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.

Comparability between the rates for all-listed inpatient procedures using National Hospital Discharge Survey and Medicare claims, 1999 and 2007.

OBJECTIVES: This report examines the comparability between the rates of inpatient procedures for persons aged 65 and over using the National Hospital Discharge Survey (NHDS) and Medicare claims data. METHODS: The estimates in this report are based on data from NHDS and Medicare claims submitted by hospital providers for inpatient stays among Part A fee-for-service Medicare beneficiaries aged 65 and over. The discharge rates, selected procedures rates, and comparability ratios are reported for older men and women, by age and sex, for 1999 and 2007. RESULTS: Between 1999 and 2007, observed decreases in discharge rates and in all-listed procedure rates derived from NHDS were not significant, while Medicare discharge rates decreased and procedure rates increased significantly. In 1999 and 2007, no statistically significant differences were found between NHDS and Medicare estimates for discharge rates in the age-sex groups examined except for those aged 85 and over. In both years, the comparability ratios between Medicare and NHDS procedure rates were significantly different from one for about 50% of selected procedures, and ranged from 1.12 to 1.26 in 1999 and from 1.16 to 1.41 in 2007. This reflects more procedures recorded in 1999 and 2007 in Medicare data per discharge. The comparability ratio was higher for most of the cardiac procedures, and in general, was closer to one when fewer procedures were performed per discharge and for procedures with lower utilization rates.

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: 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.

Use and in-hospital mortality associated with two cardiac procedures, by sex and age: national trends, 1990-2004.

This study used data from the National Hospital Discharge Survey to examine sex- and age-specific trends in use and in-hospital mortality associated with coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) among adults age forty-five and older during 1990-2004. Although use rates for PCI increased 58 percent over the study period, CABG use rates declined. In-hospital death rates declined or stayed the same even though comorbidities increased for patients who received the procedures. PCI and CABG use rates for men were at least twice those for women, although women generally had more comorbidities and higher in-hospital death rates.

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.

Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003.

US hospital discharges for which Clostridium difficile-associated disease (CDAD) was listed as any diagnosis doubled from 82,000 (95% confidence interval [CI] 71,000-94,000) or 31/100,000 population in 1996 to 178,000 (95% CI 151,000-205,000) or 61/100,000 in 2003; this increase was significant between 2000 and 2003 (slope of linear trend 9.48; 95% CI 6.16-12.80, p = 0.01). The overall rate during this period was severalfold higher in persons >65 years of age (228/100,000) than in the age group with the next highest rate, 45-64 years (40/100,000; p < or = 0.001). CDAD appears to be increasing rapidly in the United States and is disproportionately affecting older persons. Clinicians should be aware of the increasing risk for CDAD and make efforts to control transmission of C. difficile and prevent disease.

Infectious disease hospitalizations among older adults in the United States from 1990 through 2002.

BACKGROUND: To understand conditions associated with substantial morbidity among older adults (aged > or = 65 years), we describe hospitalization rates and trends for overall infectious disease (ID) and for specific ID groups among older adults in the United States from January 1, 1990, through December 31, 2002. METHODS: The National Hospital Discharge Survey was used to generate hospitalization estimates from 1990 through 2002 for the US population of older adults. By using a comprehensive list of International Classification of Diseases, Ninth Revision, Clinical Modification codes associated with IDs, we identified and analyzed hospitalizations associated with specific ID and ID-related categories. RESULTS: There were approximately 21.4 million (SE, 636 000) ID hospitalizations among older adults from 1990 through 2002, and between 1990 through 1992 and 2000 through 2002, the ID hospitalization rate increased 13% from 449.4 to 507.9 hospitalizations per 10 000 older adults (P = .01). This increase was caused in part by the increasing relative contributions of patients aged 75 through 84 years and 85 years or older to the older adult ID hospitalization rate. Almost half of ID hospitalizations (46% [SE, 0.7%]) and ID-related hospital deaths (48% [SE, 1.6%]) among older adults were associated with lower respiratory tract infections from 2000 through 2002. CONCLUSIONS: The hospitalization rate for IDs increased slightly among the older adult US population during the 13-year study and was associated with the aging of the older adult population. The reduction of ID hospitalization rates among older adults could help attenuate the anticipated increase in the number of hospitalizations among older adults and should be a high priority given the projected population growth among older adults in the United States.

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.

Gastric bypass as treatment for obesity: trends, characteristics, and complications.

OBJECTIVE: This paper describes national trends in gastric bypass procedures from 1998 through 2003 and explores the demographic and health profile of those who receive this procedure. Short-term outcomes such as length of stay and in-hospital complication rates are also examined. RESEARCH METHODS AND PROCEDURES: Data on obese hospital inpatients who had gastric bypass were obtained from the 1998 to 2003 National Hospital Discharge Survey. Gastric bypass was reported for an estimated 288,000 discharges during the 6-year study period. Trends within the 6-year period were tested using weighted regression. Characteristics of gastric bypass patients were compared with those of other inpatients using a chi(2) test of independence and the two-sided t test. RESULTS: The estimated number of hospital discharges with gastric bypass increased significantly, from 14,000 in 1998 to 108,000 in 2003. During this period, the average length of stay declined by 56% from 7.2 to 3.2 days. Gastric bypass patients were primarily women (84%), 25 to 54 years of age (82%), and privately insured (76%). A 1 in 10 complication rate was found for discharges with gastric bypass. DISCUSSION: Gastric bypass procedures in the United States have increased rapidly since 1998, whereas the average hospital stay has decreased. The decreasing length of stay needs to be evaluated in conjunction with potential complication rates and the permanent change in anatomy and lifestyle that must accompany this procedure. Monitoring trends in use of this procedure is important, especially if reimbursement policies change and the epidemic of obesity continues.

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.

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.