Vital and health statistics. Series 13, Data from the National Health Survey最新文献

Objective: This report presents statistics on ambulatory care visits to physician offices, hospital outpatient departments, and hospital emergency departments. Ambulatory medical care utilization is described in terms of patient, practice, facility, and visit characteristics. Office-based care is further subdivided into the categories of primary care, surgical specialties, and medical specialties.

Methods: Data from the 2001 and 2002 National Ambulatory Medical Care Surveys (NAMCS) and National Hospital Ambulatory Medical Care Surveys (NHAMCS) were combined to produce averaged annual estimates of ambulatory medical care utilization.

Results: Patients in the United States made an estimated 1.1 billion visits per year in 2001 and 2002 (annual average) to physician offices, hospital outpatient departments, and emergency departments, a rate of 3.8 visits per person annually. This marks the first time that the annual estimate of visits has surpassed the billion mark and is also a significant increase from the 1999-2000 estimate. The change was primarily driven by a jump in the number of visits to primary care physicians. The distribution of visits by patient age, sex, race, expected source of payment, geographic region, and whether the visit occurred in a metropolitan statistical area (MSA) varied across ambulatory care settings. Females had higher visit rates than males to all settings except office-based surgical specialists and emergency departments (ED). Black persons had higher visit rates than white persons to hospital outpatient and emergency departments, but lower visit rates to office-based surgical and medical specialists. Visits to emergency departments were more likely to be patient-paid or no charge, possibly reflecting a lack of private health insurance, than were visits to physician offices. Visit rates to office-based medical specialists were more than double in MSAs compared with non-MSAs.

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.

Objective: This report describes ambulatory care visits to physician offices, hospital outpatient departments (OPDs), and hospital emergency departments (EDs) as well as factors that may affect where care is sought. Ambulatory medical care utilization is described in terms of patient, practice/facility, and visit characteristics. Visits to office-based physicians are divided into the categories of primary care, surgical specialties, and medical specialties.

Methods: Data from the 1999 and 2000 National Ambulatory Medical Care Surveys (NAMCS) and National Hospital Ambulatory Medical Care Surveys (NHAMCS) were combined to produce averaged annual estimates of ambulatory medical care utilization. To examine changes over time, current data were compared with data from the 1993 and 1994 NAMCS and NHAMCS.

Results: Patients in the United States made an estimated 979 million visits per year in 1999 and 2000 to physician offices, hospital OPDs, and EDs, an annual rate of 3.6 visits per person. The distribution of visits by patient age, sex, race, expected source of payment, geographic region, and metropolitan statistical area (MSA) status varied across settings. The percentage of visits to office-based primary care physicians was similar for the characteristics studied, but the percentage of visits to office-based surgical and medical specialists varied considerably. Black persons had higher visit rates than white persons to hospital OPDs and EDs but lower rates to office-based surgical and medical specialists. ED visits were more likely to be patient-paid or no charge than were visits to office-based physicians. Visit rates to office-based medical specialists decreased between 1993--94 and 1999--2000. Visit rates increased for hypertension and diabetes diagnoses, as did prescription rates for central nervous system, hormonal, pain relief, and respiratory tract drugs.

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.

Objective: This report describes hospital, community, and patient factors associated with emergency departments (EDs) whose case loads are driven by "safety-net" populations. The study also explores the relationship between safety-net burden and receipt of Medicaid Disproportionate Share Hospital (DSH) Program funds.

Methods: Linked data were analyzed from the 2000 National Hospital Ambulatory Medical Care Survey (NHAMCS), Area Resource File, and reports of Medicaid DSH payments to hospitals. NHAMCS ED visit data were aggregated to the hospital ED level (n = 376). Hospital sampling weights were used to produce national estimates of hospital EDs. Hospitals were classified into high vs. low safety-net burden based on the percent of ED visits where the expected source of payment was Medicaid or uninsured (self-pay or no charge). High- and low-burden EDs were compared along five domains: hospital characteristics; community factors; patient mix; diagnosis mix using Billings' profiling algorithm; and condition severity, visit content, and outcome.

Results: Approximately one-third (36.1 percent) of U.S. EDs were classified as high safety-net burden provides. Hospitals located in the South were more likely to have a high ED safety-net burden (61.3%). High-burden EDs saw a higher percentage of cases that were either nonurgent or emergent, but primary care treatable. EDs high in uninsured burden were not necessarily high in Medicaid burden. Fewer than half of high-burden EDs received DSH payments.

Conclusions: High safety-net burden is not necessarily offset by public funding. The vast majority of EDs that serve high proportions of uninsured patients do not receive such compensation.

Objective: To obtain the maximum benefit from hospice, a person should receive hospice services for at least 30 days. For many Americans, this goal is not being met. This report presents data on hospice care discharges for 2000. Selected trend data are also presented.

Methods: Data are from the National Home and Hospice Care Survey. The data presented are numbers and percents by selected discharge characteristics. Length of service measures include average and median length of service and length of service intervals.

Results and conclusions: There were 621,100 discharges from hospice care in 2000. The typical discharge was elderly, white, lived in a private or semiprivate residence with a caregiver to whom they were related, and died while in hospice care. The primary source of payment was Medicare. Most received three or more services, were seen by three or more service providers, received help from the hospice with at least one activity of daily living (ADL), were incontinent, and had mobility limitation. Cancer is the most common primary admission diagnosis, but the proportion decreased from 75 percent in 1992 to 58 percent in 2000. Most of the discharges did not receive timely care. Sixty-three percent of discharges received hospice care for less than 30 days. The average length of service was 46.9 days, and the median length of service was 15.6 days. Shorter lengths of service occurred for those who were living in institutions, did not receive help from the agency with ADLs, had a lower level of mobility limitation, and had a primary admission diagnosis of cerebrovascular disease. Of the noninstitutionalized discharges, those whose primary caregiver was a spouse had shorter lengths of service than those who were cared for by a child.

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.

Objectives: This report presents 1998 national estimates 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 of hospitals, conditions diagnosed, and surgical and nonsurgical procedures performed. Measurements of hospital use include number and rate of discharges and days of care, and the average length of stay. 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).

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 1998, data were collected for approximately 307,000 discharges. Of the 495 eligible non-Federal short-stay hospitals in the sample, 478 (97 percent) responded to the survey.

Results: An estimated 31.8 million inpatients were discharged from non-Federal short-stay hospitals in 1998. These patients used an estimated 160.9 million days of care. Patients 65 years of age and over accounted for 39 percent of discharges and used 48 percent of days of care. Heart disease and deliveries made up 26 percent of first-listed diagnoses. One or more procedures were reported for 63 percent of discharges. The cesarean rate per 100 deliveries increased from 20.8 in 1995 to 22.5 in 1998. An estimated 3.8 million newborn infants were discharged from short-stay hospitals after average stays of 3.2 days.

Objectives: This report presents estimates of nursing home facilities, their current residents and discharges in the United States. Data are presented on facility characteristics, demographic characteristics, utilization measures, health and functional status of current residents, and discharges.

Methods: Data used in this report are based on data collected from the 1997 National Nursing Home Survey. The survey collects information about providers and recipients of care from nursing home facilities.