Hospital Discharge Database
Health Information Internet Query System
Training Manual
Version I, July 1996
Office of Health Data Analysis
Utah Department of Health
URL: http://hlunix.hl.state.ut.us/hda/
I. Data Source
The Hospital Discharge Data Base (HDDB) is the main source for the System. HDDB currently contains hospital inpatient data only. Fifty-five Utah hospitals submitted data to Utah Health Data Committee since 1992, including nine psychiatric facilities, seven specialty hospitals, and the Veterans Administration Medical Center. Shriners Hospital, a charity hospital, is exempt from reporting requirements. All hospitals report "discharge data" for each inpatient served. "Discharge data" means the consolidation of complete billing, medical, and personal information describing a patient, the services received, and charges billed for each inpatient hospital stay.
II. What is available on the HDA Office Home Page?
Databases-Utah Hospital Discharge Query System:
1. Descriptive Statistics (number of discharges, average, median, and summation of length of stay and total charges)
2. Hospitalization Rates (crude and age-sex adjusted rates by county for selected conditions)
3. External Injury (18 types of injuries coded by ICD-9 E-code, number of discharges, average, and summation of length of stay and total charges)
Data Products/Reports:
1. Hospital Utilization Profile (1993, 1994)
The 1994 report is an interactive query format.
2. Hospitalizations Related to Lifestyle
3. Consumer Brochures
4. Public File User Manual
III. What information can I query?
You can obtain the information and create your own tables of statistics using icon-driver selections for customized queries, such as
by following variables:
(1) patient age (in age groups)
(2) patient's gender
(3) patient's residential county
(4) discharge status
(5) primary payer categories
(6) DRG (Diagnosis Related Group)
(7) MDC (Major Diagnosis Categories)
(8) Pre-decided disease categories
(9) ICD-9 codes
(10) Outlier of length of stay
(11) Outlier of total charges
IV. Descriptions for Select Data Elements:
MDC is formed by dividing all possible principal diagnoses into 25 mutually exclusive diagnosis areas. The diagnoses in each MDC correspond to a single organ system or etiology and in general are associated with a particular medical specialty. MDC 1 to MDC 23 are grouped according to principal diagnoses. Patients are assigned to MDC 24 (Multiple Significant Trauma) with at least two significant trauma diagnosis codes (either as principal or secondaries) from different body site categories. Patients assigned to MDC 25 (HIV Infections) must have a principal diagnosis of an HIV Infection or a principal diagnosis of a significant HIV related condition and a secondary diagnosis of an HIV Infection.
The DRGs were developed for the Health Care Financing Administration as a patient classification scheme which provides a means of relating the type of patients a hospital treats (i.e., its case mix) to the costs incurred by the hospital. While all patients are unique, groups of patients have common demographic, diagnostic and therapeutic attributes that determine their resource needs. The DRGs form a manageable, clinically coherent set of patient classes that relate a hospital's case mix to the resource demands and associated costs experienced by the hospital. Each discharge in the UHDDB was assigned into a DRG based on the principal diagnosis, secondary diagnoses, surgical procedures, age, sex, and discharge status of the patient.
The databases for descriptive statistics and hospitalization rates only contain principal diagnosis codes. The database for external injury contains principal and secondary diagnosis codes. You need to input codes or a range of codes for your query. The format for inputting ICD-9 codes is as follows:
| TYPE OF INPUT | YOU CAN USE FORMAT I | OR FORMAT II |
| A SINGLE CODE | E890 | E890.2 |
| MULTIPLE CODES | 234.2 456.7 678.9 | 234.2
456.7 678.9 |
| A RANGE OF CODES | 123.4-125.9 | 1234-1259 |
| A SET OF COMBINED CODES | 123.4 234.5 456.1-456.9
V270 E890-E891 |
Note: When you want to select codes such as 1740-1749 (Breast Cancer), you need input the first three digits only that is "174". If you input "1740-1749", you will lose the discharges coded as "174". Also for some conditions, the trailing zero is a invalid code.
ICD-9 labels are not stored with the System due to limited space available on DOH Unix station. However, Staff in the Office of Health Data Analysis and the Office of Public Health Data can provide an on-line search for ICD-9 codes for you through their server system.
Some patients have exceptionally low or high lengths of stay (LOS) or total facility charges. A hospital's charges can be affected by just a few unusually long (or short) or expensive (or inexpensive) cases. These high or low values could be a result of coding or data submittal errors, particularly in length of stay, total charges, or data elements that affect DRG assignments. Exceptionally high LOS or charges could be due to a catastrophic condition. Whatever the reason, these values, referred to as "outliers", distort the averages and were excluded from calculations. LOS or charge high outliers are defined in this and succeeding reports as values above 2.5 standard deviations from the mean. Means and standard deviations are APR-DRG specific and calculated on a statewide basis. We do suggest HDDB users to exclude outliers when you calculate average of total charges or length of stay.
V. How is confidentiality of hospital data protected?
Only limited data elements from public use files are available on the Internet. Patient age and sex are encrypted for sensitive diagnostic information. The smallest geographic area is patient residential county. No health care providers information is on Internet.
VI. What do I need to "surf" the Internet?
You will need Web browser software, preferably "Netscape" (or Mosaic or other browsers). If your web browser supports HTML's (Hypertext Markup Language) 3rd version such as Netscape Navigator 1.1 or above, or Arena, you can experience state-of-the-art, 3-dimensional animated logo, tables, and graphics. However, HTML 2nd version will suffice for basic functions.
Don't be intimidated, just "click, click, click ....." You will have fun.
VII. LOGIN the System
to Log in home page by typing in URL address: http://hlunix.hl.state.ut.us/hda/
VIII. Step-by-Step Query Examples:
Example 1: How many people were hospitalized for diabetes in 1994? What is the age distribution of diabetes inpatients?
Before you start your query, you want to define your question more clear by asking a couple of detailed questions such as:
* Do I want all hospital discharges occurred in Utah or only Utah residents' discharges?
* Do I want all age groups, or both genders?
If you want to include all categories of the query variable, you do not need to define your population. By default, the System includes all categories for query variables.
Now you can follow the steps below:
1. Click on "Databases:
--Descriptive Statistics"
2. Define outcome: go to "Outcome" Box, then click on "Number of Discharges".
3. Click on the arrow in "Cross Variable 1" box. You will see a list of variables. (Leave "Cross Variable 2" as it is.)
4. Click on "Age Group" (Actually it is the default variable).
5. By default, query results are presented in tables. If you want to get a graph, you only go to the bottom of the OUTCOME box, you will see the table option is highlighted. But Click on Graph option.
Graph step: Click on the arrow in graph box, you will see a list of different graph types. Click on "Pie" or "Bar" as you want.
6. If you want to select only Utah patients in your query, go down to the variable box "Patient's County" and click on Beaver; then go down to Multi-county zip codes, press shift key first, then click on Multi-county zip codes.
Now you can define Diabetes. There are three ways to do so in the System.
7a. Go down to the variable box "DISEASES" and click on the down-arrow within that box. You will see "Diabetes Mellitus (250)". Click on it.
Or
7b. Go down to the variable box "DRG" and click on DRG. You will see a list of DRG labels. At the upper right corner, there is a index-search box. You can type in the key word such as "diabetes". Hit the enter key, you will see a selected DRG list (294 and 295). Then go back to the main query page and the DRG box. Block DRG 294 and 295 (refers to Step 6 about blocking a range of categories).
Or
7c. You can input your refined ICD-9 codes in the box of DIAG.CODE. The input format is listed in Section IV of this manual.
8. If you want to define a time frame, go down to the variable box "YEAR" and click on "1994". (By default, all currently available data, 1992-1994 will be included in the tabulation.)
9. Now, you can send your query. Go down to the bottom of the screen, click on the box "Send". Wait for a couple of seconds you will see the output.
10. To directly print the result from your local printer, click on "file, print". (However, you are not able to download the data from the Net.)
Example 2: How much did Medicaid spend on hospitalizations for cardiovascular disease in 1994?
1. Click on "Databases:
--Descriptive Statistics"
2. Define outcome: go to "Outcome" Box, then click on "Summation of Total Charge".
3. Click on the arrow in "Cross Variable 1" box. You will see a list of variables. (Leave "Cross Variable 2" as it is.)
You can define your selections. To obtain information on Medicaid, you need to choose the variable of "Primary Payer". Medicaid is one of the 10 primary payer categories. The tabulation will not include the charges if Medicaid is a secondary or tertiary payer.
4. Click on "PRIMARY PAYER". If your desired output is a graph instead of table, see "*How to get a graph".
Cardiovascular Disease can be defined by MDC (Major Disease Categories) or by the type of "Diseases".
5a. Go down to the variable box "MDC" and click on the down-arrow within that box. You will see "Circulatory System". Click on it.
5b. Go down to the variable box "DISEASES" and click on the down-arrow within that box. You will see "Diseases of Circulatory System (390-450)". Click on it.
6. To define a time frame, go down to the variable box "YEAR" and click on "1994". (By default, all currently available data, 1992-1994 will be included in the tabulation.)
7. You can now send your query. Go down to the bottom of the screen, click on the box "Send".
8. Wait for a couple of seconds you will see the output as a table below.
9. To directly print the result from your local printer, click on "file, print". (However, you are not able to download the data from the Net.)
IX. Improvement Plan