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Redesign of the National Hospital Discharge Survey Jane Sisk and Robert Pokras Board of Scientific Counselors May 5, 2006 Division of Health Care Statistics

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  • Redesign of the NationalHospital Discharge SurveyJane Sisk and Robert PokrasBoard of Scientific CounselorsMay 5, 2006Division of Health Care StatisticsNational Center for Health StatisticsCenters for Disease Control and Prevention

  • OverviewProvider and discharge rather than person basedNational probability sample of short-stay non-Federal hospitalsAnnual survey since 19653-stage designprimary sampling unit (PSU) facility dischargeAbout 500 hospitals, 370K discharges per yearAbout 92% response rate, in-scope hospitalsAbout half from automated systems, half from manual abstraction in hospital

  • Data Collected: UB 92 - Hospitals Bed size Sources of revenue Ownership Region - Patients- Clinical management Demographics Days of care Diagnoses Source of admission Insurance status Type of Admission Discharge status Procedures/surgery ZIP code Disposition DRG

  • Used for Policy and ResearchAssessment of quality/safety and disparitiesEpidemiology of specific medical conditionsManagement of specific medical conditionsDiffusion of health-care technologiesEffects of policy changesMonitoring changes over time

  • Hospitalizations by Age, U.S., 1970-2004

  • Coronary Artery Bypass Graft (CABG) and Percutaneous Coronary Intervention (PCI),1980-2002

    19801985199019952000Rate per 10,000 populationPCICABGSOURCE: Hospital Discharge Survey

  • Context of RedesignData elements limited to UB 92 (UB 04)Meeting needs for future policy and research?Comparative advantage given other data sources, e.g., AHRQ statewide discharges from 41 states?

  • Redesign Process So FarTo take a fresh look at future policy and researchissues and associated data needs and gapsInterviews with key stakeholders and users to identify future issues and needs- Provider associations- Providers- Government agencies- Consumer groups- Researchers- Data collectorsScan of other surveys and data sourcesWorking group meeting in March

  • Working GroupRobert BrookChip Kahn RAND Fed. of Am. Hospitals David Carlisle Beth McGlynn Calif. Off. of Statewide Health RAND Planning and DevelopmentKaren MilgateCarolyn Clancy MEDPAC AHRQJohn RolphPaul Ginsberg Univ. of So. Calif. Center for Studying Health Jim Scanlon System Change ASPE Mark HornbrookJulie Sochalski Kaiser-Permanente Portland Univ. of Penn. Center for Health Research

  • Ratings of Priority IssuesCost of care/use of resourcesincluding efficiency/wasteQuality of care/safetyincluding disparitiesCare delivered in the hospitalSurveillance and public healthincluding surge capacityGlobalizationincluding outsourcing

  • Highest Rated Options for RedesignCoordinate with AHRQ data collection (HCUP)Add clinical depth, e.g., medications, testsAdd resource use/cost/billings/paymentsImprove patient demographics, e.g., ethnicityLink to health-related outcomes, e.g., death index

  • Other OptionsTrack disease-specific careSupplement AHRQ's MEPS with medical record data on inpatientsAdd short-stay admissions and observation statusTrack encounters throughout the hospitalFollow patient over timepre and post hospital careepisode of carepatient after dischargeKeep status quoEliminate NHDS

  • Next StepsSummer 2006: Final conceptual framework Selection of strategy and data elements2006-2007: Feasibility test in 9 hospitals2008: Field test2010: New survey fielded