RFP_AHRQ-18-10001_Amendment_1_-_Attachment_1_SOW.pdf

AHRQ-18-10001 ATTACHMENT #1 – Statement of Work (SOW) Healthcare Cost and Utilization Project (HCUP) FY 2018-2023

Independently and not as an agent of the Government, the Contractor shall be required to furnish all the necessary services, qualified personnel, material, equipment, and facilities, not otherwise provided by the Government, as needed to perform the Statement of Work as follows:

Key:

Base = Base year (12/27/2017 – 12/26/2018) Year 1 = Option Year 1 (12/27/2018 – 12/26/2019) Year 2 = Option Year 2 (12/27/2019 – 12/26/2020) Year 3 = Option Year 3 (12/27/2020 – 12/26/2021) Year 4 = Option Year 4 (12/27/2021 – 12/26/2022)

Table of Contents ..................................................................................................................... i INTRODUCTION ............................................................................................................ 1 C.1.

Background Information ............................................................................................. 2 C.1.1 Description of HCUP Databases ................................................................................ 3 C.1.2 Description of HCUP-US Web site ............................................................................. 5 C.1.3

OBJECTIVES ................................................................................................................. 6 C.2.

SPECIFIC REQUIREMENTS ......................................................................................... 6 C.3.

PROJECT MANAGEMENT ............................................................................................ 7 C.4.

Meetings and Conference Calls ................................................................................. 7 C.4.1 Prepare, Arrange, and Attend an Orientation Meeting ................................................ 7 C.4.1.1

Prepare an Annual Project Management Plan ............................................................ 7 C.4.2 Annual Site Visit ......................................................................................................... 8 C.4.3 Progress and Final Reports ........................................................................................ 8 C.4.4

RECEIVE HCUP MATERIALS AND TAKE OVER OPERATIONS .................................. 9 C.5.

Finalize and Implement a Transition Plan to Receive Project Materials ...................... 9 C.5.1 Receive HCUP Materials ............................................................................................ 9 C.5.2 Take Over Ongoing Key Operations..........................................................................10 C.5.3

Take Over HCUP Central Distributor .........................................................................10 C.5.3.1 Take Over Technical Support and Expertise .............................................................11 C.5.3.2

C.5.3.3 Take over HCUP-US Web site

C.5.3.4 Take over HCUP Outreach and Dissemination Activities

DATA ACQUISITION ACTIVITIES ................................................................................12 C.6.

Conduct Ongoing Communications Regarding Project Activities ...............................13 C.6.1

Data Acquisition Record-keeping ..............................................................................14 C.6.1.1

Request for Proposal Amendment #1 v. Jan-17; FAC 93 AHRQ-2018-10001 Healthcare Cost and Utilization Project (HCUP) FY 2018-2023 Attachment #1 i

Communication on Project Activities .........................................................................14 C.6.1.2 Conference Calls and Work Groups ..........................................................................14 C.6.1.3

Acquisition Materials .................................................................................................14 C.6.2 Partner Contact List ..................................................................................................15 C.6.3 Data Availability from HCUP Partners .......................................................................15 C.6.4 Hospital Information from HCUP Partners .................................................................15 C.6.5 Obtain Annual and Quarterly Data Files ....................................................................16 C.6.6 Execute Memorandums of Agreement (MOA) ...........................................................16 C.6.7 Acquire Data .............................................................................................................16 C.6.8 Recruit New Data Types and New Partners ..............................................................17 C.6.9

Identify Potential New Data Types and Potential New Partner Organizations ............17 C.6.10 Execute MOA Amendments ......................................................................................17 C.6.11 Purchase Data ..........................................................................................................18 C.6.12

PROCESSING AND CREATING STATE DATABASES ................................................18 C.7.

State-Specific Comparative Data Report ...................................................................23 C.7.1 Compliance with the MOA and Source Documentation .............................................23 C.7.2 Validity and Consistency of Diagnoses and Procedures ............................................24 C.7.3 Exploratory Statistics to Check Consistency in Coding with Previous Years ..............24 C.7.4 HCUP Uniform State Data Elements for State Databases .........................................24 C.7.5 HCUP Quality Control Edits ......................................................................................24 C.7.6 Derived Data Elements for Use on State Databases .................................................24 C.7.7

Place and Type of Service Flags ...............................................................................24 C.7.7.1 Urban-Rural Patient Location Data Elements ............................................................25 C.7.7.2 Community-Level Median Income of ZIP Code and Create Income Categories ........26 C.7.7.3 Clinical Classification Software (CCS) .......................................................................26 C.7.7.4 CMS Medicare Severity-Diagnosis Related Groups (MS-DRG) Grouper Software to C.7.7.5 the Inpatient Data

Severity Adjustment Software ...................................................................................26 C.7.7.6 Chronic Condition Indicator, Procedure Class, Utilization Flags ................................27 C.7.7.7 Surgery Flags ............................................................................................................27 C.7.7.8 Injury Flags ...............................................................................................................27 C.7.7.9

Readmission / Revisit Data Elements ........................................................................28 C.7.8 Other New HCUP Tools ............................................................................................28 C.7.9

Evaluate the Derived Data Elements and Flags ........................................................28 C.7.10 Create State Files .....................................................................................................28 C.7.11 ii

Create State Inpatient Databases (SID) Files ............................................................29 C.7.11.1 Create Outpatient Files .............................................................................................29 C.7.12

Create State Emergency Department Databases (SEDD) Files ................................29 C.7.12.1 Create State Ambulatory Surgery and Services Databases (SASD) Files .................30 C.7.12.2

Create Quarterly Inpatient Data Files ........................................................................30 C.7.13 Data Elements in Quarterly Data ...............................................................................31 C.7.13.1 Documentation of Quarterly Data ..............................................................................31 C.7.13.2 Memo to Recommend Inpatient and Outpatient Quarterly Data ................................31 C.7.13.3 Evaluate Quarterly Data ............................................................................................31 C.7.13.4

Create HCUP Central Distributor Files ......................................................................31 C.7.14 Customize Files ........................................................................................................32 C.7.14.1

Reprocessing Log .....................................................................................................32 C.7.15 Documentation for State-Specific Files ......................................................................33 C.7.16 Copy and Deliver Data and Programs .......................................................................33 C.7.17

Copy and Provide State-Specific Data Files for Return to States ..............................33 C.7.17.1 Copy Intramural Data for Delivery for AHRQ .............................................................34 C.7.17.2 Copy of Data Processing Programs ..........................................................................34 C.7.17.3 Copy of Summary Statistics ......................................................................................34 C.7.17.4

NATIONAL INPATIENT SAMPLE (NIS) ........................................................................34 C.8.

Create the NIS Sample .............................................................................................35 C.8.1 Create the NIS Data Files .........................................................................................35 C.8.2 Quality Check of the Data Files and Review of State-Specific Restrictions................35 C.8.3 Prepare the External Release Version of the NIS Data Files .....................................36 C.8.4 Prepare the Intramural Version of the NIS Data Files ................................................36 C.8.5 Document the NIS .....................................................................................................36 C.8.6

Generate Documentation for the NIS ........................................................................36 C.8.6.1 Submit Copies of NIS Data Processing Programs .....................................................36 C.8.6.2

Other NIS-Related Activities ......................................................................................36 C.8.7 New Data Elements ..................................................................................................36 C.8.7.1 Prepare NIS Comparison Report ...............................................................................37 C.8.7.2

KIDS’ INPATIENT DATABASE (KID) ............................................................................37 C.9.

Create the KID ..........................................................................................................38 C.9.1 NATIONWIDE EMERGENCY DEPARTMENT DATABASE (NEDS)..............................38 C.10.

Create the NEDS Sample .........................................................................................38 C.10.1 iii

Create the Multi-State Emergency Department Data File ..........................................39 C.10.2 Create the NEDS Data Files .....................................................................................39 C.10.3 Prepare the Intramural Version of the NEDS Data Files ............................................40 C.10.4 Quality Check and Verification of State-Specific Restrictions ....................................40 C.10.5 Prepare the External Release Version of the NEDS Data Files .................................40 C.10.6 Document the NEDS .................................................................................................40 C.10.7

Generate Documentation for the NEDS ....................................................................40 C.10.7.1 Submit Copies of NEDS Data Processing Programs .................................................41 C.10.7.2

Other NEDS-Related Activities ..................................................................................41 C.10.8 New Data Elements ..................................................................................................41 C.10.8.1 Identify Hospital Trauma Centers ..............................................................................41 C.10.8.2 NEDS Comparison Report ........................................................................................42 C.10.8.3 Evaluate Severity Index and Potential Data Elements ...............................................42 C.10.8.4

Compare NEDS and the Multi-state Emergency Department Data File .....................42 C.10.9 NEDS Redesign Report ............................................................................................42 C.10.10

NATIONWIDE READMISSION DATABASE (NRD) .......................................................42 C.11.

NATIONWIDE AMBULATORY SURGERY SAMPLE (NASS) .......................................43 C.12.

Create the NASS Sample ..........................................................................................43 C.12.1 Create the NASS Data Files ......................................................................................45 C.12.2 Quality Check and Verification of State-Specific Restrictions ....................................45 C.12.3 Prepare the Intramural Version of the NASS Files.....................................................45 C.12.4 Prepare for Creation of the Public Version of the NASS Files ...................................45 C.12.5 Create the Multi-State Ambulatory Surgery and Services Data File ...........................46 C.12.6 Document the NASS .................................................................................................46 C.12.7 NASS Data Processing Programs .............................................................................46 C.12.8 NASS Comparison Report ........................................................................................46 C.12.9

Create Public Release NASS ....................................................................................46 C.12.10 Evaluate NASS Sampling Design ..............................................................................47 C.12.11

HOSPITAL IDENTIFICATION FILES .............................................................................47 C.13.

HCUP AHA Hospital Annual Survey Analytic File ......................................................48 C.13.1

Annually Acquire the Most Recent AHA Annual Survey File ......................................48 C.13.1.1 Check for Changes in Data Elements and Definitions and Hospital Status ................48 C.13.1.2 Create the HCUP Version of the AHA Annual Survey ...............................................48 C.13.1.3

Document the AHA Files ...........................................................................................49 C.13.2 iv

Create E-version of the AHA File Documentation ......................................................49 C.13.2.1 Update Overview of the HCUP AHA Survey Database .............................................49 C.13.2.2

AHA Linkage Files .....................................................................................................49 C.13.3 Intramural Version of AHA Linkage Files ...................................................................49 C.13.3.1 External Release Version of AHA Linkage Files ........................................................50 C.13.3.2

Compare AHA Data with State Data .........................................................................50 C.13.4 Obtain Hospital Information from HCUP Partners......................................................50 C.13.5 Explore and Acquire Other Third-Party Data Sources ...............................................51 C.13.6 HCUP Hospital Master File .......................................................................................51 C.13.7 Supplemental File on Health Systems and Networks ................................................51 C.13.8 Additional AHA EHR Data .........................................................................................52 C.13.9

HCUP SUPPLEMENTAL / LINKABLE FILES ................................................................52 C.14.

HCUP Cost-to-Charge Ratio (CCR) Files ..................................................................53 C.14.1 OPTIONAL TASK, Years 1-4, HCUP Health Insurance File ......................................54 C.14.2 OPTIONAL TASK, Years 1 and 4: Prepare Public Version of Health Insurance File .55 C.14.3

Prepare Analytic Files ...............................................................................................55 C.14.3.1 Obtain HCUP Partner Permission to Link Health Insurance Files to HCUP Databases C.14.3.2 and to Release through the HCUP Central Distributor

Prepare HCUP Central Distributor Versions of the Health Insurance File and Related C.14.3.3 Documentation

Hospital Market Structure Files .................................................................................55 C.14.4 Obtain State Partner Permission to Release Hospital Market Structure Files through C.14.4.1 the HCUP Central Distributor

HCUP Central Distributor Hospital Market Structure Files and Related DocumentationC.14.4.2

HCUP Quality Indicator Files .....................................................................................56 C.14.5 Prepare documentation on the HCUP Quality Indicator Files and documentation on C.14.5.1 the flags

Obtain State Partner Permission to Release Quality Indicator Files through the HCUP C.14.5.2 Central Distributor

HCUP Payment-to-Charge Ratio File ........................................................................57 C.14.6 Obtain State-wide Hospital Financial Data ................................................................57 C.14.6.1 Evaluate Financial Data ............................................................................................57 C.14.6.2 Prepare Analytic Files and Intramural Payment-to-Charge Files ...............................58 C.14.6.3 Obtain State Partner Permission to Release Payment-to-Charge Files through the C.14.6.4

HCUP Central Distributor v

Prepare HCUP Central Distributor Payment-to-Charge Files and Related C.14.6.5 Documentation

Create Physician Files ..............................................................................................58 C.14.7 OPTIONAL TASK, Years 1-4: Develop Other Supplemental/ Linkable Data Files ....58 C.14.8

Memo of Recommendations .....................................................................................59 C.14.8.1 Work plan and Development of Prototypes ...............................................................59 C.14.8.2 Create and Release Linkable Files ............................................................................59 C.14.8.3

HCUP CENTRAL DISTRIBUTOR ..................................................................................59 C.15.

Manage the HCUP Central Distributor .......................................................................60 C.15.1 Host Online E-Commerce Ordering Web site and Payment System..........................60 C.15.2 Technical Guide to the Central Distributor Ordering Web site ...................................60 C.15.3 Central Distributor E-Commerce Ordering Web site ..................................................61 C.15.4 Refine E-commerce Web site ....................................................................................61 C.15.5 Receive and Process Applications ............................................................................62 C.15.6 Maintain Application Kits ...........................................................................................62 C.15.7 Track Central Distributor Operations and Users ........................................................62 C.15.8 Deliver Databases to Users .......................................................................................63 C.15.9

Process Applications .................................................................................................63 C.15.10 Provide Technical Assistance ...................................................................................63 C.15.11 Maintain Public Contact Information ..........................................................................63 C.15.12 Receive Payments and Reimburse HCUP Partner Organizations .............................64 C.15.13 Reimburse HCUP Partner Organizations and Send Monthly Reports........................64 C.15.14 Monthly Activity Reports ............................................................................................64 C.15.15 Retain Applications and Data Use Agreements (DUAs) ............................................65 C.15.16

OPTIONAL TASK, Base Year and Option Years 1-4: Online acknowledgement of C.15.16.1 DUA for Non-purchasers

Customized Files.......................................................................................................65 C.15.17

DELIVERY AND MANAGEMENT OF DATABASES, DOCUMENTATION, AND C.16.

RECORDS

Databases .................................................................................................................66 C.16.1 Database Format ......................................................................................................66 C.16.1.1 Source Data Destruction ...........................................................................................66 C.16.1.2

Documentation ..........................................................................................................66 C.16.2 Data File Maintenance System ..................................................................................66 C.16.2.1 Create Database Documentation ..............................................................................66 C.16.2.2 vi

Project Management Records ...................................................................................67 C.16.3 Documentation Quality ..............................................................................................67 C.16.3.1 Back-up System for All Documentation .....................................................................67 C.16.3.2

OPTIONAL TASK, Base Years and Option Years 1-4: Obtain and Renew SAS C.16.4 Licenses

Assessment of Records Management .......................................................................68 C.16.5 HCUP-US WEB SITE ....................................................................................................68 C.17.

Maintain Content on the HCUP-US Web site ............................................................68 C.17.1 HCUP- US Web site Policy and Regulations .............................................................68 C.17.2 HCUP-US Web site Format and Accessibility ............................................................68 C.17.3 Enhancing the HCUP-US Web site ...........................................................................69 C.17.4 Management of the HCUP-US Web site ...................................................................69 C.17.5 Technical Guide to Web site .....................................................................................69 C.17.6 OPTIONAL TASK, Base Year and Option Years 1-4, Evaluate and Develop Plan for C.17.7

Redesign of the HCUP-US Web Site

OPTIONAL TASK, Base Year and Option Years 1-4, Implement Redesign of the C.17.8 HCUP-US Web site

TECHNICAL SUPPORT FOR PARTNERS ...................................................................71 C.18.

Facilitate Communication With and Among the HCUP Partners ................................71 C.18.1 HCUP Partner Workgroups .......................................................................................72 C.18.2 Participation in Conferences and Other Meetings of HCUP Partners ........................72 C.18.3 HCUP-US Partners' Web Page .................................................................................72 C.18.4 Technical Advice to Individual HCUP Partners ..........................................................72 C.18.5

HCUP PARTNERS MEETING WEBINARS ...................................................................73 C.19.

OPTIONAL TASK, Option Years 2-4: In-Person HCUP Partners Meeting ................74 C.19.1

In-Person HCUP Partners Meeting Coordination ......................................................74 C.19.1.1 Participate in the In-Person HCUP Partners Meeting ................................................75 C.19.1.2

TECHNICAL EXPERTISE TO AHRQ ............................................................................75 C.20.

Provide Technical Expertise and Support in Understanding, Utilizing, and Analyzing C.20.1

HCUP Data and Projects

PROVIDE TECHNICAL SUPPORT TO HCUP USERS .................................................76 C.21.

Respond to Technical Assistance Inquiries ...............................................................76 C.21.1 Improve HCUP through Feedback ............................................................................77 C.21.2

Develop Two Annual Technical Support Statistics Reports .......................................77 C.21.2.1 Locate and Peruse HCUP Publications .....................................................................78 C.21.3 vii

Develop Two Annual Publications Reports ................................................................78 C.21.4 PLAN, DEVELOP and EXECUTE HCUP PRESENTATIONS ........................................79 C.22.

In-Person Presentations ............................................................................................79 C.22.1 Webinars ...................................................................................................................80 C.22.2 Online tutorials and courses ......................................................................................80 C.22.3 Optional Task, Year 3: New Electronic Courseware Partnership ...............................80 C.22.4 Optional Task, Year 4: Update Electronic Courseware ..............................................80 C.22.5 Presentation Slide Decks ..........................................................................................80 C.22.6

INCREASE USE OF AND IMPACT FROM HCUP THROUGH OUTREACH .................81 C.23.

Implement Outreach Initiative ....................................................................................81 C.23.1 Create, Coordinate, and Disseminate Written Materials ............................................81 C.23.2

Create Quarterly HCUP Newsletter ...........................................................................81 C.23.2.1 Technical Support Web Pages ..................................................................................82 C.23.2.2

OPTIONAL TASK, Years 1-4: Expand Impact from HCUP through Outreach ..........82 C.23.3 Develop, Recommend, and Implement Selected Outreach Initiatives........................82 C.23.3.1 Implement Outreach Initiatives ..................................................................................83 C.23.3.2 Produce Promotional Materials .................................................................................83 C.23.3.3

Provide Management Reports on Outreach ..............................................................83 C.23.4 MAINTAIN AND CREATE SOFTWARE TOOLS ...........................................................83 C.24.

Maintain and Update Existing Software Tools ...........................................................85 C.24.1 Maintain and Update Tool Logistics Document .........................................................86 C.24.2 Update tools and perform tool-related activities and improvements. ..........................86 C.24.3 OPTIONAL TASK, Years 1-4: Develop New Software Tools .....................................86 C.24.4

ONLINE HCUP STATISTICAL REPORTING .................................................................87 C.25.

Readmission Tables ..................................................................................................87 C.25.1 Community Statistics .................................................................................................88 C.25.2 Expand Community-Level Statistics ..........................................................................88 C.25.3 HCUP Fast Stats .......................................................................................................90 C.25.4 Expand Fast Stats .....................................................................................................91 C.25.5 OPTIONAL TASK, Base Year and Option Years 1-4 - Development of New Fast Stats C.25.6

Reporting Path

STATISTICAL AND TECHNICAL REPORTS ................................................................92 C.26.

Write Statistical Briefs ...............................................................................................92 C.26.1 Write Methods Series Reports...................................................................................93 C.26.2

RESEARCH AND ANALYTIC PROJECTS ....................................................................93 C.27.

viii

Conduct Research Analyses .....................................................................................94 C.27.1 Revision and Resubmission of Manuscripts Previously Submitted ............................95 C.27.2 Recommend Research Topics for Next Contract Year ..............................................96 C.27.3 OPTIONAL TASK, Base Year and Option Years 1-4: Moderate and Limited Analytic C.27.4

Projects

Moderate-Effort Research Project .............................................................................96 C.27.4.1 Limited-Effort Research Project – 12 Months ............................................................96 C.27.4.2 Limited-Effort Research Project – 6 Months ..............................................................97 C.27.4.3 Limited-Effort Research Project – 3 Months ..............................................................97 C.27.4.4

QUICK TURN-AROUND DATA ANALYSIS ...................................................................98 C.28.

Develop Standard Approaches, Track Analyses ..................................................... 100 C.28.1 Documenting the analysis ....................................................................................... 100 C.28.2 OPTIONAL TASK, Base Year and Option Years 1-4: Additional Quick Turn-Around C.28.3 and Periodic Data Analysis

OPTIONAL TASK, YEARS 1 – 4: NEW SPECIALIZED ENCOUNTER-LEVEL C.29.

DATABASE

Develop Preliminary Databases .............................................................................. 101 C.29.1 Understand and Document the Availability of Data from Relevant Organizations .... 101 C.29.2 Develop the Concept, Create Test Database, and Evaluate the Database .............. 101 C.29.3 Create Databases for Internal Use .......................................................................... 102 C.29.4 Document the Databases ........................................................................................ 102 C.29.5 OPTIONAL TASK, Years 1-4: Release Specialized Database ............................... 102 C.29.6

Obtain Agreement from States for Release of the New Database ........................... 102 C.29.6.1 Prepare the Database for Dissemination ................................................................. 102 C.29.6.2 Delivery of Specialized Database and Documentation ............................................ 102 C.29.6.3

NATIONAL HEALTHCARE QUALITY AND DISPARITIES REPORT (QDR) ............... 103 C.30.

Assess Design of Analyses and Table Shells .......................................................... 104 C.30.1

Leadership .............................................................................................................. 104 C.30.1.1 Design Decisions .................................................................................................... 104 C.30.1.2

QDR Production ...................................................................................................... 106 C.30.2 Generating Hospital Weights ................................................................................... 107 C.30.2.1 Creating the QDR analytic sample .......................................................................... 107 C.30.2.2 Build QDR Analytic Sample ..................................................................................... 107 C.30.2.3 Evaluate QDR Analytic Sample ............................................................................... 108 C.30.2.4 Incorporating Population Denominators .................................................................. 108 C.30.2.5 ix

Applying QI Software .............................................................................................. 108 C.30.2.6 Applying Significance Testing ................................................................................. 108 C.30.2.7 Quality Control ........................................................................................................ 109 C.30.2.8

QDR Products ......................................................................................................... 109 C.30.3 Create Working Tables............................................................................................ 109 C.30.3.1 Final Tables ............................................................................................................ 109 C.30.3.2 SID and NIS QDR Skinny Files ............................................................................... 109 C.30.3.3 Task Documentation ............................................................................................... 109 C.30.3.4

Special Analyses ..................................................................................................... 110 C.30.4 Additional Statistical Tables .................................................................................... 110 C.30.4.1

Coordination with HCUP Partners on the QDR ....................................................... 110 C.30.5 Prepare State-level Preview Materials for the HCUP Partners ................................ 110 C.30.5.1 QDR Briefing Materials for HCUP Partners ............................................................. 111 C.30.5.2

QDR Option Year 1 ................................................................................................. 111 C.30.6 QDR Option Year 2 ................................................................................................. 111 C.30.7 QDR Option Year 3 ................................................................................................. 112 C.30.8 QDR Option Year 4 ................................................................................................. 112 C.30.9

QUALITY ASSURANCE, SECURITY, AND INFORMATION TECHNOLOGY (IT) ....... 112 C.31.

Provide Quality Assurance ...................................................................................... 112 C.31.1 Confidentiality and Security Protections .................................................................. 112 C.31.2 Catalogue and Return All Data ................................................................................ 113 C.31.3 HCUP Security Provisions ....................................................................................... 113 C.31.4 Legal Protections .................................................................................................... 113 C.31.5 DUA Compliance..................................................................................................... 114 C.31.6 Provide Technical Assistance to Partners for Security and Confidentiality of Data .. 114 C.31.7 Annual Privacy Training and Update Electronic Privacy Training Tools on Security C.31.8 and Confidentiality of Data

OPTIONAL TASK, BASE YEAR AND OPTION YEARS 1-4: PROJECT CLOSE-OUT C.32.

Develop and Implement End of Contract Transition Plan for Tasks Requiring Ongoing C.32.1 Operations

Source Data ............................................................................................................ 115 C.32.2 Data Inventory, Processing and Status ................................................................... 115 C.32.3 HCUP Central Distributor ........................................................................................ 116 C.32.4 Technical Support ................................................................................................... 117 C.32.5 x

HCUP-US Website .................................................................................................. 117 C.32.6 National Healthcare Quality and Disparities Report ................................................. 117 C.32.7 HCUP Project Summary Report .............................................................................. 117 C.32.8

Technical Assistance to Users ................................................................................ 118 C.32.8.1 Data Inventory, Processing, and Status .................................................................. 118 C.32.8.2 Central Distributor ................................................................................................... 118 C.32.8.3

OPTIONAL TASK, BASE YEAR AND OPTION YEARS 1-4: PROJECT TRANSITION C.33.

AND TRANSFER

HCUP Data Acquisition and Processing .................................................................. 118 C.33.1 HCUP Central Distributor ........................................................................................ 119 C.33.2 HCUP-US Web site ................................................................................................. 119 C.33.3 HCUP Technical Expertise to AHRQ ....................................................................... 119 C.33.4 Provide Technical Support to HCUP Users ............................................................. 119 C.33.5 National Quality and Disparities Report (QDR) ........................................................ 119 C.33.6 Quality Assurance, Security, and Information Technology (IT) ................................ 119 C.33.7 Project Management ............................................................................................... 119 C.33.8 xi

INTRODUCTION C.1.

The Center for Delivery, Organization, and Markets (CDOM) within the Agency for Healthcare Research and Quality (AHRQ) of the United States Department of Health and Human Services (DHHS) has established the requirement to conduct and expand the next phase of the Healthcare Cost and Utilization Project for the base period from December 2017 to December 2018, with option periods extending to 2022.

The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of health care databases, related software tools and products developed through a Federal-State- Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). HCUP databases bring together the data collection efforts of State data organizations, hospital associations, private data organizations, and the federal government to create a national information resource of encounter-level health care data. HCUP includes the largest collection of longitudinal hospital administrative data in the United States, with all-payer, encounter-level information beginning in 1988. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care, and outcomes of treatments at the national, state, and local market levels.

HCUP's objectives are to:

• Create and enhance a powerful source of national, state, and all-payer health care data.

• Produce a broad set of software tools and products to facilitate the use of HCUP and other administrative data

• Enrich a collaborative partnership with statewide data organizations aimed at increasing the quality and use of health care data

• Conduct and translate research to inform decision making and improve health care delivery

To meet the goals of this project, the following activities are required:

• Maintain data partners, complete data applications, negotiate or update Memorandums of Agreement for participation, purchase data from HCUP Partners, recruit additional data from existing partners, and establish new partnerships when possible

• Process and create uniformly formatted state inpatient and outpatient encounter-level data files obtained from HCUP Partners organizations

• Sample the HCUP state databases to create derivative national databases

• Provide for the centralized distribution of HCUP data, handling all activities directly related to the sales and dissemination of the restricted access public release HCUP databases (the national databases abbreviated NIS, KID, NEDS, NRD and related HCUP files. (See https://www.hcup-us.ahrq.gov/databases.jsp )

• Maintain and further develop the HCUP Web site (HCUP-US) which serves as the project’s primary vehicle for public outreach, and a virtual repository for project information and documentation

• Develop products, tools, and services to assist with the productive use of the data https://www.hcup-us.ahrq.gov/databases.jsp

• Facilitate the collaborative learning among all members of the project (AHRQ, HCUP Partner organizations, data users, health systems, and stakeholders) by providing technical support and training

• Deliver user technical support on HCUP databases, software tools, linkable files, written reports, and all other products developed for the HCUP project

• Conduct data analytics, research and policy analyses using the HCUP data to explore the impact of changes in health policy on health care, to document and analyze explanations for trends in health care, and to propose and test alternate hypotheses about the relative importance and impact of a variety of system and clinical factors on health care outcomes

• Prepare technical reports and publications.

• Conduct outreach to increase use and impact from HCUP

• Support the generation of estimates derived from HCUP data for other federal use, e.g.

Congressionally-mandated reports such as the National Healthcare Quality and Disparities Reports

• Develop systems for monitoring and maintaining secure and efficient computing environment

HCUP is a unique data source that provides record-level data on health care utilization for a range of settings including acute inpatient, emergency department, and ambulatory surgery.

The information provided in HCUP data includes patient demographics, diagnoses and procedures, how the patient was admitted and discharged, and resource utilization. HCUP is unique because it collects all records in all settings from those data sources that participate. It is also unique because of the derivative databases that can be used to generate national estimates.

A wide range of analysts in federal and State government, non-government organizations, and industry have come to rely on HCUP data and tools to identify, track, analyze, and compare trends at the national, regional, and State levels. In addition to university-based researchers and private sector consultants and analysts, users of HCUP data and tools include but are not limited to:

• National Institutes of Health (NIH)

• Centers for Disease Control (CDC)

• Substance Abuse and Mental Health Administration (SAMHSA)

• Food and Drug Administration (FDA)

• Health Resources and Services Administration (HRSA)

• Assistant Secretary for Planning and Evaluation (ASPE)

• Federal Trade Commission (FTC)

• Bureau of Economic Analysis (BEA)

• Organization for Economic Co-operation and Development (OECD)

• Medicare Payment Advisory Commission (MedPAC)

• Various State agencies

Background Information C.1.1 HCUP has experienced significant growth since the project began in the 1990s with only 11 HCUP Partners and a single nationwide database used only for internal research and analysis.

HCUP currently has inpatient data from 47 States and the District of Columbia, and emergency department and ambulatory surgery and services data from 35 States each. The inpatient data represents 97 percent of all community hospital discharges in the United States. Currently, HCUP is producing 48 inpatient databases (SID), 35 ambulatory surgery and services (SASD), 35 emergency department (SEDD), one national database on inpatient visits (NIS), one national database on children’s inpatient visits (KID), one nationwide database on emergency department visits (NEDS) and one nationwide database on hospital readmissions (NRD). Since some databases span up to 28 years, approximately 930 cumulative databases are now available to the public. More than one dozen data and analytic software tools and supplemental files are also supported by HCUP to facilitate users’ ability to use the large administrative databases. Two popular tools available to the public are online query systems that provide access to health statistics and information on hospital inpatient and emergency department utilization (HCUPnet), as well as timely statistics on relevant topics using the most recently quarterly or annual HCUP data (HCUP Fast Stats).

In the past five years, demand for and use of HCUP data and tools has grown significantly.

Visits to the HCUP Web sites have nearly doubled from 1.1 million to almost 2.2 million.

Applications for databases have increased from approximately 1,000 per year to more than 1,400 per year. HCUP answers 1,500 to 1,750 technical assistance inquiries each year.

National and State policymakers use these data and tools in their decision making. In addition, HCUP has increasingly been asked to take a leadership role in efforts to further develop and standardize administrative data.

The next phase of HCUP will build on the structure of the project that has been developed over the past 30 years and add to the project’s capacity to provide information that can be used by researchers and policymakers to assess and evaluate health care delivery in the United States.

By maintaining and strengthening the foundation, which includes a successful partnership with 48 HCUP Partners, and by maintaining and creating new enhancements to the project, AHRQ will broaden the reach and impact of HCUP data and products. Strengthening and enhancing the project enables improvement in its ability to inform, evaluate, analyze and measure healthcare delivery and safety improvements, and provides the possibility of developing new collaborative efforts within HHS and other federal and State partners, thereby adding to HCUP’s value and visibility .

What has not changed over time is the critical role of the HCUP partnerships with state-level data organizations that contribute data to the project. The participation of these data organizations is essential for the success of HCUP and is based on cooperative, detailed agreements made between AHRQ and each HCUP Partner. Partners also serve as a source of ideas for project improvement, expansion, and technical guidance.

Description of HCUP Databases C.1.2 HCUP databases contain a core set of clinical and nonclinical information found in a typical discharge abstract including all-listed diagnoses and procedures, discharge status, patient demographics, and charges for all patients regardless of payer (e.g., Medicare, Medicaid, private insurance, uninsured). The information is translated into a uniform format to facilitate both multi-State and national-State comparisons and analyses.

The majority of HCUP databases are used for intramural research within AHRQ. Restricted access public release versions of many of the HCUP databases are available to the public through the AHRQ-sponsored HCUP Central Distributor. The content of the restricted access public release versions of the HCUP databases is developed in conjunction with the participating HCUP Partners. The HCUP restricted access public release databases are available to users who sign a Data Use Agreement (DUA). This agreement allows the data to be used for research, public health, and aggregate statistical reporting, and prohibits the identification of individual hospitals and individuals and the use of small cell sizes in disseminated materials.

The HCUP family of databases includes:

• HCUP State databases – State-level annual inpatient and outpatient HCUP databases are used to investigate state-specific and multi-state trends in health care utilization, access, charges, quality, and outcomes (See https://www.hcup-us.ahrq.gov/databases.jsp for a description of each type of state database.)

• HCUP national databases – National or nationwide inpatient and emergency department HCUP databases that are used to identify, track, and analyze national trends in health care utilization, access, charges, quality, outcomes, and readmissions with samples derived from the HCUP State databases enabling focused research on special populations (See https://www.hcup-us.ahrq.gov/databases.jsp for a description of each type of national or nationwide database.)

• Other HCUP-related files – supplemental data files that are used to augment information in the HCUP State and national databases (See https://www.hcup-us.ahrq.gov/tools_software.jsp for a description of each type of supplemental file.)

The HCUP State databases are:

State Inpatient Databases (SID) – The SID contain the universe of inpatient discharge abstracts from data organizations. Currently 47 states plus the District of Columbia participate in the SID.

Together, the SID encompass 97 percent of all U.S. community hospital discharges; some states include hospital and county identifiers or discharges from specialty facilities such as…