National Hospital Care Survey

National Hospital Care Survey
Name	National Hospital Care Survey
Administered by	Centers for Disease Control and Prevention National Center for Health Statistics
Country	United States
Started	2010s
Frequency	Annual
Sample	Hospital inpatient and emergency department records

National Hospital Care Survey The National Hospital Care Survey is a United States federal health statistics program that collects detailed patient-level data from hospital records. It complements other federal surveys such as the National Health Interview Survey, the Medical Expenditure Panel Survey, the Healthcare Cost and Utilization Project, and the American Hospital Association datasets to produce comprehensive national estimates. The survey supports analyses linked to policy actions by entities like the Centers for Medicare and Medicaid Services, the Department of Health and Human Services, and research by institutions including the Johns Hopkins University, the Harvard T.H. Chan School of Public Health, and the Agency for Healthcare Research and Quality.

Overview

The survey provides nationally representative information about inpatient stays, emergency department visits, and outpatient visits drawn from hospital administrative records, aligning with broader efforts by the National Center for Health Statistics, the Office of Management and Budget, and the United States Census Bureau to standardize health statistics. It produces public-use files and restricted-use data for qualified researchers at agencies like the National Institutes of Health, academic centers such as Columbia University, and policy organizations including the Kaiser Family Foundation. Estimates from the program inform monitoring by bodies such as the World Health Organization and contribute to comparative work with data from the Organisation for Economic Co-operation and Development.

History and development

The program evolved from earlier federal efforts to centralize hospital data, building on initiatives by the National Center for Health Statistics and predecessors like the National Hospital Discharge Survey. Development was influenced by policy priorities under administrations of presidents such as Barack Obama and Donald Trump and by legislative frameworks including the Health Insurance Portability and Accountability Act of 1996 and the Affordable Care Act. Collaborations with the American Medical Association, the American Hospital Association, and state health departments facilitated pilot studies, methodological revisions, and expansions to include emergency department sampling. Academic partnerships with researchers at University of Michigan and University of California, Los Angeles guided validation and comparability studies.

Methodology and data collection

Sampling frames are constructed from hospital directories maintained by organizations like the American Hospital Association and state hospital associations, using stratified probability sampling similar to designs employed by the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. Data abstraction relies on electronic health record exports, discharge abstracts, and administrative billing records consistent with coding standards from the International Classification of Diseases and billing guidance linked to the Centers for Medicare and Medicaid Services. Field operations coordinate with state data centers, university research cores at places such as University of North Carolina at Chapel Hill and University of Washington, and federal partners including the Agency for Healthcare Research and Quality. Quality control procedures draw on methods used by the National Vital Statistics System and include weighting, imputation, and variance estimation.

Data content and variables

Files include person-level variables for demographics, payer source, diagnoses coded to the International Classification of Diseases, Ninth Revision and the International Classification of Diseases, Tenth Revision, procedure codes such as Current Procedural Terminology, length of stay, charges, and discharge disposition. Facility-level variables describe hospital characteristics from the American Hospital Association Annual Survey including bed size, ownership type, and teaching status tied to profiles maintained by Leapfrog Group and accreditation information from the Joint Commission. Time series permit linkage with longitudinal datasets from the National Health and Nutrition Examination Survey and trend analysis across periods corresponding to healthcare policy shifts observed by the Medicare Payment Advisory Commission.

Uses and publications

Researchers at institutions like Yale University, Stanford University, and University of Pennsylvania use the data for studies on utilization, costs, readmissions, and emergency care, publishing in journals such as the New England Journal of Medicine, the Journal of the American Medical Association, and Health Affairs. Federal reports produced by the National Center for Health Statistics and briefs by the Kaiser Family Foundation rely on the survey for national estimates used by policymakers at the Centers for Medicare and Medicaid Services and program evaluators at the Department of Veterans Affairs. The survey supports crosswalks to international datasets curated by the Organisation for Economic Co-operation and Development and comparative health services research undertaken by scholars at the London School of Economics.

Limitations and criticisms

Critiques by scholars at Princeton University, Brown University, and advocacy groups such as the Commonwealth Fund note limitations including nonresponse, sampling variability, and reliance on administrative coding subject to billing practices shaped by Centers for Medicare and Medicaid Services rules. Concerns echo methodological debates present in evaluations by the Government Accountability Office and peer reviewers in journals like The Lancet about generalizability to specialty hospitals, timeliness of public-use releases, and linkage constraints under privacy rules related to the Health Insurance Portability and Accountability Act of 1996. Calls for enhancements reference collaborative models from the Health Information Technology for Economic and Clinical Health Act implementations and integrated data systems piloted by state-level health information exchanges.

Category:Health surveys Category:United States federal statistical systems