Abstract

The Colorado All Payer Claims Database (CO APCD) is a state-legislated, secure health care claims database compliant with all federal privacy laws. It contains nearly 920 million claims for approximately 65 percent of insured lives in Colorado, with information from 42 commercial health insurance plans. Health insurance payers submit data monthly and the entire database is refreshed every other month, so the CO ACPD is continually evolving and being enhanced.

Usage

The dataset was extracted by the Center for Improving Value in Health Care (CIVHC) to support Stanford University COVID Long Haul Analysis. It includes medical, pharmacy, and dental claims files with coverage dates from 01/01/2012 to 08/31/2021.

For more information of CO APCD please refer to https://www.civhc.org/get-data/whats-in-the-co-apcd/

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Data Documentation

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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 is designed to analyze prescription drug use and spending among New York State residents at the drug product level (pharmacy claims data that have been aggregated by labeler code and product code segments of the National Drug Code). The dataset includes the number of prescriptions filled by unique members by payer type, nonproprietary name, labeler name, dosage characteristics, amount insurer paid, and more.

This data set includes comparative cost and quality information for clinics with five or more physicians for medical claims in 2016. Only clinics with eligible Total Cost of Care indices and three quality measures, Breast Cancer Screening, A1c testing, and Medical Attention for Nephropathy are included.

This data set was calculated by the Utah Department of Health, Office of Healthcare Statistics (OHCS) and HealthInsight Utah using Utah’s All Payer Claims Database (APCD).

This dataset is designed to analyze prescription drug use and spending among New York State residents at the active ingredient level. The dataset includes the number of prescriptions filled by unique members by payer type, rankings by volume, nonproprietary name, amount insurer paid, and more.

The All-Payer TCOC is calculated for most Vermont residents with claims available in VHCURES, the state’s All Payer Claims Database. Since some people have more than one type of coverage (e.g. both Medicare and Medicaid), each person is assigned a primary payer type for the month. Any claims incurred for the month (based on first service date) are included for the month’s spending, whether that care was in Vermont or outside of Vermont. The TCOC is based on allowed amounts, which includes both what the insurer paid and the member’s responsibility (i.e. copayments, coinsurance, and deductibles). It is also limited to claims paid as primary.

This dataset is designed to analyze prescription drug use and spending among New York State residents at the active ingredient level. The dataset includes the number of prescriptions filled by unique members by payer type, rankings by volume, nonproprietary name, amount insurer paid, and more.

Analysis of ‘WA-APCD Quality and Cost Summary Report: Practice Quality’ provided by Analyst-2 (analyst-2.ai), based on source dataset retrieved from https://catalog.data.gov/dataset/10d4ddee-0987-4f16-a780-430181a47bf2 on 28 January 2022.

--- Dataset description provided by original source is as follows ---

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.

--- Original source retains full ownership of the source dataset ---

This dataset is designed to analyze prescription drug use and spending among New York State residents at the active ingredient level. The dataset includes the number of prescriptions filled by unique members by payer type, rankings by volume, nonproprietary name, amount insurer paid, and more.

The Nationwide Readmissions Database (NRD) is database under the Healthcare Cost and Utilization Project (HCUP) which contains nationally representative information on hospital readmissions for all ages, including all payers and the uninsured. The NRD contains data from approximately 18 million discharges per year (35 million weighted discharges) across most of the United States.

Data elements include:

• Discharge month, quarter, and year
• Verified patient linkage number
• Timing between admissions for a patient
• Length of inpatient stay (days)
• Transfers, same-day stays, and combined transfer records
• Identification of patient residency in the state in which he or she received hospital care
• International Classification of Diseases (ICD-9-CM) diagnosis, procedure, and external cause of injury codes (prior to October 1, 2015)
• ICD-10-CM/PCS diagnosis, procedures, and external cause of morbidity codes (beginning October 1, 2015)
• Patient demographics (e.g., sex, age, income quartile, rural/urban residency)
• Expected payment source (e.g., Medicare, Medicaid, private insurance, self-pay, those billed as 'no charge', and other insurance types)
• Total charges and hospital cost (calculated using the "Cost-to-Charge Ratio" file)

The NRD consists of four data files:

• Core File: Available for all years of the NRD and contains commonly used data elements (e.g., age, expected primary payer, discharge status, ICD-10-CM/PCS codes, total charges)
• Severity File: Available for all years of the NRD and contains additional data elements related to identifying health conditions at discharge.
• Diagnosis and Procedure Groups File: Contains additional information on ICD-10-CM/PCS; available beginning in 2018.
• Hospital File: Available for all years of the NRD and contains additional information on participating hospital characteristics.

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 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.

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.

This data set includes comparative information for clinics in Utah for medical claims for the years 2017 and 2018.

This data set was calculated by the Utah Department of Health, Office of Healthcare Statistics (OHCS) using Utah’s All Payer Claims Database (APCD).

Prior years (2015-2016) may be viewed at: https://opendata.utah.gov/Health/2016-2015-Clinic-Quality-Comparisons-for-Clinics-w/35s3-nmpm

Abstract

The NIS is the largest publicly available all-payer inpatient healthcare database designed to produce U.S. regional and national estimates of inpatient utilization, access, cost, quality, and outcomes. Unweighted, it contains data from around 7 million hospital stays each year. Weighted, it estimates around 35 million hospitalizations nationally. Developed through a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality (AHRQ), HCUP data inform decision making at the national, State, and community levels.

Its large sample size is ideal for developing national and regional estimates and enables analyses of rare conditions, uncommon treatments, and special populations.

Usage

IMPORTANT NOTE: Some records are missing from the Severity Measures table for 2017 & 2018, but none are missing from any of the other 2012-2020 data. We are in the process of trying to recover the missing records, and will update this note when we have done so.

Also %3Cu%3EDO NOT%3C/u%3E

use this data without referring to the NIS Database Documentation, which includes:

• Description of NIS Database
• Restrictions on Use

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• Data Elements
• Additional Resources for Data Elements
• ICD-10-CM/PCS Data Included in the NIS Starting with 2015 (More details about this transition available here.)
• Known Data Issues
• NIS Supplemental Files
• HCUP Tools: Labels and Formats
• Obtaining HCUP Data

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Before Manuscript Submission

All manuscripts (and other items you'd like to publish) must be submitted to

phsdatacore@stanford.edu for approval prior to journal submission.

We will check your cell sizes and citations.

For more information about how to cite PHS and PHS datasets, please visit:

https:/phsdocs.developerhub.io/need-help/citing-phs-data-core

HCUP Online Tutorials

For additional assistance, AHRQ has created the HCUP Online Tutorial Series, a series of free, interactive courses which provide training on technical methods for conducting research with HCUP data. Topics include an HCUP Overview Course and these tutorials:

• The HCUP Sampling Design tutorial is designed to help users learn how to account for sample design in their work with HCUP national (nationwide) databases. • The Producing National HCUP Estimates tutorial is designed to help users understand how the three national (nationwide) databases – the NIS, Nationwide Emergency Department Sample (NEDS), and Kids' Inpatient Database (KID) – can be used to produce national and regional estimates. HCUP 2020 NIS (8/22/22) 14 Introduction • The Calculating Standard Errors tutorial shows how to accurately determine the precision of the estimates produced from the HCUP nationwide databases. Users will learn two methods for calculating standard errors for estimates produced from the HCUP national (nationwide) databases. • The HCUP Multi-year Analysis tutorial presents solutions that may be necessary when conducting analyses that span multiple years of HCUP data. • The HCUP Software Tools Tutorial provides instructions on how to apply the AHRQ software tools to HCUP or other administrative databases.

New tutorials are added periodically, and existing tutorials are updated when necessary. The Online Tutorial Series is located on the HCUP-US website at www.hcupus.ahrq.gov/tech_assist/tutorials.jsp.

Important notes about the 2015 data

In 2015, AHRQ restructured the data as described here:

https://hcup-us.ahrq.gov/db/nation/nis/2015HCUPNationalInpatientSample.pdf

Some key points:

• For the 2015 data, all diagnosis and procedure data elements, including any data elements derived from diagnoses and procedures, were moved out of the Core File and into the Diagnosis and Procedure Groups Files.
• Prior to 2015, and for Q1-3 of 2015, the DX1-30 and PR1-15 variables (which use ICD-9 codes) variables were used, but starting in Q4 of 2015, the I10_DX1-30 and I10_PR1-I10-15 (which use ICD-10 codes) were used. The best way to identify discharges for quarter 1-3 or quarter 4 is based on the value of the diagnosis version (DXVER); For quarters 1-3, DXVER has a value of 9; while for quarter 4, DXVER has a value of 10.
• Some other variables also transitioned in Q4 of 2015. Please refer to the link above for more details.
• Starting in 2016, the diagnosis and procedure information returned to the Core file. Additional details about the data in 2016 are available here: https://hcup-us.ahrq.gov/db/nation/nis/NISChangesBeginningDataYr2016.pdf

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NIS Areas of Research and HCUP Publications

The largest all-payer ambulatory surgery database in the United States, the Healthcare Cost and Utilization Project (HCUP) Nationwide Ambulatory Surgery Sample (NASS) produces national estimates of major ambulatory surgery encounters in hospital-owned facilities. Major ambulatory surgeries are defined as selected major therapeutic procedures that require the use of an operating room, penetrate or break the skin, and involve regional anesthesia, general anesthesia, or sedation to control pain (i.e., surgeries flagged as "narrow" in the HCUP Surgery Flag Software). Unweighted, the NASS contains approximately 9.0 million ambulatory surgery encounters each year and approximately 11.8 million ambulatory surgery procedures. Weighted, it estimates approximately 11.9 million ambulatory surgery encounters and 15.7 million ambulatory surgery procedures. Sampled from the HCUP State Ambulatory Surgery and Services Databases (SASD) and State Emergency Department Databases (SEDD) in order to capture both planned and emergent major ambulatory surgeries, the NASS can be used to examine selected ambulatory surgery utilization patterns. 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 NASS contains clinical and resource-use information that is included in a typical hospital-owned facility record, including patient characteristics, clinical diagnostic and surgical procedure codes, disposition of patients, total charges, facility characteristics, and expected source of payment, regardless of payer, including patients covered by Medicaid, private insurance, and the uninsured. The NASS excludes data elements that could directly or indirectly identify individuals, hospitals, or states. The NASS is limited to encounters with at least one in-scope major ambulatory surgery on the record, performed at hospital-owned facilities. Procedures intended primarily for diagnostic purposes are not considered in-scope. Restricted access data files are available with a data use agreement and brief online security training.

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.

This data set includes comparative information for clinics in Utah for medical claims for the years 2022 - 2023.

This data set was calculated by the Utah Department of Health and Human, Health Care Statistics Program using Utah’s All Payer Claims Database (APCD).

Prior years (2019-2021) may be viewed at: https://opendata.utah.gov/Health/2019-2021-Utah-Clinic-Quality-Comparisons/42ks-dsb5

Prior years (2017-2018) may be viewed at: https://opendata.utah.gov/Health/2017-2018-Utah-Clinic-Quality-Comparisons/9nhy-jp5r

Prior years (2015-2016) may be viewed at: https://opendata.utah.gov/Health/2016-2015-Clinic-Quality-Comparisons-for-Clinics-w/35s3-nmpm

This dataset tracks the updates made on the dataset "All-Payer Claims Data (APD De-Identified): Prescription Drug Summary 2019" as a repository for previous versions of the data and metadata.

The Nationwide Inpatient Sample (NIS) is a database focused on hospital stay information. Users are able to use the NIS to identify, track, and analyze national trends in health care utilization, access, charges, quality, and outcomes. Background The Nationwide Inpatient Sample (NIS) is maintained by the Healthcare Cost and Utilization Project. The NIS is the largest all-payer inpatient care database in the United States. It contains data from approximately 8 million hospital stays each year. The 2009 NIS contains all discharge data from 1,050 hospitals located in 44 States, approximating a 20-percent stratified sample of U.S. community hospitals. The sampling frame for the 2009 NIS is a sample of hospitals that comprises approximately 95 percent of all hospital discharges in the United States. The NIS is the only national hospital database containing charge information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. User functionality Users must pay to access the database. NIS releases for data years 1988-2009 are available from the HCUP Central Distributor. The 2009 NIS may be purchased for $50 for students and $350 for all others on a single DVD-ROM with accompanying documentation. . Data Notes NIS data are available from 1988 to 2009. The number of states in the NIS has grown from 8 in the first year to 44 at present. Beginning with the 2002 NIS, severity adjustment data elements including APR-DRGs, APS-DRGs, Disease Staging, and AHRQ Comorbidity Indicators, are available. Begi nning with the 2005 NIS, Diagnosis and Procedure Groups Files containing data elements from AHRQ software tools designed to facilitate the use of the ICD-9-CM diagnostic and procedure information are available. Beginning with the 2007 NIS, data elements describing hospital structural characteristics and provision of outpatient services are available in the Hospital Weights file. NIS Release 1 includes data from 8-11 States and spans the years 1988 to 1992. NIS Releases 2 and 3 contain data from 17 States for 1993 and 1994, respectively. NIS Releases 4 and 5 contain data from 19 States for 1995 and 1996. NIS Release 6 contains data from 22 States for 1997. NIS 1998 contains data from 22 States. NIS 1999 contains data from 24 States. NIS 2000 contains data from 28 States. NIS 2001 contains data from 33 States. NIS 2002 contains data from 35 States. NIS 2003 contains data from 37 States. NIS 2004 contains data from 37 States. NIS 2005 contains data from 37 States. NIS 2006 contains data from 38 States. NIS 2007 contains data from 40 States. NIS 2008 contains data from 42 States.