Rural residents who are hospitalized in rural and urban hospitals: United States, 2010.

In 2010, 17% of the U.S. population lived in rural (nonmetropolitan) areas. Many rural areas are medically underserved due to physician (especially specialist) shortages. Rural hospitals often are small, with a low volume of services, and have difficulty remaining financially viable under the regular hospital prospective payment system. Special Medicare hospital payment categories have been established so that rural residents have access to hospital care without traveling to urban areas. The share of rural residents' hospitalizations that take place in urban (metropolitan) compared with rural hospitals has been of interest for a number of years. Those who go to urban hospitals have been described as "bypassing" rural hospitals. This data brief compares characteristics of rural residents who stay in rural areas with those who travel to urban areas for their inpatient care.

Rural and urban hospitals' role in providing inpatient care, 2010.

KEY FINDINGS: Data from the National Hospital Discharge Survey, 2010. In 2010, 12% of the 35 million U.S. hospitalizations were in rural hospitals. A higher percentage of inpatients in rural hospitals were aged 65 and over (51%) compared with inpatients in urban hospitals (37%). The average number of diagnoses for rural and urban inpatients was similar, as was the average length of stay. Sixty-four percent of rural hospital inpatients, compared with 38% of urban hospital inpatients, had no procedures performed while in the hospital. Following their hospitalization, a higher percentage of rural inpatients (7%) than urban inpatients (3%) were transferred to other short-term hospitals, and a higher percentage of rural (14%) than urban (11%) inpatients were discharged to long-term care institutions.

Trends in inpatient hospital deaths: National Hospital Discharge Survey, 2000-2010.

In 2000, there were 2.4 million deaths in the United States, and in 2010 there were 2.5 million (1,2). In both years, about one-third of these deaths occurred in short-stay, general hospitals (3), despite research that found that most Americans prefer to die in their own homes (4-6). This report presents National Hospital Discharge Survey (NHDS) data from 2000 through 2010 on patients who died during hospitalization.

Hospitalization for congestive heart failure: United States, 2000-2010.

Congestive heart failure (CHF) is a serious medical condition in which the heart cannot pump enough blood to meet the body's needs. CHF is often caused by hypertension, diabetes, or coronary heart disease. It is estimated that 5.8 million people in the United States have CHF (1). CHF is one of the most common reasons those aged 65 and over are hospitalized (2). This report presents National Hospital Discharge Survey (NHDS) data from 2000 through 2010 on hospitalizations for CHF.

Hospitalization for stroke in U.S. hospitals, 1989-2009.

Stroke remains one of the most significant U.S. health problems (6). Although the stroke hospitalization rate has declined, in 2009 there were still almost 1 million hospitalizations for stroke. Many stroke patients, upon discharge, went to another short-stay hospital or a long-term care institution. In addition, outpatient or in-home services (including rehabilitation) are often provided to those who have had a stroke, to prevent future strokes and to restore functioning (6,7). In 2011, the U.S. Department of Health and Human Services announced its "Million Hearts" campaign, which aims to prevent 1 million heart attacks and strokes over the next 5 years (8). Efforts like this are especially important because the baby boomer population is aging into the years when strokes are more common. It is important to continue to track the number and rate of stroke hospitalizations, in order to gauge the effects of campaigns like Million Hearts as well as the effectiveness of provisions in health care legislation (including the Patient Protection and Affordable Care Act) that promote preventive care and coordination of care.

Inpatient care for septicemia or sepsis: a challenge for patients and hospitals.

Septicemia and sepsis are serious bloodstream infections that can rapidly become life-threatening. They arise from various infections, including those of the skin, lungs, abdomen, and urinary tract. Patients with these conditions are often treated in a hospital's intensive care unit. Early aggressive treatment increases the chance of survival. In 2008, an estimated $14.6 billion was spent on hospitalizations for septicemia, and from 1997 through 2008, the inflation-adjusted aggregate costs for treating patients hospitalized for this condition increased on average annually by 11.9%. Despite high treatment expenditures, septicemia and sepsis are often fatal. Those who survive severe sepsis are more likely to have permanent organ damage, cognitive impairment, and physical disability. Septicemia is a leading cause of death. The purpose of this report is to describe the most recent trends in care for hospital inpatients with these diagnoses.

National Hospital Discharge Survey: 2007 summary.

OBJECTIVES: This report presents national estimates of hospital inpatient care in the United States during 2007 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 2007 National Hospital Discharge Survey, an annual national probability sample survey of discharges from nonfederal, general, and short-stay hospitals. Sample data are weighted to produce annual estimates of inpatient care, excluding newborns. Diagnoses and procedures are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification. RESULTS: In 2007, there were an estimated 34.4 million hospital discharges, excluding newborns. The total hospitalization rate leveled off from 1995 to 2007 after declining during the period from 1980 to 1995. Throughout the period from 1970 to 2007 the rates for those aged 65 years and over were significantly higher than the rates for the younger groups. Although those aged 65 years and over accounted for only 13 percent of the total population, they comprised 37 percent of hospital discharges and 43 percent of hospital days. One-quarter of inpatients under age 15 years were hospitalized for respiratory diseases. There were 45 million inpatient procedures during 2007 and 15 percent of these were cardiovascular. Males aged 45-64 and 65 years and over had higher cardiac catheterization rates than females in these age groups each year from 1997 to 2007. From 2002 to 2007 the rate of inpatient cardiac catheterization procedures declined.

Factors influencing rural residents' utilization of urban hospitals.

OBJECTIVE: To examine, using nationally representative data, which patient, hospital, and county characteristics influence rural residents' urban hospitalization. METHODS: Rural residents hospitalized in urban hospitals (crossovers) are compared with those hospitalized in rural hospitals (noncrossovers). National Hospital Discharge Survey data were merged with Area Resource File and Centers for Medicare & Medicaid Services data to study rural inpatients' characteristics; hospital descriptors; and county or state socioeconomic and health service variables. Multivariate logistic regression analysis identified covariates of the likelihood of being a crossover. FINDINGS: About one-third of the rural resident hospitalizations in 2003 were in urban hospitals. Other factors constant, those requiring greater resources had higher odds of crossing over, as did younger inpatients, those transferred from other hospitals, receiving surgery, and with mental diagnoses or congenital anomalies. Males, emergency admissions, and intervertebral disk disorder inpatients had lower odds of crossing over compared with those who were not in these categories. Crossover patients' hospitals had higher Medicare case mix indices than hospitals used by noncrossovers. Rural inpatients in government hospitals, rather than proprietary or non-profit hospitals, had greater odds of crossing over, as did rural patients from counties with lower population density, fewer hospital beds, more hospitals, more commuters, and lower per capita income compared with those in other categories. CONCLUSIONS: Rural hospitals continue to be an important source of inpatient care, but rural residents travel to urban hospitals in some specific instances.

National hospital discharge survey: 2004 annual summary with detailed diagnosis and procedure data.

OBJECTIVES: This report presents 2004 national estimates and selected trend data on the use of nonfederal 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 2004, data were collected for approximately 371,000 discharges. Of the 476 eligible nonfederal short-stay hospitals in the sample, 439 (92 percent) responded to the survey. RESULTS: An estimated 34.9 million inpatients were discharged from nonfederal short-stay hospitals in 2004. They used 167.9 million days of care and had an average length of stay of 4.8 days. Hospital use by age ranged from 4.3 million days of care for patients 5-14 years of age to 31.8 million days of care for 75-84 year olds. Almost a third of patients 85 years and over were discharged from hospitals to long-term care institutions. Diseases of the circulatory system was the leading diagnostic category for males. Childbirth was the leading category for females, followed by circulatory diseases. The proportion of HIV discharges who were 40 years of age and over increased from 40 percent in 1995 to 67 percent in 2004. The rate of cardiac catheterizations was higher for males than for females and higher for patients 65-74 and 75-84 years of age than for older or younger groups. The average length of stay for both vaginal and cesarean deliveries decreased from 1980 through 1995 but stays for vaginal deliveries increased 24 percent during the period from 1995 to 2004.

Inpatient care in rural hospitals at the beginning of the 21st century.

CONTEXT: National data documenting the role that rural hospitals play in providing inpatient care to patients both younger than 65 and 65 years and older has previously been unavailable. PURPOSE: To present descriptive nationally representative data on the numbers and types of inpatients, and the care they received, in rural hospitals. METHODS: This study includes inpatient data from the 2001 National Hospital Discharge Survey, a nationally representative survey of short-stay, nonfederal hospitals in the United States. Inpatients in rural hospitals were compared to those in urban hospitals in terms of demographic and clinical characteristics and patterns of utilization. Among the variables examined were age, number and type of diagnoses, avoidable hospitalizations, comorbidity, procedures received, source of payment, average length of stay, and discharge disposition. FINDINGS: Seventeen percent (5.7 million) of hospitalizations were in rural hospitals in 2001 and a similar percent of the US population lived in rural areas. Rural hospitals provided 23 million days of inpatient care and 4.7 million inpatient procedures. Despite the emphasis placed on Medicare's role in supporting rural hospitals, half of rural hospital inpatients were younger than 65 years. Rural hospital inpatients had shorter average stays and received fewer procedures on average. Seven percent of rural hospital inpatients were transferred to other short-stay hospitals. CONCLUSIONS: National data on the broad scope of patients served and inpatient services provided by rural hospitals illustrate one important role these hospitals play in serving rural communities.