National Hospital Care Survey Demonstration Projects: Traumatic Brain Injury.

Purpose-This report demonstrates the analytical potential of the National Hospital Care Survey (NHCS) through a case study of inpatient discharges and ambulatory visits for traumatic brain injury (TBI) based on unweighted data from the 2013 NHCS of inpatient and emergency department (ED) encounters and the 2013 and 2014 NHCS for outpatient department (OPD) encounters.

Hospitalizations for patients aged 85 and over in the United States, 2000-2010.

KEY FINDINGS: Data from the National Hospital Discharge Survey. In 2010, adults aged 85 and over accounted for only 2% of the U.S. population but 9% of hospital discharges. From 2000 through 2010, the rate of hospitalizations for adults aged 85 and over declined from 605 to 553 hospitalizations per 1,000 population, a 9% decrease. The rate of fractures and other injuries was higher for adults aged 85 and over (51 per 1,000 population) than for adults aged 65-74 (9 per 1,000 population) and 75-84 (23 per 1,000 population). Adults aged 85 and over were less likely than those aged 65-74 and 75-84 to be discharged home and more likely to die in the hospital. From 2000 through 2010, the number of adults aged 85 and over in the United States rose 31%, from 4.2 million to 5.5 million, and in 2010, this age group represented almost 14% of the population aged 65 and over (1). It is estimated that by 2050, more than 21% of adults over age 65 will be aged 85 and over (2). Given this increase, adults aged 85 and over are likely to account for an increasing share of hospital utilization and costs in the coming years (3). This report describes hospitalizations for adults aged 85 and over with comparisons to adults aged 65-74 and 75-84.

Record matching between the National Hospital Care Survey and the National Death Index.

Linking the National Hospital Care Survey (NHCS) with the National Death Index (NDI) provides information on the outcomes of hospitalizations and allows for analysis of individual and provider characteristics associated with in-hospital and post-discharge mortality. We test the viability of confirming hospital mortality through the linkage of preliminary 2011 NHCS data for "known dead" inpatient discharges (i.e., patients that died during a hospitalization) with the NDI, assessing the true match rate and the quality of the match. We then expand the analysis to identify patients with a 30-, 60-, and 90-day post-discharge mortality. The true match rate for the "known dead" is 94 percent.

Pulmonary hypertension surveillance: United States, 2001 to 2010.

Pulmonary hypertension (PH) is an uncommon but progressive condition, and much of what we know about it comes from specialized disease registries. With expanding research into the diagnosis and treatment of PH, it is important to provide updated surveillance on the impact of this disease on hospitalizations and mortality. This study, which builds on previous PH surveillance of mortality and hospitalization, analyzed mortality data from the National Vital Statistics System and data from the National Hospital Discharge Survey between 2001 and 2010. PH deaths were identified using International Classification of Diseases, Tenth Revision codes I27.0, I27.2, I27.8, or I27.9 as any contributing cause of death on the death certificate. Hospital discharges associated with PH were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes 416.0, 416.8, or 416.9 as one of up to seven listed medical diagnoses. The decline in death rates associated with PH among men from 1980 to 2005 has reversed and now shows a significant increasing trend. Similarly, the death rates for women with PH have continued to increase significantly during the past decade. PH-associated mortality rates for those aged 85 years and older have accelerated compared with rates for younger age groups. There have been significant declines in PH-associated mortality rates for those with pulmonary embolism and emphysema. Rates of hospitalization for PH have increased significantly for both men and women during the past decade; for those aged 85 years and older, hospitalization rates have nearly doubled. Continued surveillance helps us understand and address the evolving trends in hospitalization and mortality associated with PH and PH-associated conditions, especially regarding sex, age, and race/ethnicity disparities.

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.