ-sponsored family of survey instruments designed to measure quality of care from the consumer's perspective.
- Diabetes Care Survey (DCS). This self-administered paper questionnaire, given to people identified as ever having had diabetes, asks about their diabetes care.
- Child Health and Preventive Care section. Starting in 2001, a Child Preventive Health section was added to the MEPS HC interviews during the second half of the year. It included health care quality measures taken from the health plan version of CAHPS; the Children with Special Health Care Needs screener questions; children's general health status as measured by several questions from the General Health Subscale of the Child Health Questionnaire; Columbia Impairment Scale questions about possible child behavioral problems; and child preventive care questions. Before 2001, the CAHPS questions and the Children with Special Health Care Needs Screener questions had been in the Parent-Administered Questionnaire (PAQ) in 2000. Therefore, estimates in the current editions of the NHQR and NHDR may not be completely comparable to estimates in earlier editions.
- Access to Care (AC). The AC section of the MEPS-HC gathers information on five main topic areas: family members' origins and preferred languages; family members' usual source of health care; characteristics of usual source of health care providers; satisfaction with and access to the usual source of health care provider; and access to medical treatment, dental treatment, and prescription medicines.
- Preventive Care (PC). For each person, a series of questions was asked primarily about the receipt of preventive care or screening examinations.
Survey Sample Design
The sampling frame for the MEPS HC is drawn from respondents to the National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics (NCHS). The MEPS HC augments NHIS by selecting a sample of NHIS respondents, collecting additional data on their health care expenditures, and linking these data with additional information from the respondents' medical providers, employers, and insurance providers.
AHRQ fields a new MEPS panel each year. In this design, 2 calendar years of information are collected from each household in a series of five rounds of data collection over a 2½-year period. These data are then linked with additional information collected from the respondents' medical providers, employers, and insurance providers. This series of data collection activities is repeated each year on a new sample of households, resulting in overlapping panels of survey data.
Primary Survey Content
The MEPS HC collects detailed data on demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment.
Like the NHIS population from which its subpopulation is drawn, the MEPS HC is a nationally representative survey of the U.S. civilian noninstitutionalized population.
Age, gender, race, ethnicity, education, industry and occupation, employment status, household composition, family income. Race and ethnicity variables and categories changed in 2002 to be compliant with Office of Management and Budget (OMB) standards that required changes by 2003.
1996 to present.
National. The HC data also can be shown for the four U.S. Census Bureau regions (Northeast, Midwest, South, and West), as well as Residence Location status.
Estimates in the tables appendix based on MEPS data are suppressed if sample size is less than 100 or relative standard error is greater than 30%.
The Residence Location categories in MEPS tables are based on the 2006 NCHS Urban-Rural Classification Scheme for Counties, a six-level urban-rural classification scheme for U.S. counties and county-equivalents:
- Large central metropolitan
- Large fringe metropolitan
- Medium metropolitan
- Small metropolitan
- Micropolitan (nonmetro)
- Noncore (nonmetro)
The county classifications are based on OMB definitions of metropolitan and nonmetropolitan counties (2003 version with revisions through 2005), U.S. Department of Agriculture Economic Research Service's Rural-Urban Continuum Code and Urban Influence Code classifications, and certain U.S. Census 2000 and 2004 postcensal population county-level estimates.
For more information on the NCHS Urban-Rural Classification Scheme for Counties, see http://www.cdc.gov/nchs/r&d/rdc_urbanrural.htm.
Agency home page: http://www.ahrq.gov.
Data system home page: http://meps.ahrq.gov.
Ezzati-Rice TM, Rohde F, Greenblatt J. Sample design of the Medical Expenditure Panel Survey Household Component, 1998-2007. Methodology Report No. 22. Rockville, MD: AHRQ; March 2008. Available at: http://meps.ahrq.gov/mepsweb/data_files/publications/mr22/mr22.pdf. (Plugin Software Help)
Cohen J. Design and methods of the Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 1. Rockville, MD: Agency for Healthcare Policy and Research (AHCPR); 1997. AHCPR Pub. No. 97-0026.
Cohen S. Sample design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 2. Rockville, MD: AHCPR; 1997. AHCPR Pub. No. 97-0027.
Cohen JW, Monheit AC, Beauregard KM, et al. The Medical Expenditure Panel Survey: A national health information resource. Inquiry 1996/1997;33:373-89. Also available as AHCPR Pub. No. 97-R043. Rockville, MD: AHCPR; 1997.
National CAHPS® Benchmarking Database (NCBD)
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ) in association with a consortium of public and private organizations.
Mode of Administration
CAHPS® is the Consumer Assessment of Healthcare Providers and Systems. By responding to a standardized set of questions administered through a mail or telephone questionnaire, health plan members report on their experiences and rate their health plans and providers in several areas. Participation in the CAHPS database is voluntary.
Survey Sample Design
The Health Plan Survey Component is the foundation of the National CAHPS Benchmarking Database. CAHPS surveys are administered to a random sample of health plan members by independent survey vendors, following standardized procedures. Since 1998, health plans, purchaser groups, State organizations, and others have participated in this component.
The Hospital CAHPS (HCAHPS) is also a component of the NCBD. See the separate HCAHPS entry for further information.
Primary Survey Content
Consumer experiences in obtaining health care, including the following five major areas: access to needed care, access to care without long waits, quality of doctors' communication, courtesy and helpfulness of office staff, and customer service.
CAHPS has specific populations for specific surveys and databases, such as adults, children, children with chronic conditions, and members of commercial, Medicaid, Medicare, and Medicare managed care plans. See specific table and measure specification information.
Estimates for tables based on CAHPS data were calculated using plan-level weights; i.e., all respondents in a plan received the same weight. Further, all plans within a State were weighted to contribute equally to the State-level statistic.
The primary purpose of the NCBD is to facilitate comparisons of CAHPS survey results by survey sponsors. By compiling survey results from a variety of sponsors in a single national database, the NCBD enables participants to compare their own results to relevant benchmarks. The NCBD also offers an important source of primary data for specialized research related to consumer assessments of quality as measured by CAHPS.
The CAHPS Health Plan Survey database holds 9 years of survey data, representing nearly 3 million survey respondents; the 2006 database contains survey results for approximately 328,000 adults and children enrolled in commercial, Medicaid, State Children's Health Insurance Program (SCHIP), and Medicare plans; the health plan database also contains data submitted by other participants, including public and private employers and health plans.
Age, gender, education, race, ethnicity, region, insurance coverage, health status.
Since 1998. The database currently contains CAHPS Health Plan Survey data from 1998 to present; the HCAHPS includes data from 2005 to the present.
States, four U.S. Census Bureau regions.
Agency home page: http://www.ahrq.gov.
Data system home page: https://cahps.ahrq.gov.
National CAHPS Benchmarking Database. 2006 CAHPS Health Plan Survey Chartbook: what consumers say about their experiences with their health plans and medical care. Rockville, MD: AHRQ; September 2006. AHRQ Publication No. 06-0081-EF.