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Preventable Hospital Costs: A County-Level Mapping Tool Web Conference: Questions and Answers

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On June 16, 2008, Melanie Chansky presented the AHRQ Preventable Hospitalization Costs: A County-Level Mapping Tool on a Web conference. These are the questions asked by participants during the event, with the associated answers.

Technical Questions

Question: From what year is the underlying data taken and how often are the data updated? (Margie Shofer)
Answer: The underlying data for the Mapping Tool are updated once a year at the same time the quality indicators are updated. Currently, that takes place each year from February to March. When this tool is updated, every part of it is brought up to date to the current indicator specifications and the current census data if there are any new census data to include. The main part of the data that really changes is the QI specifications. We actually may be changing our schedule for updating the QIs to fall at the beginning of fiscal years, so you may see another update of the underlying data for this tool in October 2008.

Question: Please tell us what format and software are needed for data input. (Eric Wolf, Colorado Medicaid)
Answer: We have not tested all of the possibilities for data input, but any comma-separated values file should work. The ones we have been using for testing are in Excel, but if you have something in a simple text editor that should work as well. It just needs to be a CSV file, so it should be simple. Also, if you have ever used the Windows Quality Indicator Software, you have files that are right there ready to go into this.

Question: Our data analysis staff worries that our county populations are too small to make this tool useful. Can we lump county data together to get numbers with statistical significance? (Eric Wolf, Colorado Medicaid)
Answer: Right now the tool is very simple, so at this point there is not a way for us to do that. It has a lot to do with the actual cost of the mapping component for us and what sort of programming sophistication it would take to allow that. However, you could take the outputs of this tool and aggregate them yourself. It is just that we don't currently have that offered as a feature of the tool. This may be a concern in a lot of States particularly given how rare some of these indicators are and how small some the counties are.

Question: Are the cost savings data based on charges or reimbursement? (Wei Yen, Washington State Office of Financial Management)
Answer: The data are based on total charges.

Question: Do we need to buy extra mapping software? (Hanten Day, Oregon Health Policy & Research)
Answer: No, not to use the tool. The tool works just fine without extra mapping software.

Question: I've used AHRQ QI software but received the following error when trying to use the cost savings tool: "Index and length must refer to a location within the string Parameter name: length." (Bill Marcinkowski, Vermont Program for Quality in Health Care)
Answer: This is a question that should be channeled to our tech support line so we can trouble shoot your problem more specifically. Please email us at

Question: How do you adjust for States with many counties without a hospital facility? For example, New Mexico has about seven counties without a hospital facility. (Georgette Cooper, State of New Mexico Medicaid)
Answer: It is ok if you have counties without hospital facilities. The Tool uses the patient's county of residence.

Question: What if hospital billing is not Diagnostic Risk Group (DRG)-based? (Dong Siegel, Bureau of TennCare, State of TN)
Answer: That is a problem right now because DRG is one of the required variables to use the tool. Therefore, if you do not have DRGs, you cannot run the tool. However, that may be something that needs to be incorporated into the tool in the future.

Question: Does the tool allow for mapping at ZIP code or other medical service area level? (Margie Shofer, AHRQ)
Answer: No, not right now. Presently you can only map within one State at a county level, so ZIP code and medical service areas are exactly the kinds of fields we want to offer to try to make this tool more useful to users. We are actively looking into adding zip code and medical service area fields, but we are not at the point where we can say that it is going to be implemented.

Question: How does the software handle missing data in the file? (Dian Kahn, VT Dept Banking, Insurance, Securities and Health Care Administration)
Answer: Multiple things will happen depending on how much data is missing. If a variable is not labeled (i.e., the name is missing), the program will not run and you will see an error message telling you that. However, if entire counties have no data, or if pieces of data are missing for a county, the program will still run. However, the counties with missing data will not be included in maps that are created and will be missing from the output Excel and.csv files.

Question: Can you import data from a.txt file rather than a.csv file? (Dian Kahn, VT Dept Banking, Insurance, Securities and Health Care Administration)
Answer: No, the data needs to come from a.csv file.

Question: Can the tool be modified to process multiple years for low population states? (Dian Kahn, VT Dept Banking, Insurance, Securities and Health Care Administration)
Answer: At this time, no. You could run the tool for those years separately and then aggregate the data yourself. However, in taking this approach, you would have data for multiple years but not maps (unless you have access to a mapping program that you can use to generate the maps outside of the mapping tool).

Other Questions

Question: What is the URL to download the Mapping Tool? (Dong Siegel, Bureau of TennCare, State of TN)
Answer: To download the Mapping Tool go to:

Question: Can the tool only be used by HCUP partners? (Theresa Richburg, Alabama Medicaid)
Answer: No, anyone can use the tool as long as they have the basic data elements that the tool requires. Right now the cost analysis component can only be used by HCUP partners, because of the cost to charge ratios that underlie how the tool calculates the cost. If you are not from an HCUP State, we are working on including the cost analysis component by fiscal year 2009. However, you can use all of the other features of the tool right now apart from the cost savings component.

Question: Do I understand correctly that the tool is not yet developed for Inpatient Quality Indicators (IQIs)? (Eric Wolf, Colorado Medicaid)
Answer: Right now, we only have the Prevention Quality Indicators (PQIs) and the Pediatric Quality Indicators (PDIs) built into the tool. The reason for this is that the PQIs are area-based, and the PDIs we included are only the area-based PDIs. Right now we do not have the capability to map the provider level or hospital level Quality Indicators. However, there are IQIs and Patient Safety Indicators (PSIs) that are area-based. If we were going to expand to anything, you would probably see us go to the other area-based indicators first, and then we would try to improve the tool to include provider level and/or hospital level quality indicators and make it more sophisticated since we've only had the tool out for a short period of time. We are still improving this tool; this is a good suggestion.

Question: When do you think the incorporation of this into the Windows Quality Indicators Software (WINQI) will be done? (Hanten Day, Oregon Health Policy & Research)
Answer: We are targeting fiscal year 2009 to complete the incorporation into WINQI, but at this time I can't provide a more specific date.

Question: We do a lot of analysis on populations aged 65-74 and 75+. Will you be breaking down the data into these age groups in the future? (Julia S Brown, Oregon Dept. Human Services)
Answer: We do not have plans to make that change, however, I will take this comment back to the development team. We're always looking for suggestions for future tool improvements.

Current as of May 2009

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