Data resource profile: State Inpatient Databases

Abstract

Profile in a nutshell• The SIDs contain data on almost all inpatient discharges from hospitals in participating states.They were established from a range of data sources for the specific purpose of undertaking health-related research.• The first SIDs are available starting in 1990.• SID data elements vary by year and state, but typically include demographic characteristics, admission and discharge details, diagnoses and procedures, charge/cost and payment details, and outcomes such as in-hospital death. They are linkable to information contained in AHA.• Some SIDs permit longitudinal linkage so that individual patients can be tracked between hospital admissions. Patients can often also be tracked through Emergency Department visits through linkage to other state-level HCUP databases.• Access to data is swift and at reasonable reduced cost, particularly for non-profit and student researchers. Data Resource Basics ScopeThe State Inpatient Databases (SID) comprise a collection of state-specific encounter-level administrative claims from 32/50 states in the United States (US). These databases are maintained by the US Agency for Healthcare Research and Quality (AHRQ) as a part of the organization's Healthcare Cost and Utilization Project (HCUP). As part of a family of six other HCUP databases (Table 1), the SIDs represent the largest collection of longitudinal hospital care data in the US inclusive of all insurance payers (e.g. Medicare, Medicaid, private insurance, and uninsured) and all patient ages. Taken together, the SIDs capture more than 97% of all eligible hospital discharges within each state. Purpose of data collectionOriginally created as the "Agency for Health Care Policy and Research," AHRQ was established by the US Omnibus Budget Reconciliation Act of 1989 with the purpose of enhancing the "quality, appropriateness, and effectiveness of health care services […] through the establishment of a broad case of scientific research." 1 In particular, the Act required that databases be created to support healthcare research. The HCUP-family of databases were, therefore, established as a federal-stateindustry partnership sponsored by AHRQ in order to "enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatment at the national, state, and local market levels." 2 The HCUP SIDs maintain data expressly for research purposes dating back to 1990. StructureThe SID share a common structure, although the precise list of available data elements vary slightly by state and calendar year. Differences in key variables used to link SID data are presented in Table 2.The SIDs are organised by calendar year based on the date of hospital discharge. The data for each SID

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“…These data are collected monthly and comprise elements pertaining to hospitalization such as LOS, discharge disposition, primary and secondary discharge diagnoses, procedures, total hospital charges, and outcomes. Demographic information including patient age, sex, race, zip code, payer, and income quartile (based on the median income for residential zip code) are also present within the database 12,13 . The datasets capture discharge information from all insurance payers and include over 95% of discharges from eligible community hospitals.…”

“…The datasets capture discharge information from all insurance payers and include over 95% of discharges from eligible community hospitals. The NIS has been extensively described and utilized 12,13 . An extensive review of the literature was performed to characterize existing data relevant to the aims of the study (Supporting information, Fig.…”

“…Demographic information including patient age, sex, race, zip code, payer, and income quartile (based on the median income for residential zip code) are also present within the database. 12,13 The datasets capture discharge information from all insurance payers and include over 95% of discharges from eligible community hospitals. The NIS has been extensively described and utilized.…”

“…The NIS has been extensively described and utilized. 12,13 An extensive review of the literature was performed to characterize existing data relevant to the aims of the study (Supporting information, Fig. S1).…”

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“…The SID data capture over 97% of all hospitalization discharges in the U.S. and SEDD files capture emergency department visits that did not result in hospitalization. (3-5). Each record captures all procedures and diagnosis codes using the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9CM), as well as demographics, payment, and length-of-stay for each patient.…”