national hospital discharge survey (nhds) and national survey of ambulatory surgery (nsas) national...

National Hospital Discharge National Hospital Discharge Survey (NHDS) Survey (NHDS)

and and National Survey of National Survey of

Ambulatory Surgery (NSAS)Ambulatory Surgery (NSAS)

2006 Data Users Conference2006 Data Users Conference

July 10, 2006July 10, 2006

3:30pm-5:00pm3:30pm-5:00pm

Session #15Session #15

NHDS: OverviewNHDS: OverviewCarol DeFrances, PhDCarol DeFrances, PhD

Analytic IssuesAnalytic IssuesKaren Lees, MPHKaren Lees, MPH

Examples of ResearchExamples of ResearchJean Kozak, PhDJean Kozak, PhD

Accessing DataAccessing DataMarni Hall, PhDMarni Hall, PhD

New DirectionsNew DirectionsBob Pokras, MABob Pokras, MA

Session OverviewSession Overview

Overview of the National Hospital Overview of the National Hospital Discharge SurveyDischarge Survey

(NHDS)(NHDS)

Carol DeFrances, PhDCarol DeFrances, PhD

NHDS Survey YearsNHDS Survey Years

Conducted annually 1965-presentConducted annually 1965-present

• Latest data available: 2004Latest data available: 2004

• 2005 will be available this Winter2005 will be available this Winter

NHDS Survey DesignNHDS Survey Design

Scope and coverage:Scope and coverage:

• Short stay, non-Federal hospitalsShort stay, non-Federal hospitals

• ALOS < 30 daysALOS < 30 days

• General and children’s general hospitalsGeneral and children’s general hospitals

NHDS Sampling PlanNHDS Sampling Plan

Three stage design:Three stage design:

• Geographic unitsGeographic units

• HospitalHospital

• DischargeDischarge

NHDS Sample SizeNHDS Sample Size

Hospitals:Hospitals:

• About 500 hospitals sampled per yearAbout 500 hospitals sampled per year

Discharges:Discharges:

• Over 300,000 sampled per yearOver 300,000 sampled per year

NHDS Data CollectionNHDS Data Collection

Manual hospitals - 56%Manual hospitals - 56%

Automated hospitals - 44%Automated hospitals - 44%

Overall response rate for the 2004 NHDS – 92%Overall response rate for the 2004 NHDS – 92%

NHDS Manual Data CollectionNHDS Manual Data Collection

NCHS – Statistical DesignNCHS – Statistical Design

Census Bureau – Field WorkCensus Bureau – Field Work

Contractor – Coding and Data EntryContractor – Coding and Data Entry

NHDS Automated Data CollectionNHDS Automated Data Collection

Electronic files obtained from:Electronic files obtained from:

• StatesStates

• Commercial firmsCommercial firms

• Individual hospitalsIndividual hospitals

NHDS Data ProcessingNHDS Data Processing

NCHS:NCHS:

• EditingEditing

• EstimationEstimation

NHDS EstimationNHDS Estimation

Weight:Weight:

• Inverse of the probability of selectionInverse of the probability of selection

• Adjustments for non-responseAdjustments for non-response

• Population weighting ratio adjustmentPopulation weighting ratio adjustment

Variables onVariables onNHDS Public Use Data FilesNHDS Public Use Data Files

Patient DataPatient Data

AgeAge

SexSex

RaceRace

Expected source of paymentExpected source of payment

Discharge statusDischarge status

Marital statusMarital status

Hospital CharacteristicsHospital Characteristics

Geographic regionGeographic region

Bed size Bed size

Ownership Ownership

Medical DataMedical Data

International Classification of Diseases, 9th International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)Revision, Clinical Modification (ICD-9-CM)

Diagnoses (up to 7)Diagnoses (up to 7)

Procedures (up to 4)Procedures (up to 4)

Additional VariablesAdditional Variables

Days of careDays of care

Month of dischargeMonth of discharge

Diagnoses Related Group (DRG)Diagnoses Related Group (DRG)

WeightWeight

New Variables for NHDSNew Variables for NHDS

Available beginning in the 2001 NHDS:Available beginning in the 2001 NHDS:

• Source of AdmissionSource of Admission

• Type of AdmissionType of Admission

New Variables for the NHDSNew Variables for the NHDS

Beginning to collect with the 2007 NHDS:Beginning to collect with the 2007 NHDS:

• Admitting DiagnosisAdmitting Diagnosis

• Present on Admission checkbox for all seven Present on Admission checkbox for all seven diagnoses collecteddiagnoses collected

Analytic IssuesAnalytic Issues

Karen Lees, MPHKaren Lees, MPH

TopicsTopics

Utilization measuresUtilization measures

Medical coding systemMedical coding system

Statistical issuesStatistical issues

NHDS providesNHDS provides data on data on

hospitalizationshospitalizations

not peoplenot people

Measures IncludeMeasures Include

DischargesDischarges

Days of careDays of care

Average length of stayAverage length of stay

DiagnosesDiagnoses

Surgeries/proceduresSurgeries/procedures

DischargesDischarges

Include deathsInclude deaths

Include transfers to other hospitals or long-term Include transfers to other hospitals or long-term care facilitiescare facilities

Do not usually include newborn infantsDo not usually include newborn infants

Days of CareDays of Care

Total number of days discharged patients spend in Total number of days discharged patients spend in the hospitalthe hospital

All stays are counted as at least 1 dayAll stays are counted as at least 1 day

The admission day is counted, but not the The admission day is counted, but not the discharge daydischarge day

The number of days divided by the number of The number of days divided by the number of discharges is the average length of staydischarges is the average length of stay

DiagnosesDiagnoses

Disease, injury or other reason for hospitalizationDisease, injury or other reason for hospitalization

Coded according to US adaptations of the Coded according to US adaptations of the International Classification of Diseases (ICD-9-CM)International Classification of Diseases (ICD-9-CM)

DiagnosesDiagnoses

Principal diagnosis: chiefly responsible for Principal diagnosis: chiefly responsible for hospitalizationhospitalization

First-listed diagnosis: principal if specified, First-listed diagnosis: principal if specified, otherwise one listed firstotherwise one listed first

DiagnosesDiagnoses

All-listed: total number of times diagnoses appears All-listed: total number of times diagnoses appears on recordon record

Any-listed: discharges with diagnosis in any Any-listed: discharges with diagnosis in any position on record position on record

Hospital discharges with Hospital discharges with fractures, 2004fractures, 2004

1,039,000

1,300,000

1,661,000

Principal or firstlisted

Any listed All listed

Source: CDC/NCHS, National Hospital Discharge Survey (NHDS)

Surgery / ProceduresSurgery / Procedures

Surgical (appendectomy)Surgical (appendectomy) Diagnostic (spinal tap)Diagnostic (spinal tap) Therapeutic (chemotherapy) proceduresTherapeutic (chemotherapy) procedures

Coded according to US adaptations of the Coded according to US adaptations of the International Classification of DiseasesInternational Classification of Diseases

NHDS providesNHDS provides data on data on

inpatient proceduresinpatient procedures

not total proceduresnot total procedures

Versions of the International Versions of the International Classification of DiseasesClassification of Diseases

88thth revision used 1970-78 revision used 1970-78

99thth revision used 1979-present revision used 1979-present

1010thth revision for use in future revision for use in future

ICD 8ICD 8thth Revision Revision

Some codes different than in 9Some codes different than in 9 th th Revision Revision

Did not use E-codes Did not use E-codes

Made modifications in coding to accommodate Made modifications in coding to accommodate available dataavailable data

ICD 9ICD 9thth Revision Revision

Addenda added annually since 1986 Addenda added annually since 1986

Codes added, deleted, expanded, and revisedCodes added, deleted, expanded, and revised

Lists of changes available in annual summary Lists of changes available in annual summary reports, file documentationreports, file documentation

WeightsWeights

Must use weighted data to obtain unbiased Must use weighted data to obtain unbiased national estimatesnational estimates

Each record has a weight Each record has a weight

Sum the weights of the recordsSum the weights of the records

ReliabilityReliability

To be reliable, estimates must be based on at least To be reliable, estimates must be based on at least 30 records30 records

And have a relative standard error of less than 30 And have a relative standard error of less than 30 percentpercent

Estimates based on 30-59 records should be used Estimates based on 30-59 records should be used with cautionwith caution

Standard ErrorsStandard Errors

Some standard errors are in Advance Data Some standard errors are in Advance Data summariessummaries

Generalized error curves are in the Series 13 Generalized error curves are in the Series 13 Annual Summaries and data documentationAnnual Summaries and data documentation

Use SUDAAN for specific standard errors - need Use SUDAAN for specific standard errors - need access to confidential dataaccess to confidential data

Examples of ResearchExamples of Research

Jean Kozak, Ph.D.Jean Kozak, Ph.D.

Discharges Days of care

0-4

5-14

15-24

25-34

35-44

45-54

55-64

65-74

75-84

85 and over

Ag

e in

yea

rs

10 10020 20Percent distribution

Percent distribution of discharges Percent distribution of discharges and days of care by age, 2004and days of care by age, 2004


Average length of hospital stay by age, Average length of hospital stay by age, 1980-20041980-2004

0

2

4

6

8

10

12

1980 1985 1990 1995 2000 2004

Day

s

85+ years

75-84 years

65-75 years

Under 65 years


Percent of hospital inpatients Percent of hospital inpatients transferred to long-term care facilities, transferred to long-term care facilities,

by age, 1990-2004by age, 1990-2004

0

5

10

15

20

25

30

35

Under 65 yearsold

65-74 years old 75-84 years old 85 years old andover

Per

cen

t

1990 1995 2000 2004


0 50 100 150 200 250 300

Injury and poisoning

Respiratory diseases

Digestive diseases

Circulatory diseases

Childbirth

Mental disorders

Injury and poisoning

Digestive diseases

Respiratory diseases

Circulatory diseases

Rate per 10,000 Population

Males

Females

Hospitalization rates for major Hospitalization rates for major diagnostic categories by sex, 2004diagnostic categories by sex, 2004



Percent distribution of patients Percent distribution of patients hospitalized for heart disease, 2003hospitalized for heart disease, 2003

All other conditions

Cardiacdysrhythmias

18%

Acute myocardial infarction

17%

Other heartdiseases

17%Congestive heart failure

24%

Coronary atherosclerosis

23%

Heartdisease

13%

All other diagnoses 87%

Hospitalization rate for cancer,Hospitalization rate for cancer,1990-20041990-2004

0

10

20

30

40

50

60

70

1990 1995 2000 2004

Year

Rat

e p

er 1

00,0

00 p

op

ula

tio

n 199063.0

200441.2


0

50

100

150

200

250

1995 2000 2004

Nu

mb

er

in t

ho

us

an

ds

40+ yrs

35-39 yrs

30-34 yrs

Under 30 yrs

Number of discharges with HIV Number of discharges with HIV diagnoses by age, 1995, 2000 and 2004diagnoses by age, 1995, 2000 and 2004


11.2

14.515.4

27.8

0

5

10

15

20

25

30

1990-92 2002-04

Rat

e p

er 1

0,00

0 p

op

ula

tio

n Boys Girls

Hospitalization rates for depression Hospitalization rates for depression for boys and girls 5-19 years of age,for boys and girls 5-19 years of age,

1990-92 and 2002-04 1990-92 and 2002-04


0

50

100

150

200

250

300

350

400

450

1996 1997 1998 1999 2000 2001 2002 2003

Year

Dis

char

ges

per

100

,000

Po

pu

lati

on

65 years and over

45-64 years

15-44 years

Hospitalization rates for inpatients Hospitalization rates for inpatients with with Clostridium difficileClostridium difficile by age, by age,

1996-20031996-2003

Source: McDonald LC, et al. Emerg Infect Dis. 2006;12(3): 410-5.

0

20

40

60

80

100

120

140

1990 1995 2000 2004

Rat

e p

er 1

0,00

0 p

op

ula

tio

n Black patients

White patients

Hospitalization rates for avoidable Hospitalization rates for avoidable conditions by race, patients under 65 conditions by race, patients under 65

years of age, 1990-2004years of age, 1990-2004


2.6

4.6

4.8

5.6

5.5

6.6

7.9

0 1 2 3 4 5 6 7 8 9

Childbirth

Heart disease

All diagnoses

Fractures

Pneumonia

Malignant neoplasms

Psychoses

Days

Average length of stay for selected Average length of stay for selected diagnostic categories, 2004diagnostic categories, 2004


0

2

4

6

8

10

12

14

1990 1992 1994 1996 1998 2000 2002 2004

Year

Day

s

1990

6.4 days


12.8 days

2004

Average length of stay for hip Average length of stay for hip fractures, 1990-2004fractures, 1990-2004

0

20

40

60

80

100

1980 1985 1990 1995 2000 2004

Year

Pe

rce

nt

of

de

live

rie

s

3+ days

2 days

1 day or less

Length of hospitalization for childbirth, Length of hospitalization for childbirth, 1980-20041980-2004


0 50 100 150 200 250

WestSouth

MidwestNortheast

85 years and over75-84 years65-74 years45-64 years

Under 45 years

FemaleMale

All

Rate per 10,000 population


Rate of cardiac catheterizations by Rate of cardiac catheterizations by sex, age, and geographic region, 2004sex, age, and geographic region, 2004

PCI

CABG

0

5

10

15

20

25

1980 1985 1990 1995 2000 2004

Year

Ra

te p

er

10

,00

0 p

op

ula

tio

n


Coronary artery bypass grafts (CABGs) Coronary artery bypass grafts (CABGs) and percutaneous coronary and percutaneous coronary

interventions (PCIs),1980-2004interventions (PCIs),1980-2004

No Stent

Drug-elutingstent

Non-drugelutingstent

30.5%22.0%

White patients Black patients


Percent distribution of white and black Percent distribution of white and black discharges with coronary angioplasty discharges with coronary angioplasty

according to stent use, 2003according to stent use, 2003

0

10

20

30

40

1998 1999 2000 2001 2002 2003

Year

Ra

te p

er

10

0,0

00

po

pu

lati

on


Hospitalization rates for obese Hospitalization rates for obese patients with gastric bypass, patients with gastric bypass,

1998-20031998-2003

0

5

10

15

20

25

30

35

1970 1975 1980 1985 1990 1995 2000 2004

Ra

te p

er

10

0 d

eli

ve

rie

s

1970 5.5

200429.9


Rate of cesarean delivery, 1970-2004Rate of cesarean delivery, 1970-2004

0

5

10

15

20

25

30

35

40

1990 1995 2000 2004

Ra

te p

er

10

0 d

eli

ve

rie

s w

ith

pre

vio

us

ce

sa

rea

n d

eli

ve

ry

1990 20.4

200410.9


Rate of vaginal birth after cesarean Rate of vaginal birth after cesarean (VBAC), 1990-2004(VBAC), 1990-2004

0

2

4

6

8

10

1990 1992 1994 1996 1998 2000 2002 2004

Year

Ra

te p

er

10

0 v

ag

ina

l de

live

rie

s

Forceps

Vacuum


Rate of forceps and vacuum Rate of forceps and vacuum extraction, 1990-2004extraction, 1990-2004

Data usersData users

HospitalsHospitals

Universities and medical schoolsUniversities and medical schools

Professional organizations, such as AMA, AHA, WHOProfessional organizations, such as AMA, AHA, WHO

Government agencies, such as NIH, CMS, CDC, IHSGovernment agencies, such as NIH, CMS, CDC, IHS

Medical research organizations, pharmaceutical and Medical research organizations, pharmaceutical and medical supply manufacturers, insurance companiesmedical supply manufacturers, insurance companies

News mediaNews media

Other users such as publishing houses, market research Other users such as publishing houses, market research groups, free lance writersgroups, free lance writers

Accessing Data from the Accessing Data from the National Hospital National Hospital Discharge SurveyDischarge Survey

Marni Hall, Ph.D.Marni Hall, Ph.D.

How can you get the data?How can you get the data?

In publications, including annual reportsIn publications, including annual reports

From data tabulations on selected topicsFrom data tabulations on selected topics

Using public-use data files (micro-data)Using public-use data files (micro-data)

Calling NCHS to request tabulationsCalling NCHS to request tabulations

On the NHDS/NSAS homepageOn the NHDS/NSAS homepage www.cdc.gov/nchswww.cdc.gov/nchs/about/major/hdasd/nhds.htm/about/major/hdasd/nhds.htm

You’ll find:You’ll find:

• A Description and Methodology of NHDS (and A Description and Methodology of NHDS (and NSAS)NSAS)

• Downloadable Publications from NCHSDownloadable Publications from NCHS

• List of other publications using NHDS or NSAS dataList of other publications using NHDS or NSAS data

• Public Use Files – micro dataPublic Use Files – micro data

How to get to the NHDS/NSAS How to get to the NHDS/NSAS webpage from the NCHS homepagewebpage from the NCHS homepage

www.cdc.gov/nchswww.cdc.gov/nchs

Under Surveys & Data Collection Systems on the Under Surveys & Data Collection Systems on the far left of the screen far left of the screen

Select NHCS which stands for National Health Select NHCS which stands for National Health Care SurveyCare Survey

When a pop-up list of surveys appears, select When a pop-up list of surveys appears, select National Hospital Discharge SurveyNational Hospital Discharge Survey

Annual Publications using NHDSAnnual Publications using NHDS

Advance Data reportsAdvance Data reports

• 2004 available on the website2004 available on the website

Annual Summary with Detailed Diagnosis and Annual Summary with Detailed Diagnosis and Procedure DataProcedure Data

• 2003 available on the website2003 available on the website

• 2004 available later this summer2004 available later this summer

How to download publicationsHow to download publications

Publications, data tables, and data file Publications, data tables, and data file documentation are in Adobe Acrobat PDF formatdocumentation are in Adobe Acrobat PDF format

Require use of the free Adobe Acrobat Reader Require use of the free Adobe Acrobat Reader software, available for download at: software, available for download at: www.adobe.comwww.adobe.com

Public-Use Files Available on the WebPublic-Use Files Available on the Web

Data files and documentation available for free Data files and documentation available for free from the NHDS webpagefrom the NHDS webpage

NHDS: 1996 through 2004NHDS: 1996 through 2004

• NSAS: 1994, 1995, 1996* NSAS: 1994, 1995, 1996*

*2006 NSAS data will be available early in *2006 NSAS data will be available early in 20082008

Obtaining and using data filesObtaining and using data files

Data files are in ASCII format and must be Data files are in ASCII format and must be downloaded via FTP server.downloaded via FTP server.

Downloadable public-use data files are “zipped” for Downloadable public-use data files are “zipped” for a speedier download a speedier download

““Unzip” these files with free data extraction Unzip” these files with free data extraction software such as:software such as:

• WinZip (WinZip (www.winzip.comwww.winzip.com) )

• PKunzip (PKunzip (www.pkware.comwww.pkware.com))

Analyzing Public Use DataAnalyzing Public Use Data

Files require the use of standard statistical Files require the use of standard statistical software packages, such as SAS, SPSS, Stata, software packages, such as SAS, SPSS, Stata, etc. etc.

Multi-year data filesMulti-year data files

Two separate multi-year files on CD-ROM are Two separate multi-year files on CD-ROM are available for free from NCHS:available for free from NCHS:

1970-1978 data years (ICD-8 coding) 1970-1978 data years (ICD-8 coding)

1979-2004 data years (ICD-9-CM coding)1979-2004 data years (ICD-9-CM coding)

DRG’s are not included on the multi-year files.DRG’s are not included on the multi-year files.

For NSAS a 1994-1996 data file is available.For NSAS a 1994-1996 data file is available.

Where to find ICD-9-CM codes for Where to find ICD-9-CM codes for Diagnoses or ProceduresDiagnoses or Procedures

www.cdc.gov/nchs/icd9.htmwww.cdc.gov/nchs/icd9.htm

Full-text ICD-9-CM documents are RTF (Rich Text Full-text ICD-9-CM documents are RTF (Rich Text Format) files and can be handled with any word Format) files and can be handled with any word processing packageprocessing package

Addenda and conversion tables are PDF Addenda and conversion tables are PDF documentsdocuments

Very lengthy documentVery lengthy document

Publications and Information Products Publications and Information Products

http://www.cdc.gov/nchs/products.htmhttp://www.cdc.gov/nchs/products.htm

• Lists electronic productsLists electronic products

• Additional Information about obtaining reports, Additional Information about obtaining reports, data, and other productsdata, and other products

Other sources of tabulated NHDS DataOther sources of tabulated NHDS Data

• FASTATS A to ZFASTATS A to Z

• Aging – Trends in Aging Aging – Trends in Aging Database provides Database provides information on national trends and key variables that information on national trends and key variables that depict the health status of older Americans compiled depict the health status of older Americans compiled from a number of surveys – mostly on persons 50 from a number of surveys – mostly on persons 50 years old and overyears old and over

• Healthy PeopleHealthy People

• Health, United StatesHealth, United States

Restricted Data in NHDSRestricted Data in NHDS

http://www.cdc.gov/nchs/r&d/rdc.htmhttp://www.cdc.gov/nchs/r&d/rdc.htm

HCSB maintains confidential information in files HCSB maintains confidential information in files which are not publicly disseminatedwhich are not publicly disseminated

Restricted data pose disclosure risks to survey Restricted data pose disclosure risks to survey respondentsrespondents

These data are available to researchers through These data are available to researchers through the NCHS Research Data Center (RDC)the NCHS Research Data Center (RDC)

Confidential files for NHDS and NSAS variance Confidential files for NHDS and NSAS variance estimationestimation

NHDS and NSAS analytic files that have been NHDS and NSAS analytic files that have been linked with outside data sourceslinked with outside data sources

Through the RDC Through the RDC Researchers Can Use:Researchers Can Use:

ZIP Codes for residence of patient and for ZIP Codes for residence of patient and for hospitalshospitals

State/County FIPS CODE for both patient and State/County FIPS CODE for both patient and hospitalhospital

AHA ID for hospitalAHA ID for hospital

Design Variables needed to run SUDAANDesign Variables needed to run SUDAAN

NOTENOTE: Identifiers such as patient name, address, : Identifiers such as patient name, address, and SSN are not collected in the NHDSand SSN are not collected in the NHDS

Confidential Variables Available Confidential Variables Available only on Restricted Filesonly on Restricted Files

NHDS Can be Linked with Other Files, NHDS Can be Linked with Other Files, for examplefor example

American Hospital Association File (AHA) which American Hospital Association File (AHA) which has data on hospital characteristicshas data on hospital characteristics

Area Resource File (ARF) which has county level Area Resource File (ARF) which has county level data (e.g. SES variables and health service data (e.g. SES variables and health service availability)availability)

Linkage is with contextual NOT personal / Linkage is with contextual NOT personal / demographic informationdemographic information

NHDS or NSAS Questions?NHDS or NSAS Questions?

By telephone: By telephone:

• Hospital Care Statistics Branch: 301-458-4321Hospital Care Statistics Branch: 301-458-4321

• NCHS Information Dissemination Staff (toll free) NCHS Information Dissemination Staff (toll free) 1-866-441-NCHS [1-866-441-6247] 1-866-441-NCHS [1-866-441-6247]

Send an email to: Send an email to: [email protected]@cdc.gov

Future Activities Future Activities and Directionsand Directions

Robert Pokras, MARobert Pokras, MA

Future Activities and DirectionsFuture Activities and Directions

Redesigning the NHDSRedesigning the NHDS

Refielding the NSASRefielding the NSAS

Context for Redesigning the NHDSContext for Redesigning the NHDS

Data elements limited to UB 92 (UB 04)Data elements limited to UB 92 (UB 04)

The value of primary data collection to meeting The value of primary data collection to meeting current and future policy and research needscurrent and future policy and research needs

To take a fresh look at current and future policy To take a fresh look at current and future policy and research issues and associated data needs and research issues and associated data needs and gapsand gaps

Meetings and interviewsMeetings and interviews

Working group meeting in March, 2006Working group meeting in March, 2006

Priority IssuesPriority Issues

Cost of care/ use of resourcesCost of care/ use of resources• including efficiency/ wasteincluding efficiency/ waste

Quality of care/ safetyQuality of care/ safety• including disparitiesincluding disparities

Care delivered in the hospitalCare delivered in the hospital Surveillance and public healthSurveillance and public health

• including surge capacityincluding surge capacity

GlobalizationGlobalization• including outsourcingincluding outsourcing

Coordinate with AHRQ data collection Coordinate with AHRQ data collection (HCUP)(HCUP)

Add resource use/ costAdd resource use/ cost/ billings/ payments/ billings/ payments

Add clinical depthAdd clinical depth

• e.g., medications, testse.g., medications, tests

Improve patient demographicsImprove patient demographics

• e.g., ethnicitye.g., ethnicity

Link to health-related outcomesLink to health-related outcomes

• e.g., death indexe.g., death index

Highest Rated Options for RedesignHighest Rated Options for Redesign

Clinical Depth Core Data SetClinical Depth Core Data Set(All Sampled Cases)(All Sampled Cases)

HeightHeight

WeightWeight

Administered drugsAdministered drugs

Clinical DepthClinical DepthDiagnostic/ Procedure/ DemographicDiagnostic/ Procedure/ Demographic

Module (Subsample of Cases)Module (Subsample of Cases)

Lab valuesLab values

Pathology resultsPathology results

Resource Use/ Cost/ EfficiencyResource Use/ Cost/ Efficiency

Billings -- chargesBillings -- charges

Medicare programMedicare program

• Cost-to-charge ratiosCost-to-charge ratios

• DRG hospital-specific paymentsDRG hospital-specific payments

Improved Patient DemographicsImproved Patient Demographics

RaceRace

EthnicityEthnicity

Link to Health-Related OutcomesLink to Health-Related Outcomes

Link with the National Death Index to look at 30-Link with the National Death Index to look at 30-day mortalityday mortality

Additional Aspects of the RedesignAdditional Aspects of the Redesign

Link mother and newborn recordsLink mother and newborn records

Collect data from ED and observation status (for Collect data from ED and observation status (for sampled inpatients)sampled inpatients)

Collect data from last previous admissionCollect data from last previous admission

• Length of stayLength of stay

• Principal diagnosisPrincipal diagnosis

Summer 2006:Summer 2006:

• Final conceptual frameworkFinal conceptual framework

• Strategy and data elementsStrategy and data elements

2006-2007: Feasibility test in 9 hospitals2006-2007: Feasibility test in 9 hospitals

2007: Contract for field test2007: Contract for field test

2008: Field test2008: Field test

2010: New survey fielded2010: New survey fielded

Next StepsNext Steps

Refielding the National Survey of Refielding the National Survey of Ambulatory Surgery (NSAS)Ambulatory Surgery (NSAS)

First fielded in 1994-1996First fielded in 1994-1996

Back in the field for 2006Back in the field for 2006

Data collect ends in March 2007Data collect ends in March 2007

Public Use files will be available in early 2008Public Use files will be available in early 2008

0

50

100

150

200

250

300

350

400

450

500

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Years

Nu

mb

er

of

Pro

ce

du

res

(i

n t

ho

us

an

ds

)

Ambulatory

Inpatient

Total ?

Sources: CDC/NCHS, National Survey of Ambulatory Surgery (NSAS) and National Hospital Discharge Survey (NHDS)

Breast lumpectomy proceduresBreast lumpectomy procedures

... .

Any questions?Any questions?

national hospital discharge survey (nhds) and national survey of ambulatory surgery (nsas) national...

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