The Nationwide Inpatient SampleEssay

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Florida State College at Jacksonville *

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1000

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Health Science

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Dec 6, 2023

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docx

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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:

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