VUHDDS Frequently Asked Questions
Overview and Notes about Access to Files
What is the Vermont Uniform Hospital Discharge Data Set (VUHDDS)?
What is the Policy Related to the VUHDDS?
What is included in the Public Use File?
What are the conditions of use for the Public Use File?
What do I need to know in order to download the VUHDDS?
How are hospital service areas (HSA's) defined in the VUHDDS?
VUHDDS Contacts for Questions, Access to Files, or Problems
To request a file with non-public data elements not included in the Public Use File, fill out the following form:
Agreement Form for Release of Non-public Data Elements (Word format) (PDF)
Go to VUHDDS Files 2009 and Earlier
What is the Vermont Uniform Hospital Discharge Data Set?
Vermont has been collecting and reporting hospital discharge data since the early 1980s. All fourteen of Vermont's general acute care hospitals and the Veterans Administration hospital in White River Junction currently contribute records for Vermont residents and non-residents to the Vermont Uniform Hospital Discharge Data Set (VUHDDS). Under the statutory authority to collect these data (18 V.S.A. §§§ 9410, 9456 and 9457), the Vermont Department of Banking, Insurance, Securities, and Health Care Administration (BISHCA) administers the program and the Vermont Department of Health (VDH) manages the data set under an agreement with BISHCA. BISHCA currently has a contract with the Vermont Association of Hospitals and Health Systems- Network Services Organization (VAHHS-NSO) for collection of the data from Vermont hospitals that are incorporated into the VUHDDS following a series of quality assurance checks performed by VDH.
In addition to the data collected from Vermont hospitals, BISHCA obtains records for Vermont residents using hospital services in the bordering states of New Hampshire, New York and Massachusetts under data use agreements with the New Hampshire Department of Health and Human Services, the New York Department of Health, and the Massachusetts Division of Health Care Finance and Policy. While records for Vermont residents using hospitals in New Hampshire, New York, and Massachusetts include inpatient discharges, not all states collect comparable data sets for outpatient and emergency department discharges. BISHCA is prohibited from releasing records obtained from these bordering states per provisions of the data use agreements with each state.
The Vermont hospital subset of the VUHDDS includes records for inpatient, outpatient, emergency department, observation bed, and series patient discharges for both Vermont residents and non-residents. The collection of emergency department records from Vermont hospitals began with reporting year 2001. From 1989-2000, outpatient data collection was limited to records that each hospital identified as surgical procedures performed in operating rooms. Starting in reporting year 2001, the outpatient definition was revised to include ICD-9-CM procedure codes 00.0-86.99 that occurred in all hospital-based outpatient settings. Starting in reporting year 2006, while all Vermont hospitals continued to report the core outpatient set specified by code range, most hospitals also started to submit all records considered outpatient procedures beyond the specified code range. This includes a wider range of diagnostic procedures and treatments. BISHCA is working with VDH, VAHHS-NSO, and Vermont hospitals to determine how to define, edit, and use the expanded outpatient data set. Until the collection of the expanded outpatient data set has been finalized, tested, and implemented in all Vermont general acute care hospitals, BISHCA will continue to release only the core set of outpatient records within the specified code range. This assures relative consistency in reporting across all hospitals.
What is included in the Public Use File?
Public Use File Data Elements
- Patient type (Inpatient, Ambulatory, Emergency Department, Observation Bed, Series Patient)
- Hospital of discharge
- Admission type
- Admission source
- Age (in the following groups)-Under 1, 1-17, 18-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75+
- ZIP code -(3-digit ZIP for most of Vermont and all other states; combined 058 and 059 area; 5-digit ZIP for areas with a population of over 10,000 (12 ZIP Codes))
- Sex
- Discharge status
- Principal payment source
- Total charges
- Special Care Unit (SCU) days (not in outpatient or emergency department datasets)
- Diagnosis related group (DRG)
- Major diagnostic category (MDC)
- Principal diagnosis and up to 19 secondary diagnoses
- Principal procedure and up to 19 secondary procedures (2009 and earlier)
- Principal Current Procedural Terminology (2010 and later)
- E-code
- Grouper used to assign DRG and MDC
- Clinical Classifications Software (CCS) diagnosis group
- Clinical Classifications Software (CCS) procedure group (2009 and earlier)
- Hospital service area
- Patient days (length of stay)
- Same day flag – flags those admitted and discharged on the same day
- Year of discharge
- ER flag – flags those records with an associated emergency department revenue record
What are the conditions of use for the public use file?
Release of public use data is subject to the following conditions, which the requestor agrees to comply with upon accepting copies of the data:
- Hospital Data Release Policy (Last updated Noevember 2002)
- The data may not be used in any manner that attempts to or does identify, directly or indirectly, any individual patient or health care practitioner (18 V.S.A. § 9457).
- The requestor agrees to incorporate the following, or a substantially similar, disclaimer in all reports or publications that include public use data:
“Hospital discharge data for use in this study were supplied by the Vermont Association of Hospitals and Health Systems-Network Services Organization (VAHHS-NSO) and the Vermont Department of Banking, Insurance, Securities and Health Care Administration (BISHCA). All analyses, interpretations or conclusions based on these data are solely that of [the requestor]. VAHHS-NSO and BISHCA disclaim responsibility for any such analyses, interpretations or conclusions. In addition, as the data have been edited and processed by VAHHS-NSO, BISHCA assumes no responsibility for errors in the data due to coding or processing by hospitals, VAHHS-NSO or any other organization, including [the requestor].”
What do I need to know in order to download the VUHDDS?
This documentation has been prepared to assist you with loading and using the Vermont Uniform Hospital Discharge Data Set (VUHDDS) public use files. This document covers Installation Minimum Requirements, Concepts & Purpose of this Relational Data Set, Data Oddities, and Getting Started Instructions. If you have questions about or run into issues with the loading of these Data Sets please send an email requesting assistance to lucas.herring@state.vt.us and he will respond to your inquires.
Installation Minimum Requirements
Some of the public use files are very large containing millions of records, most notably the Expanded Outpatient and Revenue Code files. The larger data files are tool large to load into software packages such as Microsoft Excel or Microsoft Access. To load the large files and take advantage of their features requires a relational database application. Examples of some of these database packages that are capable of managing large relational data sets include but are not necessarily limited to MYSql, Oracle, DB2, SAS, SPSS or SQLServer.
It is also recommended that sufficient hard drive storage space be available to efficiently manage the processing of the data tables. As these data sets grow through continued updates, so will the storage space requirement. Your Database Administrator (DBA) should be able to determine minimum storage requirements based on the size of the files that are extracted to your computer. Once these data sets have been successfully loaded it would be appropriate to use any type of SQL querying and/or reporting tool to access the data. This would include tools like Microsoft Access using an ODBC connection to the database.
Concepts & Purpose of this Relational Data Set
The primary purpose of this relational data set is to give research entities access to de-identified hospital discharge data that can be used to produce public research analyses. The concept used in the creation of this data set was to create primary data tables that hold specific information and then provide code tables that define the values listed within primary data tables. A conceptual layout of the field properties and code tables is included on the web site.
Each line of information is a unique discharge where all information relating to a given discharge record has already been combined. Since there are a large number of variables in these files, the unique discharge is separated from the revenue code file, but can be linked together using the unique id for each record. There may be many revenue records that link to a single discharge record. This method provides a useable dataset where all adjustments to the data have been applied to the extent possible within the given time period.
The annual data sets provided on the website are based on the discharge date by calendar year. A given year’s data set will be posted as soon as the data is cleaned and becomes available for public use.
Data Oddities
Discharge records may contain negative dollar charge values or values that are blank. Although the data is edited and cleaned, there may still be missing information or unresolved code issues in some cases. Timely availability of data requires the acceptance of a reasonable degree of errors or missing data.
Getting Started
The Vermont Public Use data files on the web site are in a comma-delimited text file format and can be read by any software package/database loading process that can use this format. In each of the data files the first row contains the appropriate Data Dictionary field/column name. Each field is delimited with a ‘,’ or comma.
How are hospital service areas (HSA) defined in the VUHDDS ?
The hospital service area (HSA) definitions used in the Vermont Uniform Hospital Discharge Data Set (VUHDDS) have been modified three times to reflect changing discharge patterns. Starting with the 2002 Monograph, HSAs are based on inpatient discharges, where the diagnosis indicated the need for immediate care, for the cumulative reporting years spanning 1997-2001. Prior definitions of HSAs had been based on all inpatient stays (except for newborns) and have used a strict decision rule for inclusion of ZipTowns which are towns or groups of towns (see definition below for ZipTowns) in a hospital’s service area. Use of a strict inclusion rule meant that there were always towns that were not assigned to any HSA and were labeled “contested.”
In preparing for this fourth version of HSAs, rules used to define the 3rd version of HSAs were applied to 1997-2001 data. The number of contested towns rose from 54 to 80, nearly a third of all Vermont towns. This resulted in the loss of one hospital service area and a serious erosion of others. As a result of this increase in contested towns, two major changes were made to the process of defining HSAs. In addition to these definitional changes, HSA names were changed. To distinguish these new HSAs from previous ones, HSAs were given the name of the most populous town in their area.
The first major change was that selection of records was limited to those discharges with diagnoses considered to require immediate hospitalization as described by Newton and Goldacre in their 1994 article, “How many patients are admitted in districts other than their own, and why?” (Journal of Public Health Medicine, 1994, Vol. 16, No. 2, pp. 159-164). Newton and Goldacre used records of patients with acute conditions that require immediate hospitalization, because patients with these conditions tend to go to the hospital nearest to them when they become ill. The authors excluded newborns and patients transferred from another hospital. The authors included records with the following acute conditions as their primary diagnoses: appendicitis, abcess of anal and rectal regions, peritonitis, acute myocardial infarction, pneumococcal pneumonia, and asthma.
The second major change was the shift to a plurality rule in assigning ZipTowns to HSAs, so that all towns are assigned to an HSA with none remaining contested. ZipTowns are towns or groups of towns with over 1,000 residents and relatively contained ZIP code boundaries. ZipTowns were assigned to hospital service areas as follows:
- If the plurality of a ZipTown’s discharges were from a Vermont hospital or Dartmouth Hitchcock Medical Center (DHMC) in Lebanon, New Hampshire, the ZipTown was assigned to that hospital’s service area.
- If the plurality of a ZipTown’s discharges were from a non-Vermont hospital other than DHMC, the ZipTown was assigned to the HSA of the Vermont hospital (or DHMC) with the next highest number of discharges.
The HSAs continue to include two multi-hospital areas: the White River Junction HSA (Dartmouth Hitchcock Medical Center, Mt. Ascutney Hospital, and the Veterans Administration Hospital) and the Brattleboro HSA (Brattleboro Memorial Hospital and Grace Cottage Hospital). These HSAs include multiple hospitals because resident hospitalizations are split among the hospitals with no clear majority of inpatient discharges concentrated at any one hospital.
VUHDDS Contacts for Questions, Access to Files, or Problems
Vermont Department of Banking, Insurance, Securities
& Health Care Administration (BISHCA)
Division of Health Care Administration
89 Main St. Drawer 20
Montpelier, VT 05620-3101
If you wish to recieve a copy of the Vermont Public Use Files:
Dian Kahn, Director of Analysis and Data Management
(802) 828-2906 dian.kahn@state.vt.us
If you have a question about accessing non-public data elements:
Dian Kahn, Director of Analysis and Data Management
(802) 828-2906 dian.kahn@state.vt.us
If you have questions about the content and use of the Vermont Uniform Hospital Discharge Data Set:
Barbara Carroll, Public Health Analyst III
(802) 865-7704 jmongeon@ahs.state.vt.us