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HCUP Facts and Figures 2008
Statistics on Hospital-Based Care in the United States, 2008
 
TABLE OF CONTENTS

HIGHLIGHTS

INTRODUCTION

HCUP PARTNERS

1. OVERVIEW

2. DIAGNOSES

3. PROCEDURES

4. COSTS

5. MHSA

SOURCES/METHODS

DEFINITIONS

FOR MORE INFO

ACKNOWLEDGMENTS

CITATION

FACTS & FIGURES 2008 PDF
SOURCES AND METHODS

Unit of Analysis

The unit of analysis is the hospital stay rather than the patient. All discharges have been weighted to produce national estimates.

Coding Diagnoses and Procedures

Diagnoses and procedures associated with an inpatient hospitalization can be defined using several different medical condition classification systems. The Clinical Classifications Software (CCS) was used predominantly within this report to identify specific diagnoses and procedures. CCS is based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), a uniform and standardized coding system containing over 13,600 diagnosis codes and 3,700 procedure codes. Each discharge record in the NIS is associated with one or more ICD-9-CM diagnosis code(s) and may contain one or more ICD-9-CM procedure code(s) if a procedure was performed during that hospitalization. Each hospital stay can have multiple CCS diagnoses and multiple CCS procedures.

In the CCS, ICD-9-CM codes are clustered into a smaller number of clinically meaningful categories that are sometimes more useful for presenting descriptive statistics than are individual ICD-9-CM codes. CCS codes are used extensively in this report to define groups of diagnoses and procedures for analysis. The CCS codes allow the reader to quickly and easily recognize patterns and trends in broad categories of hospital utilization. More information on CCS can be found online (http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp). Specific CCS conditions or diagnoses can also be summarized into CCS body system or condition categories, which are broad groups of CCS conditions, such as Neoplasms, Mental Disorders, and Diseases of the Circulatory System.

Exhibit Diagnoses and Procedures

Throughout this report, combinations of diagnostic and procedure codes are used to isolate specific conditions or procedures. These codes are defined below by exhibit number.

SECTION 1 — OVERVIEW STATISTICS FOR INPATIENT HOSPITAL STAYS

EXHIBIT 1.3

Reasons for hospital stays are based on principal diagnosis defined by the following Major Diagnostic Categories (MDC):

MDC CATEGORY DESCRIPTION
0 Principal diagnosis cannot be assigned to MDC (invalid or pre-MDC)
1 Diseases and disorders of the nervous system
2 Diseases and disorders of the eye
3 Diseases and disorders of the ear, nose, mouth and throat
4 Diseases and disorders of the respiratory system
5 Diseases and disorders of the circulatory system
6 Diseases and disorders of the digestive system
7 Diseases and disorders of the hepatobiliary system and pancreas
8 Diseases and disorders of the musculoskeletal system and connective tissue
9 Diseases and disorders of the skin, subcutaneous tissue and breast
10 Endocrine, nutritional and metabolic diseases and disorders
11 Diseases and disorders of the kidney and urinary tract
12 Diseases and disorders of the male reproductive system
13 Diseases and disorders of the female reproductive system
14 Pregnancy, childbirth and the puerperium
15 Newborns and other neonates with conditions originating in the perinatal period
16 Diseases and disorders of blood, blood forming organs, immunological disorders
17 Myeloproliferative diseases and disorders, poorly differentiated neoplasm
18 Infectious and parasitic diseases, systemic or unspecified sites
19 Mental diseases and disorders
20 Alcohol/drug use and alcohol/drug induced organic mental disorders
21 Injuries, poisonings and toxic effects of drugs
22 Burns
23 Factors influencing health status and other contacts with health services
24 Multiple significant trauma
25 Human Immunodeficiency Virus infections

SECTION 2 — INPATIENT HOSPITAL STAYS BY DIAGNOSIS

EXHIBIT 2.1

Discharges for pregnancy, childbirth and newborn infants were identified as those assigned to Major Diagnostic Category 14 (Pregnancy, childbirth and the puerperium) or as having one of the following CCS diagnosis codes, which constitute total infant discharges:

CCS DIAGNOSIS DESCRIPTION
218 Liveborn infant
219 Short gestation, low birth weight, and fetal growth retardation
220 Intrauterine hypoxia and birth asphyxia
221 Respiratory distress syndrome
222 Hemolytic jaundice and perinatal jaundice
223 Birth trauma
224 Other perinatal conditions

Maternal CCS categories not listed on the exhibit table but included in total maternal discharges:

CCS DIAGNOSIS DESCRIPTION
176 Contraceptive and procreative management
177 Spontaneous abortion
178 Induced abortion
179 Postabortion complications
180 Ectopic pregnancy
181 Other complications of pregnancy
182 Hemorrhage during pregnancy, abruptio placenta, placenta previa
185 Prolonged pregnancy
186 Diabetes or abnormal glucose tolerance complicating pregnancy, childbirth, or the puerperium
187 Malposition, malpresentation
188 Fetopelvic disproportion, obstruction
190 Fetal distress and abnormal forces of labor
194 Forceps delivery
195 Other complications of birth, puerperium affecting management of the mother

SECTION 3 — INPATIENT HOSPITAL STAYS BY PROCEDURE

EXHIBIT 3.1 (graphic)

Childbirth-related hospitalizations were defined using the following Diagnosis Related Groups (DRG) for 1997:

Childbirth-related hospitalizations:

DRG PROCEDURE DESCRIPTION
370 Cesarean section with complications and comorbidities
371 Cesarean section without complications and comorbidities
372 Vaginal delivery with complicating diagnoses
373 Vaginal delivery without complicating diagnoses
374 Vaginal delivery with sterilization and/or dilation and curettage
375 Vaginal delivery with operating room procedure except sterilization and/or dilation and curettage

Childbirth-related hospitalizations were defined using the following Diagnosis Related Groups (DRG) for 2008:

Childbirth-related hospitalizations:

DRG PROCEDURE DESCRIPTION
765 Cesarean section with complications and comorbidities/mcc
766 Cesarean section without complications and comorbidities/mcc
767 Vaginal delivery with sterilization and/or dilation and curettage
768 Vaginal delivery with operating room procedure except sterilization and/or dilation and curettage
774 Vaginal delivery with complicating diagnoses
775 Vaginal delivery without complicating diagnoses

SECTION 4 — SPENDING FOR INPATIENT HOSPITAL STAYS

EXHIBIT 4.5

See definition for Major Diagnostic Categories (MDC) under Exhibit 1.3 above.

Maternal/neonatal is the sum of MDC 14 (Pregnancy, childbirth and the puerperium) and MDC 15 (Newborns and other neonates with conditions originating in the perinatal period).

SECTION 5 — HOSPITAL CARE FOR MENTAL HEALTH AND SUBSTANCE ABUSE CONDITIONS

EXHIBIT 5.1

MHSA stays were defined by CCS diagnostic codes for principal MH and SA stays.

MH-related disorders:

CCS DIAGNOSIS DESCRIPTION
650 Adjustment disorders
651 Anxiety disorders
652 Attention-deficit/conduct/disruptive behavior disorders
654 Developmental disorders
655 Autism/other childhood disorders
656 Impulse control disorders
657 Mood disorders (bipolar disorders and depression)
658 Personality disorders
659 Schizophrenia/other psychotic disorders
670 Pregnancy-related/other misc. MH disorders

SA-related disorders:

CCS DIAGNOSIS DESCRIPTION
660 Alcohol-related disorders
661 Drug-related disorders

EXHIBIT 5.2

Depression and bipolar disorders were defined by the following ICD-9-CM principal diagnosis codes.

Depression:

ICD-9-CM DIAGNOSIS DESCRIPTION
293.83 Other specified transient mental disorders due to conditions classified elsewhere
296.2 Major depressive disorder, single episode
296.3 Major depressive disorder, recurrent episode
300.4 Dysthymic disorder
311 Depressive disorder, not elsewhere classified

Bipolar disorders:

ICD-9-CM DIAGNOSIS DESCRIPTION
296.0 Bipolar I disorder, single manic episode
296.1 Manic disorder, recurrent episode
296.4 Bipolar I disorder, most recent episode (or current) manic
296.5 Bipolar I disorder, most recent episode (or current) depressed
296.6 Bipolar I disorder, most recent episode (or current) mixed
296.7 Bipolar I disorder, most recent episode (or current) unspecified
296.8 Other and unspecified bipolar disorder
296.9 Other and unspecified episodic mood disorder

EXHIBIT 5.7, 5.10, 5.11

Pregnancy -related MH disorders were defined by the following ICD-9-CM principal diagnosis code:

ICD-9-CM DIAGNOSIS DESCRIPTION
648.4 Complications in pregnancy, mental disorders

EXHIBIT 5.11

Alcohol-related and drug-related disorders were defined by the following ICD-9-CM principal diagnosis codes:

ICD-9-CM DIAGNOSIS DESCRIPTION
291 Alcohol induced mental disorders
292 Drug induced mental disorders
303 Alcohol dependence syndrome
304 Drug dependence
305.0 Non-dependent abuse of alcohol
305.2-305.9 Non-dependent abuse of illicit/legal drugs

EXHIBIT 5.12

In addition to the MHSA diagnoses listed in Exhibit 5.1, emergency department MHSA visits included:

CCS DIAGNOSIS DESCRIPTION
662 Suicide/intentional self-inflicted injury

 

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Internet Citation: Facts and Figures 2008 - Sources and Methods. Healthcare Cost and Utilization Project (HCUP). October 2010. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/factsandfigures/2008/sources_methods.jsp.
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