The Nationwide Inpatient SampleEssay
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Health Science
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Dec 6, 2023
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Essay
Introduction
The patient record is the principal repository for information concerning a patient's health care. It
affects, in some way, virtually everyone associated with providing, receiving, or reimbursing health care
services. Despite the many technological advances in health care over the past few decades, the typical
patient record of today is remarkably similar to the patient record of 50 years ago. This failure of patient
records to evolve is now creating additional stress within the already burdened U.S. healthcare system as
the information needs of practitioners,1 patient, administrators, third-party payers, researchers, and
policymakers often go unmet. As described by Ellwood (1988:1550),
The intricate machinery of our health care system can no longer grasp the threads of experience… Too
often, payers, physicians, and health care executives do not share common insights into the life of the
patient… The healthcare system has become an organism guided by misguided choices; it is unstable,
confused, and desperately in need of a central nervous system that can help it cope with the
complexities of modern medicine.
The Nationwide Inpatient Sample (NIS) is a database focused on hospital stay information. Users can use
the NIS to identify, track, and analyze national trends in healthcare utilization, access, charges, quality,
and outcomes.
The NIS is the largest all-payer inpatient care database in the United States, containing
data on more than seven million hospital stays. Its large sample size is ideal for developing national and
regional estimates, and it enables analyses of rare conditions, uncommon treatments, and special
populations. The NIS is the only national hospital database containing charge information on all patients,
regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the
uninsured.
The NIS does NOT contain any identifying information; therefore, it is not suitable for research that
requires the tracking of hospital readmissions, and patient progress.
The National Inpatient Sample (NIS) can be used for research on a variety of topics, including:
Access to care
Quality of care and patient safety
Use and cost of hospital services
Variations in medical practice
Healthcare cost inflation
The remainder of this chapter discusses the current state of patient record systems, including their
strengths and weaknesses, and the environment of opportunity that exists for implementing computer-
based patient records. Chapter 2 delineates the needs of patient record users and describes how future
patient record systems can meet user needs. Chapter 3 identifies technologies essential to future
systems and assesses how well existing systems meet future requirements. Chapter 4 describes
nontechnological barriers to improving patient records and presents a strategic plan for overcoming
them. Finally, Chapter 5 sets forth the committee's recommendations for accelerating the realization of
computer-based patient records and suggests an agenda for their implementation and dissemination
within a decade.
The overall number of discharges for data year 2020 decreased by almost 9 percent from 2019. The
largest decrease was in the second quarter, which had almost 19 percent fewer discharges than the prior
year. There were about 7 percent fewer discharges in the third and fourth quarters and 3 percent fewer
discharges in the first quarter than the previous year. Also, the overall in-hospital mortality rate
increased from 2.0 to 2.8 percent for 2020.
Beginning with data year 2020, COVID-19-related hospitalizations may be identified by any-listed ICD-10-
CM diagnosis code of "U071" (2019 novel coronavirus disease) on the discharge record. Per coding
guidelines, the use of diagnosis code "U071" is based on documentation by the provider or
documentation of a positive COVID-19 test result. The ICD-10-CM diagnosis code for COVID-19 was
implemented beginning April 1, 2020. There may be other ICD-10-CM codes that reflect conditions
related to COVID-19 stays.
NIS
Researchers and policymakers use the NIS to make national estimates of health care utilization, cost,
quality, and outcomes. The NIS contains information on all hospital stays, regardless of expected payer
for the hospital stay. NIS data are available from 1988 through 2020, which allows analysis of trends over
time. The NIS is sampled from the State Inpatient Databases (SID), including all inpatient data that are
currently contributed to HCUP. The number of States participating in the NIS has grown from 8 in the first
year to 48, plus the District of Columbia, at present.
Beginning with the 2012 data year, the NIS approximates a 20-percent stratified sample of all discharges
from U.S. community hospitals, excluding rehabilitation and long-term acute care hospitals. The NIS was
redesigned to improve national estimates. To highlight the design change, beginning with 2012 data,
AHRQ renamed the NIS from the "Nationwide Inpatient Sample" to the "National Inpatient Sample." The
redesign incorporates three major types of changes:
Revisions to the sample design - the NIS is now a sample of discharge records from all HCUP-participating
hospitals, rather than a sample of hospitals from which all discharges were retained.
Revisions to how hospitals are defined - the NIS now uses the definitions of hospitals and discharges
supplied by the statewide data organizations that contribute to HCUP, rather than the definitions used by
the AHA Annual Survey.
Revisions to enhance confidentiality - the NIS now eliminates State and hospital identifiers and other
data elements that are not uniformly available across States.
Dataset Summary
The Nationwide Inpatient Sample is the largest U.S. database of inpatient hospital stays that incorporates
data from all payers, containing data from approximately 20% of U.S. community hospitals.
Started in
1988 and continuing through the present, NIS collects information on a variety of data elements
including diagnoses and procedures, severity adjustment elements (such as APR-DRGs and comorbidity
indicators), admission and discharge status, payment source, hospital organizational characteristics, and
more.
In addition, NIS contains hospital and county identifiers that allow linkage to the American
Hospital Association Annual Survey and Area Resource File (both described elsewhere in this dataset
compendium).
Extensive documentation and resources are available to facilitate data analysis.
Data is
available for download after completing a data use agreement, online training, and for $200 to $350 per
year ($20 to $50 for students).
Refences
Guides. (n.d.). Overview - Accessing the National Inpatient Sample (NIS) Database - Library Research
Guides at New York Medical College.
https://guides.library.nymc.edu/nisdata
.
Hcup-us. (n.d.). HCUP-US NIS Overview.
https://hcup-us.ahrq.gov/nisoverview.jsp
.
Sgim. (n.d.). HCUP Nationwide Inpatient Sample (NIS) | sgim.org.
https://www.sgim.org/communities/research/dataset-compendium/hcup-nationwide-inpatient-sample-
nis#.
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