NHDS Survey Presentation

National Hospital Discharge Survey

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NHDS Survey Presentation

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National Hospital
Care Survey (NHCS)

We’re here today to talk with you about the National Center for Health Statistics’ National Hospital Care Survey and your possible participation in that effort.

Overview

What is the National Center for Health Statistics (NCHS)?
What is the National Hospital Care Survey (NHCS)?
What are we asking of you?

•Here is an overview of what we will be covering today.

We’ll be answering the following three questions:

What is the National Center for Health Statistics or NCHS?

What is the National Hospital Care Survey or NHCS?

What are we asking of you?

We are the part of CDC, which monitors the health of the Nation by providing data on:

- Health care trends
- Health status of the population
- Impact of health policy decisions and programs

What is the National Center for
Health Statistics?

•So, what is NCHS?

•We are the part of the Centers for Disease Control and Prevention, which monitors the health of the Nation by providing data to assess:

Health care trends

Health status of the population

The impact of health policy decisions and programs

NCHS gathers data in many health care settings

Inpatient settings

National Hospital Care Survey (NHCS) starting 2011

Ambulatory care settings

- Emergency departments (EDs)
- Outpatient departments in hospitals (OPDs)
- Ambulatory surgery centers (ASCs)
Doctors’ offices
Nursing homes
Home health care agencies
Hospices
Residential care facilities

NCHS gathers data in many health care settings

Inpatient settings

National Hospital Care Survey (NHCS)

Ambulatory care settings

- Emergency departments
- Outpatient departments in hospitals
- Ambulatory surgery centers
Doctors’ offices
Nursing homes
Home health care agencies
Hospices
Residential care facilities

The NHCS will expand data collection in 2013, adding data from a sample of visits to emergency and outpatient departments, and ambulatory surgery locations in hospitals and freestanding centers.

NHCS Background

The National Hospital Care Survey integrates current hospital inpatient and ambulatory care surveys into one hospital care survey that includes:

NHDS, the longest continuously fielded sample of inpatient care - annually since 1965
NHAMCS surveying hospital EDs and OPDs since 1992, hospital ambulatory surgery locations since 2009, and freestanding surgery centers since 2010

What is the National Hospital Care Survey (NHCS)?

Nationally representative sample of encounters in non-institutional, non-federal hospitals and freestanding ambulatory surgery centers.
Collects information on inpatient discharges and visits to emergency (EDs), and outpatient departments (OPDs), and ambulatory surgery centers (ASCs).
Serves as a valuable source of information for policymaking, health care researchers, academics, and the hospital industry.
Information about NHCS can be found at

http://www.cdc.gov/nchs/nhcs.htm

•The National Hospital Care Survey is a nationally representative sample of encounters in nonfederal non-institutional hospitals, emergency departments, outpatient departments, and ambulatory surgery locations in hospitals and freestanding centers in the United States.

•It collects information on inpatient discharges and visits to emergency and outpatient departments, and ambulatory surgery facilities.

•The survey will serve as a valuable source of information for policymaking, health care research, academics, and the hospital industry.

•You can find more information about the National Hospital Care Survey at our website.

http://www.cdc.gov/nchs/nhcs.htm

Advanced medical imaging among non-injury emergency department visits for persons age 18 years and over: United States, 1999-2008.

The following 3 graphs illustrate uses of NHAMCS and NHDS data.

This graph using NHAMCS data shows the increased use of advanced medical imaging for noninjury emergency department visits for chest pain, abdominal pain, and all other visits over a 10 year period.

Trend in average length of inpatient stay by age: United States, 1970-2008

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

•This graph uses data from the National Hospital Discharge Survey to demonstrate the decrease in the average length of hospital stay from 1970 to 2008 for patients in four age groups.

•Length of stay has decreased significantly for all age groups, except in children, where it has stayed about the same.

Hospitalization rates for inpatients with Clostridium difficile by age, 1996-2008

Source: McDonald LC, et al. Emerging Infectious Disease. 2006;12(3): 410-5. and unpublished estimates from the National Hospital Discharge Survey, 2004-2008

•Clostridium difficile is an infection of growing concern because it is largely a hospital acquired infection, though it can also occur in the community.

•The number of hospitalized patients coded with C Difficile, which can lead to diarrhea, blood poisoning, and even death, increased by more than 150 percent between 2000 and 2005.

•Also, the majority of cases and the vast increase in cases have occurred in the over 65 age group.

Patient discharge level data

2011 inpatient component:

- Uniform Bill (UB) 04 claims data for all discharges in the calendar year
- Special studies with chart abstraction for a sample of discharges
2013 ambulatory component:
- Chart abstraction for a sample of visits to EDs, OPDs and ASCs.

We will collect patient discharge level data in the 2011 inpatient component that includes:

Uniform Bill (UB) 04 claims data for all discharges in the calendar year and

special studies with chart abstraction for a sample of discharges when requested.

Then in 2013 the ambulatory component will be added to the NHCS and will collect clinical data using chart abstraction for a sample of medical visits to EDs, OPDs, and ASCs.

Sources of facility level data

In 2011-inpatient component:

- Telephone interviews
- Facility questionnaire completed by hospital staff

Starting in 2013-ambulatory component:

- In-person interviews

Your participation is voluntary. There is no penalty for not participating.

All information from your hospital or health care center will be used solely for research and statistical purposes.

All information will be kept strictly confidential.

We are asking for your participation in NHCS

•We are here today to ask for your participation in the survey.

-- Your participation is voluntary and there is no penalty for not participating.

-- All of the information NCHS receives from your hospital or health care facility will be used solely for research and statistical purposes.

Finally, all information will be kept strictly confidential.

A $500 set-up fee for establishing the UB-04 electronic transmission and $500 after completion of each year of data collection.

Health care staff who are HIM professionals are eligible for CEU credit after completion of an on-line module at www.cdc.gov/nchs/continuing_education.htm

We are asking for your participation in NHCS (continued)

•Your hospital will receive a $500 set-up fee for establishing the UB-04 electronic transmission protocol and will receive $500 after completion of each year of data collection.

•In addition, health care staff who specialize in health information management are eligible to receive continuing education credit for completing a short on-line couse that describes the National Hospital Care Survey. The CEU credits have been approved for use in fulfilling the continuing education requirements of the American Health Information Management Association and the Healthcare Information and Management Systems Society.

How was my health care facility chosen?

A sample of all hospitals in the United States was chosen to represent different kinds of hopsitals.

We cannot replace your facility with another, as this would introduce a bias into the data we collect.

Your hospital was selected as part of random probability sample from all non-federal, non-institutional hospitals in the United States. Your facility was chosen to provide representative data not only for its services but also for those hospitals and ambulatory care centers of similar size, service type, and geographical location.

Without your participation, neither your facility nor others like yours can benefit from being represented in the national description of hospital and ambulatory surgery center utilization. This would severely hinder the quality of estimates about the amount and types of hospital and ambulatory surgery care provided nationwide.

Response rate for NHCS

Although facility participation in the NHCS is voluntary, in similar studies, over 90% of hospitals asked agreed to participate.

A sample of hospitals has been drawn for this new survey and we hope to achieve comparable results.

Read bullets on the slide.

What is involved in participation?

Inpatient component starting in 2011:

Speaking with NCHS contractor staff to learn about the study and answer a few questions about your hospital.
Agreeing to participate.
Identifying a primary contact within the hospital who will coordinate the transmission of UB-04 data on a quarterly basis for all inpatient discharges.

In the next 3 slides, I will briefly describe what your participation means:

To participate in NHCS we are asking you to do the following as part of the 2011 Inpatient component:

Speak with National Center for Health Statistics contractor staff to learn about the study and answer a few questions about your hospital.

Agree to participate.

And finally identify a primary contact within the hospital who will coordinated the transmission of UB-04 data on a quarterly basis for all inpatient discharges.

What is involved in participation?
(continued)

Working with NCHS’s contractor to establish procedures for transferring electronic UB-04 data to a secure server.
Providing additional information about the characteristics of the hospital by answering a self-administered facility questionnaire.
Occasionally participating in special studies.

Work with NCHS’s contractor to establish procedures for transferring electronic UB-04 claims data to a secure server.

Provide additional information about the characteristics of the hospital by answering a self-administered facility questionnaire.

You may be asked occasionally to participate in special studies.

What is involved in participation? (continued)

In 2013 inpatient and ambulatory components:

Continuing to provide UB-04 data on a quarterly basis for all inpatients discharged from the hospital.
Providing information to determine whether your hospital’s EDs, OPDs, and ASCs are eligible for participation.

Starting in 2013, an ambulatory component will be added to the inpatient component:

Hospitals will continue to provide electronic submission of UB-04 claims data on a quarterly basis for all inpatients discharged.

In addition they will be asked to provide information to allow NCHS to determine whether the hospital’s emergency department, outpatient departments, and ambulatory surgery locations are eligible for participation.

What is involved in participation? (continued)

Identifying contacts within your facility who will be responsible for enrolling the ambulatory units in NHCS.
Providing additional information about the sampled EDs, OPDs, and ASCs by answering a self-administered facility questionnaire.
Allowing abstraction and limited re-abstraction of medical records data.

Additionally, hospitals will be asked to identify contacts within their facilities who will be responsible for enrolling the ambulatory units in NHCS.

The contacts will be asked to provide additional information about the characteristics of emergency departments, outpatient departments and ambulatory surgery locations that have been sampled by answering a self-administered questionnaire.

A sample of visits to the ambulatory units will be drawn for abstraction and limited re-abstraction of medical records data.

Please note that all activities involved in NHCS will be conducted either at participating hospitals and freestanding ASCs or by telephone.

Work with your hospital to find the best way to transmit the UB-04 data over a secure network.

Take as little of your time as possible.

Promptly answer any questions you have.

NCHS will provide competent, well-trained and experienced staff to

The National Center for Health Statistics and its contractor will provide competent, well-trained and experienced staff to:

•Work with your hospital to find the best way to transmit the UB-04 data over a secure network.

•Take as little of your time as possible.

•Promptly answer any questions you have.

How long will participation take?

2011 inpatient component:

Telephone induction interviews:

about 2 hours

Facility questionnaire:

about 2 hours

Transfer of UB-04 data:

1 hour every reporting period

Participation in NHCS will require time from a primary contact at the hospital.

The primary contact is needed to help ensure that the hospital completes all of the telephone induction interviews, which will take about 2 hours overall.

The contact will also need to facilitate completion of the facility questionnaire, a task that will take about 2 hours.

Finally, the contact will help coordinate the transfer your hospital’s UB-04 data, which is expected to take 1 hour every reporting period.

We will collect patients’ personal identifiers, such as name, address, zip code, social security number, and medical record number.

To adhere to all requirements of federal privacy legislation, we will provide detailed written information for your records explaining your participation in this CDC research.

Patient identifiers

•We will be collecting all UB-04 data including personal identifiers such as name, address, zip code, social security number, and medical record number.

•As part of this process, in order to adhere to all requirements of federal privacy legislation, we will provide you with detailed written information for your records explaining your participation in this CDC research.

Why do we need this identifying information?

To aggregate patient data over time for research purposes.
To link to other sources of data, such as the National Death Index and Medicare and Medicaid data.
To learn more about the geographic and socioeconomic factors that affect patient lives and health by connecting to Census data.

•Having patient identifiers will allow us to aggregate patient data over time for research purposes.

•Collecting patient identifiers will allow us to link NHCS data with the National Death Index, and Medicare and Medicaid data.

Finally, the use of patient identifiers will allow us to learn more about the geographic and socioeconomic factors that affect patient lives and health by combining survey data with Census data.

NCHS safeguards the privacy of data

NCHS law and other privacy laws require us to

- Maintain very strict confidentiality of facility and patient data
- Follow procedures to ensure confidentiality of all provider and patient records
Hospitals may participate in this research while strictly adhering to the requirements of Federal privacy legislation, including HIPAA.

NCHS ‘s law and other privacy laws require us to:

-- Maintain very strict confidentiality of provider and patient data

-- Follow steps/procedures to ensure the privacy of all provider and patient records

•Hospitals may participate in NHCS while strictly adhering to the requirements of federal privacy legislation, including HIPAA's Privacy Rule.

Why should you do this?

Data from hospitals and ambulatory surgery centers such as yours contribute to the nation’s ability to make health care policy.
It is important to the public health community and hospitals to continue to collect national data about people cared for in the nation’s hospitals and ambulatory surgery centers to plan for future services.

•Why should your hospital participate in this survey?

•Hospitals will benefit from having health care data available at the national level.

•It is important to the public health community and hospitals to continue to collect national data about people cared for in the nation’s hospitals in order to plan for future services.

•Contributes to the nation’s ability to make health care policy, and your participation will be a service to the nation.

What is the next step?

Designate a primary contact person

The NCHS contractor will work with the primary contact and the staff he/she recommends to

- Establish procedures for electronic transmission of UB-04 claims data.
- Complete the facility questionnaire

•We will first ask you to designate a primary contact person for us to work with during the national survey.

•The National Center for Health Statistics contractor will work with this contact at your hospital and the staff he/she recommends to establish procedures for the electronic transmission of UB-04 claims data and to complete the facility questionnaire.

Questions

•Now that I have had the opportunity to meet with you and discuss the National Hospital Care Survey, I would like to invite you to participate. Do you have any additional questions for me, or is there anyone else that I need to meet to with to obtain approval for participation?

•I am really looking forward to getting started. Could you identify the person who will serve as your hospital’s primary contact? If possible, could I meet with him/her today?

•If you need more time to consider your decision about participating in the NHCS or if you think of additional questions after I have left, you can contact me  Hand out business cards.

Thank you so much!

Hope we can count on you!

Notice - Public reporting burden for this collection of information is estimated to average 1 hour per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to: CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0212).

Assurances of Confidentiality –All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).

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