New COVID-19 Hospital Data

April 21, 2021

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NCHS has released new National Hospital Care Survey (NHCS) data from 50 hospitals submitting inpatient and 47 hospitals submitting ED Uniform Bill (UB)-04 administrative claims from March 18, 2020–December 29, 2020.  Even though the data are not nationally representative, they can provide insight on the impact of COVID-19 on various types of hospitals throughout the country. This information is not available in other hospital reporting systems.

The NHCS data from these hospitals can show results by a combination of indicators related to COVID-19, such as length of inpatient stay, in-hospital mortality, comorbidities, and intubation or ventilator use. NHCS data allow for reporting on patient conditions and treatments within the hospital over time.

 

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Opioid-involved Emergency Department Visits in the National Hospital Care Survey and the National Hospital Ambulatory Medical Care Survey

December 15, 2020

Questions for Geoffrey Jackson, Health Statistician and Lead Author of “Opioid-involved Emergency Department Visits in the National Hospital Care Survey and the National Hospital Ambulatory Medical Care Survey.”

Q: Why did you decide to research opioid-involved emergency department (ED) visits?

GJ: From 2005 through 2014, it is estimated that the rate of ED visits due to opioid use increased 99.4%, from 89.1 per 100,000 population in 2005 to 177.7 per 100,000 population in 2014. We were struck by the large increase and know that ED data can provide critical information on opioid use-related treatments, such as opioid use disorder treatment, detoxification for safe opioid withdrawal, and management of adverse effects. NCHS hospital surveys can be used to monitor trends in opioid overdoses, as well as other opioid-related morbidity and mortality measures.

Q: Can describe the difference between the difference between the National Hospital Care Survey and the National Hospital Ambulatory Medical Care Survey?

GJ: Even though both surveys collect data from hospital emergency departments, the mode of data collection differs between the two surveys. The National Hospital Care Survey (NHCS) is an all-electronic data collection of administrative claims or billing data. NCHS receives all inpatient, ED, and outpatient hospitals for a calendar year.  In addition, to patient demographics, diagnoses, procedures, laboratory tests, and medications, NHCS collects patient name, address, and Social Security number, which allows patients to be followed over time and linkage to external data sources, such as the National Death Index, providing a more complete picture of patient care and post-acute mortality.

In contrast, the National Hospital Ambulatory Medical Care Survey (NHAMCS) data collection relies on medical record abstraction by U.S. Census Bureau field representatives during a 4-week period. A random sample of about 100 ED visits are selected from all visits during the reporting period, and data are manually abstracted directly from medical records by Census staff. NHAMCS collects similar information as NHCS, but NHAMCS does not collect patient identifiers.  As a consequence, NHAMCS data cannot be linked to other sources nor can patients be collected over time.

Q: Was there a specific finding in the data that surprised you from this report?

GJ: One finding that surprised me was the increase in percentage the patients that died of an opioid overdose 90 days after their hospital visits. Specifically, of the patients with an opioid-involved ED visit that died with 91 and 365 days after their ED visit, 20.6% died with an opioid overdose, compared to approximately 15% that died within 90 days post-ED visit died of an opioid overdose.

Q: Is this the most recent data you have on this topic?

GJ: The most recent NHCS data available in the NCHS Research Data Center (RDC) are from 2016. The 2016 NHCS data are linked to the 2016 and 2017 National Death Index and include information on specific drugs mentioned on the death certificate from the Drug-Involved Mortality file. Additionally, the 2016 NHCS RDC data include identification of opioids using an enhanced methodology that uses natural language processing and machine learning techniques. The most recent NHAMCS public use data file available are from 2018.

Q: What is the take home message for this report?

GJ: NHCS is an important data source for studying opioid-involved ED visits. Through the collection of patient identifiers, the data can be linked to the National Death Index to provide information on post-acute mortality. The information on post-acute mortality is not available in other hospital data sources. Even though the NHCS data are not nationally representative, the NHCS data have similar distributions to NHAMCS data for national estimates of ED visits of male and female opioid-involved ED visits and for persons aged 35 and over.

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National Hospital Care Survey Demonstration Projects: Stroke Inpatient Hospitalizations

November 13, 2019

Questions for Lead Author Geoffrey Jackson, Health Statistician, of “National Hospital Care Survey Demonstration Projects: Stroke Inpatient Hospitalizations.”

Q: What was your objective in conducting this study?

GC: The objective of this study is to demonstrate the analytic potential of the National Hospital Care Survey (NHCS) by examining inpatient and emergency department hospital encounters due to stroke. Stroke is a leading cause of death and an economic burden with an estimated $33 billion spent each year on stroke-related health care services. NHCS provides a unique opportunity to study hospital care by examining length of stay and number of admissions due to stroke within the year. Additionally, NHCS is linked to the National Death Index to track mortality 30, 60, and 90 days after the hospitalization. This study shows that NHCS is a valuable data source for analyzing healthcare utilization and post-acute mortality.

Q: Is this a topic you’ve looked at before?

GC: I have not looked at hospitalizations related to stroke prior to this paper. The National Hospital Care Survey has been used in previous NCHS reports to study hospital visits related to pneumonia, Alzheimer disease, and traumatic brain injuries.

Q: Can you explain what the demonstration project is?

GC: A demonstration report is a venue that the National Center for Health Statistics uses to demonstrate the analytic capabilities of data sources that are not yet nationally representative. The National Hospital Care Survey is designed to produce national estimates on hospitalizations and emergency department visits. However, due to low responses rates in 2014, we were not able to produce reliable national estimates for the National Hospital Care Survey.

Q: How can one interpret the results that you found?

GC: The results in this report are not nationally representative. The results are only representative of the 94 National Hospital Care Survey hospitals that provided inpatient data and the 83 hospitals that provided emergency department data.

Q: What is the main point you want people to take away from this study?

GC: The NHCS provides researchers with hospital-related research opportunities not available in other hospital data sources.  Even though NHCS data are not nationally representative, insight into the hospital care received by stroke patients is possible through analysis of Intensive Care Unit use, multiple visits due to strokes, and post-acute mortality.

 

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National Hospital Care Survey Demonstration Projects: Pneumonia Inpatient Hospitalizations and Emergency Department Visits

August 24, 2018

Sonja Williams, M.P.H., NCHS Statistician

Questions for Sonja Williams, M.P.H. and Lead Author of “National Hospital Care Survey Demonstration Projects: Pneumonia Inpatient Hospitalizations and Emergency Department Visits”

Q: What is a demonstration project as mentioned in the title of your new study?

SW: A demonstration project is a report that exhibits the potential power of an up and coming national survey.  The National Hospital Care Survey is a survey collecting data from a nationally representative sample of hospitals across the United States. This survey data will allow linkage across settings and to outside data sources. Currently, with only a small number of the sampled hospitals reporting, we are not able to make national estimates. This project is an opportunity to tell researchers that although the data are not nationally representative yet, there are great insights that can be gleaned from the data we currently have.

Q: Why did you produce this report if the statistical results are not nationally representative?

SW: It is the dramatic potential of the National Hospital Care Survey data that motivated me to write this report. I want the U.S. Public Health Community to have information that will help them in their important work throughout America, and this survey could provide that. Although not yet nationally representative, we have millions of records that can demonstrate the power of the survey and still give us insight into what is happening in hospitals in the United States. This report also gives us an opportunity to demonstrate the ability to link to outside sources, such as the National Death Index, and examine what happens to patients after they leave the hospital.

Q: What type of trend data do you have on pneumonia hospitalizations and emergency room visits?

SW: We have extensive trend data from a number of surveys at the National Center for Health Statistics. For example, the National Hospital Discharge Survey, which is the predecessor to the National Hospital Care Survey, has trend data on pneumonia hospitalizations dating from the 1970s all the way to 2010—the last year the National Hospital Discharge Survey was fielded. For emergency room visits, we have trend data dating from 1992 to 2015 through the National Hospital Ambulatory Medical Care Survey. Once nationally representative, the National Hospital Care Survey will be able to produce trend data and possibly create trends for linked data.    

Q: Was there a finding in your new study that really surprised you?

SW: One finding that surprised me was that most pneumonia patients who died within 30 days after their discharge from the hospital, died of something other than pneumonia.

We were able to link our data to the National Death Index (NDI) and examine 30-, 60-, and 90 day- mortality along with looking at cause of death and average age of death after pneumonia hospitalizations. It was interesting to see that most patients lived past 90 days post-discharge, but of those who died, the number one cause of death was malignant neoplasm of an unspecified part of the bronchus or lung. Pneumonia was only the underlying cause of death for 5% of the patients who were hospitalized for pneumonia. Currently, with only a small number of the sampled hospitals reporting, we are not able to make national estimates.

Q: What differences or similarities did you see between or among various demographic groups in this analysis?

SW: There were some interesting differences among demographic groups. For example, there were several age distribution differences.

Among the records in our survey, most hospitalizations for pneumonia were aged 65 and over, while most of those being seen in the emergency department were under age 15. For those inpatients that stayed in the ICU, their average length of stay increased by 50% overall. Also, the gap between the average length of stay with and without time spent in the ICU, seemed to be the largest among those under age 15. For those under 15, their average length of stay was 3.1 days, while for the same age group—among those who stayed in the ICU—their average length of stay was 7.7 days. This is nearly a 5-day difference. The gap between ICU and non-ICU involved hospitalizations for other age groups did not have such a wide difference. Currently, with only a small number of the sampled hospitals reporting, we are not able to make national estimates.

Q: What would you say is the take-home message of this report?

SW: I think the real take-home message of this report is that once nationally representative, the National Hospital Care Survey will present an opportunity to look at hospital utilization—along with hospital care—across settings in the United States. The ability to link to outside sources of data, demonstrated in our current linkage to the National Death Index, will allow researchers to explore underlying cause of death and mortality details not previously available. This ability to link will also allow researchers to explore how surrounding social and economic factors can contribute to outcomes of hospital stays through linkage to other data sources such as U.S Census Bureau data. Also, the ability to look at key items of interest in greater detail, such as discharge status, and tracking ICU-involved hospitalizations, will give us a unique view into the care being conducted in hospitals across the United States.

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Identification of Substance-involved Emergency Department Visits Using Data From the National Hospital Care Survey

August 20, 2018

Questions for Amy M. Brown, Health Statistician and Lead Author of “Identification of Substance-involved Emergency Department Visits Using Data From the National Hospital Care Survey”

Q: Why is this National Health Statistics Report (NHSR) important?

AB: The use of substances containing drugs or alcohol continues to be an important national health concern.  According to data from the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2011, an estimated 2.5 million emergency department (ED) visits resulted from medical emergencies involving drug misuse or abuse.  This paper presents two approaches (algorithms) to identify substance-involved ED visits using administrative claims data submitted to the National Hospital Care Survey. The ability to identify substance-involved ED visits will allow the National Center for Health Statistics (NCHS) and researchers to track and characterize these visits, including services provided, demographics, and co-morbidities.  

Q: What are the differences between these algorithms?  

AB: The two algorithms are termed ‘general’ and ‘enhanced.’ Both use selected diagnoses and external cause of injury codes. The general algorithm can be used to monitor trends in the number of ED patients with any record of substance use (either recent or past history). The enhanced algorithm adds codes for substance use-related symptoms and procedures and was designed to meet a more specific case definition to identify ED visits involving recent substance use that was related to the reason for visit.

Q: Which substances can be identified by the algorithms? 

AB: The general and enhanced algorithms can be used to identify 10 substance categories:  alcohol (under age 21); antidepressants; antipsychotics; benzodiazepines or sedatives; cannabinoids; cocaine; hallucinogens; heroin; opiates or opioids; and pharmaceutical central nervous system stimulants. 

Q: What was found when these algorithms were applied to survey data?

AB: For demonstration purposes, both algorithms were applied to unweighted data from the 2013 National Hospital Care Survey. Overall, the general algorithm identified 81% more ED visits involving at least one of the priority substance categories compared with the enhanced algorithm.  However, the relative percent difference in the number of ED visits identified between the general and enhanced algorithms varied widely depending on the type of substance involved, ranging from 28% for antidepressants to 120% for cannabinoids.

The percent distributions of patient sex, age, and expected source of payment across all substances were similar between the general and enhanced algorithms.  In contrast, there were differences in discharge status distributions between both algorithms across all substances.

Q: What is the take home message of this report?

AB: Two algorithms are described that search for selected standard medical codes in administrative claims to identify ED visits involving the use of selected substances. NCHS plans to continue refining the algorithms to incorporate additional data elements available in the growing volume of submitted electronic health record (EHR) data, such as clinical notes capturing patient statements regarding events leading up to an ED visit, positive blood or urine tests for specific substances, and types of medication administered or prescribed during the encounter. Once refined and formally validated to ensure accuracy, they can be used with National Hospital Care Survey data to eventually generate national estimates of substance-involved ED visits.

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Posted by briantsai