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HCUP Facts and Figures
Statistics on Hospital-Based Care in the United States, 2005
 

HCUP Facts and Figures

STATISTICS ON HOSPITAL-BASED CARE IN THE UNITED STATES, 2005

TABLE OF CONTENTS


HIGHLIGHTS

HCUP Facts and Figures: Statistics on Hospital-based Care in the United States in 2005 presents information derived from the 2005 HCUP Nationwide Inpatient Sample (NIS) with trend information as far back as 1993. This report includes information from the most recent database containing discharge records for all patients treated in a sample of approximately 1,000 hospitals in 2005. These discharges are weighted to represent all inpatient stays in community hospitals across the nation. Community hospitals include all non-federal, short-term acute care hospitals and exclude psychiatric and substance abuse facilities.

Overall hospital statistics

Childbirth and newborns

Children

Young adults and middle age

Elderly

Specific diagnoses and procedures

Cardiovascular conditions and procedures

Bariatric surgery

Injuries

Musculoskeletal conditions and orthopedic procedures

Diabetes

FOREWORD

The mission of the Agency for Healthcare Research and Quality (AHRQ) is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. To help fulfill this mission, AHRQ develops a number of databases, including the powerful Healthcare Cost and Utilization Project (HCUP). HCUP is a Federal-State-Industry partnership designed to build a standardized, multi-State health data system. HCUP features databases, software tools, and statistical reports to inform policymakers, health system leaders, researchers, and the public.

For data to be useful, they must be disseminated in a timely, accessible manner. To meet this objective, AHRQ launched HCUPnet, an interactive, Internet-based tool for identifying, tracking, analyzing, and comparing statistics on hospital utilization, outcomes, and charges (http://hcupnet.ahrq.gov/). The HCUPnet user-friendly interface guides users in tailoring specific queries about hospital care online; with a click of a button, users receive answers within seconds.

To make HCUP data even more accessible, AHRQ disseminates HCUP Fact Books and online Statistical Briefs to present statistics about hospital care in easy-to-use and accessible formats (http://www.hcup-us.ahrq.gov/reports.jsp). Fact Books provide information on broad aspects of hospital care. The most recent editions cover topics of mental health and substance abuse disorders, procedures performed in hospitals, ambulatory surgeries, and safety-net hospitals. Statistical Briefs provide information on more focused health care topics. The most recent editions address issues of methicillin-resistant Staphylococcus aureus (MRSA) infections, musculoskeletal procedures, emergency department admissions for children and adolescents, childbirth-related hospitalizations among adolescent girls, and prostate cancer.

The most recent addition to HCUP information sources is HCUP Facts and Figures, designed to showcase the wealth of statistics available from HCUP. This edition of HCUP Facts and Figures presents an overview of the information accessible through HCUP and illustrates the types of analyses that HCUP can address. This report also provides updates on many topics presented in previously published Fact Books and Statistical Briefs. New to this report are downloadable tables and graphs to make this information even more readily available.

We invite you to tell us how you are using HCUP Facts and Figures and other HCUP data and tools, and to share suggestions on how HCUP products might be enhanced to further meet your needs. Please e-mail us at hcup@ahrq.gov or send a letter to the address below.

Irene Fraser, Ph.D.
Director
Center for Delivery, Organization, and Markets
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850

HCUP AND ITS DATA PARTNERS

HCUP is a family of powerful health care databases, software tools, and products for advancing research. Sponsored by the Agency for Healthcare Research and Quality (AHRQ), HCUP includes the largest all-payer encounter-level collection of longitudinal hospital inpatient, ambulatory surgery, and emergency department data in the United States. The HCUP Federal-State-Industry Partnership brings together the data collection efforts of many organizations—State data organizations, hospital associations, private data organizations, and the Federal government—to create this national information resource. The HCUP Partnership has grown from 8 states in 1988 to 38 in 2007.

HCUP would not be possible without the current contributions of the following data collection Partners from across the United States:

Arizona Department of Health Services
Arkansas Department of Health & Human Services
California Office of Statewide Health Planning & Development
Colorado Health & Hospital Association
Connecticut Integrated Health Information (Chime, Inc.)
Florida Agency for Health Care Administration
Georgia GHA: An Association of Hospitals & Health Systems
Hawaii Health Information Corporation
Illinois Health Care Cost Containment Council and Department of Public Health
Indiana Hospital&Health Association
Iowa Hospital Association
Kansas Hospital Association
Kentucky Department for Public Health
Maryland Health Services Cost Review Commission
Massachusetts Division of Health Care Finance and Policy
Michigan Health & Hospital Association
Minnesota Hospital Association
Missouri Hospital Industry Data Institute
Nebraska Hospital Association
Nevada Division of Health Care Financing and Policy, Department of Human Resources
New Hampshire Department of Health & Human Services
New Jersey Department of Health & Senior Services
New York State Department of Health
North Carolina Department of Health and Human Services
Ohio Hospital Association
Oklahoma State Department of Health
Oregon Association of Hospitals and Health Systems
Rhode Island Department of Health
South Carolina State Budget & Control Board
South Dakota Association of Healthcare Organizations
Tennessee Hospital Association
Texas Department of State Health Services
Utah Department of Health
Vermont Association of Hospitals and Health Systems
Virginia Health Information
Washington State Department of Health
West Virginia Health Care Authority
Wisconsin Department of Health & Family Services

INTRODUCTION

Accurate and reliable hospital information is of vital importance—for a researcher investigating treatment outcomes, for a newly-diagnosed patient seeking information on the frequency with which procedures are performed, or for hospital executives researching medical trends to support purchasing decisions. The Healthcare Cost and Utilization Project (HCUP) can provide comprehensive information to help fulfill these and other needs.

Sponsored by the Agency for Healthcare Research and Quality (AHRQ), HCUP is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership, creating a national information resource of patient-level discharge health care data.

HCUP is only possible through the collective efforts of State and private data organizations, hospital associations, and the Federal government to create the single largest all-payer discharge record resource from all hospitals in the U.S.—representing more than 4,900 community, non-Federal, short-term (acute care) general and specialty hospitals. Data on conditions treated in the hospital, as well as information on medical and surgical procedures are included. HCUP data are ideal for analyzing treatment use and diagnostic trends, examining patient characteristics, conducting cost and charge studies, and investigating quality of care.

The most popular HCUP database is the Nationwide Inpatient Sample (NIS), the largest all-payer database in the U.S. The NIS contains all discharge records from approximately 1,000 hospitals in HCUP-participating states. This broad-based collection of data provides information on patient and hospital demographics, diagnoses, procedures, charges, estimated costs, payers, source of admission and discharge destinations.

HCUP Facts and Figures highlights the rich potential of HCUP by providing targeted analysis of important trends organized around high-interest topics—hospital and discharge characteristics, diagnoses, procedures, costs and charges, and the uninsured. This report was designed to illustrate the range of information available from the HCUP NIS and its capacity to track the evolution of hospital use over time.

Many of the statistics presented in this report are available online through HCUPnet (http://hcupnet.ahrq.gov/). Graphical presentations, statistical tables, and bulleted notes highlight key facts and emerging trends for each topic. Downloadable tables, charts, and links to Definitions are available online by clicking on links throughout the report. In addition, a separate file containing downloadable tables and charts is available at http://www.hcup-us.ahrq.gov/reports.jsp.

HCUP has been a leader in hospital data and products and continues to be on the forefront of health care research in the 21st century. For more information, please visit the HCUP website at http://www.hcup-us.ahrq.gov.

SECTION 1

OVERVIEW STATISTICS FOR HOSPITALS AND INPATIENT HOSPITAL STAYS

EXHIBIT 1.1 Number and Characteristics of U.S. Hospitals
EXHIBIT 1.2 Inpatient Hospital Stays and Average Length of Stay
EXHIBIT 1.3 Reasons for Hospital Stays
EXHIBIT 1.4 Admission Source
EXHIBIT 1.5 Discharge Status
EXHIBIT 1.6 Patient Age
EXHIBIT 1.7 Expected Primary Payer

EXHIBIT 1.1 Number and Characteristics of U.S. Hospitals

(text version)

Number of U.S. Registered Hospitals and Characteristics of Community Hospitals, 1997, 2004, and 2005

Hospital Categories and Characteristics 1997 2004 2005
Number of U.S. registered hospitals† 6,100 5,759 5,756
Number of U.S. community hospitals 5,060 4,919 4,936
Number of non-government not-for-profit hospitals 3,000 2,967 2,958
Number of investor-owned (for-profit) community hospitals 797 865 868
Number of State and local government community hospitals 1,260 1,117 1,110
Community hospitals as a share of registered hospitals 83% 85% 86%
 
Community hospitals‡      
Discharges:      
Total discharges in millions 34.7 38.7 39.2
Discharges per 1,000 population* 127.8 131.7 132.1
Total days of care in millions 168.1 179.1 181.5
Average length of stay in days 4.8 4.6 4.6
 
Percent of discharges from:      
Metropolitan hospitals 84% 87% 87%
Teaching hospitals 47% 45% 42%
Hospital ownership:      
Non-Federal government hospitals 14% 14% 14%
Private not-for-profit hospitals 73% 73% 72%
Private for-profit hospitals 13% 13% 13%
 
Population in millions†† 271.4 293.7 296.4

† Statistics from the American Hospital Association's Annual Survey of Hospitals.
‡ Statistics from the Healthcare Cost and Utilization Project (HCUP).
* Calculated using population from the U.S. Bureau of the Census.
†† Statistics from the U.S. Bureau of the Census (http://www.census.gov/popest/).

Hospital costs rose rapidly and most hospital characteristics changed slowly over time.

(text version)

Charges and Costs for Community Hospital Stays, 1997, 2004, and 2005

Hospital Categories and Characteristics 1997 2004 2005
Charges and Costs*
Average charges per stay $11,300 $20,400 $22,300
Costs
Total aggregate costs in billions $177.1 $294.6 $310.9
Average costs per stay $5,100 $7,600 $7,900
Inflation-adjusted costs in 2005 dollars**
Total aggregate costs in billions $209.2 $303.5 $310.9
Average costs per stay $6,000 $7,900 $7,900

* Charges represent amounts billed by hospitals. These amounts are seldom paid in full by insurers. Costs are calculated from charges using reported cost-to-charge ratios calculated from information on Medicare Cost Reports, reported by hospitals to the Centers for Medicare and Medicaid Services (CMS).
**Adjusted for inflation using the GDP deflator (http://www.bea.gov/national/nipaweb/TableView.asp#Mid, Table 1.1.4. Price Indexes for Gross Domestic Product).

EXHIBIT 1.2 Inpatient Hospital Stays and Average Length of Stay

(text version)

Exhibit 1.2. Bar chart showing Inpatient Hospital Stays and Average Length of Stay

The average length of stay in U.S. community hospitals has stabilized since 2000, while the number of hospital stays continued to rise.

1Forest S, Goetghebeur M, Hay J. Forces Influencing Inpatient Hospital Costs in the United States. Chicago: Blue Cross Blue Schield Association. 2002.

EXHIBIT 1.3 Reasons for Hospital Stays

(text version)

Exhibit 1.3. Bar chart showing Hospital Stays for Males and Females by Major Reason, 2005

Circulatory conditions were the most frequent causes of hospital stays.

Circulatory conditions represented a higher percentage of stays for males (20 percent) than females (13 percent).

(text version)

Hospital Stays for Males and Females by Major Reason, 2005

EXHIBIT 1.4 Admission Source

(text version)

Exhibit 1.4. Bar chart showing Number and Distribution of Hospital Inpatient Stays by Admission Source, 2005

Admission source in HCUP indicates routine admission and other specific settings from which the patient might enter the hospital.

Exhibit 1.5 Discharge Status

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Exhibit 1.5. Bar chart showing Number and Distribution of Hospital Inpatient Stays by Discharge Status, 2005

Discharge status indicates where the patient went after discharge from the hospital or the circumstance surrounding the discharge.

Exhibit 1.6 Patient Age

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Exhibit 1.6. Bar chart showing Distribution of U.S. Population and Hospital Discharges by Age, 2005

Older people account for a large share of hospitalizations.

(text version)

Exhibit 1.6b. Bar chart showing Discharges per 1,000 US Population by Age Group, 2005

Discharges for an age group divided by the number of people in that age group (discharges per 1,000 population) shows that increased age is often associated with a greater chance of hospitalization.

EXHIBIT 1.7 Expected Primary Payer

(text version)

Exhibit 1.7. Bar chart showing Number of Discharges and Percent Distribution by Expected Primary Payer, 2005

The expected primary payer bears the major financial responsibility for the hospital stay. However, other payers, including the patients themselves, may also bear part of the cost of hospitalization.

SECTION 2

HOSPITAL INPATIENT STAYS BY DIAGNOSIS

EXHIBIT 2.1 Most Frequent Principal Diagnoses
EXHIBIT 2.2 Most Frequent Diagnoses by Age
EXHIBIT 2.3 Most Frequent Diagnoses by Gender
EXHIBIT 2.4 Average Length of Stay and Average Charges
EXHIBIT 2.5 Circulatory Conditions
EXHIBIT 2.6 Diabetes
EXHIBIT 2.7 Pressure Sores
EXHIBIT 2.8 Alcoholism
EXHIBIT 2.9 Mental Health
EXHIBIT 2.10 Injuries
EXHIBIT 2.11 Influenza

EXHIBIT 2.1 Most Frequent Principal Diagnoses

(text version)

Number of Discharges, Percent Distribution, and Rank of Most Frequent Principal Diagnoses for Inpatient Hospital Stays, 1997, 2004, 2005

PRINCIPAL DIAGNOSIS NUMBER OF DISCHARGES IN THOUSANDS PERCENT OF DISCHARGES RANK
1997 2004 2005 1997 2004 2005 1997 2004 2005
All discharges 34,679 38,662 39,164 100.0 100.0 100.0      
Pregnancy, childbirth, and infants 8,237 9,175 9,145 23.8 23.7 23.4 1 1 1
Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 1,232 1,213 1,355 3.6 3.1 3.5 3 2 2
Coronary atherosclerosis (coronary artery disease) 1,407 1,192 1,110 4.1 3.1 2.8 2 3 3
Congestive heart failure, nonhypertensive 991 1,104 1,090 2.9 2.9 2.8 4 4 4
Non-specific chest pain 538 846 825 1.6 2.2 2.1 10 5 5
Osteoarthritis (degenerative joint disease) 418 659 738 1.2 1.7 1.9 17 9 6
Mood disorders (depression and bipolar disorder) 641 792 713 1.8 2.0 1.8 6 6 7
Cardiac dysrhythmias (irregular heart beat) 572 694 697 1.7 1.8 1.8 8 8 8
Acute myocardial infarction (heart attack) 732 695 662 2.1 1.8 1.7 5 7 9
Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones in spinal column) 536 616 647 1.5 1.6 1.7 11 10 10
Chronic obstructive pulmonary disease and bronchiectasis (chronic obstructive lung disease) 551 556 630 1.6 1.4 1.6 9 12 11
Complication of medical device, implant or graft 491 601 616 1.4 1.6 1.6 12 11 12
Skin and subcutaneous tissue infections 330 505 582 1.0 1.3 1.5 24 16 13
Fluid and electrolyte disorders (primarily dehydration or fluid overload) 468 555 574 1.4 1.4 1.5 13 13 14
Septicemia (blood infection, except in labor) 413 452 538 1.2 1.2 1.4 18 21 15
All maternal discharges 4,338 4,763 4,716 100.0 100.0 100.0      
Trauma to external female genitals (vulva) and area between anus and vagina (perineum), related to childbirth 713 785 784 16.4 16.5 16.6 1 1 1
Previous C-section 271 456 481 6.3 9.6 10.2 4 2 2
Normal pregnancy and/or delivery 544 338 325 12.5 7.1 6.9 2 3 3
Early or threatened labor 261 255 236 6.0 5.4 5.0 5 4 4
Fetal distress and abnormal forces of labor 420 247 234 9.7 5.2 5.0 3 5 5
Prolonged pregnancy 104 218 234 2.4 4.6 5.0 11 8 6
Hypertension complicating pregnancy, childbirth and the puerperium (high blood pressure during pregnancy) 185 224 220 4.3 4.7 4.7 8 7 7
Umbilical cord complication 259 235 217 6.0 4.9 4.6 6 6 8
Polyhydramnios and other problems of amniotic cavity (excess amniotic fluid and other problems of amniotic cavity) 202 192 191 4.7 4.0 4.1 7 9 9
All infant discharges 3,899 4,411 4,429 100.0 100.0 100.0      
Liveborn (newborn infant) 3,777 4,249 4,228 96.9 96.3 95.5 1 1 1
Other perinatal conditions (other conditions occurring around the time of birth) 56 72 94 1.4 1.6 2.1 2 2 2
Hemolytic jaundice and perinatal jaundice (infant jaundice following birth) 33 47 57 0.8 1.1 1.3 3 3 3
Short gestation, low birth weight, and fetal growth retardation (premature birth and low birth weight) 22 25 31 0.6 0.6 0.7 4 4 4
Infant respiratory distress syndrome 8 16 16 0.2 0.4 0.4 5 5 5
Birth trauma 1 1 1 0.0 0.0 0.0 7 6 6
Intrauterine hypoxia and birth asphyxia (lack of oxygen to baby in uterus or during birth) 1 1 1 0.0 0.0 0.0 6 7 7
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997, 2004 and 2005.

The top 15 most frequently occurring principal diagnoses accounted for half of all discharges in 2005. While 12 of the 15 most frequent principal diagnoses in 2005 were among the most frequent diagnoses in 1997, there were notable changes within the rankings.

Among all discharges:

Among maternal and infant discharges:

EXHIBIT 2.2 Most Frequent Diagnoses by Age

(text version)

Number of Discharges and Percent Distribution of the Most Frequent Principal Diagnoses by Age, 1997, 2004, 2005

AGE GROUP AND PRINCIPAL DIAGNOSIS NUMBER OF DISCHARGES IN THOUSANDS PERCENT OF DISCHARGES PERCENT OF AGE-SPECIFIC TOTAL DISCHARGES
1997 2004 2005 1997 2004 2005 1997 2004 2005
All ages* 34,679 38,662 39,164            
‹ 1 year 4,426 4,898 4,978 12.8 12.7 12.7 100.0 100.0 100.0
Liveborn (newborn infant) 3,776 4,244 4,223 10.9 11.0 10.8 85.3 86.7 84.8
Acute bronchitis 108 112 107 0.3 0.3 0.3 2.4 2.3 2.2
Hemolytic jaundice and perinatal jaundice (infant jaundice following birth) 33 47 56 0.1 0.1 0.1 0.7 1.0 1.1
Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 55 39 43 0.2 0.1 0.1 1.3 0.8 0.9
Short gestation, low birth weight, and fetal growth retardation (premature birth and low birth weight) 22 25 31 0.1 0.1 0.1 0.5 0.5 0.6
1-17 years 1,821 1,784 2,059 5.3 4.6 5.3 100.0 100.0 100.0
Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 135 108 142 0.4 0.3 0.4 7.4 6.0 6.9
Asthma 159 133 139 0.5 0.3 0.4 8.7 7.4 6.8
Fluid and electrolyte disorders (primarily dehydration or fluid overload) 64 79 98 0.2 0.2 0.3 3.5 4.4 4.8
Appendicitis and other appendiceal conditions 65 82 90 0.2 0.2 0.2 3.6 4.6 4.3
Mood disorders (depression and bipolar disorder) 64 84 73 0.2 0.2 0.2 3.5 4.7 3.6
18-44 years 9,444 10,323 10,041 27.2 26.7 25.6 100.0 100.0 100.0
Trauma to external female genitals (vulva) and area between anus and vagina (perineum), related to childbirth 676 754 753 1.9 2.0 1.9 7.2 7.3 7.5
Previous C-section 270 453 478 0.8 1.2 1.2 2.9 4.4 4.8
Mood disorders (depression and bipolar disorder) 335 416 364 1.0 1.1 0.9 3.5 4.0 3.6
Normal pregnancy and/or delivery 511 323 312 1.5 0.8 0.8 5.4 3.1 3.1
Fetal distress and abnormal forces of labor 399 238 224 1.2 0.6 0.6 4.2 2.3 2.2
45-64 years 6,496 8,546 8,660 18.7 22.1 22.1 100.0 100.0 100.0
Coronary atherosclerosis (coronary artery disease) 526 492 461 1.5 1.3 1.2 8.1 5.8 5.3
Non-specific chest pain 242 396 388 0.7 1.0 1.0 3.7 4.6 4.5
Osteoarthritis (degenerative joint disease) 105 235 272 0.3 0.6 0.7 1.6 2.7 3.1
Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 199 246 271 0.6 0.6 0.7 3.1 2.9 3.1
Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones in spinal column) 190 249 266 0.5 0.6 0.7 2.9 2.9 3.1
65+ years 12,482 13,059 13,374 36.0 33.8 34.2 100.0 100.0 100.0
Congestive heart failure, nonhypertensive 783 820 815 2.3 2.1 2.1 6.3 6.3 6.1
Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 711 713 781 2.0 1.8 2.0 5.7 5.5 5.8
Coronary atherosclerosis (coronary artery disease) 810 641 596 2.3 1.7 1.5 6.5 4.9 4.5
Cardiac dysrhythmias (irregular heart beat) 402 477 469 1.2 1.2 1.2 3.2 3.7 3.5
Osteoarthritis (degenerative joint disease) 300 405 419 0.9 1.0 1.1 2.4 2.9 3.1
Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. *Includes a small number of discharges (less than 55,000 or 0.1 percent) with missing age.

The principal diagnoses for hospitalizations generally varied by age. Older patients were more frequently admitted with cardiovascular and musculoskeletal conditions and younger patients were more frequently admitted with pregnancy- and childbirth-related conditions.

EXHIBIT 2.3 Most Frequent Diagnoses by Gender

(text version)

Number of Discharges,* Percent Distribution, and Rank of Most Frequent Principal Diagnoses for Inpatient Hospital Stays by Gender, 2005

PRINCIPAL DIAGNOSIS MALES FEMALES
NUMBER OF DISCHARGES IN THOUSANDS PERCENT OF MALE DISCHARGES RANK NUMBER OF DISCHARGES IN THOUSANDS PERCENT OF FEMALE DISCHARGES RANK
All diagnoses 16,053 100.0   22,980 100.0  
Pregnancy and childbirth - - - 4,705 20.5 1
Liveborn (newborn infant) 2,160 13.5 1 2,058 9.0 2
Coronary atherosclerosis (coronary artery disease) 691 4.3 2 418 1.8 7
Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 645 4.0 3 708 3.1 3
Congestive heart failure, nonhypertensive 524 3.3 4 566 2.5 4
Acute myocardial infarction (heart attack) 392 2.4 5 270 1.2 20
Non-specific chest pain 365 2.3 6 459 2.0 5
Cardiac dysrhythmias (irregular heart beat) 341 2.1 7 355 1.5 10
Complication of medical device, implant or graft 316 2.0 8 298 1.3 15
Skin and subcutaneous tissue infections 307 1.9 9 273 1.2 19
Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones in spinal column) 304 1.9 10 339 1.5 13
Mood disorders (depression and bipolar disorders) 296 1.8 11 414 1.8 8
Osteoarthritis (degenerative joint disease) 280 1.7 12 455 2.0 6
Urinary tract infections 151 0.9 27 377 1.6 9
Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.
*Excludes a small number of discharges (less than 135,000 or 0.3 percent) with missing gender.

Most diagnoses are common to both males and females if those related to childbirth are excluded. However, some diagnoses were more frequent in one gender, in part because of differences between males and females in health-seeking behaviors and attitudes.

EXHIBIT 2.4 Average Length of Stay and Average Charges

In general, longer lengths of stay are associated with higher average charges. While full charges are seldom paid because of negotiated discounts, they can be used as a benchmark for comparing the costliness of different types of hospital stays.

(text version)

Exhibit 1.7. Bar chart showing Inpatient Hospital Stays for Principal Diagnosis: Number of Discharges, Average Length of Stay and Average Charges, Ordered by Average Length of Stay, 2005

EXHIBIT 2.5 Circulatory Conditions

Although the share of all discharges for circulatory disease was essentially equal between male (51 percent) and female (49 percent) in 2005, the gender share differed according to conditions.

(text version)

Number of Discharges, Percent Distribution, and Rank for the Most Frequent Principal Diagnoses of Circulatory Conditions by Gender, 2005
Principal Diagnosis Total* Male Female
Discharges in Thousands Percent Male Rank for Males Percent Female Rank for Females
All circulatory disease discharges 6,627 51   49  
Coronary atherosclerosis (coronary artery disease) 1,110 62 1 38 3
Congestive heart failure, nonhypertensive 1,090 48 2 52 1
Acute myocardial infarction (heart attack) 662 59 3 41 6
Non-specific chest pain 825 44 4 56 2
Cardiac dysrhythmias (irregular heart beat) 697 49 5 51 4
Acute cerebrovascular disease (stroke) 526 46 6 54 5
Hypertension with complications and secondary hypertension (high blood pressure with complications) 215 46 7 54 7
Peripheral and visceral atherosclerosis (hardening of arteries other than heart) 183 46 8 54 9
Occlusion or stenosis of precerebral arteries (blockage of arteries before brain) 141 57 9 43 13
Transient cerebral ischemia (mini-stroke) 183 40 10 60 8
Phlebitis, thrombophlebitis, and thromboembolism (inflammation and blood clots in the veins) 161 45 11 55 10
Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.
* Includes a small number of discharges (less than 5,500 or 0.1 percent) with missing gender.

(text version)

Exhibit 2.5. Bar chart showing Discharges per 100,000 Population for Principal Diagnoses of Circulatory Conditions by Gender,* Ordered by the Prevalence of Male Discharges per 100,000 Population, 2005

EXHIBIT 2.6 Diabetes

Diabetes is a chronic condition characterized by high levels of blood glucose that can lead to serious complications, including lower limb amputations and premature death. There were 2,200 diabetes-related hospitalizations per 100,000 people in the U.S. The prevalence of diabetes discharges, however, varied across age, region, and income.

(text version)

Exhibit 2.6. Bar chart showing Hospital Stays and Discharge Prevalence for All-listed Diabetes by Patient Age, 2005

(text version)

Exhibit 2.6. Bar chart showing Hospital Stays and Discharge Prevalence for All-listed Diabetes by Region, 2005

(text version)

Exhibit 2.6. Bar chart showing Hospital Stays and Discharge Prevalence for All-listed Diabetes Diagnoses by Median Income of Patients' ZIP Code, 2005

EXHIBIT 2.7 Pressure Sores

(text version)

Exhibit 2.7. Bar chart showing Number of Discharges for Pressure Sores, 1993-2005

Pressure sores typically result from prolonged periods of uninterrupted pressure on the skin, soft tissue, muscle, and bone. This often occurs in wheelchair- or bedridden-patients whose positions are not changed regularly. The presence of pressure sores for patients in the hospital increases their lengths of stay and total costs.

EXHIBIT 2.8 Alcoholism

(text version)

Exhibit 2.8. Bar chart showing Number and Distribution of Discharges with a Principal Diagnosis of Alcoholism by Gender and Age, 2005

(text version)

Exhibit 2.8. Number and Distribution of Discharges with a Principal Diagnosis of Alcoholism by Age, 2005

Alcohol abuse and dependence can result in illness, disability, and early death. About 14 million Americans abuse or have a dependency on alcohol. More than half of American adults have a close family member who has suffered from alcoholism.1

1U.S. Department of Health and Human Services. National Institute on Alcohol Abuse and Alcoholism. Alcohol Research & Health: Highlights from the Tenth Special Report to Congress—Health Risks and Benefits of Alcohol Consumption (Volume 24, Number 1). Washington, D.C.: U.S. Government Printing Office, 2000. Retrieved April 27, 2006, at http://pubs.niaaa.nih.gov/publications/arh24-1/05-11.pdf.

(text version)

Exhibit 2.8. Bar chart showing Number and Distribution of Discharges with a Principal Diagnosis of Alcoholism by Expected Payer, 2005

EXHIBIT 2.9 Mental Health

The data for this report exclude discharges from mental health and substance abuse facilities. Nevertheless, mood disorders were the seventh most frequent reason for hospital admission in 2005 (see Exhibit 2.1). Mood disorders represented only one of many mental health conditions for which people were hospitalized in that year. These conditions generally differed with age.

Youth less than 18 years of age:

Patients 18–44 years of age:

(text version)

Exhibit 2.9. Bar chart showing Number and Distribution of Discharges by Age for Stays with a Principal Diagnosis of a Mental Health Condition, 2005

Patients 45–64 years of age:

Patients ages 65–84 years and ages 85 years and older:

EXHIBIT 2.10 Injuries

(text version)

Number of Stays, Average Cost per Stay, Average Length of Stay, and In-hospital Death Rate for Discharges with an Injury Diagnosis, 2005
Principal Diagnosis Total Number of Stays in Thousands Average Costs per Stay Average Length of Stay in Days In-hospital Death Rate (Percent)
All injuries 1,891 $10,300 4.6 3.1
Spinal cord injury 12 38,800 12.7 5.9
Crushing injury or internal injury 106 16,900 6.7 3.4
Intracranial injury (brain injury) 171 16,500 6.4 9.1
Burns 41 15,300 7.1 2.4
Fracture of neck of femur (hip fracture) 317 12,300 6.3 2.8
Fracture of lower limb (leg) 267 10,600 4.6 0.5
Other fractures 194 10,100 5.3 1.4
Skull and face fractures 53 9,600 3.4 0.4
Joint disorders and dislocations, trauma-related 33 9,100 3.1 0.3
Fracture of upper limb (arm) 154 8,000 3.2 0.4
Open wounds of extremities (arms and legs) 50 7,100 3.5 0.2
Other injuries and conditions due to external causes 102 7,000 3.5 3.3
Open wounds of head, neck, and trunk 38 6,900 2.6 0.6
Poisoning by nonmedicinal substances (substances other than medicine) 25 6,700 3.1 1.7
Poisoning by other medications and drugs 155 5,500 2.9 1.2
Sprains and strains 45 5,400 2.6 0.2
Superficial injury, contusion (bruise) 53 4,900 3.4 0.6
Poisoning by psychotropic agents (psychiatric drugs) 77 4,800 2.5 0.8
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2005.

(text version)

Exhibit 2.10. Bar chart showing Number of Discharges and Percent Change in Discharges with a Principal Diagnosis of Injuries, 1997-2005

In 2005, nearly 5 percent of all hospital stays—about 1.9 million hospitalizations—were for treatment of an injury. Costs, lengths of stay, and hospital death rates differed according to the type of injury.

Over time, the number of hospitalizations associated with each injury has changed.

EXHIBIT 2.11 Influenza

(text version)

Characteristics of All Hospital Stays and Stays with a Principal Diagnosis of Influenza, 2005
Characteristics All Hospital Stays Hospital Stays for Influenza
Total number of discharges in thousands 39,164 50
Mean length of stay in days 4.6 4.1
Mean cost of hospitalization $7,900 $5,400
Mean hospital cost per day $1,700 $1,300
Aggregate costs for U.S. in millions $310,916.2 $272.0
Percent of admissions through the emergency department 43% 68%
Percent died in hospital 2.1% 1.6%
Percent < 1 year (excluding newborns*) 2% 11%
Percent 1-64 years 53% 38%
Percent 65 years and above 34% 51%
Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.
*Newborns account for 11 percent of all hospital discharges.

(text version)

Exhibit 2.11. Bar chart showing Number of Discharges with a Diagnosis of Influenza, 1993-2005

Influenza (flu) is a contagious respiratory viral disease. In 2005, there were over 50,000 hospital stays principally for influenza, resulting in about $272 million in aggregate costs.

2Centers for Disease Control and Prevention. Influenza (Flu): Clinical Description and Diagnosis. August 23, 2006. http://www.cdc.gov/flu/professionals/diagnosis/

SECTION 3

HOSPITAL INPATIENT STAYS BY PROCEDURE

EXHIBIT 3.1 Most Frequent All-listed Procedures
EXHIBIT 3.2 Most Frequent All-listed Procedures by Age
EXHIBIT 3.3 Childbirth
EXHIBIT 3.4 Cardiovascular Procedures
EXHIBIT 3.5 Bariatric Surgery
EXHIBIT 3.6 Orthopedic Procedures

EXHIBIT 3.1 Most Frequent All-listed Procedures

(text version)

Number, Percent Distribution, and Rank of Discharges for the Most Frequent All-listed Inpatient Hospital Procedures, 1997, 2004, and 2005
All-listed Procedures Number of Stays with the Procedure in Thousands Percent of Discharges with the Procedure Rank
1997 2004 2005 1997 2004 2005 1997 2004 2005
All discharges 34,679 38,662 39,164            
All discharges with procedure 21,187 23,835 24,145 100.0 100.0 100.0      
Blood transfusion 1,098 2,228 2,359 5 9 10 5 1 1
Diagnostic cardiac catheterization, coronary arteriography (diagnostic procedure to explore the functioning of the heart) 1,461 1,611 1,589 7 7 7 1 2 2
Repair of obstetric laceration 1,137 1,342 1,334 5 6 6 3 3 3
Cesarean section (C-section) 800 1,271 1,304 4 5 5 9 4 4
Circumcision 1,164 1,212 1,237 5 5 5 2 7 5
Upper gastrointestinal endoscopy (procedure to view and biopsy the esophagus, stomach, and first portion of intestine through a lighted tube) 1,105 1,267 1,224 5 5 5 4 5 6
Respiratory intubation and mechanical ventilation 919 1,240 1,223 4 5 5 7 6 7
Prophylactic vaccinations and inoculations 567 849 954 3 4 4 14 10 8
Fetal monitoring 1,002 1,047 911 5 4 4 6 8 9
Artificial rupture of membranes to assist delivery 747 866 885 4 4 4 10 9 10
Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality

Rankings of the top 10 most frequently performed procedures were based on all-listed procedures.

EXHIBIT 3.2 Most Frequent All-listed Procedures by Age

(text version)

Number and Percent Distribution of Discharges for the Most Frequent All-listed Inpatient Hospital Procedures by Age Group, 1997, 2004, and 2005
Age Group and All-listed Procedures Number of Discharges in Thousands Percent of All Discharges Percent of Age-specific Discharges
1997 2004 2005 1997 2004 2005 1997 2004 2005
All discharges, all ages† 34,679 38,662 39,164 100.0 100.0 100.0      
< 1 year 4,426 4,898 4,978 12.8 12.7 12.7 100.0 100.0 100.0
Circumcision 1,159 1,206 1,232 3.3 3.1 3.1 26.2 24.6 24.7
Prophylactic vaccinations and inoculations 549 794 865 1.6 2.1 2.2 12.4 16.2 17.4
Ophthalmologic and otologic diagnosis and treatment (vision and hearing diagnosis and treatment) * 339 471 * 0.9 1.2 * 6.9 9.5
Respiratory intubation and mechanical ventilation 163 214 196 0.5 0.6 0.5 3.7 4.4 3.9
Diagnostic spinal tap 147 104 125 0.4 0.3 0.3 3.3 2.1 2.5
1-17 years, all discharges 1,821 1,784 2,059 5.3 4.6 5.3 100.0 100.0 100.0
Appendectomy (removal of appendix) 74 87 95 0.2 0.2 0.2 4.1 4.9 4.6
Cancer chemotherapy 43 46 64 0.1 0.1 0.2 2.4 2.6 3.1
Blood transfusion 26 52 59 0.1 0.1 0.2 1.4 2.9 2.9
Repair of obstetric laceration 58 53 54 0.2 0.1 0.1 3.2 3.0 2.6
Diagnostic spinal tap 43 47 49 0.1 0.1 0.1 2.4 2.6 2.4
18-44 years, all discharges 9,444 10,323 10,041 26.7 25.6 100.0 100.0 100.0
Repair of obstetric laceration 1,079 1,287 1,278 3.1 3.3 3.3 11.4 12.5 12.7
Cesarean section (C-section) 773 1,238 1,270 2.2 3.2 3.2 8.2 12.0 12.6
Fetal monitoring 952 1,005 876 2.7 2.6 2.2 10.1 9.7 8.7
Artificial rupture of membranes to assist delivery 706 830 850 2.0 2.1 2.2 7.5 8.0 8.5
Episiotomy (surgical incision into the perineum and vagina to prevent traumatic tearing during delivery) 813 490 418 2.3 1.3 1.1 8.6 4.7 4.2
45-64 years, all discharges 6,496 8,546 8,660 18.7 22.1 22.1 100.0 100.0 100.0
Diagnostic cardiac catheterization, coronary arteriography (diagnostic procedure to explore the functioning of the heart) 578 681 674 1.7 1.8 1.7 8.9 8.0 7.8
Blood transfusion 247 568 601 0.7 1.5 1.5 3.8 6.6 6.9
Upper gastrointestinal endoscopy (procedure to view and biopsy the esophagus, stomach and first portion of intestine through a lighted tube) 275 369 356 0.8 1.0 0.9 4.2 4.3 4.1
PTCA (percutaneous transluminal coronary angioplasty, procedure involving use of a balloon-tipped catheter to enlarge a narrowed artery) 247 344 349 0.7 0.9 0.9 3.8 4.0 4.0
Respiratory intubation and mechanical ventilation 186 312 310 0.5 0.8 0.8 2.9 3.7 3.6
65+ years, all discharges 12,484 13,059 13,374 36.0 33.8 34.2 100.0 100.0 100.0
Blood transfusion 652 1,294 1,377 1.9 3.3 3.5 5.2 9.9 10.3
Diagnostic cardiac catheterization, coronary arteriography (diagnostic procedure to explore the functioning of the heart) 773 805 789 2.2 2.1 2.0 6.2 6.2 5.9
Upper gastrointestinal endoscopy (procedure to view and biopsy the esophagus, stomach and first portion of intestine through a lighted tube) 653 689 666 1.9 1.8 1.7 5.2 5.3 5.0
Respiratory intubation and mechanical ventilation 431 516 524 1.2 1.3 1.3 3.5 4.0 3.9
PTCA (percutaneous transluminal coronary angioplasty, procedure involving use of a balloon-tipped catheter to enlarge a narrowed artery) 299 405 409 0.9 1.0 1.0 2.4 3.1 3.1
Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.
*Statistics based on estimates with a relative standard error (standard error/weighted estimate) greater than 0.30 or with standard error = 0 in the nationwide statistics are not reliable.
† Includes a small number of discharges (less than 55,000 or 0.1 percent) with missing age.

The most frequent procedures usually varied by age group, except for individuals ages 45–64 and ages 65 and above: these two groups had in common the five most frequently performed procedures.

EXHIBIT 3.3 Childbirth

(text version)

Exhibit 3.3. Chart showing Percent of Childbirth Stays by Birth Type, 2005



(text version)

Exhibit 3.3. Chart showing Number of Maternal Stays for C-Section and VBAC, 1993-2005

Pregnancy and childbirth is the second most common reason for admission to the hospital (see Exhibit 1.3). The types of procedures used for childbirth have changed over time.

(text version)

Exhibit 3.3. Chart showing Percent of Maternal Stays with Deliveries by C-Section, 1993-2005

EXHIBIT 3.4 Cardiovascular Procedures

(text version)

Exhibit 3.4. Chart showing Number of Inpatient Hospital Cardiovascular Procedures, 1993-2005

Cardiovascular procedures to treat heart disease and stroke are the most common reasons for admission to the hospital for both men and women, excluding pregnancy and childbirth.

EXHIBIT 3.5 Bariatric Surgery

(text version)

Exhibit 3.5. Chart showing Number of Bariatric Surgery Discharges, 1995-2005

Bariatric surgery reduces the size of the stomach to achieve weight loss for people who are morbidly obese. It may be used to control the effects of serious medical conditions, such as diabetes.

1Bradley DW, Sharma BK. Centers of Excellence in Bariatric Surgery: design, implementation, and one-year outcomes. Surgery for Obesity and Related Diseases. 2006 Sep-Oct;2(5):513-7; Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Annals of Surgery. 2004 Oct;240(4):586-93.

EXHIBIT 3.6 Orthopedic Procedures

(text version)

Exhibit 3.6. Chart showing Number of Discharges with Any Musculoskeletal Procedures, 1993-2005

Hospital stays for musculoskeletal treatments often involve repair of fractures and joint procedures to relieve pain.

(text version)

Exhibit 3.6. Chart showing Growth in Discharges with Procedures on the Muskuloskeletal System, 1993-2005

Taken together, the most frequent musculoskeletal (or orthopedic) procedures increased with age, but the distribution of specific treatments differed by age group in 2005.

For patients less than 18 years of age:

For patients 18–44 years of age:

For patients 45–64 years of age:

For patients 65–84 years of age:

For patients 85 years of age and older:

(text version)

Exhibit 3.6. Chart showing Number and Percent Distribution of the Most Frequent Musculoskeletal All-listed Procedures within Age Groups, 2005

SECTION 4

SPENDING FOR HOSPITAL INPATIENT STAYS

EXHIBIT 4.1 Costs for the Most Frequent Diagnoses
EXHIBIT 4.2 Average Charges for the Most Frequent Conditions

EXHIBIT 4.1 Costs for the Most Frequent Diagnoses

(text version)

Top 20 Inpatient Hospital Principal Diagnoses with the Highest Aggregate Costs, 1997, 2004, and 2005, Ordered by Rank for 2005
Principal Diagnosis Total Inflation-adjusted* Hospital Costs in Millions Percent of Total Costs Rank
1997 2004 2005 1997 2004 2005 1997 2004 2005
All diagnoses $209.2 $303.5 $310.9 100 100 100      
Coronary atherosclerosis (coronary artery disease) 14.0 16.3 15.5 7 5 5 1 1 1
Acute myocardial infarction (heart attack) 8.7 11.6 10.9 4 4 4 2 2 2
Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 8.5 10.1 10.7 4 3 3 3 5 3
Congestive heart failure, nonhypertensive 6.4 10.7 10.5 3 4 3 5 3 4
Liveborn (newborn infant) 7.6 10.6 9.8 4 3 3 4 4 5
Osteoarthritis (degenerative joint disease) 4.5 8.7 9.7 2 3 3 8 6 6
Complication of medical device, implant or graft 5.3 8.4 8.9 3 3 3 6 7 7
Septicemia (blood infection) 3.9 6.7 8.4 2 2 3 9 8 8
Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones on spinal column) 3.3 6.5 7.1 2 2 2 12 9 9
Adult respiratory failure, insufficiency, or arrest 3.2 5.4 7.0 2 2 2 15 12 10
Cardiac dysrhythmias (irregular heart beat) 3.4 6.2 6.0 2 2 2 11 11 11
Acute cerebrovascular disease (stroke) 5.2 6.2 5.9 2 2 2 7 10 12
Rehabilitation care, fitting of prostheses, and adjustment of devices 3.6 5.1 5.1 2 2 2 10 13 13
Complications of surgical procedures or medical care 2.8 4.6 4.7 1 2 2 18 14 14
Chronic obstructive pulmonary disease and bronchiectasis (chronic obstructive lung disease) 3.2 3.8 4.2 2 1 1 14 17 15
Biliary tract disease (gall bladder disease) 3.2 4.1 4.1 2 1 1 13 15 16
Diabetes mellitus with complications 2.6 4.0 3.9 1 1 1 19 16 17
Fracture of neck of femur (hip fracture) 3.0 3.8 3.9 1 1 1 16 18 18
Non-specific chest pain 1.6 3.6 3.5 1 1 1 36 20 19
Mood disorders (depression and bipolar disorders) 3.0 3.6 3.4 1 1 1 17 19 20
Total for top 20 conditions 96.7 140.0 142.9 46 46 46      
Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.
*Adjusted for inflation using the GDP deflator (http://www.bea.gov/national/nipaweb/TableView.asp#Mid, Table 1.1.4. Price Indexes for Gross Domestic Product)

The top 20 principal diagnoses with the highest aggregate inpatient hospital costs represented 46 percent of the $310.9 billion total cost for all stays in U.S. community hospitals in 2005, the same share as in 1997 and 2004.

The most costly diagnoses:

Increasing costs:

Stable or decreasing costs:

(text version)

Exhibit 4.1. Chart showing Amount and Growth in Inflation-adjusted* Hospitalization Costs for Six of the Most Costly Cardiovascular Conditions, 1998-2005

EXHIBIT 4.2 Average Charges for the Most Frequent Conditions

Hospital charges are the amounts usually seen by a patient when they receive their hospital bill. However, charges seldom represent what is actually paid for hospital stays because of negotiated discounts, but they do offer a useful benchmark for comparing the relative costliness of conditions.

(text version)

Exhibit 4.1. Chart showing Average Charge per Stay and per Day, Average Length of Stay, Discharges, and Charges for the Top 10 Principal Diagnoses with Highest Charges per Stay, 2005

SECTION 5

SPECIAL TOPIC

EXHIBIT 5.1 Uninsured Inpatient Hospital Stays: Admission Source and Discharge Status

(text version)

Exhibit 5.1. Chart showing Share of Uninsured and Insured Stays Admitted through the Emergency Department, 2005

(text version)

Exhibit 5.1. Chart showing Share of Uninsured and Insured Stays by Discharges Status, 2005

Five percent (nearly 2.1 million) of the 39.2 million U.S. community hospital discharges in 2005 were considered uninsured because they were not covered by private insurance or public programs.

Admission Source:

Discharge Status:

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
The diagnoses and procedures associated with an inpatient hospitalization can be defined using several different medical condition classification systems. The following four systems are used within this report to identify specific diagnoses and procedures: International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Clinical Classifications Software (CCS), Diagnosis Related Groups (DRGs), and Major Diagnostic Categories (MDCs).

The most detailed system is the ICD-9-CM that contains over 12,000 detailed diagnoses and 3,500 detailed procedures. 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.

To make the number of ICD-9-CM diagnoses and procedures more manageable, AHRQ has designed the CCS tool that groups ICD-9-CM codes into 260 diagnostic and 231 procedure categories. This software aggregates similar diagnoses or procedures into clinically meaningful categories. More information on CCS can be found online (www.ahrq.gov/data/hcup/; http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp). 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.

In addition, diagnoses can also be grouped into DRGs. DRGs comprise a classification system that categorizes patients into groups that are clinically coherent and homogeneous with respect to resource use. DRGs group patients according to diagnosis, type of treatment (procedures), age, and other relevant criteria. Each hospital stay has one DRG assigned to it. The Centers for Medicare and Medicaid Services (CMS) uses this classification system as a basis for Medicare payments for inpatient hospital stays.

DRGs, in turn, can be summarized into MDCs, which are broad groups of DRGs such as Diseases and Disorders of the Nervous System or Diseases and Disorders of the Eye. Each hospital stay has one DRG and one MDC assigned to it.

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 2—DIAGNOSES

EXHIBIT 2.1

Maternal CCS categories:
183     Hypertension complicating pregnancy, childbirth, and the puerperium (high blood pressure during pregnancy)
184     Early or threatened labor
185     Prolonged pregnancy
189     Previous C-section
190     Fetal distress and abnormal forces of labor
191     Polyhydramnios and other problems of amniotic cavity (excess amniotic fluid and other problems of amniotic cavity)
192     Umbilical cord complication
193     Trauma to external female genitals (vulva) and area between anus and vagina (perineum)
196     Normal pregnancy and/or delivery

Other maternal CCS categories:
176     Contraceptive and procreative management (birth control or helping with conception)
177     Spontaneous abortion
178     Induced abortion
179     Postabortion complications (complications following abortion)
180     Ectopic pregnancy (abdominal or tubal pregnancy)
181     Other complications of pregnancy
182     Hemorrhage during pregnancy, abruptio placenta, placenta previa (bleeding and placenta disorders during pregnancy)
186     Diabetes or abnormal glucose tolerance complicating pregnancy, childbirth, or the puerperium (diabetes or high blood glucose during pregnancy)
187     Malposition, malpresentation (breech birth and other disorders of baby’s position during birth)
188     Obstructed labor or fetopelvic disproportion
194     Forceps delivery
195     Other maternal complications of birth, puerperium affecting management of mother (other maternal complications of birth and period after childbirth)

Infant CCS categories:
218     Liveborn (newborn infant)
219     Short gestation, low birth weight, and fetal growth retardation (premature birth and low birth weight)
220     Intrauterine hypoxia and birth asphyxia (lack of oxygen to baby in uterus or during birth)
221     Infant respiratory distress syndrome
222     Hemolytic jaundice and perinatal jaundice (infant jaundice following birth)
223     Birth trauma
224     Other perinatal conditions (other conditions occurring around the time of birth)

EXHIBIT 2.5

Circulatory CCS categories:
99       Hypertension with complications and secondary hypertension (high blood pressure with complications)
100     Acute myocardial infarction (heart attack)
101     Coronary atherosclerosis (coronary artery disease)
102     Non-specific chest pain
106     Cardiac dysrhythmias (irregular heart beat)
108     Congestive heart failure, nonhypertensive
109     Acute cerebrovascular disease (stroke)
110     Occlusion or stenosis of precerebral arteries (blockage of arteries before brain)
112     Transient cerebral ischemia (mini-stroke)
114     Peripheral and visceral atherosclerosis (hardening of arteries outside heart)
118     Phlebitis, thrombophlebitis, and thromboembolism (inflammation and blood clots in the veins)

Other circulatory CCS categories:
96       Heart valve disorders
97       Peri-, endo-, and myocarditis, cardiomyopathy (disorders of heart muscle and surrounding tissue, except that caused by tuberculosis or sexually transmitted disease)
98       Essential hypertension (high blood pressure)
103     Pulmonary heart disease (heart disease due to lung disorders)
104     Other and ill-defined heart disease
105     Conduction disorders (disturbance of electrical activity of heart)
107     Cardiac arrest and ventricular fibrillation (uncoordinated contraction of heart)
111     Other and ill-defined cerebrovascular disease (other blockage of brain blood supply)
113     Late effects of cerebrovascular disease (late effects of stroke)
115     Aortic, peripheral, and visceral artery aneurysms (ballooning or rupture of an artery)
116     Aortic and peripheral arterial embolism or thrombosis (arterial blood clots)
117     Other circulatory disease (other blood vessel disease)
119     Varicose veins of lower extremity (varicose veins in leg)
120     Hemorrhoids
121     Other diseases of veins and lymphatics (lymph system)

EXHIBIT 2.6

Diabetes CCS categories:
49       Diabetes mellitus without complication
50       Diabetes mellitus with complications

EXHIBIT 2.7

Pressure sore ICD-9-CM codes:
707.0         Decubitus ulcer
707.00       Decubitus ulcer, unspecified site
707.01       Decubitus ulcer, elbow
707.02       Decubitus ulcer, upper back
707.03       Decubitus ulcer, lower back
707.04       Decubitus ulcer, hip
707.05       Decubitus ulcer, buttock
707.06       Decubitus ulcer, ankle
707.07       Decubitus ulcer, heel
707.09       Decubitus ulcer, other site

EXHIBIT 2.8

Alcoholism and alcohol abuse ICD-9-CM codes:
291.0       Alcohol withdrawal delirium
291.1       Alcohol-induced persisting amnestic disorder
291.2       Alcohol-induced persisting dementia
291.3       Alcohol-induced psychotic disorder with hallucinations
291.4       Idiosyncratic alcohol intoxication
291.5       Alcohol-induced psychotic disorder with delusions
291.8       Other specified alcohol-induced mental disorders
291.81     Alcohol withdrawal
291.82     Alcohol-induced sleep disorders
291.89     Other
291.9       Unspecified alcohol-induced mental disorders
303.00     Acute alcoholic intoxication, unspecified
303.01     Acute alcoholic intoxication, continuous
303.02     Acute alcoholic intoxication, episodic
303.03     Acute alcoholic intoxication, in remission
303.90     Other and unspecified alcohol dependence, unspecified
303.91     Other and unspecified alcohol dependence, continuous
303.92     Other and unspecified alcohol dependence, episodic
303.93     Other and unspecified alcohol dependence, in remission
305.00     Alcohol abuse, unspecified
305.01     Alcohol abuse, continuous
305.02     Alcohol abuse, episodic
305.03     Alcohol abuse, in remission
357.5       Alcoholic polyneuropathy
425.5       Alcoholic cardiomyopathy
535.3       Alcoholic gastritis
535.31     Alcoholic gastritis, with hemorrhage
571.0       Alcoholic fatty liver
571.1       Acute alcoholic hepatitis
571.2       Alcoholic cirrhosis of liver
571.3       Alcoholic liver damage, unspecified
760.71     Noxious influences affecting fetus or newborn via placenta or breast milk, alcohol
790.3       Excessive blood level of alcohol
V11.3       Personal history of mental disorder, alcoholism
V79.1       Special screening for mental disorders and developmental handicaps, alcoholism

EXHIBIT 2.9

Mental health CCS categories:
650       Adjustment disorders
652       Attention-deficit, conduct, and disruptive behavior disorders
653       Delirium, dementia, and amnestic and other cognitive disorders
657       Mood disorders
659       Schizophrenia and other psychotic disorders
660       Substance-related disorders

Other mental health CCS categories:
651       Anxiety disorders
654       Developmental disorders
655       Disorders usually diagnosed in infancy, childhood, or adolescence
656       Impulse control disorders, not elsewhere classified
658       Personality disorders
661       Miscellaneous mental disorders

EXHIBIT 2.10

Injury CCS categories:
225       Joint disorders and dislocations, trauma-related
226       Fracture of neck of femur (hip fracture)
227       Spinal cord injury
228       Skull and face fractures
229       Fracture of upper limb (arm)
230       Fracture of lower limb (leg)
231       Other fractures
232       Sprains and strains
233       Intracranial injury (brain injury)
234       Crushing injury or internal injury
235       Open wounds of head, neck, and trunk
236       Open wounds of extremities (arms and legs)
239       Superficial injury, contusion (bruise)
240       Burns
241       Poisoning by psychotropic agents (psychiatric drugs)
242       Poisoning by other medications and drugs
243       Poisoning by nonmedicinal substances (substances other than medicine)
244       Other injuries and conditions due to external causes

EXHIBIT 2.11

Influenza CCS category:
123         Influenza

SECTION 3—PROCEDURES

Because the NIS is limited to inpatient hospital data, conditions treated or procedures performed in outpatient settings are not reflected here.

EXHIBIT 3.3

Childbirth DRG categories:
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

Within DRG 370-371 and 372-375, all-listed diagnoses were also subsetted using the following CCS diagnosis category:
189       Previous C-section

EXHIBIT 3.4

Cardiovascular CCS categories:
44       CABG (coronary artery bypass graft, procedure to restore blood supply to the heart muscle)
45       PTCA (percutaneous transluminal coronary angioplasty, procedure involving use of a balloon-tipped catheter to enlarge a narrowed artery)
51       Endarterectomy (surgical removal of an obstructing clot from the arteries of the neck and head)

In addition, abdominal aortic aneurysm repair was defined using the following ICD-9-CM procedures and diagnoses:

EXHIBIT 3.5

Bariatric surgery procedures were identified using these steps:
1) identify likely bariatric procedures using ICD-9-CM procedure codes; 2) identify additional likely stays for bariatric surgeries using a combination of DRG and ICD-9-CM categories; 3) remove stays where the procedures were performed because of cancer; and 4) eliminate cases where an obesity diagnosis was not present.

1) Bariatric procedures using ICD-9-CM procedure codes:
44.31       High gastric bypass
44.38       Laparoscopic gastroenterostomy
44.39       Other gastroenterostomy
44.68       Laparoscopic gastroplasty
44.69       Other
44.95       Laparoscopic gastric restrictive procedure
44.96       Laparoscopic revision of gastric restrictive procedure
44.97       Laparoscopic removal of gastric restrictive device(s)
44.98       (Laparoscopic) adjustment of size of adjustable gastric restrictive device

2) Additional likely stays for bariatric surgeries. If the DRG was equal to 288 (O.R. procedures for obesity), additional bariatric surgery procedures were defined using the following ICD-9-CM categories:
44.5         Revision of gastric anastomosis
44.99       Other operations on the stomach
45.91       Small-to-small intestinal anastomosis

3) For all cases above, exclude cancer cases defined by the following ICD-9-CM diagnosis categories:
150.0-159.9       Malignant neoplasm of digestive organs and peritoneum
230.1-230.9       Carcinoma in situ of digestive organs

4) Exclude cases without one of the following ICD-9-CM diagnostic codes for obesity:
278.0         Obesity
278.00       Obesity, unspecified
278.01       Morbid obesity
V77.8        Obesity

EXHIBIT 3.6

Orthopedic procedure CCS categories:
142       Partial excision of bone
145       Treatment of fracture or dislocation of radius and ulna (lower arm)
146       Treatment of fracture or dislocation of hip and femur
147       Treatment of fracture or dislocation of lower extremity (leg, other than hip or femur)
152       Arthroplasty of knee (surgical reconstruction or replacement of knee)
153       Hip replacement, total and partial
157       Amputation of lower extremity (leg, foot, or toe)
158       Spinal fusion (correction of an unstable part of the spine by joining two or more vertebrae)

Other orthopedic procedure CCS categories:
143       Bunionectomy (repair of toe deformities)
144       Treatment of facial fracture or dislocation
148       Other fracture and dislocation procedure
149       Arthroscopy (procedure to view the inside of a joint through a lighted tube and to diagnose and treat problems)
150       Division of joint capsule, ligament or cartilage
151       Excision of semilunar cartilage of knee
154       Arthroplasty other than hip or knee (surgical reconstruction or replacement of other joints)
155       Arthrocentesis (procedure that involves introducing a needle into a joint to remove joint fluid)
156       Injections and aspirations of muscles, tendons, bursa, joints, and soft tissue
159       Other diagnostic procedures on musculoskeletal system
160       Other therapeutic procedures on muscles and tendons
161       Other operating room therapeutic procedures on bone
162       Other operating room therapeutic procedures on joints
163       Other non-operating room therapeutic procedures on musculoskeletal system
164       Other operating room therapeutic procedures on musculoskeletal system

DEFINITIONS

For definitions of medical terms, refer to: http://www.nlm.nih.gov/medlineplus/mplusdictionary.html

Admission source
Admission source indicates where the patient was located prior to admission to the hospital.

Adjusted for inflation
Cost can be adjusted for economy-wide inflation by removing increases that reflect the effect of changing average prices for all goods and services. In this report, the U.S. Bureau of Economic Analysis Gross Domestic Product Price Index is used to remove economy-wide inflation. Additional inflation that is specific to the hospital sector is not removed in this calculation. Data in Exhibit 1.1 and 4.1 are adjusted for economy-wide inflation.

Aggregate costs
Aggregate costs are the sum of all costs for all hospital stays.

Charges
Hospital charges reflect the amount the hospital billed for the entire hospital stay and do not include professional (physician) fees. The charge is generally more than the amount paid to the hospital by payers for the hospitalization and is also generally more than the hospital’s costs of care.

Community hospitals
HCUP is based on data from community hospitals, defined as short-term, non-Federal, general and other hospitals, excluding hospital units of other institutions (e.g., prisons). Community hospitals (and HCUP data) include OB-GYN, ENT, orthopedic, cancer, pediatric, public, and academic medical hospitals. They exclude hospitals whose main focus is long-term care, psychiatric, and alcoholism and chemical dependency treatment, although discharges from these types of units that are part of community hospitals are included.

Costs
Costs are derived from total hospital charges using cost-to-charge ratios based on hospital accounting reports from the Centers for Medicare and Medicaid Services (CMS). Costs will tend to reflect the actual costs to produce hospital services, while charges represent what the hospital billed for the case. For each hospital, a hospital-wide cost-to-charge ratio is used to transform charges into costs. Cost-to-charge ratios for 2005 will not be available until later this year. These ratios were estimated by multiplying the 2004 ratio for each hospital by .96, which represents the average annual change exhibited in the charge-to-cost ratios over the past few years.

Diagnoses

Discharge
Discharge refers to the hospital stay. The unit of analysis for HCUP data is the hospital discharge, not a person or patient. This means that a person who is admitted to the hospital multiple times in one year will be counted each time as a separate discharge from the hospital.

Discharge status
Discharge status indicates the disposition of the patient at the time of discharge from the hospital, and includes the following six categories: routine (to home), transfer to another short-term hospital, other transfers (including skilled nursing facility, intermediate care, rehabilitation care, swing bed, and another type of facility such as a nursing home), home health care, against medical advice (AMA), or died in the hospital.

Discharge per population
Discharge per population is the hospital discharge rate of a particular procedure, diagnosis, or event per 100,000 individuals. This measure indicates the prevalence of hospitalizations, procedures or diagnoses within the population.

In-hospital deaths
In-hospital deaths refer to hospitalizations in which the patient died during his or her hospital stay.

Infant discharges
Infant discharges are hospital stays during which a child is born.

Length of stay
Length of stay is the number of nights the patient remained in the hospital for his or her stay. A patient admitted and discharged on the same day has a length of stay equal to 0.

Maternal discharges
Maternal discharges are hospital stays for females who are pregnant or gave birth.

Median income
Median income is the median household income of the patient’s ZIP Code of residence. This is a proxy measure of a patient’s socioeconomic status.

Morbid obesity
Morbid obesity is defined as at least twice a person’s ideal weight, 100 pounds overweight, or a body mass index (BMI) that is greater than 39.

Neonates
Neonates are newborns and infants 30 days of age or less.

Ownership/control
Ownership/control was obtained from the American Hospital Association (AHA) Annual Survey of Hospitals and includes categories for government non-Federal (public), private not-for-profit (voluntary), and private investor-owned (proprietary). These types of hospitals tend to have different missions and different responses to government regulations and policies.

Patient age
Patient age in years, calculated based on the patient’s date of birth and admission date to the hospital.

Payers
Payer is the expected payer for the hospital stay. To make coding uniform across all HCUP data sources, Payer combines detailed categories into more general groups:

When more than one payer is listed for a hospital discharge, the first-listed payer is used.

Procedures

Region
Region is one of the four regions defined by the U.S. Bureau of the Census: Northeast, Midwest, South, and West.

Not all states participate in HCUP, so not all states will be present in HCUP data. However, the statistics have been weighted to represent the entire U.S.

Stays
The unit of analysis for HCUP data is the hospital stay (i.e., the hospital discharge), not a person or patient. This means that a person who is admitted to the hospital multiple times in one year will be counted each time as a separate "discharge" from the hospital.

FOR MORE INFORMATION

HCUP Background Information
For a detailed description of HCUP, information on the design of the NIS, and methods to calculate estimates, please refer to the following publications:

Steiner C, Elixhauser A, Schnaier J. The Healthcare Cost and Utilization Project: An Overview. Effective Clinical Practice 5(3):143–51, 2002.

Design of the HCUP Nationwide Inpatient Sample, 2005. Online. June 13, 2007. U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/db/nation/nis/reports/NIS_2005_Design_Report.pdf

Houchens R, Elixhauser A. Final Report on Calculating Nationwide Inpatient Sample (NIS) Variances, 2001. HCUP Methods Series Report #2003-2. Online. June 2005 (revised June 6, 2005). U.S. Agency for Healthcare Research and Quality. https://www.hcup-us.ahrq.gov/reports/methods/CalculatingNISVariances200106092005.pdf

Houchens RL, Elixhauser A. Using the HCUP Nationwide Inpatient Sample to Estimate Trends. (Updated for 1988-2004). HCUP Methods Series Report #2006-05 Online. August 18, 2006. U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/methods/2006_05_NISTrendsReport_1988-2004.pdf

HCUP Statistics and Website
For additional HCUP statistics, visit HCUPnet, our interactive query system at http://hcup.ahrq.gov.

Technical Assistance
For Technical Assistance with HCUP Products:
E-mail: hcup@ahrq.gov
Phone: 1-866-290-HCUP

ACKNOWLEDGMENTS

Thanks to Eva Witt and Nils Nordstrand at Thomson Healthcare for their programming support; Laurel Holmquist and Anne Pfuntner at Thomson Healthcare for their assistance in the preparation of tables and text; Gail Eisen, also at Thomson Healthcare, for her editorial assistance; Roxanne Andrews, Pamela Owens, and Claudia Steiner of AHRQ for contributions to early content decisions; and The Madison Design Group for their assistance in design and layout of the report. Special thanks to Chaya Merrill of Thomson Healthcare and Megan Hambrick of AHRQ for their helpful comments on drafts. This document draws from and updates previously published HCUP Fact Books and Statistical Briefs, which can be found at http://www.hcup-us.ahrq.gov/reports.jsp and http://www.hcup-us.ahrq.gov/reports/statbriefs/sbtopic.jsp.

RECOMMENDED CITATION

Levit K, Ryan K, Elixhauser A, Stranges E, Kassed C, Coffey R. HCUP Facts and Figures: Statistics on Hospital-based Care in the United States in 2005. Rockville, MD: Agency for Healthcare Research and Quality, 2007. http://www.hcup-us.ahrq.gov/reports.jsp


Internet Citation: Facts and Figures 2005. Healthcare Cost and Utilization Project (HCUP). February 2011. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/factsandfigures/facts_figures_2005.jsp.
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