Telehealth and Public Health Practice in the United States-Before, During, and After the COVID-19 Pandemic.

Telehealth is the use of electronic information and telecommunication technologies to provide care when the patient and the provider are not in the same room at the same time. Telehealth accounted for less than 1% of all Medicare Fee-for-Service outpatient visits in the United States in 2019 but grew to account for 46% of all visits in April 2020. Changes in reimbursement and licensure policies during the COVID-19 pandemic appeared to greatly facilitate this increased use. Telehealth will continue to account for a substantial portion of care provided in the United States and globally. A better understanding of telehealth approaches and their evidence base by public health practitioners may help improve their ability to collaborate with health care organizations to improve population health. The article summarizes the Centers for Disease Control and Prevention's (CDC's) approach to understanding the evidence base for telehealth in public health practice, possible applications for telehealth in public health practice, and CDC's use of telehealth to improve population health.

COVID-19 Pandemic Impact on the National Health Care Surveys.

While underscoring the need for timely, nationally representative data in ambulatory, hospital, and long-term-care settings, the COVID-19 pandemic posed many challenges to traditional methods and mechanisms of data collection. To continue generating data from health care and long-term-care providers and establishments in the midst of the COVID-19 pandemic, the National Center for Health Statistics had to modify survey operations for several of its provider-based National Health Care Surveys, including quickly adding survey questions that captured the experiences of providing care during the pandemic. With the aim of providing information that may be useful to other health care data collection systems, this article presents some key challenges that affected data collection activities for these national provider surveys, as well as the measures taken to minimize the disruption in data collection and to optimize the likelihood of disseminating quality data in a timely manner. (Am J Public Health. 2021;111(12):2141-2148. https://doi.org/10.2105/AJPH.2021.306514).

Telemedicine Use Among Physicians by Physician Specialty: United States, 2021.

The 2019 novel coronavirus (COVID-19) pandemic led to an increase in telemedicine use among physicians, from 15.4% in 2019 to 86.5% in 2021 (1-4). Interest has increased in how telemedicine has affected a physician's ability to deliver quality care similar to an in-person office visit, and in technological barriers to telemedicine use (5). This report describes telemedicine use and challenges among physicians sampled in the 2021 National Electronic Health Records Survey. This report builds upon previous work (4) and describes the use of telemedicine, ability to provide quality care during telemedicine visits, satisfaction with telemedicine, and appropriateness of telemedicine use by physician specialty type.

Emergency Department Visits Related to Mental Health Disorders Among Adults, by Race and Hispanic Ethnicity: United States, 2018-2020.

Objective-This report describes emergency department (ED) visits related to mental health disorders among adults and assesses differences in mental health-related ED visit characteristics by race and Hispanic ethnicity.

National Hospital Care Survey Demonstration Projects: Examination of Inpatient Hospitalization and Risk of Mortality Among Patients Diagnosed With Pneumonia.

Objective-This report demonstrates the ability of data from the National Hospital Care Survey (NHCS) linked to the National Death Index (NDI) to provide information on inpatient hospitalizations and in-hospital and post-acute mortality among patients hospitalized for a specific condition, in this case pneumonia.

National Hospital Care Survey Demonstration Projects:Characteristics and Mortality Outcomes of Opioid-involved Hospital Encounters With Co-occurring Disorders.

This report demonstrates the use of National Hospital Care Survey (NHCS) data to describe characteristics of patients experiencing opioid-involved hospital encounters with co-occurring disorders, defined as lifetime diagnoses of both a substance use disorder (SUD) and a selected mental health issue (MHI), that is, diagnosed at any point in the past or during the present encounter.

National hospital discharge survey: 2006 annual summary.

Objectives-This report presents 2006 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 the International Classification of Diseases, Ninth Revision, Clinical Modification 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 2006, data were collected for approximately 376,000 discharges. Of the 478 eligible nonfederal short-stay hospitals in the sample, 438 (92 percent) responded to the survey. Results-An estimated 34.9 million inpatients were discharged from nonfederal short-stay hospitals in 2006. These discharges used 166.3 million days of care and had an average length of stay of 4.8 days. In 2006, hospitals with under 100 beds accounted for 77 percent of inpatient discharges in nonmetropolitan areas, but only 13 percent of inpatient discharges in metropolitan areas. Forty-three percent of the total days of care were accounted for by persons age 65 and over, although this age group represented only 12 percent of the population. The rate of discharges with a first-listed diagnosis of stroke among persons age 65-74, 75-84, and 85 and over dropped significantly from 1996 to 2006. The leading diagnostic category was diseases of the circulatory system. Among the 8.7 million inpatient discharges age 45-64, 4.2 million (48 percent) had at least one surgical procedure.

Emergency Department Visits Among Adults With Mental Health Disorders: United States, 2017-2019.

Mental health disorders, which include mental illnesses and substance use disorders, are a group of conditions characterized by alterations in thinking, emotions, or behavior (1). In 2019, 61.2 million adults aged 18 and over in the United States had a mental health disorder in the past year (2). This report presents data on emergency department (ED) visits by adults with mental health disorders.

Respiratory Illness Emergency Department Visits in the National Hospital Care Survey and the National Hospital Ambulatory Medical Care Survey.

Purpose-This report compares emergency department (ED) visits for respiratory illness between the 2014 National Hospital Care Survey (NHCS) and the 2014 National Hospital Ambulatory Medical Care Survey (NHAMCS) to determine the potential of researching respiratory illness in EDs with non-nationally representative NHCS data. The 2014 NHCS data linked to records in the 2014-2015 National Death Index (NDI) are also described to provide results on mortality after ED visits for respiratory illness. Methods-For both surveys, encounters with respiratory illness were identified using diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Weighted NHAMCS percentage estimates and their 95% confidence intervals (CIs) are shown for all demographic characteristics. Unweighted NHCS percentages are presented for all demographic and health care characteristics and are compared with weighted NHAMCS percentage estimates and used to report NHCS-only results. Standard errors and CIs are also presented for the NHCS unweighted percentages as a measure of variability. Results-The percentage of NHCS ED visits for respiratory illness fell within NHAMCS measures of statistical variation for overall and specific respiratory illnesses. Additionally, respiratory illness by sex, older age groups, older men, and female patients of all ages fell within these measures. Compared with NHAMCS, NHCS had a higher percentage of ED visits for respiratory illness for both infants (under 1 year) and children (1-17 years) but a lower percentage for adults aged 18-44. NHCS data show that 15.2% of patients with ED visits for respiratory illness were hospitalized and of those hospitalized, 6.6% died within 90 days post-discharge. However, 11.1% of patients admitted to the intensive care unit died within 90 days. Conclusion-Although the 2014 NHCS data are not nationally representative, the data may be used for exploratory analyses and have analytical capabilities that are not available in other hospital surveys.

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

Purpose-This report compares 2014 National Hospital Care Survey (NHCS) emergency department (ED) data with national estimates of ED visits due to opioid use (i.e., "opioid-involved visits") from the 2013-2015 National Hospital Ambulatory Medical Care Survey (NHAMCS) to determine the potential of researching the impact and outcomes of opioid use on hospital EDs with non-nationally representative NHCS data. The 2014 NHCS data are also linked to records in the 2014 and 2015 National Death Index (NDI) to examine mortality after the opioid-involved ED visit. Methods-A previously published algorithm, which uses a list of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes and external-cause-of-injury codes denoting opioid use, was used to identify opioid-involved visits in NHCS and NHAMCS, which are compared by sex and age. Weighted percentage estimates and their 95% confidence intervals (CIs) are shown for all demographic characteristics using NHAMCS data. Unweighted percentages are presented for all demographic and health care characteristics using NHCS data. Standard errors and CIs are also presented for the NHCS unweighted percentages as a measure of variability. Results-The percentage of opioid-involved ED visits from NHCS fell within measures of statistical variation from NHAMCS by sex and several age groups. Less consistency of NHCS results compared with NHAMCS was seen for sex-specific age groups. NHCS has a higher percentage of opioid-involved ED visits and a higher percentage of opioid-involved ED visits for those aged 25-34, but a lower percentage for those aged 25 and under. NHCS data show that 19.2% of patients with any opioid-involved ED visit made two or more such visits, and 1.2% died within 30 days post-discharge.

National Hospital Care Survey Demonstration Projects: Opioid-involved Emergency Department Visits, Hospitalizations, and Deaths.

Objective-This report demonstrates the utility of linking the restricted-use 2014 National Hospital Care Survey (NHCS), 2014-2015 National Death Index (NDI), and 2014-2015 Drug-Involved Mortality (DIM) data to study opioid-involved emergency department (ED) visits, hospitalizations, and mortality within 1 year post-discharge. Example research questions and unweighted results are presented. Results are not nationally representative. Methods-Patient records from the 2014 NHCS with sufficient identifying information were linked to the 2014-2015 NDI and DIM data. Visits were considered opioid-involved if they had International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 304.00-304.02, 304.70-304.72, 305.50-305.52, 760.72, 965.00-965.02, 965.09, 970.1, or E850.0-E850.2 in any diagnosis or external cause of injury code field. Opioid-involved drug overdose deaths were deaths with an International Classification of Diseases, 10th Revision (ICD-10) underlying cause-of-death code of X40-44, X60-64, X85, or Y10-Y14 and a multiple cause code of T40.0-T40.4 or T40.6. Results-In the 2014 NHCS, there were 15,495 patients with an opioid-involved ED-only visit and 24,059 patients with an opioid-involved hospitalization. Of the 20,962 patients with an opioid-involved hospitalization eligible to be linked to NDI, 1,805 died (9%) within 1 year of discharge. Of these deaths, 341 (19%) resulted from a drug overdose. Of drug overdose deaths, 243 (71%) involved an opioid, where 12% died within 30 days post-discharge, 19% within 31-90 days, and 69% within 91-365 days. Opioids most frequently mentioned included heroin (46%), fentanyl (20%), oxycodone (13%), methadone (12%), and morphine (12%). These categories are not mutually exclusive because a death may involve more than one drug. For approximately 22% of patients who died of an opioid-involved drug overdose in 2014, their last ED-only visit or hospitalization was opioid-involved. Conclusion-While the NHCS data are not nationally representative, these unlinked and linked National Center for Health Statistics data allow for exploratory analyses of ED visits, hospitalizations, and associated mortality outcomes.

National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data.

OBJECTIVES: This report presents 2005 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, Ninth Revision, Clinical Modification codes. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey. The survey has been conducted annually since 1965. In 2005, data were collected for approximately 375,000 discharges. Of the 473 eligible nonfederal short-stay hospitals in the sample, 444 (94 percent) responded to the survey. RESULTS: An estimated 34.7 million discharges from nonfederal short-stay hospitals occurred in 2005. Discharges used 165.9 million days of care and had an average length of stay of 4.8 days. Persons 65 years and over accounted for 38 percent of the hospital discharges and 44 percent of the days of care. The proportion of discharges whose status was described as routine discharge or discharged to the patient's home declined with age, from 91 percent for inpatients under 45 years of age to 41 percent for those 85 years and over. Hospitalization for malignant neoplasms decreased from 1990-2005. The hospitalization rate for asthma was the highest for children under 15 years of age and those 65 years of age and over. The rate was lowest for those 15-44 years of age. Thirty-eight percent of hospital discharges had no procedures performed, whereas 12 percent had four or more procedures performed. An episiotomy was performed during a majority of vaginal deliveries in 1980 (64 percent), but by 2005, it was performed during less than one of every five vaginal deliveries (19 percent).

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

This report demonstrates the use of the National Hospital Care Survey (NHCS) for the study of pneumonia inpatient hospitalizations and emergency department (ED) visits. The analysis is based on unweighted data of inpatient and ED encounters from the 2014 NHCS and is intended to illustrate the capabilities of the survey, including the ability to link inpatient hospitalizations or ED visits across settings and with other data sources, once hospital participation allows for nationally representative estimates.

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

This report describes the development of methods to identify emergency department (ED) visits involving substance use. Two different algorithms are compared using claims data from the 2013 National Hospital Care Survey (NHCS), a facility-based survey. While NHCS was designed to produce national estimates, this report is based on 2013 data, which are not nationally representative.

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).

National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data.

OBJECTIVES: This report presents 2003 national estimates and trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to the 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 2003, data were collected for approximately 320,000 discharges. Of the 479 eligible non-Federal short-stay hospitals in the sample, 426 (89 percent) responded to the survey. RESULTS: An estimated 34.7 million inpatients were discharged from non-Federal short-stay hospitals in 2003. They used 167.3 million days of care and had an average length of stay of 4.8 days. Females used almost one-third more days of hospital care than males. Patients with five or more diagnoses rose from 29 percent of discharges in 1990 to 57 percent in 2003. The leading diagnostic category was respiratory diseases for children under 15 years, childbirth for 15-44 year olds, and circulatory diseases for patients 45 years of age and over. Only surgical procedures were performed for 27 percent of discharges, 18 percent had surgical and nonsurgical procedures, and 16 percent had only nonsurgical procedures. A total of 664,000 coronary angioplasties were performed, and stents were inserted during 86 percent of these procedures with drug-eluting stents used in 28 percent. The number and rate of total and primary cesarean deliveries rose from 1995 to 2003. The rate of vaginal birth after cesarean delivery dropped 58 percent, from 35.5 in 1995 to 14.8 in 2003.

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.

2004 National Hospital Discharge Survey.

OBJECTIVES: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 2004 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 medical abstract data collected through the 2004 National Hospital Discharge Survey (NHDS). The survey has been conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) since 1965. Diagnoses and procedures presented are coded using 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 and over) increased 24 percent from 1970 through 2004 despite a decrease in the 1980s. The rates for the other age groups declined overall. In 2004, those 65 years and over comprised 12 percent of the U.S. population, 38 percent of all hospital discharges, and used 44 percent of all inpatient days of care. In 2004, there were an estimated 34.9 million hospital discharges, excluding newborn infants. The average length of stay was 4.8 days for all inpatients and 5.6 days for the elderly. Almost one-half of hospital stays for heart disease had a first-listed discharge diagnosis of either congestive heart failure (25 percent) or coronary atherosclerosis (24 percent). There were 45 million procedures performed on inpatients during 2004. From 1995 through 2004, for those 65 years and over, the rate of hip replacements increased 38 percent, and the rate of knee replacements increased 70 percent. One-quarter of all procedures performed on females were obstetrical. Almost one-quarter of all procedures performed on males were cardiovascular.

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.