Emergency Department Visits by Patients Aged 45 and Over With Diabetes: United States, 2015.

An estimated 30 million Americans have diabetes, of whom 26 million are aged 45 and over (1). Healthy eating and exercise can prevent diabetes progression (1,2). Around 12 million emergency department (ED) visits in 2015 were by patients aged 45 and over with diabetes, representing 24% of ED visits by patients aged 45 and over and 80% of diabetes ED visits by patients of all ages (3). This report presents data on ED visits by patients aged 45 and over with diabetes, defined as visits for which diabetes is mentioned as either a diagnosis or as one of a set of conditions that the patient is reported to have.

Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010.

Objectives-This report presents national estimates of surgical and nonsurgical ambulatory procedures performed in hospitals and ambulatory surgery centers (ASCs) in the United States during 2010. Patient characteristics, including age, sex, expected payment source, duration of surgery, and discharge disposition are presented, as well as the number and types of procedures performed in these settings. Methods-Estimates in this report are based on ambulatory surgery data collected in the 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS has collected outpatient department and emergency department data since 1992 and began gathering ambulatory surgery data from both hospitals and ASCs in 2010. Sample data were weighted to produce annual national estimates. Results-In 2010, 48.3 million surgical and nonsurgical procedures were performed during 28.6 million ambulatory surgery visits to hospitals and ASCs combined. For both males and females, 39% of procedures were performed on those aged 45-64. For females, about 24% of procedures were performed on those aged 15-44 compared with 18% for males, whereas the percentage of procedures performed on those under 15 was lower for females than for males (4% compared with 9%). About 19% of procedures were performed on those aged 65-74, while about 14% were performed on those aged 75 and over. Private insurance was listed as the principal expected source of payment for 51% of ambulatory surgery visits, Medicare for 31% of visits, and Medicaid for 8% of visits. The most frequently performed procedures included endoscopy of large intestine (4.0 million), endoscopy of small intestine (2.2 million), extraction of lens (2.9 million), insertion of prosthetic lens (2.6 million), and injection of agent into spinal canal (2.9 million). Only 2% of visits with a discharge status were admitted to the hospital as an inpatient.

National Hospital Ambulatory Medical Care Survey: 2007 outpatient department summary.

OBJECTIVES: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1997 through 2007, as well as items new to the 2007 survey, are presented. METHODS: The data presented in this report were collected in the 2007 National Hospital Ambulatory Medical Care Survey, a national probability sample survey of visits to emergency departments and OPDs of nonfederal short-stay and general hospitals in the United States. Sample data were weighted to produce annual national estimates. RESULTS: During 2007, an estimated 88.9 million visits were made to hospital OPDs in the United States: about 30.0 visits per 100 persons. Females (36.7 per 100 persons) had higher OPD visit rates than males (23.0 visits per 100 persons). Black or African-American persons (58.4 visits per 100 persons) had higher OPD visit rates than white persons (26.5 visits per 100 persons). Visit rates to OPD clinics for preventive care were highest for children under 1 year of age (39.4 per 100 persons). About a third of all OPD visits (33.2%) were made by patients having Medicaid or the State Children's Health Insurance Program (SCHIP) as an expected source of payment. Medicaid or SCHIP was the source of payment for more than half (56.3%) of OPD visits made by children under age 18. The rate of preventive care visits for patients with Medicaid or SCHIP as an expected source of payment (23.1 per 100 persons) was at least four times higher than for patients having other payment sources (3.3-4.9 per 100 persons). About 82.9% of visits were made by established patients and 17.1% were made by new patients. In 2007, visits to OPDs by new and established patients averaged 5.9 visits during the past 12 months. Essential hypertension was the leading primary diagnosis at OPD visits. Moderate to severe blood pressure elevations were seen more frequently in visits by non-Hispanic or non-Latino patients than Hispanic patients and in visits by black patients compared with white patients.

Use of electronic medical records by ambulatory care providers: United States, 2006.

OBJECTIVES: This report presents 2006 information on adoption of electronic medical records (EMRs) in five ambulatory care settings. Use of EMR systems within these settings is presented by selected provider characteristics. METHODS: Nationally representative estimates are from 2006 provider-based surveys, including the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the National Survey of Ambulatory Surgery (NSAS). RESULTS: In 2006, 62.4 percent of hospital-based ambulatory surgery centers (ASCs) reported using EMR systems, almost triple the percentage reported by freestanding ASCs (22.3 percent). EMR use by hospital emergency departments (EDs) was 46.2 percent, followed by hospital outpatient departments (OPDs) (29.4 percent) and office-based physicians (29.2 percent). Based on items collected in the 2006 NAMCS, NHAMCS, and NSAS, 18.6 percent of hospital-based ASCs, 14.0 percent of hospital EDs, and 10.5 percent of office-based physicians had systems with similar features of a basic system, but only 1.7 percent of hospital EDs and 3.1 percent of office-based physicians had systems with similar features of a fully functional system. Fully functional systems are a subset of basic systems. Physicians in practices with 11 or more physicians were most likely to use EMRs (46.5 percent), whereas physicians in solo practices were least likely to use EMRs (24.0 percent). Use of EMR systems was higher among physicians located in the West (42.3 percent) than in other regions of the country (23.5 percent to 29.3 percent). EMR use did not vary by neighborhood poverty level for any of the ambulatory providers studied. From 2001 through 2005, EMR systems in hospital EDs increased by 47.2 percent. Use of EMRs among office-based physicians increased by 60.4 percent from 2001 through 2006. If those without EMR systems in 2006 with definite plans to install a system actually do so, 85.4 percent of hospital-based ASCs, 72.2 percent of EDs, 62.6 percent of OPDs, 47.3 percent of freestanding ASCs, and 47.0 percent of physicians will be using EMR systems in 2009.

Ambulatory surgery in the United States, 2006.

OBJECTIVES: This report presents national estimates of surgical and nonsurgical procedures performed on an ambulatory basis in hospitals and freestanding ambulatory surgery centers in the United States during 2006. Data are presented by types of facilities, age and sex of the patients, and geographic regions. Major categories of procedures and diagnoses are shown by age and sex. Selected estimates are compared between 1996 and 2006. METHODS: The estimates are based on data collected through the 2006 National Survey of Ambulatory Surgery by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). The survey was conducted from 1994-1996 and again in 2006. Diagnoses and procedures presented are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). RESULTS: In 2006, an estimated 57.1 million surgical and nonsurgical procedures were performed during 34.7 million ambulatory surgery visits. Of the 34.7 million visits, 19.9 million occurred in hospitals and 14.9 million occurred in freestanding ambulatory surgery centers. The rate of visits to freestanding ambulatory surgery centers increased about 300 percent from 1996 to 2006, whereas the rate of visits to hospital-based surgery centers remained largely unchanged during that time period. Females had significantly more ambulatory surgery visits (20.0 million) than males (14.7 million), and a significantly higher rate of visits (132.0 per 1000 population) compared with males (100.4 per 1000 population). Average times for surgical visits were higher for ambulatory surgery visits to hospital-based ambulatory surgery centers than for visits to freestanding ambulatory surgery centers for the amount of time spent in the operating room (61.7 minutes compared with 43.2 minutes), the amount of time spent in surgery (34.2 minutes compared with 25.1 minutes), the amount of time spent in the postoperative recovery room (79.0 minutes compared with 53.1 minutes), and overall time (146.6 minutes compared with 97.7 minutes). Although the majority of visits had only one or two procedures performed (56.3 percent and 28.5 percent, respectively), 2.6 percent had five or more procedures performed. Frequently performed procedures on ambulatory surgery patients included endoscopy of large intestine (5.8 million), endoscopy of small intestine (3.5 million), extraction of lens (3.1 million), injection of agent into spinal canal (2.7 million), and insertion of prosthetic lens (2.6 million). The leading diagnoses at ambulatory surgery visits included cataract (3.0 million); benign neoplasms (2.0 million), malignant neoplasms (1.2 million), diseases of the esophagus (1.1 million), and diverticula of the intestine (1.1 million).

National Hospital Ambulatory Medical Care Survey: 2006 outpatient department summary.

OBJECTIVES: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1996 through 2006, as well as items new to the 2006 survey, are also presented. METHODS: The data presented in this report were collected in the 2006 National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability sample survey of visits to emergency departments (EDs) and OPDs of nonfederal short-stay and general hospitals in the United States. Sample data were weighted to produce annual national estimates. RESULTS: During 2006, an estimated 102.2 million visits were made to hospital OPDs in the United States, about 34.7 visits per 100 persons. Females had higher OPD visit rates (41.2 per 100 persons) than males (28.0 visits per 100 persons). Black or African-American persons had higher OPD visit rates (63.5 visits per 100 persons) than white persons (31.3 visits per 100 persons). Visit rates to OPD clinics for preventive care were highest for children under 1 year of age (43.2 visits per 100 persons). About one-third of OPD visits (31.1%) were made by patients relying on Medicaid or the State Children's Health Insurance Program (SCHIP). The preventive care visit rate for Medicaid or SCHIP patients (23.3 visits per 100 persons) was almost four or more times higher than for patients using other payment sources (3.5 to 6.0 visits per 100 persons). For the first time since the survey began in 1992, diabetes mellitus was the leading primary diagnosis at OPD visits, ahead of essential hypertension. About one-half of OPD visits (51.4%) were made by patients with one or more comorbid chronic conditions. From 1996-2006, the percentage of visits made by adults aged 18 years and over with chronic diabetes increased by 43%, and visits among adults with hypertension as a chronic condition increased by 51%.

2005 National Hospital Discharge Survey.

OBJECTIVES: This report presents national estimates of the use of nonfederal short-stay hospitals in the United States during 2005 and selected trend data. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and by sex. METHODS: The estimates are based on data collected through the 2005 National Hospital Discharge Survey (NHDS). The survey has been conducted annually by NCHS since 1965. Diagnoses and procedures presented are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). RESULTS: Trends in the utilization of nonfederal short-stay hospitals show that the overall average length of a hospital stay has declined significantly. In 2005, the average length of stay for all inpatients was 4.8 days compared with 7.8 days in 1970. Stays for discharges aged 15-44, 45-64 and 65 years and over also declined, but the average lengths of stay for those under 15 years of age were the same in 1970 and 2005. In 2005, there were an estimated 34.7 million hospital discharges, excluding newborn infants. Persons aged 65 years and over comprised 38 percent of all inpatients. One notable trend for elderly people is that their rate of hospitalization for septicemia increased 47 percent from 2000 to 2005. There were 45 million procedures performed on inpatients during 2005. Obstetrical procedures (6.9 million) comprised 25 percent of all procedures performed on females. Cesarean section (18 percent), repair of current obstetric laceration (18 percent), and artificial rupture of membranes (14 percent) accounted for one-half of all obstetrical procedures. Males had more cardiovascular procedures than females (4.1 million compared with 2.9 million), whereas females had more operations on the digestive system than males (3.2 million compared with 2.4 million).

Effects of unfractionated heparin and glycoprotein IIb/IIIa antagonists versus bivalirdin on myeloperoxidase release from neutrophils.

UNLABELLED: OBJECTIVES The objective of this study was to determine whether adjunctive therapy during percutaneous coronary intervention (PCI) affects markers of systemic inflammation or platelet activation. Despite different mechanisms of action, direct-thrombin inhibition with bivalirudin during PCI provided similar protection from periprocedural and chronic ischemic complications as compared with unfractionated heparin (UFH) plus planned use of GPIIb/IIIa antagonists in the REPLACE-2 and ACUITY trials. METHODS AND RESULTS: Patients undergoing nonurgent PCI of a native coronary artery were randomized to receive adjunctive therapy with bivalirudin or UFH+eptifibatide. Interleukin (IL)-6 and C-reactive protein (CRP) transiently increased in both groups after PCI. In the UFH+eptifibatide, but not the bivalirudin group, myeloperoxidase (MPO) levels were elevated 2.3-fold above baseline (P=0.004) immediately after PCI. In an in vitro assay, heparin and to a lesser extent enoxaparin, but not bivalirudin or eptifibatide, stimulated MPO release from and binding to neutrophils and neutrophil activation. A mouse model of endoluminal femoral artery denudation was used to investigate further the importance of MPO in the context of arterial injury. CONCLUSIONS: Adjuvant therapy during PCI may have undesired effects on neutrophil activation, MPO release, and systemic inflammation.

National Hospital Discharge Survey: 2002 annual summary with detailed diagnosis and procedure data.

OBJECTIVES: This report presents 2002 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2002, data were collected for approximately 327,000 discharges. Of the 474 eligible non-Federal short-stay hospitals in the sample, 445 (94 percent) responded to the survey. RESULTS: An estimated 33.7 million inpatients were discharged from non-Federal short-stay hospitals in 2002. They used 164.2 million days of care and had an average length of stay of 4.9 days. Common first-listed discharge diagnoses included delivery, ischemic heart disease, psychoses, pneumonia, and malignant neoplasms. Inpatients had 6.8 million cardiovascular procedures and 6.6 million obstetric procedures. Males had higher rates for cardiac procedures such as cardiac catheterization and coronary artery bypass graft, but males and females had similar rates of pacemaker procedures. The number and rate of all cesarean deliveries, primary and repeat, rose from 1995 to 2002; the rate of vaginal birth after cesarean delivery dropped from 35.5 in 1995 to 15.8 in 2002.

National Hospital Discharge Survey: 2001 annual summary with detailed diagnosis and procedure data.

OBJECTIVES: This report presents 2001 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Admission source and type, collected for the first time in the 2001 National Hospital Discharge Survey, are shown. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2001, data were collected for approximately 330,000 discharges. Of the 477 eligible non-Federal short-stay hospitals in the sample, 448 (94 percent) responded to the survey. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code numbers. Rates are computed with 2001 population estimates based on the 2000 census. The appendix includes a comparison of rates computed with 1990 and 2000 census-based population estimates. RESULTS: An estimated 32.7 million inpatients were discharged from non-Federal short-stay hospitals in 2001. They used 159.4 million days of care and had an average length of stay of 4.9 days. Common first-listed discharge diagnoses included delivery, psychoses, pneumonia, malignant neoplasm, and coronary atherosclerosis. Males had higher rates for procedures such as cardiac catheterization and coronary artery bypass graft, and females had higher rates for procedures such as cholecystectomy and total knee replacement. The rates of all cesarean deliveries, primary and repeat, rose from 1995 to 2001; the rate of vaginal birth after cesarean delivery dropped 37 percent during this period.

2002 National Hospital Discharge Survey.

OBJECTIVES: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 2002 and trend data for selected variables. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and sex. METHODS: The estimates are based on medical abstract data collected through the 2002 National Hospital Discharge Survey. The survey has been conducted annually since 1965 by the National Center for Health Statistics. Diagnoses and procedures presented are coded using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). RESULTS: Trends in the utilization of non-Federal short-stay hospitals show that the average age and age distribution of inpatients has changed dramatically from 1970 through 2002. In 1970, the average age of all inpatients was 40.7 years compared with 52.1 years in 2002. The percent of discharges aged 65 years and over comprised 20 percent of hospital discharges in 1970 whereas they comprised 38 percent in 2002. During this same period, the percent of inpatients under 15 years of age declined from 13 to 8 percent and inpatients 15-44 years of age declined from 43 to 32 percent. The percent of inpatients aged 45-64 years was more stable during these 23 years. In 2002, there were an estimated 33.7 million hospital discharges, excluding newborn infants. The discharge rate was 1,174.6 per 10,000 population. The rate of respiratory disease diagnoses among persons 65 years and over was significantly higher than for other age groups and has risen since 1975. There were 42.5 million procedures performed on inpatients during 2002. About one-quarter of all procedures performed on females were obstetrical. Almost one-quarter of all procedures performed on males were cardiovascular.

2000 National Hospital Discharge Survey.

UNLABELLED: OBJECTIVES; This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 2000. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Discharges are also shown by geographic region of hospital. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and by sex. Trend data for selected variables are also provided. METHODS: The estimates are based on medical abstract data collected through the National Hospital Discharge Survey for 2000. The survey has been conducted annually by the National Center for Health Statistics since 1965. Diagnoses and procedures presented are coded according to the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM. RESULTS: Trends in the utilization of non-Federal short-stay hospitals show that the rate of hospitalization of the elderly (those 65 years of age and over) increased over the entire period from 1970 to 2000, despite a decrease in the 1980s. The rates for the other age groups declined overall. In 2000, there were an estimated 31.7 million discharges of inpatients, excluding newborn infants, from non-Federal short-stay hospitals in the United States. The discharge rate was 1,140.1 per 10,000 population and the average length of stay was 4.9 days. There were 40 million procedures performed on hospital inpatients during 2000. Males had more cardiovascular procedures than females (3.4 million versus 2.5 million), while females had more operations on the digestive system than males (3.0 million versus 2.2 million). About one-quarter of all procedures performed on females were obstetrical.

National Hospital Discharge Survey: 2000 annual summary with detailed diagnosis and procedure data.

OBJECTIVES: This report presents national estimates for 2000 and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by demographic characteristics of patients discharged, geographic region, ownership and bed size of hospitals, principal expected source of payment, conditions diagnosed, and surgical and nonsurgical procedures performed. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey. The survey has been conducted annually by the National Center for Health Statistics since 1965. In 2000, data were collected for approximately 313,000 discharges. Of the 481 eligible non-Federal short-stay hospitals in the sample, 434 (90 percent) responded to the survey. Measurements of hospital use include number and rate of discharges and days of care, and the average length of stay. The population estimates used to compute rates were based on the 1990 Census. Estimates of first-listed diagnoses, days of care, all-listed diagnoses, and all-listed procedures are presented according to their code number in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). RESULTS: An estimated 31.7 million inpatients were discharged from non-Federal short-stay hospitals in 2000. These patients used an estimated 155.9 million days of care. Females had 19.2 million discharges compared with 12.5 million for males. Fifty-four percent of all discharges under age 65 years had a principal expected source of payment from a private source, and 22 percent were covered by Medicaid. Discharge rates per 1,000 population ranged from 85.4 in the West to 135.5 in the Northeast. The leading discharge diagnosis was delivery for patients under age 65 years and heart disease for those 65 years of age and over. The rate of discharges with coronary artery bypass graft for males was 2.4 times the rate for females, and males had almost twice the female rate for discharges with removal of coronary artery obstruction. Hospital stays were 1 day or less for 15 percent of women with deliveries in 2000, compared with 37 percent in 1995.