Skip Navigation

HCUP Facts and Figures
Statistics on Hospital-Based Care in the United States, 2006
 

HCUP FACTS AND FIGURES, 2006

STATISTICS ON HOSPITAL-BASED CARE IN THE UNITED STATES

TABLE OF CONTENTS


HIGHLIGHTS

HCUP Facts and Figures, 2006: Statistics on Hospital-based Care in the United States presents information derived from the 2006 HCUP Nationwide Inpatient Sample (NIS), with trend information as far back as 1993. This report includes information from the 2006 database containing discharge records for all patients treated in a sample of approximately 1,000 hospitals. 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; psychiatric and substance abuse facilities and short-term rehabilitation hospitals are not included.

Overall Hospital Statistics

Most Frequent Diagnoses

Most Frequent Procedures

Spending for Hospitalization

Priority Conditions

The Institute of Medicine (IOM) and the U.S. Department of Health and Human Services (DHHS) have identified a number of priority conditions where important quality improvements in delivery of health care could increase effectiveness and efficiency. Five of the IOM and DHHS designated conditions are covered in this report.

Childbirth and Newborns

Childbirth

Newborns

Depression

Cancer

Asthma

Arthritis

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 datasets, including the powerful Healthcare Cost and Utilization Project (HCUP) databases. 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 violence-related hospital stays and emergency department visits for adults, as well as hospital stays for epilepsy and convulsions, circumcision, gastroesophageal reflux disease (GERD), and Clostridium difficile infections.

This is the second annual edition of HCUP Facts and Figures, designed to provide a sample of the wealth of statistics available from HCUP. This 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, Statistical Briefs, and Facts and Figures.

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 39 in 2008.

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
California Office of Statewide Health Planning and Development
Colorado Hospital Association
Connecticut Chime, Inc.
Florida Agency for Health Care Administration
Georgia Hospital Association
Hawaii Health Information Corporation
Illinois Department of Public Health
Indiana Hospital Association
Iowa Hospital Association
Kansas Hospital Association
Kentucky Cabinet for Health and Family Services
Maine Health Data Organization
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 Department of Health and Human Services
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 and 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 hospitals in the U.S.—representing 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 a sample of more than 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 status.

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. In the last section, we have focused on hospitalizations related to four of the priority health conditions designated by the Institute of Medicine (IOM) in its report, Priority Areas for National Action: Transforming Health Care Quality1; these are childbirth, depression, cancer, and asthma. This section also includes one condition—arthritis—which was chosen from among ten priority conditions designated by the U.S. Department of Health and Human Services that affect individuals covered by government programs.2 The conditions on both lists, including the five we present in this report, represent areas of greatest consequence for the patient population, affect a broad range of people, and offer the most important opportunities for quality improvement.

In documenting hospitalization trends, this report illustrates 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.

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.




1 Committee on Identifying Priority Areas for Quality Improvement, Board of Health Care Services (2003). Priority Areas for National Action: Transforming Health Care Quality. Adams K and Corrigan JM (Ed). Washington, D.C.: Institute of Medicine (IOM).
2 Agency for Healthcare Research and Quality (2004). Press Release: List of Priority Conditions for Research under Medicare Modernization Act Released. December 15, 2004. http://archive.ahrq.gov/news/press/pr2004/mmapr.htm



SECTION 1

OVERVIEW STATISTICS FOR INPATIENT HOSPITAL STAYS

EXHIBIT 1.1 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 Expected Primary Payer
EXHIBIT 1.5 Admission Source
EXHIBIT 1.6 Discharge Status
EXHIBIT 1.7 Patient Age



EXHIBIT 1.1 Characteristics of U.S. Hospitals

Characteristics of U.S. Community Hospitals, 1997, 2005, and 2006
UTILIZATION, CHARGES, AND COSTS 1997 2005 2006
Discharges:
Total discharges in millions 34.7 39.2 39.5
Discharges per 1,000 population* 127.8 132.1 131.9
Total days of care in millions 168.1 181.5 181.3
Average length of stay in days 4.8 4.6 4.6
 
Percent of discharges from:
Metropolitan hospitals 84% 87% 87%
Hospital ownership:
Non-Federal government hospitals 14% 14% 14%
Private not-for-profit hospitals 73% 72% 72%
Private for-profit hospitals 13% 14% 14%
 
Charges and costs†
Charges:
Average charges per stay $11,300 $22,300 $24,000
Average inflation-adjusted charges per stay in 2006 dollars‡ $13,800 $23,000 $24,000
Costs:
Total aggregate costs in billions $177.1 $316.3 $329.2
Average costs per stay $5,100 $8,100 $8,400
Inflation-adjusted costs in 2006 dollars:‡
Total aggregate costs in billions $216.3 $326.3 $329.2
Average costs per stay $6,200 $8,300 $8,400

*Calculated using population from the U.S. Bureau of the Census (http://www.census.gov/popest/).
†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/SelectTable.asp#S1, Table 1.1.4 Price Indexes for Gross Domestic Product).

The volume of discharges changed little and increases in inpatient hospital costs slowed in 2006.




1 Fast Facts on US Hospitals. Online. October 23, 2007. American Hospital Association. http://www.aha.org/aha/resource-center/Statistics-and-Studies/fast-facts.html.



EXHIBIT 1.2 Inpatient Hospital Stays and Average Length of Stay

(text version)

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

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




2From 1998 to 2001, low unemployment and the need for employers to attract and retain workers through generous health benefits produced a loosening of care management by insurance plans. Forest 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. Chart showing Distribution of Discharges by Major Reason* for Hospital Stay, 2006



(text version)

Exhibit 1.3  Chart showing Hospital Stays for Males and Females by Major Reason, 2006



EXHIBIT 1.4 Expected Primary Payer

(text version)

Exhibit 1.4. Chart showing Percent Distribution of Discharges by Expected Primary Payer, 2006



(text version)

Exhibit 1.4. Chart showing Growth in Number of Discharges by Expected Primary Payer, 1997-2006

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

Between 1997 and 2006, the number of hospital discharges grew by 14 percent; however, the growth varied widely by expected primary payer.



EXHIBIT 1.5 Admission Source

(text version)

Exhibit 1.5. Chart showing Distribution of Discharges by Admission Source, 1997-2006

Admission source indicates routine admission and other specific settings where the patient was located prior to admission to the hospital.



EXHIBIT 1.6 Discharge Status

(text version)

Exhibit 1.6. Chart showing Distribution of Inpatient Hospital Stays by Discharge Status, 2006

Discharge status indicates the circumstance surrounding the discharge or where the patient went after discharge from the hospital. Most discharges were routine in nature, but discharges to follow-on care were also frequent.

The number of discharges increased by 14 percent from 1997 to 2006, but growth varied by discharge status.



(text version)

Exhibit 1.6. Chart showing Distribution of Inpatient Hospital Stays by Discharge Status, 2006 and Growth in Number of Hospital Stays by Discharge Status, 1997-2006



(text version)

Exhibit 1.6. Chart showing Percent Distribution of Routine Discharges and Discharges Against Medical Advice by Payer, 2006

Compared with routine discharges, hospital stays that ended in a discharge against medical advice had a different distribution of expected payers.



EXHIBIT 1.7 Patient Age

(text version)

Exhibit 1.7. Chart showing Distribution of U.S. Population and Hospital Discharges by Age, 2006



(text version)

Exhibit 1.7. Chart showing Distribution of U.S. Population and Hospital Discharges by Age, 2006

Older people account for a disproportionately larger share of hospitalizations compared to other age groups.

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



SECTION 2

INPATIENT HOSPITAL STAYS BY DIAGNOSIS

EXHIBIT 2.1 Most Frequent Principal Diagnoses
EXHIBIT 2.2 Most Frequent Principal Diagnoses by Age
EXHIBIT 2.3 Most Frequent Principal Diagnoses by Gender



EXHIBIT 2.1 Most Frequent Principal Diagnoses

Number of Discharges, Percent Distribution, Rank, and Growth of the Most Frequent Principal Diagnoses for Inpatient Hospital Stays, 1997, 2005, and 2006
PRINCIPAL CCS DIAGNOSIS NUMBER OF DISCHARGES IN THOUSANDS PERCENT OF DISCHARGES RANK GROWTH
1997 2005 2006 1997 2005 2006 1997 2005 2006 1997-2006
All discharges 34,679 39,164 39,450 100.0% 100.0% 100.0%       14%
Pregnancy, childbirth, and newborn infants 8,236 9,145 9,252 23.7 23.4 23.5 1 1 1 12
Pneumonia 1,232 1,355 1,218 3.6 3.5 3.1 3 2 2 -1
Coronary atherosclerosis (coronary artery disease) 1,407 1,110 1,198 4.1 2.8 3.0 2 3 3 -15
Congestive heart failure 991 1,090 1,099 2.9 2.8 2.8 4 4 4 11
Non-specific chest pain 538 825 857 1.6 2.1 2.2 10 5 5 59
Cardiac dysrhythmias (irregular heart beat) 572 697 749 1.7 1.8 1.9 8 8 6 31
Osteoarthritis (degenerative joint disease) 418 738 735 1.2 1.9 1.9 17 6 7 76
Mood disorders (depression and bipolar disorders) 641 713 729 1.8 1.8 1.8 6 7 8 14
Acute myocardial infarction (heart attack) 732 662 675 2.1 1.7 1.7 5 9 9 -8
Disorders of intervertebral discs and bones in spinal column (back problems) 536 647 636 1.5 1.7 1.6 11 10 10 19
Complication of device, implant or graft 491 616 634 1.4 1.6 1.6 12 12 11 29
Septicemia (blood infection) 413 538 611 1.2 1.4 1.5 18 15 12 48
Chronic obstructive lung disease 551 630 598 1.6 1.6 1.5 9 11 13 8
Skin and subcutaneous tissue infections 330 582 597 1.0 1.5 1.5 24 13 14 81
Acute cerebrovascular disease (stroke) 616 526 537 1.8 1.3 1.4 7 17 15 -13

In 2006, there were 39.5 million hospital stays, an increase of 14 percent since 1997. The 15 most frequently occurring principal diagnoses accounted for just over half of all discharges in 2006. Twelve of the 15 most frequent principal diagnoses in 2006 were among the most frequent diagnoses in 1997.

Among all discharges:

Number of Discharges, Percent Distribution, Rank, and Growth of the Most Frequent Principal Diagnoses for Maternal and Infant Inpatient Hospital Stays, 1997, 2005, and 2006
PRINCIPAL CCS DIAGNOSIS NUMBER OF DISCHARGES IN THOUSANDS PERCENT OF DISCHARGES RANK GROWTH
1997 2005 2006 1997 2005 2006 1997 2005 2006 1997-2006
All maternal discharges* 4,338 4,716 4,796 100.0% 100.0% 100.0%       11%
Trauma to external female genitals (vulva) and area between anus and vagina (perineum) due to childbirth 713 784 818 16.4 16.6 17.1 1 1 1 15
Previous C-section 271 481 505 6.3 10.2 10.5 3 2 2 86
Normal pregnancy and/or delivery 544 325 315 12.5 6.9 6.6 2 3 3 -42
Prolonged pregnancy § 234 242 § 5.0 5.0 § 6 4 §
Early or threatened labor 261 236 239 6.0 5.0 5.0 4 4 5 -9
Hypertension complicating pregnancy, childbirth and the puerperium (high blood pressure during pregnancy) 185 220 225 4.3 4.7 4.7 7 7 6 22
Fetal distress and abnormal forces of labor § 234 223 § 5.0 4.6 § 5 7 §
Umbilical cord complication 259 217 220 6.0 4.6 4.6 5 8 8 -15
Polyhydramnios and other problems of amniotic cavity (excess amniotic fluid and other problems of amniotic cavity) 202 191 190 4.7 4.1 4.0 6 9 9 -6
 
All infant discharges 3,898 4,429 4,456 100.0% 100.0% 100.0%       14%
Liveborn (newborn infant) 3,777 4,228 4,289 96.9 95.5 96.2 1 1 1 14
Other perinatal conditions (other conditions occurring around the time of birth) 56 94 82 1.4 2.1 1.8 2 2 2 46
Hemolytic jaundice and perinatal jaundice (infant jaundice following birth) 33 57 46 0.8 1.3 1.0 3 3 3 40
Short gestation, low birth weight, and fetal growth retardation (premature birth and low birth weight) 22 31 26 0.6 0.7 0.6 4 4 4 15
Infant respiratory distress syndrome 8 16 12 0.2 0.4 0.3 5 5 5 46
Birth trauma 1 1 1 0.0 0.0 0.0 7 6 6 10
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 -32
* Includes additional maternal CCS diagnoses not shown on this table but listed in the Sources and Methods of this report.
§ Consistent data is not available for this diagnosis due to coding changes that took place between 1997 and 2005.

There were 4.8 million maternal discharges in 2006, an 11-percent increase since 1997. Not all of these maternal discharges involved the birth of an infant; some dealt with complications during pregnancy. There were also 4.5 million infant discharges, a 14-percent increase since 1997.1

Among maternal discharges:

Among infant discharges:




1Only principal diagnoses (the main reason for the hospital stay) are listed in this exhibit. The table provides information on the number of discharges, assigning one diagnosis to each hospital stay based on the principal diagnosis. The number of cases and growth rates for specific maternal and infant conditions may differ from those shown in Exhibit 5.1, which shows all-listed diagnoses (principal plus all secondary conditions) for childbirth and newborn stays.



EXHIBIT 2.2 Most Frequent Principal Diagnoses by Age

Number of Discharges, Percent Distribution, and Growth of the Most Frequent Principal Diagnoses for Inpatient Hospital Stays by Age, 1997, 2005, and 2006
AGE GROUP AND PRINCIPAL CCS DIAGNOSIS NUMBER OF DISCHARGES IN THOUSANDS PERCENT OF AGE-SPECIFIC TOTAL DISCHARGES GROWTH
1997 2005 2006 1997 2005 2006 1997-2006
All ages, total discharges† 34,679 39,164 39,450       14%
‹ 1 year, total discharges 4,426 4,978 4,908 100.0% 100.0% 100.0% 11
Liveborn (newborn infant) 3,776 4,223 4,284 85.3 84.8 87.3 13
Acute bronchitis 108 107 102 2.4 2.2 2.1 -6
Hemolytic jaundice and perinatal jaundice (infant jaundice following birth) 33 56 46 0.7 1.1 0.9 40
Pneumonia 55 43 39 1.3 0.9 0.8 -29
Short gestation, low birth weight, and fetal growth retardation (premature birth and low birth weight) 22 31 26 0.5 0.6 0.5 15
1-17 years, total discharges 1,821 2,059 1,711 100.0 100.0 100.0 -6
Asthma 159 139 122 8.7 6.8 7.1 -23
Pneumonia 135 142 116 7.4 6.9 6.8 -14
Appendicitis and other appendiceal conditions 65 90 80 3.6 4.3 4.7 23
Fluid and electrolyte disorders (primarily dehydration or fluid overload) 64 98 74 3.5 4.8 4.3 15
Mood disorders (depression and bipolar disorders) 64 73 62 3.5 3.6 3.6 -3
18-44 years, total discharges 9,444 10,041 10,212 100.0 100.0 100.0 8
Trauma to external female genitals (vulva) and area between anus and vagina (perineum), due to childbirth 676 753 785 7.2 7.5 7.7 16
Previous C-section 270 478 502 2.9 4.8 4.9 86
Mood disorders (depression and bipolar disorder) 335 364 375 3.5 3.6 3.7 12
Normal pregnancy and/or delivery 511 312 303 5.4 3.1 3.0 -41
Prolonged pregnancy § 224 231 § 2.2 2.3 §
45-64 years, total discharges 6,496 8,660 9,100 100.0 100.0 100.0 40
Coronary atherosclerosis (coronary artery disease) 526 461 501 8.1 5.3 5.5 -5
Non-specific chest pain 242 388 408 3.7 4.5 4.5 69
Osteoarthritis (degenerative joint disease) 105 272 281 1.6 3.1 3.1 167
Disorders of intervertebral discs and bones in spinal column (back problems) 190 266 269 2.9 3.1 3.0 42
Pneumonia 199 271 260 3.1 3.1 2.9 31
65-84 years, total discharges 10,121 10,449 10,512 100.0 100.0 100.0 4
Coronary atherosclerosis (coronary artery disease) 741 541 584 7.3 5.2 5.6 -21
Congestive heart failure 581 571 559 5.7 5.5 5.3 -4
Pneumonia 514 550 494 5.1 5.3 4.7 -4
Osteoarthritis (degenerative joint disease)) 281 419 406 2.8 4.0 3.9 44
Cardiac dysrhythmias (irregular heart beat) 333 366 392 3.3 3.5 3.7 18
85+ years, total discharges 2,362 2,926 2,970 100.0 100.0 100.0 26
Congestive heart failure 202 244 250 8.6 8.4 8.4 24
Pneumonia 197 231 203 8.3 7.9 6.8 3
Fracture of neck of femur (hip fracture) 125 123 119 5.3 4.2 4.0 -5
Septicemia (blood infection) 76 103 115 3.2 3.5 3.9 51
Urinary tract infections 75 111 114 3.2 3.8 3.9 53
† Includes a small number of discharges (less than 38,000 or 0.1 percent) with missing age.
§ Consistent data is not available for this diagnosis due to coding changes that took place between 1997 and 2005.

The top five 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. The largest increase in hospitalizations occurred for 45-64 year olds (up 40 percent) and adults 85 and older (up 26 percent).



EXHIBIT 2.3 Most Frequent Principal Diagnosis by Gender

Number of Discharges, Percent Distribution, and Rank of the Most Frequent Principal Diagnoses for Inpatient Hospital Stays by Gender, 2006
PRINCIPAL CCS DIAGNOSIS MALES FEMALES PERCENT OF PRINCIPAL DIAGNOSIS TOTAL DISCHARGES
NUMBER OF DISCHARGES IN THOUSANDS PERCENT OF MALE DISCHARGES RANK NUMBER OF DISCHARGES IN THOUSANDS PERCENT OF FEMALE DISCHARGES RANK MALES FEMALES
All diagnoses† 16,296 100.0%   23,052 100.0%   41% 59%
Pregnancy and childbirth       4,785 20.8 1    
Liveborn (newborn infant) 2,191 13.4 1 2,090 9.1 2 51 49
Coronary atherosclerosis (coronary artery disease) 747 4.6 2 451 2.0 6 62 38
Pneumonia 583 3.6 3 633 2.7 3 48 52
Congestive heart failure 534 3.3 4 565 2.4 4 49 51
Acute myocardial infarction (heart attack) 406 2.5 5 269 1.2 20 60 40
Non-specific chest pain 379 2.3 6 477 2.1 5 44 56
Cardiac dysrhythmias (irregular heart beat) 369 2.3 7 379 1.6 10 49 51
Complication of medical device, implant or graft 327 2.0 8 307 1.3 16 52 48
Skin and subcutaneous tissue infections 319 2.0 9 276 1.2 19 54 46
Mood disorders (depression and bipolar disorders) 310 1.9 10 418 1.8 8 43 57
Osteoarthritis (degenerative joint disease) 281 1.7 13 451 2.0 7 38 62
Urinary tract infections 149 0.9 28 382 1.7 9 28 72
† Excludes a small number of discharges (less than 103,000 or 0.3 percent) with missing gender.

The top ten most frequent conditions for men and women in the hospital were responsible for almost 40 percent of all stays for men and 50 percent of all stays for women. 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.



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 Most Frequent All-listed Procedures by Gender



EXHIBIT 3.1 Most Frequent All-listed Procedures

Number, Percent Distribution, Rank, and Growth of Discharges for the Most Frequent All-listed Inpatient Hospital Procedures, 1997, 2005, and 2006
All-listed CCS Procedures Number of Stays with the Procedure in Thousands Percent of Discharges with the Procedure Rank Growth
1997 2005 2006 1997 2005 2006 1997 2005 2006 1997-2006
All discharges (with and without procedures) 34,679 39,164 39,450             14%
All discharges with any procedure 21,257 24,145 24,445 100% 100% 100%       15
Percent of all discharges with a procedure 61% 62% 62%              
Blood transfusion 1,097 2,359 2,382 5 10 10 5 1 1 117
Diagnostic cardiac catheterization, coronary arteriography (diagnostic procedure to explore the functioning of the heart) 1,461 1,589 1,671 7 7 7 1 2 2 14
Repair of obstetric laceration 1,137 1,334 1,373 5 6 6 3 3 3 21
Cesarean section (C-section) 800 1,304 1,346 4 5 6 9 4 4 68
Respiratory intubation and mechanical ventilation 919 1,223 1,294 4 5 5 7 7 5 41
Circumcision 1,164 1,237 1,224 5 5 5 2 5 6 5
Upper gastrointestinal endoscopy (procedure to view and biopsy the esophagus, stomach and first portion of intestine through a lighted tube) 1,105 1,224 1,213 5 5 5 4 6 7 10
Artificial rupture of membranes to assist delivery 747 885 1,007 4 4 4 10 10 8 35
Fetal monitoring 1,002 911 958 5 4 4 6 9 9 -4
Prophylactic vaccinations and inoculations 567 954 945 3 4 4 14 8 10 67
Episiotomy (surgical incision into the perineum and vagina to prevent traumatic tearing during delivery) 866 444 393 4 2 2 8 22 24 -55

During six out of ten hospital stays in 2006, at least one procedure was performed, and this proportion has changed little since 1997. The number of discharges with procedures increased from 21.3 million in 1997 to 24.4 million in 2006, a 15 percent increase.



(text version)

Exhibit 3.1. Chart showing Number of Stays with the Most Frequent All-listed Maternal and Newborn Procedures, 1997-2006



(text version)

Exhibit 3.1. Chart showing Number of Stays with the Most Frequent All-listed Procedures (Excluding Maternal and Newborn Stays), 1997-2006



Exhibit 3.2 Most Frequent All-listed Procedures by Age

Number of Discharges, Percent Distribution, and Growth for the Most Frequent All-listed Inpatient Hospital Procedures by Age Group, 1997, 2005, and 2006
AGE GROUP AND ALL-LISTED CCS PROCEDURES NUMBER OF DISCHARGES IN THOUSANDS PERCENT OF AGE-SPECIFIC TOTAL DISCHARGES GROWTH
1997 2005 2006 1997 2005 2006 1997-2006
All ages, total discharges† 34,679 39,164 39,450       14%
‹ 1 year, total discharges 4,426 4,978 4,908 100.0 100.0 100.0 11
Circumcision 1,159 1,232 1,220 26.2 24.7 24.9 5
Prophylactic vaccinations and inoculations 549 865 845 12.4 17.4 17.2 54
Ophthalmologic and otologic diagnosis and treatment (vision and hearing diagnosis and treatment) * 471 406 * 9.5 8.3 *
Respiratory intubation and mechanical ventilation 163 196 197 3.7 3.9 4.0 21
Enteral and parenteral nutrition 39 101 106 0.9 2.0 2.2 173
1-17 years, total discharges 1,821 2,059 1,711 100.0 100.0 100.0 -6
Appendectomy (removal of appendix) 74 95 84 4.1 4.6 4.9 13
Repair of obstetric laceration 58 54 56 3.2 2.6 3.3 -4
Blood transfusion 26 59 45 1.4 2.9 2.6 72
Cancer chemotherapy 43 64 40 2.4 3.1 2.3 -7
Artificial rupture of membranes to assist delivery 40 34 39 2.2 1.6 2.3 -4
18-44 years, total discharges 9,444 10,041 10,212 100.0 100.0 100.0 8
Repair of obstetric laceration 1,079 1,278 1,316 11.4 12.7 12.9 22
Cesarean section (C-section) 773 1,270 1,312 8.2 12.6 12.8 70
Artificial rupture of membranes to assist delivery 706 850 968 7.5 8.5 9.5 37
Fetal monitoring 952 876 919 10.1 8.7 9.0 -3
Episiotomy (surgical incision into the perineum and vagina to prevent traumatic tearing during delivery) 813 418 370 8.6 4.2 3.6 -55
45-64 years, all discharges 6,496 8,660 9,100 100.0 100.0 100.0 40
Diagnostic cardiac catheterization, coronary arteriography (diagnostic procedure to explore the functioning of the heart) 578 674 723 8.9 7.8 7.9 25
Blood transfusion 247 601 623 3.8 6.9 6.8 152
PTCA (percutaneous transluminal coronary angioplasty, procedure involving use of a balloon-tipped catheter to enlarge a narrowed artery) 247 349 398 3.8 4.0 4.4 61
Upper gastrointestinal endoscopy (procedure to view and biopsy the esophagus, stomach and first portion of intestine through a lighted tube) 275 356 368 4.2 4.1 4.0 34
Respiratory intubation and mechanical ventilation 186 310 348 2.9 3.6 3.8 87
65-84 years, total discharges 10,121 10,449 10,512 100.0 100.0 100.0 4
Blood transfusion 514 1,059 1,072 5.1 10.1 10.2 109
Diagnostic cardiac catheterization, coronary arteriography (diagnostic procedure to explore the functioning of the heart) 738 727 755 7.3 7.0 7.2 2
Upper gastrointestinal endoscopy (procedure to view and biopsy the esophagus, stomach and first portion of intestine through a lighted tube) 530 524 509 5.2 5.0 4.8 -4
Respiratory intubation and mechanical ventilation 366 430 454 3.6 4.1 4.3 24
PTCA (percutaneous transluminal coronary angioplasty, procedure involving use of a balloon-tipped catheter to enlarge a narrowed artery) 286 376 426 2.8 3.6 4.1 49
85+ years, total discharges 2,362 2,926 2,970 100.0 100.0 100.0 26
Blood transfusion 138 318 324 5.8 10.9 10.9 135
Upper gastrointestinal endoscopy (procedure to view and biopsy the esophagus, stomach and first portion of intestine through a lighted tube) 122 142 139 5.2 4.9 4.7 14
Respiratory intubation and mechanical ventilation 65 94 98 2.8 3.2 3.3 50
Treatment, fracture or dislocation of hip and femur 87 87 84 3.7 3.0 2.8 -3
Colonoscopy and biopsy 71 77 74 3.0 2.6 2.5 4
* 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 38,000 or 0.1 percent) with missing age.

The most frequent procedures tended to vary by age group.



EXHIBIT 3.3 Most Frequent All-listed Procedures by Gender

Procedures were performed in 62 percent of the discharges for both males and females in 2006. In the remaining 38 percent of discharges, no procedures were performed during the hospitalizations.

For males:

For females:



(text version)

Exhibit 3.3. Chart showing Percent of Discharges With and Without Procedures by Gender, 2006



Number of Discharges, Percent Distribution, and Rank of the Most Frequent All-listed Procedures for Inpatient Hospital Stays Excluding Pregnancy and Childbirth, by Gender, 2006
ALL-LISTED CCS PROCEDURES NUMBER OF DISCHARGES IN THOUSANDS PERCENT OF DISCHARGES WITH A PROCEDURE RANK
MALES FEMALES MALES FEMALES MALES FEMALES
Discharges with a procedure† 8,999 12,476 100% 100%    
Blood transfusion 1,024 1,358 11 11 1 1
Diagnostic cardiac catheterization, coronary arteriography (diagnostic procedure to explore the functioning of the heart) 1,017 654 11 5 2 3
Respiratory intubation and mechanical ventilation 690 603 8 5 3 4
PTCA (percutaneous transluminal coronary angioplasty, procedure involving use of a balloon-tipped catheter to enlarge a narrowed artery) 599 308 7 2 4 13
Upper gastrointestinal endoscopy (procedure to view and biopsy the esophagus, stomach and first portion of intestine through a lighted tube) 547 666 6 5 5 2
Hemodialysis (dialysis, cleaning the blood by means of a machine or filter to compensate for poor kidney function) 397 369 4 3 6 8
Echocardiogram (diagnostic ultrasound of heart) 376 346 4 3 7 12
Alcohol and drug rehabilitation/detoxification 275 116 3 1 8 37
Enteral and parenteral nutrition 265 269 3 2 9 17
Colonoscopy and biopsy 249 357 3 3 10 9
Arthroplasty knee 205 346 2 3 17 11
Hysterectomy (removal of the uterus) - 549 - 4 - 5
Oophorectomy, unilateral and bilateral (removal of an ovary or ovaries) - 407 - 3 - 6
† Excludes procedures related to pregnancy and childbirth and a small number of discharges (less than 103,000 or 0.3 percent) with missing gender.


(text version)

Exhibit 3.3. Chart showing Hysterectomy and Oophorectomy All-listed Procedures, 1997-2006

Most procedures unrelated to childbirth and newborns are the same for both males and females.



SECTION 4

SPENDING FOR INPATIENT HOSPITAL STAYS

EXHIBIT 4.1 Costs for the Most Frequent Principal Diagnoses
EXHIBIT 4.2 Costs for the Most Frequent Principal Diagnoses by Body System
EXHIBIT 4.3 Average Length of Stay and Average Charges



EXHIBIT 4.1 Costs for the Most Frequent Principal Diagnoses

Top 20 Inpatient Hospital Principal Diagnoses with the Highest Aggregate Costs, 1997, 2003*, and 2006
PRINCIPAL CCS DIAGNOSIS TOTAL INFLATION-ADJUSTED† HOSPITAL COSTS IN BILLIONS: 2006 DOLLARS PERCENT OF TOTAL COSTS AVERAGE ANNUAL PERCENT GROWTH
1997 2003 2006 1997 2003 2006 1997-2003 2003-2006 1997-2006
All diagnoses $216.3 $305.1 $329.2 100% 100% 100% 5.9% 2.6% 4.8%
Coronary atherosclerosis (coronary artery disease) 14.5 17.1 17.5 7 6 5 2.9 0.7 2.1
Acute myocardial infarction (heart attack) 9.0 12.3 11.8 4 4 4 5.3 -1.4 3.0
Congestive heart failure 6.6 10.7 11.2 3 4 3 8.5 1.5 6.1
Liveborn (newborn infant) 7.8 10.0 10.8 4 3 3 4.2 2.4 3.6
Osteoarthritis (degenerative joint disease) 4.6 7.7 10.3 2 3 3 8.8 10.3 9.3
Septicemia (blood infection) 4.0 5.4 10.2 2 2 3 5.1 23.6 10.9
Pneumonia 8.8 10.9 9.9 4 4 3 3.6 -3.0 1.3
Complication of medical device, implant or graft 5.5 9.0 9.4 3 3 3 8.6 1.6 6.2
Adult respiratory failure, insufficiency, or arrest 3.3 5.0 8.1 2 2 2 7.3 17.6 10.7
Disorders of intervertebral discs and bones in spinal column (back problems) 3.4 6.7 7.6 2 2 2 12.1 4.3 9.4
Cardiac dysrhythmias (irregular heart beat) 3.5 6.5 6.8 2 2 2 11.0 1.3 7.7
Acute cerebrovascular disease (stroke) 5.3 6.6 6.7 2 2 2 3.6 0.6 2.6
Complications of surgical procedures or medical care 2.9 4.8 5.1 1 2 2 9.0 2.1 6.6
Rehabilitation care, fitting of prostheses, and adjustment of devices 3.7 4.6 5.0 2 2 2 3.7 2.7 3.4
Diabetes mellitus with complications 2.7 4.0 4.5 1 1 1 6.9 3.4 5.7
Biliary tract disease (gall bladder disease) 3.3 4.3 4.4 2 1 1 4.6 1.0 3.4
Chronic obstructive lung disease 3.3 4.3 4.2 2 1 1 4.7 -0.9 2.8
Fracture of neck of femur (hip fracture) 3.1 3.8 4.1 1 1 1 3.2 2.5 2.9
Non-specific chest pain 1.6 3.7 3.9 1 1 1 14.4 1.6 10.0
Skin and subcutaneous tissue infections 1.5 2.7 3.5 1 1 1 9.9 8.9 9.6
Total for top 20 conditions 98.4 140.2 155.0 46 46 47 6.1 3.4 5.2
Total for top 6 cardiovascular conditions 40.5 57.0 57.9 19 19 18 5.8 0.5 4.0
* Rather than showing costs for 2005, this table includes data for 2003, the year when growth in costs for cardiac conditions began to slow. Specific cost growth information on cardiac conditions is highlighted in Exhibit 4.2.
† Adjusted for inflation using the GDP deflator (http://www.bea.gov/national/nipaweb/SelectTable.asp#S1, Table 1.1.4. Price Indexes for Gross Domestic Product).

The top 20 principal diagnoses with the highest aggregate inpatient hospital costs represented 47 percent of the $329.2 billion total cost for all stays in U.S. community hospitals in 2006. The top 20 diagnoses made up a similar share of costs (46 percent) in 1997 and 2003.

The most costly diagnoses:

Cost increases:

Cost stabilization and decreases:



EXHIBIT 4.2 Costs for the Most Frequent Principal Diagnoses by Body System

(text version)

Exhibit 4.2. Chart showing Distribution of Costs by Major Reason for Hospital Stay, 2006



(text version)

Exhibit 4.2. Chart showing Average Annual Growth in Total Inflation-adjusted Costs for the Most Expensive Circulatory Conditions, 1997-2006



EXHIBIT 4.3 Average Length of Stay and Average Charges

In general, longer lengths of stay are associated with higher average charges. While charges are generally more than the amount paid by payers for the hospitalization because of negotiated discounts, they can be used as a benchmark for comparing the costliness of different types of hospital stays.



(text version)

Exhibit 4.3. Chart showing Inpatient Hospital Stays for Principal Diagnosis: Average Length of Stay and Average Charges, 2006



SECTION 5

PRIORITY CONDITIONS

EXHIBIT 5.1 Childbirth
EXHIBIT 5.2 Depression
EXHIBIT 5.3 Cancer
EXHIBIT 5.4 Asthma
EXHIBIT 5.5 Arthritis



EXHIBIT 5.1 Childbirth

(text version)

Exhibit 5.1. Chart showing Vaginal and C-Section Deliveries as a Share of All Deliveries, 1993 and 2006



(text version)

Exhibit 5.1. Chart showing Maternal Stays for C-Section and Vaginal Deliveries, 1993-2006

In 2006, there were 4.3 million maternal stays that resulted in a delivery.

Maternal Stays for C-Section and Vaginal Deliveries, 1993-2006
  TOTAL ALL DELIVERIES IN THOUSANDS
VAGINAL C-SECTION
TOTAL AFTER C-SECTION TOTAL FIRST TIME
1993 3,774 2,958 138 817 518
1994 3,784 2,982 152 802 508
1995 3,768 2,977 157 791 507
1996 3,744 2,964 162 780 498
1997 3,809 3,010 160 799 506
1998 3,750 2,963 156 787 497
1999 3,840 2,993 145 848 532
2000 4,058 3,127 138 931 577
2001 3,980 2,986 112 995 600
2002 4,128 3,025 94 1,103 659
2003 4,052 2,882 76 1,170 695
2004 4,217 2,946 70 1,270 748
2005 4,192 2,889 62 1,303 756
2006 4,259 2,914 62 1,345 772

Overall, maternal complications are more commonly listed among women undergoing C-sections than among women who deliver vaginally. Some of these complications provide the rationale for performing C-sections.



(text version)

Exhibit 5.1. Chart showing Percent of Maternal Stays with Complications† by Delivery Type, 1993 and 2006



(text version)

Exhibit 5.1. Chart showing Number of Infant Complications† by Delivery Type, 2006

Between 1993 and 2006, the number of infant births grew from 3.8 million to 4.3 million. The number of vaginally delivered infants did not change significantly in this period. However, the number of infants born by C-section increased by 0.6 million, or 69 percent, at an annual rate of 4 percent.



(text version)

Exhibit 5.1. Chart showing Average Annual Growth of Infant Complications by Delivery Type, 1993-2006



EXHIBIT 5.2 Depression

(text version)

Exhibit 5.2. Chart showing Distribution of Discharges with a Principal Diagnosis of Depression and All Discharges by Age Group, 2006

Depression, including major depressive disorder and dysthymic disorder (chronic, mild depression), is a leading cause of disability in the US, affecting about 18 million adults.1

Patients hospitalized for depression are often diagnosed with comorbid (or secondary) psychiatric and physical conditions.2




1Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, Severity, and Comorbidity of Twelve-month DSM-IV Disorders in the National Comorbidity Survey Replication (NCS-R). 2005 Archives of General Psychiatry 62(6):617-27, 2005.
2Katon W. Clinical and Health Services Relationships between Major Depression, Depressive Symptoms, and General Medical Illness. Biological Psychiatry 54(3):216-226, 2003.



(text version)

Exhibit 5.2. Chart showing Percent of Depression Stays with Secondary Chronic Conditions or Secondary Mental Health and Substance Abuse Diagnoses by Age, 2006

Depression may be caused or exacerbated by multiple medical conditions. Because older adults often have multiple chronic conditions, they are particularly vulnerable to depression. Other chronic conditions add to the complexity of a depression diagnosis and can be responsible for under-diagnosis of this condition.3




3Hitchcock PN, Williams JW, Unützer J, et al. Depression and Comorbid Illness in Elderly Primary Care Patients: Impact on Multiple Domains of Health Status and Well-being. Annals of Family Medicine 2:555-562, 2004.





(text version)

Exhibit 5.2. Chart showing Discharge Prevalence for Depression by Median Income of Patient Zip Code, 2006

Nationwide, there were 142 discharges per 100,000 population for depression in 2006. The rate at which patients were hospitalized with a principal diagnosis of depression in 2006 varied by income4 and by region.




4Daniel J, Honey W, Landen M, Marshall-Williams S, Chapman D, Lando J. Mental Health in the United States: Health Risk Behaviors and Conditions Among Persons with Depression—New Mexico, 2003. Center for Disease Control Morbidity and Mortality Weekly Report 54(39):989-91, October 7, 2005; Beard JR, Tracy M, Vlahov D, Galea S. Trajectory and Socioeconomic Predictors of Depression in a Prospective Study of Residents of New York City. Annals of Epidemiology 18(3):235-43, March 2008.




(text version)

Exhibit 5.2. Chart showing Discharge Prevalence for Depression by Region, 2006



EXHIBIT 5.3 Cancer




5Cancer Facts and Figures, 2006. Online. 2006. American Cancer Society. http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf.





(text version)

Exhibit 5.3. Chart showing Cancer Conditions with the Greatest Change in Number of Discharges Between 1997 and 2006



(text version)

Exhibit 5.3. Chart showing Discharge Prevalence for Cancer by Region, 2006



(text version)

Exhibit 5.3. Chart showing Most Frequent Hospitalizations with a Principal Diagnosis of Cancer by Gender, 2006



EXHIBIT 5.4 Asthma



(text version)

Exhibit 5.4. Chart showing Rate of Asthma Hospitalizations by Patient Gender and Age, 2006



(text version)

Exhibit 5.4. Chart showing Distribution of Discharges with a Principal Diagnosis of Asthma by Expected Primary Payer, 1997 and 2006



(text version)

Exhibit 5.4. Chart showing Rates of Asthma Hospitalization by Median Income of Patient Zip Code and Region, 2006



EXHIBIT 5.5 Arthritis



(text version)

Exhibit 5.5. Chart showing Hospitalizations with a Principal Diagnosis of Arthritis, 1993-2006



(text version)

Exhibit 5.5. Chart showing Number of Arthritis Stays by Type of Arthritis, Gender, and Age, 2006



(text version)

Exhibit 5.5. Chart showing Percent of Specific Joint Procedures with Arthritis as a Principal Diagnosis, 2006

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 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 13,600 detailed diagnoses and 3,700 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 about 280 diagnostic and 230 procedure categories. This software aggregates similar diagnoses or procedures into clinically meaningful categories. More information on CCS can be found online (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, which 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—INPATIENT HOSPITAL STAYS BY DIAGNOSIS

EXHIBIT 2.1

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

SECTION 3—INPATIENT HOSPITAL STAYS BY PROCEDURE

EXHIBIT 3.3

Two steps were used to define maternal and infant procedures. First, all maternal and newborn stays were identified using the following codes:

Maternal stays were identified using Major Diagnostic Code 14: Pregnancy, childbirth and the puerperium.

Newborn stays were identified using the following CCS codes:
218 Liveborn
219 Short gestation, low birth weight, and fetal growth retardation
220 Intrauterine hypoxia and birth asphyxia (lack of oxygen to baby in uterus or during birth)
221 Respiratory distress syndrome
222 Hemolytic jaundice and perinatal jaundice
223 Birth trauma
224 Other perinatal conditions (other conditions occurring around the time of birth)


Second, maternal and newborn stays were examined for the following CCS all-listed procedures that were typically associated with maternal and infant stays:

Maternal procedures:
133 Episiotomy (surgical incision into the perineum and vagina to prevent traumatic tearing during delivery)
134 Cesarean section
135 Forceps, vacuum, and breech delivery
136 Artificial rupture of membranes to assist delivery
137 Other procedures to assist delivery
138 Diagnostic amniocentesis (diagnostic sampling of the fluid in the amniotic sac)
139 Fetal monitoring
140 Repair of obstetric laceration
141 Other therapeutic obstetrical procedures


Infant procedures:
115 Circumcision
220 Ophthalmologic and otologic diagnosis and treatment (vision and hearing diagnosis and treatment)
228 Prophylactic vaccinations and inoculations

SECTION 4—SPENDING FOR INPATIENT HOSPITAL STAYS

EXHIBIT 4.2

Top 6 most expensive circulatory system diagnoses:
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
109 Acute cerebrovascular disease (stroke)

SECTION 5—PRIORITY CONDITIONS

EXHIBIT 5.1

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 categories to produce repeat C-section and Vaginal Birth After C-section (VBAC):
189 Previous C-section


Childbirth complication CCS categories:
59 Deficiency and other anemia
182 Hemorrhage during pregnancy, abruptio placenta, placenta previa (bleeding and placenta disorders during pregnancy)
183 Hypertension complicating pregnancy, childbirth, and the puerperium (high blood pressure during pregnancy)
184 Early or threatened labor
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
189 Previous C-section
191 Polyhydramnios and other problems of amniotic cavity (excess amniotic fluid and other problems of amniotic cavity)
192 Umbilical cord complication


Infant delivery type ICD-9-CM codes:
V30-V39 Liveborn infants
.00 delivered without mention of cesarean delivery (vaginal delivery)
.01 delivered by cesarean delivery

Infant complication ICD-9-CM codes (selected ICD-9-CM codes were grouped together for graphic display):

Preterm birth:
765.0 Extreme immaturity
765.1 Other preterm infant


Meconium aspiration:
770.1 Fetal and newborn aspiration


Post-birth respiratory problems:
770.8 Other respiratory problems after birth


Neonatal jaundice:
774.2 Neonatal jaundice associated with preterm delivery
774.6 Unspecified fetal and neonatal jaundice


Other conditions listed separately:
761.1 Premature rupture of membrane affecting newborn
766.0 Exceptionally large baby
766.1 Heavy-for-dates infant
768.3 Fetal distress during labor
769 Respiratory distress syndrome
770.6 Transitory tachypnea
772.6 Cutaneous hemorrhage
773.1 Hemolytic disease due to ABO isoimmunization
775.0 "Infant of a diabetic mother" syndrome
775.6 Neonatal hypoglycemia
779.3 Feeding problems

EXHIBIT 5.2

Depression ICD-9-CM codes:
293.83 Mood disorder in conditions classified elsewhere-Transient organic psychotic condition, depressive type
296.2 Major depressive disorder, single episode
296.3 Major depressive disorder, recurrent episode
300.4 Dysthymic disorder
311 Depressive disorder, not elsewhere classified


Other Mental Health and Substance Abuse Secondary Conditions were identified in the following CCS-MHSA categories that were created using the CCS-MHSA tool:
650 Adjustment disorders
651 Anxiety disorders
652 Attention-deficit, conduct, and disruptive behavior disorders
653 Delirium, dementia, and amnestic and other cognitive disorders
654 Developmental disorders
655 Disorders usually diagnosed in infancy, childhood, or adolescence
656 Impulse control disorders, not elsewhere classified
657 Mood disorders
658 Personality disorders
659 Schizophrenia and other psychotic disorders
660 Alcohol-related disorders
661 Substance-related disorders

EXHIBIT 5.3

Cancer CCS categories:
11 Cancer of head and neck
12 Cancer of esophagus
13 Cancer of stomach
14 Cancer of the colon
15 Cancer of rectum and anus
16 Cancer of liver and intrahepatic bile duct
17 Cancer of pancreas
18 Cancer of GI organs and peritoneum
19 Cancer of bronchus, lung
20 Cancer, other respiratory and intrathoracic
21 Cancer of bone and connective tissue
22 Melanomas of skin
23 Other non-epithelial cancer of skin
24 Cancer of breast
25 Cancer of uterus
26 Cancer of cervix
27 Cancer of ovary
28 Cancer of other female genital organs
29 Cancer of prostate
30 Cancer of testis
31 Cancer of other male genital organs
32 Cancer of bladder
33 Cancer of kidney and renal pelvis
34 Cancer of other urinary organs
35 Cancer of brain and nervous system
36 Cancer of thyroid
37 Hodgkin's disease
38 Non-Hodgkin's lymphoma
39 Leukemias
40 Multiple myeloma
41 Cancer, other primary
43 Malignant neoplasm without specification of site
44 Neoplasms of unspecified nature or uncertain behavior
** Multiple cancer sites
** No specific sites listed
**CCS Diagnosis Code 42 ‘Secondary malignancies’ and 45 ‘Maintenance chemotherapy, radiotherapy’ were reclassified and discharges were assigned to a specific cancer category listed as a secondary condition. If no secondary cancer diagnosis was listed, then discharges for CCS diagnosis codes 42 and 45 were counted as ‘No specific sites listed.’ If multiple secondary CCS diagnoses were listed, then CCS diagnosis codes 42 and 45 discharges were counted as ‘Multiple cancer sites.’

EXHIBIT 5.4

Asthma CCS category:
128 Asthma

EXHIBIT 5.5

Arthritis CCS categories:
202 Rheumatoid arthritis and related disease
203 Osteoarthritis

DEFINITIONS

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

Adjusted for general inflation
Costs can be adjusted for economy-wide inflation by removing increases that reflect the effect of changing average prices for the same 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.

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

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 far more than what it costs hospitals to provide 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 care. For each hospital, a hospital-wide cost-to-charge ratio is used to transform charges into costs.

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 1,000 population
Discharges per 1,000 population is the hospital discharge rate of a particular procedure, diagnosis, or event per 1,000 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.

Metropolitan location
Metropolitan location indicates that the hospital is in a metropolitan area ("urban") rather than a non-metropolitan area ("rural"), as defined by the American Hospital Association (AHA) Annual Survey, using the 1993 U.S. Office of Management and Budget definition.

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. http://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
Many of the statistics presented here were taken directly from HCUPnet. For additional HCUP statistics, visit HCUPnet, our interactive query system at http://hcupnet.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 Reuters for their programming support; Anne Pfuntner at Thomson Reuters for her assistance in the preparation of tables and text; Cheryl Kassed, also at Thomson Reuters, for her editorial assistance; and Robyn Short of The Madison Design Group for her creative design and layout of the report. 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 (Thomson Reuters), Stranges E (Thomson Reuters), Ryan K (Thomson Reuters), Elixhauser A (AHRQ). HCUP Facts and Figures, 2006: Statistics on Hospital-based Care in the United States. Rockville, MD: Agency for Healthcare Research and Quality, 2008. http://www.hcup-us.ahrq.gov/reports.jsp


Internet Citation: Facts and Figures 2006. 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_2006.jsp.
Are you having problems viewing or printing pages on this Website?
If you have comments, suggestions, and/or questions, please contact hcup@ahrq.gov.
Privacy Notice, Viewers & Players
Last modified 2/1/11