The Redesigned National Hospital Discharge Survey

1. National Center for Health Statistics Division of Health Care Statistics Hospital Care Team Last Updated: November 19, 2008 The Redesigned National Hospital Discharge Survey

2. NHDS Background • Nationally representative sample of inpatient discharges • Longest continuously fielded survey of inpatient care - annually since 1965 • Nonfederal, general, and short-stay hospitals

3. Inpatient Hospitalization rates with Clostridium difficile first and any listed 1996-2006 Citation: McDonald LC, et al. Emerg Infect Dis. 2006;12(3): 410-5.

4. Coronary Artery Bypass Graft (CABG) and Percutaneous Coronary Intervention (PCI)1980-2004 Rate per 10,000 population PCI CABG Source: National Hospital Discharge Survey 1980-2004.

5. Average Length of Stay by Age U.S., 1970-2006 Source: CDC/NCHS, National Hospital Discharge Survey (NHDS)

6. 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

7. 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

8. Current vs. Redesigned NHDS Sampling Scope Depth of content Linking ability via patient identifiers Data collection methods Analytical Enhancements

9. Current Non Federal Non institutional 6 beds or more General Short-stay (LOS <30 days) Redesigned Non Federal Non institutional 6 beds or more Scope

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

11. Current (UB 04 only) Not collected Redesigned Specific technologies/services EMR specifics Uncompensated care Staffing Content, Hospital Level

12. Current 112 geographic primary sampling units (PSUs) 239 hospitals Hospitals stratified by bed size Annual discharges 250 per manual hospital Oversample automated 150,000 discharges annually Redesigned List sample stratified by service type 240 hospitals Stratification of discharges: Observation cases Normal newborns (undersample) Acute myocardial infarction Deaths Other patients 24,000 annually Sampling

13. Redesigned Survey: Potential • Link to NDI, birth records, CMS data • Risk adjustment possible • Quality of care analyses • Payment and cost analyses • Facility-level analyses

14. 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

15. 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)

16. 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

17. 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