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About State Health Care Data Reporting Systems

States have implemented health care data reporting systems in order to monitor the performance of the health care delivery system and its impact on the population.  Major sources of these data, also called administrative data, are hospitals and, in a growing number of states, claims data from payers.  These data provide detailed information on patient demographics, health care utilization, and finance.  When aggregated, health care data bases can highlight variations in use and outcomes and can help target community-based interventions. 

State Hospital Discharge Databases are the only source of hospital utilization data that capture information about a patient’s demographic characteristics, diagnoses, procedures, and source of payment for every patient discharged from an acute care hospital within a state. The number of states with health data programs is growing. In 2011;

  • 48 states and jurisdictions have implemented hospital inpatient reporting systems
  • 34 states have ambulatory surgery data reporting
  • 31 states have emergency department reporting
  • 13 states have implemented or developing and All Payer Claims Database (APCD) 

            For more information on APCDs go to www.apcdcouncil.org

In general there are three models of governance for state health data agencies, which may impact release of data and allowable uses:

  1. A state agency with a legislative mandate collecting the data.
  2. A delegated authority, such as hospital association or private entity, collecting data under a state mandate.
  3. A private agency, usually a hospital association, collecting the data voluntarily from its members and community hospitals.

The state data agency profiles provides information on the agency responsible for collecting hospital data in each state including, the name and type of agency, if they collect data under a mandate or voluntarily (links to the laws), the data systems they maintain and a link to the agency website and reports.

 Characteristics of Statewide Discharge Datasets

  • They are population based, representing a known population that is defined by residence within geographic or political boundaries
  • Are increasingly being used for community assessment, providing information about preventable, avoidable hospitalizations, including ambulatory care sensitive conditions.
  • Data contain a large volume of observations on all patients hospitalized in short-term-care facilities in a state (federal hospitals and specialty hospitals are often excluded from state data collection requirements) 
  • More states are adding data elements important for public health and research to their discharge data in response to national standards and user needs for example Ecodes and POA (present on admission)
  • Data are based on national standards established by the National Uniform Billing Committee and thus, are relatively comparable across states.
  • Data quality is usually higher than other injury data as data are collected by licensed/certified professional medical record coders and serve as the basis for payment

 

 Strengths and limitations of Hospital Discharge Data

Attributes of Discharge Data

Strengths

Limitations

Availability/accessibility

Data availability—inpatient data maintained in 48 states and ED systems maintained in 31 states

Data access may be difficult, particularly when owned by private entities. If access is granted by private owners, it may be costly.

Cost-effective source of population-based information

Costs of public and research data vary across states

Reliability/consistency

More reliable than other sources of data, such as patient self-reporting of medical expenditures or physician reporting of specific conditions for disease surveillance

 

Primarily established for billing or administrative purposes, the hospital data may lacking  clinical detail for surveillance of certain environmental health conditions

Comparable across states and providers, based on national UB-04 formats

While many data elements are uniform across states, states vary the most in their collection of number of E-codes, number of diagnoses codes, race/ethnicity, lab results, and patient address. Coding accuracy has also been questioned.

Scope of Coverage

Inpatient discharge data allows ongoing surveillance as these data are collected on an ongoing basis, capturing information about every hospitalization in acute care hospitals.

Excludes federal or specialty hospitals and does not reflect non-facility outpatient care settings.  Also, may exclude emergency department visits, when there is not an admission.

State systems are population-based, including all acute care hospitals in a state

Data capture charges not actual costs

Analytic Utility

Available for multiple years, supporting trend analyses over time

Lack of timeliness.  Most states capture the data 45 days after the close of the previous quarter.  Data are aggregated in a reporting year, edited, updated, and verified before their public release

Benchmarks can be established for state, regional, national rates

Limited geographic referents for patient residence (zip code is not true proxy for community), coupled with limited availability of denominator data at community level.

Large volume, number of observations, supporting small-area and sub-group analyses

Coding practices vary by hospitals

Geographic and temporal variations in diagnosis, admissions, and procedure decisions.

Enhancement potential

When linked with other data sources, hospital discharge data provide important information about health systems performance, patient outcomes, and utilization and cost for target conditions of interest (injuries, chronic disease, complications of care)

Some states may lack a reliable, stable unique patient identifier, required for efficient record level linkage with other data sets that would enhance the value of the discharge data.

Hospital data can be linked at community level

Many states do not collect patient’s address as one of the required elements. Addition of this variable will allow geo-coding of discharge data and in term effective disease surveillance at community level.

(Modified and updated from; Love, Rudolph and Shah Lessons Learned in Using Hospital Discharge Data for State and National Public Health Surveillance: Implications for Centers for Disease Control and Prevention Tracking Program Journal of Public Health Management and Practice Nov-Dec 2008, Vol 14, No 6 p 533-542) Available at http://journals.lww.com/jphmp/Abstract/2008/11000/Lessons_Learned_in_Using_Hospital_Discharge_Data.5.aspx

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