WA-APCD - Washington All-Payer Claims Database

The WA-APCD is the state’s most complete source of health care eligibility, medical claims, pharmacy claims, and dental claims insurance data. It contains claims from more than 50 data suppliers, spanning commercial, Medicaid, and Medicare managed care. The WA-APCD has historical claims data for five years (2013-2017), with ongoing refreshes scheduled quarterly. Workers' compensation data from the Washington Department of Labor & Industries will be added in fall 2018.

Download the attachment for the data dictionary and more information about WA-APCD and the data.

This dataset contains data for the Healthcare Payments Data (HPD) Snapshot visualization. The Enrollment data file contains counts of claims and encounter data collected for California's statewide HPD Program. It includes counts of enrollment records, service records from medical and pharmacy claims, and the number of individuals represented across these records. Aggregate counts are grouped by payer type (Commercial, Medi-Cal, or Medicare), product type, and year. The Medical data file contains counts of medical procedures from medical claims and encounter data in HPD. Procedures are categorized using claim line procedure codes and grouped by year, type of setting (e.g., outpatient, laboratory, ambulance), and payer type. The Pharmacy data file contains counts of drug prescriptions from pharmacy claims and encounter data in HPD. Prescriptions are categorized by name and drug class using the reported National Drug Code (NDC) and grouped by year, payer type, and whether the drug dispensed is branded or a generic.

The table Medical_Claims_Procedures is part of the dataset CO APCD RIF, available at https://redivis.com/datasets/f485-0035c2392. It contains 519976457 rows across 5 variables.

Variables and data resources in the study.

The table Dental_Claims_Line is part of the dataset CO APCD RIF, available at https://redivis.com/datasets/f485-0035c2392. It contains 87939080 rows across 34 variables.

Regression adjusted results for association of total medical spending and utilization with network statistics.

This dataset contains data for the Healthcare Payments Data (HPD) Healthcare Measures report. The data cover three measurement categories: Health conditions, Utilization, and Demographics. The health condition measurements quantify the prevalence of long-term illnesses and major medical events prominent in California’s communities like diabetes and heart failure. Utilization measures convey rates of healthcare system use through visits to the emergency department and different categories of inpatient stays, such as maternity or surgical stays. The demographic measures describe the health coverage and other characteristics (e.g., age) of the Californians included in the data and represented in the other measures. The data include both a count or sum of each measure and a count of the base population so that data users can calculate the percentages, rates, and averages in the visualization. Measures are grouped by year, age band, sex (assigned sex at birth), payer type, Covered California Region, and county.

The table DIM_Provider_Entities is part of the dataset CO APCD RIF, available at https://redivis.com/datasets/f485-0035c2392. It contains 4 rows across 2 variables.

Comparative information from the All Payer Claims Database on two quality measures, Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis and Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing for clinics with five or more physicians.

Average costs of outpatient services.

The Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD) is a unique and powerful database designed to support various types of analyses of national readmission rates for all payers and the uninsured. The NRD includes discharges for patients with and without repeat hospital visits in a year and those who have died in the hospital. Repeat stays may or may not be related. The criteria to determine the relationship between hospital admissions is left to the analyst using the NRD. This database addresses a large gap in health care data - the lack of nationally representative information on hospital readmissions for all ages. Outcomes of interest include national readmission rates, reasons for returning to the hospital for care, and the hospital costs for discharges with and without readmissions. Unweighted, the NRD contains data from approximately 18 million discharges each year. Weighted, it estimates roughly 35 million discharges. Developed through a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality, HCUP data inform decision making at the national, State, and community levels. The NRD is drawn from HCUP State Inpatient Databases (SID) containing verified patient linkage numbers that can be used to track a person across hospitals within a State, while adhering to strict privacy guidelines. The NRD is not designed to support regional, State-, or hospital-specific readmission analyses. The NRD contains more than 100 clinical and non-clinical data elements provided in a hospital discharge abstract. Data elements include but are not limited to: diagnoses, procedures, patient demographics (e.g., sex, age), expected source of payer, regardless of expected payer, including but not limited to Medicare, Medicaid, private insurance, self-pay, or those billed as ‘no charge, discharge month, quarter, and year, total charges, length of stay, and data elements essential to readmission analyses. The NIS excludes data elements that could directly or indirectly identify individuals. Restricted access data files are available with a data use agreement and brief online security training.

The datasets contain hospital discharges counts (numerators, denominators, volume counts), observed, expected and risk-adjusted rates with corresponding 95% confidence intervals for Patient Safety Indicators generated using methodology developed by Agency for Healthcare Research and Quality (AHRQ).

The PSIs are a set of indicators providing information on potential in hospital complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed by AHRQ after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses.

All PSI measures were calculated using Statewide Planning and Research Cooperative System (SPARCS) inpatient data beginning 2009. US Census data files provided by AHRQ were used to derive denominators for county level (area level) PSI measures.

The mortality, volume and utilization measures PSIs are presented by hospital as rates or counts. Area-level measures are presented by county as rates.

The Statewide Planning and Research Cooperative System (SPARCS) is a comprehensive data reporting system which collects patient level detail on patient characteristics, diagnoses, treatments, services, and charges for every hospital discharge from an Article 28 facility; ambulatory surgery discharges from hospital-based ambulatory surgery centers and all other facilities providing ambulatory surgery services; and emergency department visits in New York State. This dataset is a summary of the SPARCS inpatient discharge data.

The Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS) is the largest all-payer emergency department (ED) database in the United States. yielding national estimates of hospital-owned ED visits. Unweighted, it contains data from over 30 million ED visits each year. Weighted, it estimates roughly 145 million ED visits nationally. Developed through a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality, HCUP data inform decision making at the national, State, and community levels. Sampled from the HCUP State Inpatient Databases (SID) and State Emergency Department Databases (SEDD), the HCUP NEDS can be used to create national and regional estimates of ED care. The SID contain information on patients initially seen in the ED and subsequently admitted to the same hospital. The SEDD capture information on ED visits that do not result in an admission (i.e., treat-and-release visits and transfers to another hospital). Developed through a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality, HCUP data inform decision making at the national, State, and community levels. The NEDS contain information about geographic characteristics, hospital characteristics, patient characteristics, and the nature of visits (e.g., common reasons for ED visits, including injuries). The NEDS contains clinical and resource use information included in a typical discharge abstract, with safeguards to protect the privacy of individual patients, physicians, and hospitals (as required by data sources). It includes ED charge information for over 85% of patients, regardless of expected payer, including but not limited to Medicare, Medicaid, private insurance, self-pay, or those billed as ‘no charge’. The NEDS excludes data elements that could directly or indirectly identify individuals, hospitals, or states.Restricted access data files are available with a data use agreement and brief online security training.

The Medicare Secondary Payer project is an annual process which attempts to identify working Medicare beneficiaries and/or their spouses. The first stage of this process is to extract all of the Medicare beneficiaries from the MBR. Prior to 2015, CSPOTRUN performed this function. Beginning in 2015, CSRETAP accomplishes this. In this process two files are prepared. One file goes to the Internal Revenue Service (IRS) for a tax return search and the other file is used for the Master Earnings File (MEF) search. IRS searches their tax return database and identifies returns that have spouses identified and returns this information to SSA. This file is then run against the MEF to obtain any current employment information for the beneficiary or the spouse. This data is sent to CMS for their process to determine whether Medicare should be the secondary payer for hospital and doctors bills. They determine whether the beneficiary and/or spouse have current health insurance coverage from their employer.

Abstract (en): Overview: The goal of the project was to develop a unique database linking chronic disease clinical data from an electronic medical record (EMR) of a large academic healthcare system to multi-payer claims data. The longitudinal relational database can be used to study clinical effectiveness of many diagnostic and treatment interventions. The population of patients used consisted of those patients who were attributed to the University of Michigan Health System (UMHS) as continuing care patients, who are also in adjudicated and validated chronic disease registries. Data Access: These data are not available from ICPSR. The data are restricted to use by the principal investigator and cannot be shared. This project concerned AHRQ priority populations, including low income and uninsured patients, older adult patients, and patients with diabetes. The population of patients used consisted of those patients who were attributed to the UMHS as continuing care patients, who were also in adjudicated and validated chronic disease registries. These registries organize EMR diagnostic and management information for patients with physician adjudicated chronic disease diagnoses. Complete claims are available for most of the relevant patient population. Funding insitution(s): United States Department of Health and Human Services. Agency for Healthcare Research and Quality (R24 HS019459).

The datasets contain hospital discharges counts (numerators, denominators, volume counts), observed, expected and risk-adjusted rates with corresponding 95% confidence intervals for Patient Safety Indicators generated using methodology developed by Agency for Healthcare Research and Quality (AHRQ).

The PSIs are a set of indicators providing information on potential in hospital complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed by AHRQ after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses.

All PSI measures were calculated using Statewide Planning and Research Cooperative System (SPARCS) inpatient data beginning 2009. US Census data files provided by AHRQ were used to derive denominators for county level (area level) PSI measures.

The mortality, volume and utilization measures PSIs are presented by hospital as rates or counts. Area-level measures are presented by county as rates.

The table Provider_to_Provider_Composite_Crosswalk is part of the dataset CO APCD RIF, available at https://redivis.com/datasets/f485-0035c2392. It contains 3840120 rows across 3 variables.

Organizations can license synthetic, structured data generated by Syntegra from electronic health record systems of community hospitals across the United States, reaching beyond just claims and Rx data.

The synthetic data provides a detailed picture of the patient's journey throughout their hospital stay, including patient demographic information and payer type, as well as rich data not found in any other sources. Examples of this data include: drugs given (timing and dosing), patient location (e.g., ICU, floor, ER), lab results (timing by day and hour), physician roles (e.g., surgeon, attending), medications given, and vital signs. The participating community hospitals with bed sizes ranging from 25 to 532 provide unique visibility and assessment of variation in care outside of large academic medical centers and healthcare networks.

Our synthetic data engine is trained on a broadly representative dataset made up of deep clinical information of approximately 6 million unique patient records and 18 million encounters over 5 years of history. Notably, synthetic data generation allows for the creation of any number of records needed to power your project.

EHR data is available in the following formats: — Cleaned, analytics-ready (a layer of clean and normalized concepts in Tuva Health’s standard relational data model format — FHIR USCDI (labs, medications, vitals, encounters, patients, etc.)

The synthetic data maintains full statistical accuracy, yet does not contain any actual patients, thus removing any patient privacy liability risk. Privacy is preserved in a way that goes beyond HIPAA or GDPR compliance. Our industry-leading metrics prove that both privacy and fidelity are fully maintained.

— Generate the data needed for product development, testing, demo, or other needs — Access data at a scalable price point — Build your desired population, both in size and demographics — Scale up and down to fit specific needs, increasing efficiency and affordability

Syntegra's synthetic data engine also has the ability to augment the original data: — Expand population sizes, rare cohorts, or outcomes of interest — Address algorithmic fairness by correcting bias or introducing intentional bias — Conditionally generate data to inform scenario planning — Impute missing value to minimize gaps in the data

The Nationwide Emergency Department Sample (NEDS) was created to enable analyses of emergency department (ED) utilization patterns and support public health professionals, administrators, policymakers, and clinicians in their decision-making regarding this critical source of care. The NEDS can be weighted to produce national estimates. The NEDS is the largest all-payer ED database in the United States. It was constructed using records from both the HCUP State Emergency Department Databases (SEDD) and the State Inpatient Databases (SID), both also described in healthdata.gov. The SEDD capture information on ED visits that do not result in an admission (i.e., treat-and-release visits and transfers to another hospital). The SID contain information on patients initially seen in the emergency room and then admitted to the same hospital. The NEDS contains 25-30 million (unweighted) records for ED visits for over 950 hospitals and approximates a 20-percent stratified sample of U.S. hospital-based EDs. The NEDS contains information about geographic characteristics, hospital characteristics, patient characteristics, and the nature of visits (e.g., common reasons for ED visits, including injuries). The NEDS contains clinical and resource use information included in a typical discharge abstract, with safeguards to protect the privacy of individual patients, physicians, and hospitals (as required by data sources). It includes ED charge information for over 75% of patients, regardless of payer, including patients covered by Medicaid, private insurance, and the uninsured. The NEDS excludes data elements that could directly or indirectly identify individuals, hospitals, or states.