AHRQ unveils new children’s database

Inpatient data cover common and rare procedures

The Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD, has launched the first database on the hospital inpatient care of America’s children. The Kids’ Inpatient Database (KID) was developed to make national and regional estimates of children’s treatment, including surgery and other procedures, and for estimating treatment outcomes and hospital charges.

The database includes pediatric patients from birth through age 18, regardless of whether they had insurance, public assistance, or were uninsured. The KID’s large sample size enables researchers to analyze hospital care and charges for common conditions in children, such as respiratory diseases and injuries, as well as rare conditions, such as congenital abnormalities. The power of the database also enhances the ability to study infrequently used procedures, such as bone marrow biopsy and organ transplantation.

Lisa Simpson, AHRQ deputy director, says, "Not only does the KID make it easier for researchers to obtain the data they need, but the size and power of the database enable them to study hospital care for even the rarest conditions by specific age groups of children." Until now, researchers had to obtain pediatric information from databases that covered all patients, regardless of age.

The KID contains information on about 1.9 million children’s hospital inpatient stays at more than 2,500 hospitals across the United States in 1997. Included is information on children’s principal and secondary diagnoses, tests, surgeries, and other procedures, length of stay, hospital charges, payment sources and type of hospital.

By going on-line to the AHRQ’s database, HCUPnet, (www.hcupnet.ahrq.gov) users can get some quick and easy data answers on a variety of issues, with a variety of characteristics. For instance, if you want to know about septicemia that isn’t labor related, you can find out how many children had it, and look at the information based on any characteristic you want — payer, income level, region, location, size of hospital, or age of patient.

Anne Elixhauser, PhD, senior research scientist at the AHQR and one of the creators of the KID, says there has long been a gap in children’s health care data that is now being filled by the KID. "We have 60% to 70% of all hospital discharges in our national inpatient sample, and we thought we could develop some specialized databases that would help others. So first, we started working on the KID." The work began in late 1999 with a pilot project, she says. "We weren’t sure how feasible it was going to be. [Healthcare Cost and Utilization Project; HCUP] is a partnership between the states, the federal government, and the hospital industry.

"We get data from 24 states on all payers and all hospitals that we transform in to a uniform format." The result is the national inpatient sample, which is available to users for $160 per year. Now AHRQ is breaking out the children’s data from the overall data set. The data aren’t perfect since not every state participates. But, she says, "even though we have fewer than half the states, we have more than half the discharges."

Elixhauser adds that AHRQ has a good geographic representation and that all the data are weighted. There is also an active effort to recruit more states, and it increases yearly. After all, she notes, there were only eight states in 1988. Children aren’t little adults, Elixhauser says, so looking at adult health care data and simply extrapolating them for children isn’t appropriate. "There are also a lot of conditions that are child-specific, like childhood cancers and congenital anomalies that just aren’t that common. We think the KID will allow for more analysis of children’s hospital care than has been available in the past."

For now, the data are updated about every three years and is available in its entirety for $220. Those interested in accessing it can contact the HCUP central distributor at (866) 556-4287 or e-mail at hcup@s-3.com.

In the future, Elixhauser expects the data will include a variable that lists whether the patient was in a children’s hospital or not. "Right now, we have agreements with the states that we won’t release hospital identifications, and in some cases, a state will have only one children’s hospital. So we want to try to find a way to include that information without identifying the hospital."

She also anticipates that HCUP will be able to come up with some other specialized databases that hospitals could find useful. "Right now, we have no idea where we will go. Maybe specific conditions. We’d love to hear some ideas."

Those who wish to provide such guidance can e-mail the AHRQ at hcup@ahrq.gov.