national hospital discharge survey (nhds) national survey of ambulatory surgery (nsas) centers for...
TRANSCRIPT
![Page 1: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/1.jpg)
National Hospital Discharge Survey(NHDS)
National Survey of Ambulatory Surgery
(NSAS)
Centers for Disease Control and Prevention
![Page 2: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/2.jpg)
Session OverviewNHDS and NSAS: Overview
Bob Pokras
Analytic Issues
Jean Kozak, Ph.D.
Examples of Research
Marni Hall, Ph.D.
Accessing Data
Maria Owings, Ph.D.
New Directions
![Page 3: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/3.jpg)
N H A N E S D V S N H IS N H C S
N a tio n a l C e n te r fo r H e a lth S ta tis t ics
![Page 4: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/4.jpg)
National Health Care Surveys• Visits to
– Doctors’ offices (NAMCS)– Emergency rooms (NHAMCS)– Outpatient departments (NHAMCS)
• Inpatients (NHDS)• Ambulatory surgery (NSAS) (1994-96)
• Long term care– Nursing homes (NNHS)– Home health care (NHHCS)– Hospices (NHHCS)
![Page 5: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/5.jpg)
Handout
Internet Resources: Hospital Discharge and Ambulatory Surgery Data
For an email of this table of hotlinks, write to: [email protected]
![Page 6: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/6.jpg)
![Page 7: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/7.jpg)
![Page 8: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/8.jpg)
Survey Years
• NHDS: Annually 1965-present– Latest data available – 2000– 2001 will be available this Winter
• NSAS: Annually 1994-1996
![Page 9: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/9.jpg)
Survey Design and Operations
• NCHS Publications
– NSAS – Series 1 No. 37
– NHDS – Series 1 No. 39
![Page 10: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/10.jpg)
![Page 11: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/11.jpg)
![Page 12: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/12.jpg)
Survey Design
• Similar designs and methods
• National probability samples– Short stay non-Federal hospitals
(NHDS/NSAS)– Freestanding ambulatory surgery centers
(NSAS)
![Page 13: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/13.jpg)
Survey Design
• Three stage design
• PSU
• Facility
• Discharge/visit
![Page 14: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/14.jpg)
Facility Sample Size
• 525 NHDS hospitals
• 751 NSAS facilities– 418 Hospitals– 333 Freestanding surgery centers
![Page 15: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/15.jpg)
Response Rates
• NHDS – over 90 percent 300,000 sampled discharges per year
• NSAS -- 80 percent for hospitals -- 70 percent for FSASC
120,000 sampled visits per year
![Page 16: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/16.jpg)
Data Collection
• NHDS– Manual; 60%– Automated; 40%
• NSAS– All manual
![Page 17: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/17.jpg)
Manual Data Collection
• NCHS – Statistical Design
• Census Bureau – Field Work
• ASI – Coding and Data Entry
![Page 18: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/18.jpg)
Automated Data Collection
• Purchase files– States– Commercial firms– Individual hospitals
![Page 19: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/19.jpg)
Data Collection
• NCHS
– Editing
– Estimation
![Page 20: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/20.jpg)
Estimation
• Weight
– Inverse of the probability of selection
– Adjustments for non-response
– Population weighting ratio adjustment
![Page 21: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/21.jpg)
Variables on
Public Use Data Files
![Page 22: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/22.jpg)
![Page 23: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/23.jpg)
![Page 24: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/24.jpg)
Patient Data
• Age
• Sex
• Race
• Expected source of payment
• Discharge status
• Marital status
![Page 25: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/25.jpg)
Facility Characteristics
• Geographic region
• Bed size (NHDS)
• Ownership (NHDS)
• Hospital vs. Freestanding (NSAS)
![Page 26: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/26.jpg)
Medical Data
• Diagnoses and procedures
• International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)
![Page 27: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/27.jpg)
Additional Variables
• NHDS– Days of care– Month of admission/discharge– DRG
• NSAS– Month of visit– Type of anesthesia– Anesthesia provider
– WEIGHT
![Page 28: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/28.jpg)
New Variables for NHDS
• Available for Year 2001 NHDS– Source of Admission– Type of Admission
![Page 29: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/29.jpg)
Source of Admission
• Physician Referral• Clinical Referral• HMO Referral• Transfer from a Hospital• Transfer from Skilled Nursing Facility• Transfer from other health facility• Emergency Room• Court/Law Enforcement• Other• Not Available
![Page 30: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/30.jpg)
Type of Admission
• Emergent
• Urgent
• Elective
• Newborn
• Not available/unknown
![Page 31: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/31.jpg)
![Page 32: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/32.jpg)
Summary
• Source of the data– Design– Methods
• Variables
![Page 33: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/33.jpg)
Analytic Issues
(things you need to know about NHDS data)
Lola Jean Kozak, Ph.D.
![Page 34: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/34.jpg)
Topics
• Utilization measures
• Populations
• Medical coding system
• Statistical issues
![Page 35: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/35.jpg)
NHDS Provides Data on
Hospitalizations
Not People
![Page 36: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/36.jpg)
Measures Include:
• Discharges
• Days of care
• Average length of stay
• Diagnoses
• Surgeries/procedures
![Page 37: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/37.jpg)
Discharges
• Include deaths
• Include transfers to other hospitals or long-term care facilities
• Do not usually include newborn infants
![Page 38: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/38.jpg)
Days of Care
• Total number of days discharged patients spend in the hospital
• All stays are counted as at least 1 day
• The admission day is counted, but not the discharge day
![Page 39: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/39.jpg)
Average Length of Stay
• Calculated by dividing the number of days of care by the number of discharges
• May want to examine length of stay distributions
![Page 40: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/40.jpg)
Length of stay for women with deliveries: 1995 and 2000
0
500
1,000
1,500
2,000
1 day 2 days 3-4 days 5-7 days 8+ days
1995 2000
Discharges in thousands
![Page 41: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/41.jpg)
Diagnoses
• Disease, injury or other reason for hospitalization
• Coded according to US adaptations of the International Classification of Diseases
![Page 42: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/42.jpg)
Diagnoses
• Principal diagnosis: chiefly responsible for hospitalization
• First-listed diagnosis: principal if specified, otherwise one listed first
![Page 43: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/43.jpg)
Diagnoses
• All-listed: total number of times diagnoses appears on record
• Any-listed: discharges with diagnosis in any
position on record
![Page 44: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/44.jpg)
Hospital discharges with fractures, 2000
Principal or first listed
Any listed All listed
982,000
1,226,000
1,542,000
![Page 45: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/45.jpg)
Surgery/Procedures
• Surgical (appendectomy)• Diagnostic (spinal tap)• Therapeutic (chemotherapy) procedures
• Coded according to US adaptations of the International Classification of Diseases
![Page 46: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/46.jpg)
NHDS Provides Data on
Inpatient Procedures
Not Total Procedures
![Page 47: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/47.jpg)
Procedures mainly performed in inpatient settings, 1996
0 250 500 750
Ambulatory Inpatient
Cesarean section
Hysterectomy
Coronary artery bypass graft
Appendectomy
Number in thousands
![Page 48: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/48.jpg)
Procedures mainly performed in ambulatory settings, 1996
0 500 1,000 1,500 2,000 2,500
Ambulatory Inpatient
Insertion of lens
Endoscopy oflarge intestine
D & C
Arthroscopy Of knee
Number in thousands
![Page 49: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/49.jpg)
Population for Rates
• Mid-year population estimates from the U.S. Bureau of the Census
• Civilian resident population
• Adjustments for underenumeration
![Page 50: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/50.jpg)
Versions of the International Classification of Diseases
• 8th revision used 1970-78
• 9th revision used 1979-2002
• 10th revision for use in future
![Page 51: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/51.jpg)
8th Revision
• Some codes different than in 9th Revision
• Did not use E-codes
• Made modifications in coding to accommodate available data
![Page 52: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/52.jpg)
9th Revision
• Addenda added annually since 1986
• Codes added, deleted, expanded, and revised
• Lists of changes available in annual summary reports, file documentation
![Page 53: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/53.jpg)
Weights
• Must use weighted data to obtain unbiased national estimates.
• Each record has a weight
• Sum the weights of the records
![Page 54: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/54.jpg)
Reliable Estimates
• Are based on 30 records or more*
• And have a relative standard error of 30 percent or less
*Use estimates based on 30-59 records with caution
![Page 55: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/55.jpg)
Standard Errors
• Some standard errors are in Advance Data summaries
• Generalized error curves are in the Series 13 Annual Summaries and data documentation
• Use SUDAAN for specific standard errors - need access to confidential data
![Page 56: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/56.jpg)
Examples of Research Using the National Hospital Discharge
Survey
Marni Hall, Ph.D.
![Page 57: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/57.jpg)
Hospital Transfers to Long Term Care Facilities in the 1990’s
Lola Jean Kozak, Ph.D.
Long-Term Care Interface – June 2002
![Page 58: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/58.jpg)
Transfers to long-term care,1990-1999
0
0.5
1
1.5
2
2.5
3
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Num
ber
in M
illi
ons
1.6 Million
2.8 Million
![Page 59: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/59.jpg)
Average hospital stay for long-term transfers, 1990-1999
0
2
4
6
8
10
12
14
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
12.8 days
8.3 days
![Page 60: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/60.jpg)
Hospital discharges transferred to long-term care institutions by length of stay,
1990-1999
0 200 400 600 800 1000 1200
0-2 days
3-5 days
6-7 days
8+ days
19991990
Hos
pita
l Sta
y
Transfers in Thousands
![Page 61: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/61.jpg)
Long-term transfers by first-listed diagnoses
0100300600 600300100
1990 1999
Circulatory
Respiratory
Injury & poisoning
Digestive
Musculoskeletal
Endocrine, metabolic
Genitourinary
Neoplasms
Infectious & parasitic
Mental disorders
Number in thousands
![Page 62: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/62.jpg)
Hospital Transfers to Long Term Care Institutions study:
• Trend data – 10 years
• Changing roles of hospitals and nursing homes
• Assessment of the effects of Medicare policy changes
• Post-acute care in nursing homes substituting for end of hospital stay
![Page 63: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/63.jpg)
Trends in Avoidable Hospitalization: United States,
1980-1998
Lola Jean Kozak, Ph.D.
Margaret J. Hall, Ph.D.
and Maria F. Owings Ph.D.
![Page 64: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/64.jpg)
Avoidable hospitalization diagnoses
• Selected by a panel of physicians
• Can often be prevented, controlled, or managed over time without the need for hospitalization if the patient receives timely and appropriate ambulatory care
• Used as indicators of access and the adequacy of ambulatory care
![Page 65: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/65.jpg)
Diagnoses studied in avoidable hospitalization study
• Pneumonia• Congestive heart failure• Asthma• Cellulitis• Perforated or bleeding ulcer• Pyelonephritis• Diabetes with ketoacidosis or coma• Ruptured appendix• Malignant hypertension• Hypokalemia• Immunizable conditions• Gangrene
![Page 66: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/66.jpg)
Avoidable hospitalizations
1980 1998
• # of discharges 2,200,000 3,700,000 million
• Rate per 1,000
population 99.2 133.8
![Page 67: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/67.jpg)
Trend in rate of avoidable hospitalizations
0
60
120
180
1980 1984 1988 1992 1996 1998
Rat
e p
er 1
0,00
0
99.2
133.8
![Page 68: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/68.jpg)
Trend in rate of other hospitalizations
0
60
120
180
1980 1984 1988 1992 1996 1998
Rat
e p
er 1
,000
157.8
103.1
![Page 69: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/69.jpg)
Trend in rate of avoidable hospitalizations
0
100
200
300
400
500
600
700
1980 1984 1988 1992 1996 1998
Rat
e p
er 1
0,00
0
Under 65
Over 65
364.6
573.5
65 71.1
![Page 70: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/70.jpg)
Trend in rate of avoidable hospitalizations for those over 65
0
100
200
300
400
500
600
700
1980 1984 1988 1992 1996 1998
Rat
e p
er 1
0,00
0
Whites
Blacks
352.8
564
325.2
450
![Page 71: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/71.jpg)
Trend in rate of avoidable hospitalizations for those under 65
40
60
80
100
120
1980 1984 1988 1992 1996 1998 1990 1998
Rat
e p
er 1
0,00
0
Blacks
Whites
92.5
113.5
53.849.1
![Page 72: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/72.jpg)
Avoidable hospitalization study:
• Trend data – 20 years• Avoidable hospitalization conditions as defined by
the literature• Measured access to care over time• Identified disparities between elderly/nonelderly
and white/black and identified those who should be targeted for intervention
• Used as a model for additional research funded by Center for Medicare and Medicaid Services
![Page 73: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/73.jpg)
Pneumonia hospital discharge rate for the elderly
0
50
100
150
200
250
19801984
19881992
19962000
Rat
e p
er
10,0
00
65 and over
125.3
221.2
![Page 74: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/74.jpg)
Disparities in the Rate of Hospitalization for Pneumonia Patients in Rural and
Urban Areas
Maria F. Owings, Ph.D.
Margaret J. Hall, Ph.D.
![Page 75: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/75.jpg)
Study Objectives
• To compare urban and rural patients hospitalized for pneumonia based on
– Patient characteristics
– County characteristics, including health services availability and socioeconomic status (SES)
![Page 76: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/76.jpg)
Disparity in Urban/Rural Pneumonia Hospitalizations, 2000
0
20
40
60
80
37.5
78.0
Rat
e pe
r 10
,000
pop
ulat
ion
Rural Urban
![Page 77: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/77.jpg)
Indicators of Severity of Illness Urban Rural
Average # diagnoses 5.1 4.9
% with serious comorbidities 36% 40%
Average # seriouscomorbidities 1.2 1.3
1
1
Significant Difference
![Page 78: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/78.jpg)
Urban Rural
Average age 59 641
Average length of 6.2 5.3
1
stay (days)
Routine Discharge 70% 65%
1
Significant difference
Indicators of Severity of Illness
![Page 79: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/79.jpg)
0
5
10
15
20
25
Urban Rural
% w/some college Unemployment rate
Education, Unemployment and Poverty
% in poverty
![Page 80: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/80.jpg)
0
5
10
15
20
25
Urban Rural
Active MD’s Hospital Beds
MD/Hospital Availability
Rate per 1,000 elderly
![Page 81: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/81.jpg)
HMO Penetration
0
1
2
3
Urban RuralRate per 1,000 elderly
![Page 82: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/82.jpg)
What policies could reduce avoidable hospitalizations?
• Promotion of rural managed care
• Programs which attract/keep rural MD’s
• More affordable, accessible outpatient health care
• More health education / outreach programs - e.g. smoking cessation, influenza / pneumonia shots
![Page 83: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/83.jpg)
Urban/rural pneumonia hospitalization study:
• Urban/rural indicators
• NHDS merged with Area Resource File (ARF) data
• Severity of illness indicators using NHDS data
• Policy recommendations
![Page 84: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/84.jpg)
Medical Care Expenditures for Hypertension, Its Complications,
and Its Comorbidities
Thomas A. Hodgson, Ph.D. , NCHS
Liming Cai, Ph.D., NOVA Research Co.
![Page 85: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/85.jpg)
Estimated the economic burden of hypertension using utilization for:
• First-listed hypertension
• Cardiovascular complications
• Unrelated conditions for which hypertensives are at greater risk
• Comorbidities, i.e. secondary diagnoses
![Page 86: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/86.jpg)
Data from the Centers for Medicare and Medicaid Services (CMS):
• Personal Health Expenditures• Part B Data
Data from the Agency for Healthcare Research and Quality (AHRQ):
• National Medical Expenditure Survey
![Page 87: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/87.jpg)
Data from the National Center for Health Statistics:
• National Hospital Discharge Survey
• National Ambulatory Medical Care Survey
• National Hospital Ambulatory Medical Care Survey
• National Home and Hospice Care Survey
• National Nursing Home Survey
• National Health Interview Survey
![Page 88: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/88.jpg)
Data on hospital costs were calculated using these data:
• National Hospital Discharge Survey data on the number of inpatient days
• National Medical Expenditure Survey data on the average facility charge per hospital inpatient day
![Page 89: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/89.jpg)
$ 4.2 billion - diagnosis of hypertension
$ 17.1 billion - cardiovascular complications
$ 24.2 billion - other diagnoses
___________________________________
$45.5 billion – total hospital expenditures attributed to
hypertension
Total hospital expenditures attributed to hypertension
![Page 90: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/90.jpg)
Expenditures for hypertension, 1998
Hospital care 42%
Physician Services 26%
Prescription Drugs 17%
Nursing home 12%
Home health care 4%
![Page 91: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/91.jpg)
$ 22.8 billion - diagnosis of hypertension
$ 29.7 billion - cardiovascular complications
$ 56.4 billion - other diagnoses
___________________________________
$108.8 billion - total expenditures attributed to hypertension
Total expenditures attributed to hypertension
![Page 92: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/92.jpg)
Expenditures for hypertension study:
• Example of how cost data can be combined with utilization data
• Hospital care studied as part of entire spectrum of health services – how it fits into the total picture
• Uses multiple national data sources• Regression analyses• Provides data for cost benefit analysis
![Page 93: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/93.jpg)
For more information see our Internet Resources handout
![Page 94: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/94.jpg)
Accessing Data from NHDS and NSAS
Maria Owings, Ph.D.
Centers for Disease Control and Prevention
![Page 95: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/95.jpg)
Sources of Available Data
• Publications, including annual reports– Downloadable from the Internet
– Data years 1985 through 2000– Order and purchase – years before 1993
• Data tables on selected topics –viewed or downloaded from Internet
• Public-use data files for DO-IT-YOURSELF analysis– Downloadable from the Internet – On CD-ROM
• ICD-9-CM – to assist in using medical data
![Page 96: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/96.jpg)
Quick and Easy Access to NHDS and NSAS Data
• Telephone the Hospital Care Statistics Branch: 301-458-4321
• Send an email to: [email protected]
• Go to the NCHS website on the World Wide Web: www.cdc.gov/nchs
![Page 97: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/97.jpg)
Annual Publications
• ADVANCE DATA on Vital and Health Statistics reports provide early release of NHDS data – Very general and usually short
• Series 13 Reports provide more specific statistics on hospital utilization– Are more comprehensive and contain
detailed tables of diagnoses and procedures
![Page 98: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/98.jpg)
Recent Annual Publications
• 2000 NHDS Advance Data : http://www.cdc.gov/nchs/data/ad/ad329.pdf
• 1999 NHDS Annual Summary : http://www.cdc.gov/nchs/data/series/sr_13/sr13_151.pdf –Includes estimates of diagnoses and
procedures by detailed ICD-9-CM code number
![Page 99: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/99.jpg)
What to Know to Access Data and Pubs on the WWW
• Publications and data tables are in Adobe Acrobat PDF format.
• Require use of the free Adobe Acrobat Reader software, available for download at www.adobe.com
![Page 100: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/100.jpg)
Where to Find NHDS and NSAS Data and Pubs on the WWW
http://www.cdc.gov/nchs/about/major/hdasd/listpubs.htm • Lists annual pubs (back to 1990 only) and special topic
reports by name and numberhttp://www.cdc.gov/nchs/products.htm
• Provides links by topic area for all NCHS products (not just NHDS & NSAS), including
– Data Warehouse (for microdata and tabulations)– Published Reports (by type, e.g. Advance Data, Series
13 Vital and Health Statistics, etc)--ADs and Series 13 for pre-1990 years
![Page 101: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/101.jpg)
NHDS & NSAS Homepage• http://www.cdc.gov/nchs/about/major/hdasd/nhds.htm provides
links to all aspects of survey design, data, and dissemination, including
– Survey Methodology and Data Collection
– Publications and Journal Articles
– Public Use Data Files (microdata)
– Special Reports
– NCHS Health E-Stats
– Data Highlights & Selected Tables on topics such as hospital discharges among females with deliveries, HIV inpatients, newborn infants, and hospital inpatient deaths, and ambulatory surgery utilization
![Page 102: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/102.jpg)
Public-Use Files Available on the Internet
• Data and documentation available for free from the NCHS website
–NHDS: 1996 through 2000
–NSAS: 1994, 1995, 1996
• These are “raw” ASCII data that require the use of statistical software packages, such as SAS, SPSS, Stata, etc.
![Page 103: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/103.jpg)
What to Know to Access Public-Use Files on the WWW
•Downloadable public-use data files are “zipped” for a speedier download.
•“Unzip” these files with
•WinZip at http://www.winzip.com/
• PKunzip at http://www.pkware.com/
•Data documentation are available either as text files or PDF files.
![Page 104: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/104.jpg)
Public-Use Files Available onCD-ROM
• Two separate multi-year files containing
– 1979-2000 data years (ICD-9-CM coding)
– 1970-1978 data years (ICD-8 coding)
• Single year files for 1990, 1994 to 2000
• IMPORTANT: DRGs are available on single year files only. Multi-year files do NOT have DRGs.
![Page 105: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/105.jpg)
How to Get PU Files on CD-ROM
• Can be obtained at no cost from NCHS • Division of Data Services: 301-458-INFO• Hospital Care Statistics Branch: 301-458-4321
• Or ordered from National Technical Information Service (NTIS)• by phone at 1-800-553-6847 or (703) 605-6000 • online at http://www.ntis.gov/
• Annual files for single years prior to 1994 can be ordered from NTIS, not directly from NCHS
![Page 106: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/106.jpg)
ICD-9-CM
• For full-text, addenda, and conversion tables of ICD-9-CM, see www.cdc.gov/nchs/icd9.htm
• Full-text ICD-9-CM documents are RTF (Rich Text Format) files and can be handled with any word processing package.
• Addenda and conversion tables are PDF documents.
![Page 107: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/107.jpg)
Restricted Data in NHDS
• HCSB maintains confidential information in files which are restricted from unauthorized use
• These data are available to researchers through the NCHS Research Data Center (RDC)
• http://www.cdc.gov/nchs/r&d/rdc.htm
![Page 108: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/108.jpg)
Through the RDCResearchers Can Use:
• Confidential files for NHDS and NSAS variance estimation;
• NHDS and NSAS analytic files that have been linked with outside data sources
![Page 109: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/109.jpg)
NCHS Research Data Center
• Located within NCHS facilities in Hyattsville, MD
• Requires preapproval of research projects by an internal proposal review committee
• Subjects analytic results to disclosure limitation review and clearance
• Provides different modes of data access for approved research projects
![Page 110: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/110.jpg)
Confidential Variables Available Only on Restricted Files
• ZIPCODE for residence of discharged patient• ZIPCODE for hospital• STATE/COUNTY FIPS CODE for both patient and
hospital• AHA ID for hospital• DESIGN VARIABLES needed to run SUDAAN to
obtain variances of complex NHDS statistics********************************************
• NOTE: Patient name and address are NOT collected in the NHDS
![Page 111: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/111.jpg)
Restricted Data Needed by SUDAAN for NHDS and NSAS Applications:
• Variables corresponding to design stages for sampling and stratification
• Population counts at each sampling stage
• Type of sampling performed at each stage
![Page 112: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/112.jpg)
SUDAAN Software
• Incorporates design-related variables unique to each survey
• Utilizes sampling weights of discharges and visits that reflect unequal probabilities of selection
• Produces sampling errors for NHDS and NSAS estimates that take into account the complexity of the survey design
![Page 113: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/113.jpg)
NHDS Linked Files
• NHDS + American Hospital Association (AHA)
• NHDS + Area Resource File (ARF)
• Linkage is with contextual NOT personal / demographic information
• Contextual data include
– Hospital characteristics, services (AHA)
– County level information (ARF)
![Page 114: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/114.jpg)
American Hospital Association (AHA) Database
• Hospital-specific data on over 6,200 hospitals and health care systems
• More than 600 data items collected with the assistance of State and Metropolitan Hospital Associations
![Page 115: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/115.jpg)
Types of Variables in AHA
• Organizational Structure• Staffing• Utilization• Facilities and Services• Financial• Geographic codes• Approval and Accreditation Codes
![Page 116: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/116.jpg)
Area Resource File(ARF)
• County-specific health resources information system designed to aid research on the health care delivery system and factors that may impact health status and health care in the U.S.
• Contains more than 7,000 variables from over 50 different source files for each county.
![Page 117: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/117.jpg)
General Categories of Variables in the ARF
• Health facilities
• Health professions
• Health care utilization
• Morbidity and mortality measures
• County economic activity
• Socioeconomic and environmental variables
![Page 118: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/118.jpg)
Beyond 20/20 Browser
• http://www.cdc.gov/nchs/about/otheract/aging/howto.htm#browser2
• Database providing up-to-date information on national trends and key variables that depict the health status of older Americans
• Data for persons 45 years old and over by sex and race
![Page 119: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/119.jpg)
Listserv
• http://www.cdc.gov/nchs/about/major/hdasd/nhdslistserv.htm
• Provides current information about new data releases and publications
• Subscribers can post messages to other members and exchange information
![Page 120: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/120.jpg)
How to Subscribe to HDAS Listserv
• In the body of an email message (leaving the subject line blank), type:
• subscribe hdas-data your name
• Send this message to:
![Page 122: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/122.jpg)
New Directions
• Beyond 20/20
• Public use variance file
![Page 123: National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS) Centers for Disease Control and Prevention](https://reader035.vdocuments.us/reader035/viewer/2022062423/56649e845503460f94b85e23/html5/thumbnails/123.jpg)
New Directions
• Clinical data
• Evaluation of drugs in the NHDS
• Two phase contract– Phase I – Research– Phase II – Field test