The Redesigned National Hospital Discharge Survey by kei41600

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									The Redesigned National
Hospital Discharge Survey


   National Center for Health Statistics
    Division of Health Care Statistics
           Hospital Care Team

   Last Updated: November 19, 2008
           NHDS Background

• Nationally representative sample of
  inpatient discharges
• Longest continuously fielded survey of
  inpatient care - annually since 1965
• Nonfederal, general, and short-stay
  hospitals
     Inpatient Hospitalization rates with
    Clostridium difficile first and any listed
                 1996-2006

                                    120
                                                          Any listed
Discharges per 100,000 Population




                                    100                   First listed


                                    80


                                    60


                                    40


                                    20


                                     0
                                          1996   1997      1998     1999      2000     2001      2002      2003   2004   2005   2006
                                            Citation: McDonald LC, et al. Emerg Infect Dis. 2006;12(3): 410-5.
                                                                                        Year
Coronary Artery Bypass Graft (CABG) and
Percutaneous Coronary Intervention (PCI)
               1980-2004
25
       Rate per 10,000 population

20                                                             PCI

15


10
                                                     CABG
 5


 0
     1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

       Source: National Hospital Discharge Survey 1980-2004.
       Average Length of Stay by Age
              U.S., 1970-2006
                                                                       65 years & over
       14
                                                                       45-64 years
       12                                                              15-44 years
       10                                                              Under 15 years
        8
Days




        6
        4
        2
        0
            1970     1980         1985        1990        1995        2000    2006
                                               Year


               Source: CDC/NCHS, National Hospital Discharge Survey (NHDS)
         Context for Redesign
• Current data limited to Uniform Bill (claims data)
• More flexible survey needed
  – To address policy and research issues
  – To reflect different patient and health-care
    environment
• HCUP and others built on administrative data
            Redesign Priorities

• Resource use/cost/billings/payments
• Clinical depth
  medications, laboratory results
• Improved patient demographics
  race, ethnicity, address for geocoding
• Health-related outcomes
  death index, readmissions, Medicare data
            Current vs. Redesigned NHDS


                                Depth                 Sampling
        Scope                 of content




                          Linking ability via
Data collection methods   patient identifiers
                                                Analytical Enhancements
                    Scope
Current                 Redesigned
• Non Federal           • Non Federal
• Non institutional     • Non institutional
• 6 beds or more        • 6 beds or more
• General
• Short-stay (LOS <30
  days)
     Content, Inpatient Discharges

Current (UB 04 only)        Redesigned
Patient age, gender,        All current data
  race/ethnicity, marital   More clinical depth
  status                    • Laboratory results
Source and type of          • Medications
  admission
                            • Vital signs
Diagnoses and procedures
                            • ICU use
Discharge status
                            Payments, billings
Length of stay
                            Patient identifiers
Expected payment source
                            Special/sponsored topics
         Content, Hospital Level

Current (UB 04 only)   Redesigned
Not collected          Specific
                         technologies/services
                       EMR specifics
                       Uncompensated care
                       Staffing
                        Sampling
Current                         Redesigned
• 112 geographic primary        • List sample stratified by
  sampling units (PSUs)           service type
• 239 hospitals                 • 240 hospitals
• Hospitals stratified by bed   • Stratification of
  size                            discharges:
• Annual discharges                – Observation cases
   – 250 per manual hospital       – Normal newborns
   – Oversample automated            (undersample)
   – 150,000 discharges            – Acute myocardial infarction
     annually                      – Deaths
                                   – Other patients
                                   – 24,000 annually
  Redesigned Survey: Potential

• Link to NDI, birth records, CMS data
• Risk adjustment possible
• Quality of care analyses
• Payment and cost analyses
• Facility-level analyses
           Potential Analyses:
      Quality of Care/Patient Safety
• Discharge medications by patient and provider
  characteristics
• Effects of antibiotic resistance patterns within the
  hospital on patient outcomes
• Effects of surgeon specialty on health-related outcomes
• Readmission and post-discharge mortality rates for
  selected diagnoses or procedures by patient and
  provider characteristics
     Potential Economic Analyses

• Variation in payment by payer
• Variation in payment for similar diagnoses or
  procedures by patient and provider
  characteristics
• Relationship between payment rates and quality
  of care for specific diagnoses or procedures
• Relationship among billings, costs, and
  payments
• Effects of case mix on profitability (specialty
  hospitals)
            Potential Analyses:
            Sponsored Topics
• True rate of hospitalized acute myocardial
  infarction
• Disparities in do-not-resuscitate use among in-
  hospital deaths
• Variation in nosocomial bloodstream infections
  by hospital characteristics
           For more information

Contact:
  Carol DeFrances, Ph.D.
  Hospital Care Team Leader
  National Center for Health Statistics
  3311 Toledo Road
  Hyattsville, MD 20782
  301-458-4440
  E-mail: cdefrances@cdc.gov

								
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