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2005 HCUP Nationwide Inpatient Sample (NIS) Comparison Report


HCUP Methods Series 2005 Nationwide Inpatient Sample (NIS) Comparison Report

Report #2008-01

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Healthcare Cost and Utilization Project (HCUP)
Agency for Healthcare Research and Quality
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Recommended Citation: Whalen D, Houchens R, Elixhauser A, 2005 HCUP Nationwide Inpatient Sample (NIS) Comparison Report. HCUP Method Series Report # 2008-01. Online February 22, 2008. U.S. Agency for Healthcare Research and Quality.
Available: http://www.hcup-us.ahrq.gov/reports/methods/methods_topic.jsp



TABLE OF CONTENTS

INDEX OF TABLES

INDEX OF FIGURES 


INTRODUCTION

This report provides a summary of analyses that compare estimates from the HCUP Nationwide Inpatient Sample (NIS) for 2005 to three related data sources: the American Hospital Association (AHA) Annual Survey, the National Hospital Discharge Survey (NHDS) from the National Center for Health Statistics, and the MedPAR inpatient data from the Centers for Medicare and Medicaid Services (CMS). For full information on these databases and complete details on prior years’ findings, refer to earlier versions of this report under the heading "NIS Comparison Reports" at http://www.hcup-us.ahrq.gov/db/nation/nis/nisrelatedreports.jsp

As shown in Figure 1 and Table 1, the NIS is drawn from a sampling frame comprising 37 states.

Figure 1. States Participating in the NIS, 2005 (text version)

Figure 1: Map of states participating in the 2005 NIS

The findings in this report are summarized in tables that highlight differences and similarities between the databases.

Based on the analyses presented in this report, the NIS appears to provide reliable national estimates when compared with other national data sources along the dimensions of hospital characteristics, numbers of discharges, length of stay, and in-hospital mortality.

Each of the data sources discussed has its strengths and weaknesses, and each may be the preferred choice for different research questions. The NIS offers a large sample that enables study of low incidence disorders and less common procedures; NIS estimates can be calculated for literally thousands of special sub-populations that may be of interest to researchers. In addition, NIS hospitals accurately reflect the universe of United States hospitals, particularly the relative mix of large and small hospitals. Therefore, the NIS may be more appropriate when hospital type and size are important considerations.

In contrast, the NHDS and MedPAR both offer data drawn from all 50 states, rather than the more limited sampling frame for the NIS. Where a comprehensive geographic representation is more important than a large sample size, and the question under study requires all age groups, the NHDS might be preferable. In the same situation, if only Medicare clients are of interest, the MedPAR data set might be preferable.

As for which of the data sources discussed is preferable or better, the answer depends on the needs of the researcher. The intended use of the data is the most critical factor in determining which data source will be most valuable. In general, the NIS estimates of variables essential to health care policy – including in-hospital mortality, inpatient population size, length of stay, and charges – are accurate and precise. Statistics can be calculated for large groups ranging from the inpatient population of the United States, as well as for small subsets featuring specific conditions. The characteristics documented in this report suggest that the NIS is a valuable tool for researchers and policy makers alike.

Table 1. Comparison of States in the NIS with the Universe
  NIS 2005 Universe (U.S.)
Number of States 37 50 plus District of Columbia
Population 255,210,568 295,895,897
Sampling frame for the NIS includes: 78% of U.S. Community Hospitals 100%
84% of community hospital discharges 100%
86% of U.S. population 100%
Average population density (persons per square mile) 116.5 30.22
Population density for the least populated states (persons per square mile) Nevada (21.9)
South Dakota (10.3)
Montana (6.4)
Wyoming (5.2)
Alaska (1.2)
Market penetration of Medicare managed care providers 13.6% 12.1%

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NIS-AHA Comparisons

NIS hospitals resembled typical hospitals in the AHA universe in most characteristics, although NIS hospitals were more active, had higher and more intensive staffing rates, had larger expenditures compared to the AHA universe, and more Medicaid-covered patients. NIS facilities also admitted and discharged more patients and had higher expenditures and larger payrolls than hospitals in the AHA universe. NIS hospitals also tended to offer slightly more high-technology services, as compared with the universe. Nearly all NIS discharge estimates closely align with the discharge counts from the AHA Survey. This is not surprising, because NIS sampling strata and NIS discharge weights were based on AHA Annual Survey results. The AHA-derived sampling weights in the NIS yield discharge counts consistent with the AHA universe, overall, by region, and for most categories of hospital control and type. The 35 discharge comparisons shown in Table 6, exhibited no significant differences.

In contrast, the overall NIS estimated average length of stay was slightly longer than the AHA statistic. Rural hospitals was the one category where the weighted NIS hospital count differed from the actual AHA hospital count--the NIS includes relatively fewer small rural hospitals and relatively more large rural hospitals than found in the AHA universe.

Table 2. Number of Hospitals in NIS Frame and Universe, 2005
  2005 NIS Frame1 (Weighted) 2005 NIS Frame1 (Unweighted) 2005 AHA Universe
U.S. 5,146 1,054 5,203
Region
Northeast 669 138 669
Midwest 1,481 301 1,481
South 2,054 420 2,054
West 942 195 942
Hospital Control
Public 1,150 238 1,125
Not for-profit 3,006 614 2,953
Proprietary 989 202 1,068
Location / Teaching Status
Rural 2,056 421 2,056
Small 1,008 205 1,313
Medium 445 91 408
Large 603 125 335
Urban, non-teaching 2,339 476 2,339
Small 1,069 217 1,081
Medium 582 119 622
Large 688 140 636
Urban, teaching 751 157 751
Small 216 45 204
Medium 245 52 228
Large 290 60 319

Note: Significance tests were not performed because AHA numbers are not sample statistics.
1 The 2005 frame contains 37 states.

Table 3. NIS Hospitals and AHA Universe Comparisons, 2005
  NIS (Unweighted) Universe
High Tech Index1 (mean) 2.57 2.41
High Tech Index1 (median) 2.00 2.00
Neonatal ICUs2 (pct) 16.79 18.20
Cardiac Catheterization2 (pct) 26.19 25.21
CT Scanners2 (pct) 78.75 70.96
MRIs2 (pct) 55.41 50.28
Open Heart Surgeries2 (pct) 20.49 20.63
Transplant Services2 (pct) 7.50 7.25
Intensity Modulated Radiation Therapy2 (pct) 15.84 16.17
Extracorporeal Shock Wave Lithotripsy2 (pct) 21.35 19.86
PET Scanners2 (pct) 14.99 12.44
 
Pediatric Specialty Hospitals (pct) 1.80 1.37
Burn Units (pct) 3.80 3.88
Rehabilitation Units (pct) 23.81 23.93
Alc/Chem Dep Services (pct) 7.59 7.50
Trauma Centers (pct) 27.89 27.50
Emergency Departments (pct) 80.36 73.97

Note: Significance tests were not performed because AHA numbers are not sample statistics.
1Prior to 2004, the index included Angioplasty services.
2High technology service - used in the "High Tech Index."

Table 4. NIS Hospitals and AHA Universe Comparisons, 2005
  NIS Mean (Unweighted) Universe Mean NIS Median (Unweighted) Universe Median
Hospital Admissions 7,004.68 6,790.64 3,386.50 3,178.00
Hospital Discharges 7,004.68 6,790.64 3,386.50 3,178.00
Hospital Discharges1 7,828.76 7,558.52 3,759.00 3,483.00
Average Length of Stay 6.14 5.84 4.43 4.41
Average Length of Stay1 5.62 5.45 4.05 4.04
Births 824.08 767.88 302.00 232.00
Percent Medicare Days 55.20 55.72 55.20 56.79
Percent Medicare Discharges 49.37 49.13 48.76 48.50
Percent Medicare Discharges1 45.84 45.83 43.99 44.07
Percent Medicaid Days 14.73 14.39 12.69 12.42
Percent Medicaid Discharges 15.75 15.60 15.30 14.95
Percent Medicaid Discharges1 14.12 14.16 13.75 13.55
Hospital Beds 146.20 144.50 83.50 81.00
Occupancy Rate 53.21 53.12 54.83 55.56
Inpatient Surgeries 1,987.14 1,991.45 898.00 825.00
FTE2 846.75 829.46 395.00 381.50
FTE2 per Bed 5.60 5.56 5.18 5.11
RN FTE2 per 1000 Patient Days 3.17 3.29 2.96 2.94
Intern-Resident FTE2 per 100 Beds 5.45 5.92 0.00 0.00
Intern-Resident FTE2 per 100 Beds (Teaching Hospitals) 30.32 35.73 10.53 13.58
Total Hospital Expenses [dollars] 103,599,162 99,353,450 43,455,064 39,361,147
Hosp. Expenses per Bed [dollars] 628,002 616,550 561,940 560,385
Total Hospital Payroll [dollars] 42,397,469 40,086,698 17,610,999 16,080,243
Hosp. Payroll per Bed [dollars] 254,295 247,186 228,138 221,846

Note: Significance tests were not performed because AHA numbers are not sample statistics.

1Adjusted for well newborns.
2Full-time equivalents.

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Table 5. NIS and AHA Comparisons by Overall, 2005
  Number of Discharges in Thousands (Standard Error) Average Length of Stay in Days (Standard Error)
NIS AHA NIS AHA
Overall 39,163 (765) 39,611 4.65 (0.03) 4.54**
 
Region
Northeast 7,753 (333) 7,753 5.27 (0.09) 5.15
South 9,020 (296) 9,020 4.42 (0.06) 4.34
Midwest 14,942 (537) 14,942 4.60 (0.05) 4.56
West 7,447 (311) 7,447 4.35 (0.09) 4.10**

*Significant at a 5 percent level.
**Significant at a 1 percent level.

Table 6. NIS and AHA Comparisons by Hospital Ownership, 2005
Hospital Ownership Number of Discharges in Thousands (Standard Error) Average Length of Stay in Days (Standard Error)
NIS AHA NIS AHA
Total Public 5,524 (604) 5,284 4.83 (0.11) 4.74
1-99 Beds 1,130 (64) 1,086 3.92 (0.18) 4.02
100-199 Beds 683 (90) 874* 3.96 (0.14) 4.19
200-299 Beds 573 (136) 671 4.71 (0.15) 4.31*
300-499 Beds 1,405 (223) 1,252 5.29 (0.10) 5.14
500+ Beds 1,730 (368) 1,399 5.44 (0.28) 5.49
Total Private Non-Profit 28,231 (953) 28,546 4.62 (0.04) 4.49**
1-99 Beds 2,878 (162) 2,708 3.78 (0.06) 3.84
100-199 Beds 4,989 (293) 5,023 4.36 (0.06) 4.17**
200-299 Beds 5,682 (490) 5,766 4.66 (0.09) 4.39**
300-499 Beds 8,829 (769) 8,401 4.66 (0.07) 4.47*
500+ Beds 5,851 (836) 6,646 5.17 (0.12) 5.12
Total Proprietary 5,408 (341) 5,333 4.60 (0.09) 4.58
1-99 Beds 934 (91) 1,019 4.95 (0.34) 4.98
100-199 Beds 1,667 (108) 1,693 4.35 (0.16) 4.25
200-299 Beds 1,679 (202) 1,323 4.47 (0.14) 4.43
300-499 Beds 635 (178) 882 4.79 (0.13) 4.90
500+ Beds 491 (90) 415 4.95 (0.23) 4.78

*Significant at a 5 percent level.
**Significant at a 1 percent level.

Table 7. NIS and AHA Comparisons by Location / Teaching Status, 2005
Location / Teaching Status Number of Discharges in Thousands (Standard Error) Average Length of Stay in Days (Standard Error)
NIS AHA NIS AHA
Rural 5,176 (179) 5,176 3.98 (0.06) 4.18**
small 1,291 (55) 1,320 3.64 (0.15) 3.68
medium 1,509 (128) 1,337 3.69 (0.05) 3.97**
large 2,375 (220) 2,518 4.34 (0.08) 4.55*
Urban, Non-teaching 17,899 (431) 17,899 4.56 (0.04) 4.34**
small 2,016 (140) 2,065 4.52 (0.17) 4.49
medium 4,482 (200) 4,867 4.33 (0.08) 4.09**
large 11,401 (395) 10,965 4.65 (0.05) 4.43**
Urban, Teaching 16,088 (605) 16,088 4.96 (0.06) 4.87
small 2,447 (321) 2,136 4.50 (0.14) 4.54
medium 4,652 (530) 4,403 4.86 (0.12) 4.68
large 8,988 (846) 9,547 5.15 (0.09) 5.04

*Significant at a 5 percent level.
**Significant at a 1 percent level.

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NIS-NHDS COMPARISONS

All NIS and NHDS estimates agreed in the overall and regional comparisons. Agreements were also observed for most comparisons across hospital, patient, diagnoses, and procedure categories. Overall, agreement between the NIS and NHDS was observed for 70 percent of the discharge comparisons and 99 percent of the average length of stay (ALOS) comparisons. The degree of consistency for in-hospital mortality rates was also high: no significant differences were found among these region and patient categories, and estimates agreed for 65 percent of hospital category comparisons. Of the NIS-NHDS differences discovered, most occur in diagnosis and procedure groupings.

The NIS provides a large sample size that tends to yield estimates with much smaller standard errors than does a sample such as the NHDS. Without a sample of several million, as provided by the NIS, estimates for less common procedures and diagnoses are unreliable. While the NIS may over-represent urban areas, the prevalence of higher-density states in the NIS yields data on atypical conditions rarely included in a smaller sample.

When estimating ALOS and in-hospital mortality for the nation, or within any major categories, NIS rates were consistent with the NHDS data. Because NIS estimates have greater precision – the result of the large sample size – it may be preferred for certain analyses based on relatively uncommon conditions. Furthermore, the NIS contains total hospital charges, while the NHDS does not.

Table 8. NIS and NHDS Comparisons by Overall, 2005
Overall Number of Discharges in Thousands (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error)
  NIS NHDS NIS NHDS NIS NHDS
Overall 39,163 (765) 38,666 (1,763) 4.63 (0.03) 4.62 (0.33) 2.09 (0.04) 1.98 (0.12)
Region
Northeast 7,753 (333) 7,931 (1,078) 5.26 (0.09) 5.191 (c) 2.45 (0.17) 2.131 (c)
South 9,020 (296) 8,753 (1,039) 4.41 (0.06) 4.091 (c) 1.91 (0.05) 2.011 (c)
Midwest 14,942 (537) 14,335 (795) 4.58 (0.05) 4.74 (0.41) 2.08 (0.05) 1.91 (0.15)
West 7,447 (311) 7,646 (570) 4.33 (0.09) 4.401 (c) 1.94 (0.07) 1.92 (0.20)

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.
(c) A valid standard error could not be calculated.

Table 9. NIS and NHDS Comparisons by Hospital Control, 2005
Hospital Control Number of Discharges in Thousands (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error)
  NIS NHDS NIS NHDS NIS NHDS
Total Public 5,524 (604) 4,559 (211) 4.81 (0.11) 4.82 (0.35) 2.05 (0.07) 1.76* (0.11)
1-99 Beds 1,130 (64) 1,235 (59) 3.90 (0.18) 3.64 (0.27) 2.37 (0.08) 1.31** (0.09)
100-199 Beds 683 (90) 850 (42) 3.94 (0.14) 4.15 (0.32) 1.89 (0.14) 1.68 (0.11)
200-299 Beds 573 (136) 377 (20) 4.69 (0.15) 4.50 (0.36) 1.95 (0.22) 1.76 (0.13)
300-499 Beds 1,405 (223) 1,408 (67) 5.27 (0.10) 5.45 (0.41) 1.93 (0.11) 2.27 (0.15)
500+ Beds 1,730 (368) 686** (34) 5.42 (0.28) 6.61* (0.51) 2.03 (0.17) 1.63 (0.11)
Total Private Non-Profit 28,231 (953) 29,351 (1,339) 4.60 (0.04) 4.56 (0.33) 2.09 (0.05) 2.05 (0.13)
1-99 Beds 2,878 (162) 6,626** (305) 3.75 (0.06) 4.02 (0.29) 2.01 (0.06) 1.72* (0.11)
100-199 Beds 4,989 (293) 6,269** (289) 4.34 (0.06) 4.43 (0.32) 2.10 (0.08) 2.01 (0.13)
200-299 Beds 5,682 (490) 6,172 (284) 4.65 (0.09) 4.62 (0.33) 2.25 (0.22) 2.04 (0.13)
300-499 Beds 8,829 (769) 6,380** (294) 4.64 (0.07) 4.75 (0.34) 2.04 (0.07) 2.32 (0.15)
500+ Beds 5,851 (836) 3,902* (181) 5.15 (0.12) 5.27 (0.38) 2.03 (0.10) 2.29 (0.15)
Total Proprietary 5,408 (341) 4,755 (220) 4.58 (0.09) 4.82 (0.35) 2.11 (0.06) 1.74** (0.11)
1-99 Beds 934 (91) 1,014 (49) 4.93 (0.34) 5.24 (0.39) 2.26 (0.20) 1.60** (0.11)
100-199 Beds 1,667 (108) 2,170** (102) 4.33 (0.16) 4.69 (0.34) 2.00 (0.10) 1.57** (0.10)
200-299 Beds 1,679 (202) 945** (46) 4.45 (0.14) 4.68 (0.35) 2.11 (0.09) 2.25 (0.15)
300-499 Beds 635 (178) 625 (32) 4.77 (0.13) 4.78 (0.37) 2.27 (0.18) 1.83 (0.13)
500+ Beds 491 (90) 01 (a) 4.93 (0.23) 0.001 (a) 2.00 (0.14) 0.001 (a)

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.
(a) Because of very small sample size, the NHDS estimate and standard error were unreliable and not reported.

Table 10. NIS and NHDS Comparisons by Patient Characteristics, 2005
  Number of Discharges in Thousands (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error)
NIS NHDS NIS NHDS NIS NHDS
Age Group
0-15 Years 6,632 (261) 6,594 (303) 3.68 (0.08) 3.88 (0.28) 0.41 (0.02) 0.43 (0.02)
16-44 Years 10,445 (259) 10,494 (481) 3.61 (0.04) 3.69 (0.27) 0.41 (0.01) 0.36 (0.02)
45-64 Years 8,659 (201) 8,349 (383) 4.93 (0.04) 4.96 (0.36) 1.83 (0.05) 1.77 (0.11)
65+ Years 13,374 (314) 13,228 (605) 5.70 (0.04) 5.51 (0.40) 4.40 (0.07) 4.17 (0.27)
Gender
Female 22,980 (472) 22,720 (1,037) 4.41 (0.03) 4.39 (0.32) 1.80 (0.04) 1.65 (0.10)
Male 16,052 (310) 15,946 (729) 4.95 (0.03) 4.94 (0.36) 2.51 (0.04) 2.45 (0.15)
Race
White 19,636 (776) 23,031* (1,504) 4.75 (0.04) 4.63 (0.46) 2.42 (0.05) 2.09 (0.19)
Black 3,395 (219) 4,527** (316) 5.26 (0.08) 5.29 (0.58) 1.93 (0.10) 1.72 (0.17)
Other 5,522 (348) 1,706** (234) 4.33 (0.08) 4.681 (c) 1.42 (0.06) 2.051 (c)
Unknown 10,609 (729) 9,401 (1,224) 4.36 (0.06) 4.261 (c) 1.88 (0.04) 1.841 (c)

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.
(c) A valid standard error could not be calculated.

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Table 11. NIS and NHDS Comparisons by Principal Payer, 2005
Principal Payer Number of Discharges in Thousands (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error)
NIS NHDS NIS NHDS NIS NHDS
Medicare 14,556 (337) 13,790 (704) 5.75 (0.04) 5.61 (0.43) 3.89 (0.06) 3.69 (0.26)
Medicaid 7,642 (271) 7,433 (591) 4.33 (0.07) 4.461 (c) 0.85 (0.03) 0.80 (0.09)
Private Insurance 13,684 (421) 13,204 (764) 3.74 (0.03) 3.79 (0.36) 1.01 (0.04) 1.05 (0.08)
Self Pay 1,920 (110) 1,668 (105) 3.87 (0.08) 3.84 (0.40) 1.39 (0.05) 1.18 (0.10)
No Charge 175 (42) 65* (12) 4.35 (0.24) 4.941 (c) 1.21 (0.13) 1.041 (c)
Other 1,135 (59) 2,504** (474) 4.31 (0.08) 4.491 (c) 1.55 (0.12) 1.551 (c)
Missing 10 (3) 01 (a) 3.59 (0.70) 0.001 (a) 1.24 (0.76) 0.001 (a)

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.
(a) Because of very small sample size, the NHDS estimate and standard error were unreliable and not reported.
(c) A valid standard error could not be calculated.

Table 12. NIS and NHDS Comparisons by the 25 Most Common Principal Diagnoses, 2005
Principal Diagnosis Number of Discharges in Thousands (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error)
NIS NHDS NIS NHDS NIS NHDS
218: Liveborn 4,228 (157) 4,008 (186) 3.17 (0.05) 3.39 (0.25) 0.32 (0.01) 0.40* (0.02)
122: Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 1,355 (28) 1,382 (66) 5.52 (0.04) 5.27 (0.39) 3.98 (0.07) 3.31** (0.22)
101: Coronary atherosclerosis and other heart disease 1,109 (49) 1,110 (54) 3.31 (0.05) 3.30 (0.25) 0.52 (0.01) 0.59 (0.04)
108: Congestive heart failure; nonhypertensive 1,090 (25) 1,113 (54) 5.38 (0.04) 5.09 (0.38) 3.87 (0.07) 3.11** (0.21)
102: Nonspecific chest pain 824 (32) 40** (4) 1.81 (0.01) 1.421 (c) 0.05 (0.00) 0.001 (c)
193: OB-related trauma to perineum and vulva 784 (36) --1 (a) 2.05 (0.01) --1 (a) 0.00 (0.00) --1 (a)
195: Other complications of birth; puerperium affecting management of mother 761 (29) 71** (5) 2.72 (0.02) 3.12 (0.36) 0.02 (0.00) 0.00** (0.00)
203: Osteoarthritis 738 (29) 760 (38) 3.72 (0.03) 3.74 (0.29) 0.10 (0.00) 0.09 (0.00)
106: Cardiac dysrhythmias 696 (19) 758 (38) 3.51 (0.03) 3.30 (0.25) 1.09 (0.03) 0.50** (0.03)
100: Acute myocardial infarction 662 (23) 682 (34) 5.23 (0.06) 5.50 (0.42) 6.81 (0.13) 7.91 (0.56)
205: Spondylosis; intervertebral disc disorders; other back problems 647 (28) 610 (31) 3.06 (0.04) 3.08 (0.24) 0.15 (0.01) 0.11** (0.00)
69: Affective disorders 642 (39) 963** (47) 7.37 (0.17) 7.21 (0.54) 0.03 (0.00) 0.05 (0.00)
127: Chronic obstructive pulmonary disease and bronchiectasis 630 (14) 719* (36) 4.89 (0.04) 4.74 (0.36) 2.04 (0.06) 2.06 (0.14)
237: Complication of device; implant or graft 615 (22) 539* (28) 5.98 (0.07) 5.97 (0.47) 1.77 (0.05) 1.34** (0.09)
197: Skin and subcutaneous tissue infections 582 (13) 566 (29) 4.55 (0.04) 4.66 (0.36) 0.34 (0.01) 0.23** (0.01)
55: Fluid and electrolyte disorders 573 (13) 740** (37) 3.69 (0.03) 3.45 (0.27) 1.93 (0.06) 1.73 (0.12)
2: Septicemia (except in labor) 537 (16) 492 (25) 8.84 (0.10) 8.21 (0.64) 18.28 (0.28) 19.15 (1.42)
159: Urinary tract infections 528 (11) 641** (32) 4.44 (0.04) 4.30 (0.33) 1.22 (0.04) 1.01* (0.07)
109: Acute cerebrovascular disease 526 (13) 528 (27) 6.18 (0.07) 6.34 (0.49) 10.12 (0.16) 10.77 (0.79)
254: Rehabilitation care; fitting of prostheses; and adjustment of devices 516 (33) 495 (26) 12.26 (0.18) 11.56 (0.90) 0.71 (0.09) 0.49* (0.03)
181: Other complications of pregnancy 513 (20) 211** (12) 2.42 (0.01) 2.76 (0.25) 0.03 (0.00) 0.00** (0.00)
50: Diabetes mellitus with complications 491 (11) 486 (25) 5.34 (0.06) 5.20 (0.41) 1.00 (0.03) 0.75** (0.05)
189: Previous C-section 481 (19) --1 (a) 2.85 (0.02) --1 (a) 0.00 (0.00) --1 (a)
238: Complications of surgical procedures or medical care 463 (12) 451 (24) 6.28 (0.06) 5.95 (0.47) 1.39 (0.04) 1.80** (0.13)
149: Biliary tract disease 455 (10) 433 (23) 4.23 (0.03) 4.22 (0.34) 0.73 (0.03) 0.74 (0.05)

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.
(a) Because of very small sample size, the NHDS estimate and standard error were unreliable and not reported.
(c) A valid standard error could not be calculated.

Table 13. NIS and NHDS Comparisons by the 25 Most Common Principal Procedures, 2005
Principal Procedure Number of Discharges in Thousands (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error)
NIS NHDS NIS NHDS NIS NHDS
137: Other procedures to assist delivery 1,475 (64) 1,020** (50) 2.12 (0.01) 2.17 (0.16) 0.00 (0.00) 0.00** (0.00)
134: Cesarean section 1,301 (49) 1,255 (60) 3.62 (0.03) 3.49 (0.26) 0.01 (0.00) 0.02** (0.00)
115: Circumcision 1,195 (49) 1,152 (56) 2.99 (0.05) 2.90 (0.22) 0.00 (0.00) 0.03** (0.00)
45: Percutaneous transluminal coronary angioplasty (PTCA) 749 (45) 579** (29) 2.70 (0.04) 2.80 (0.22) 0.75 (0.03) 0.92* (0.06)
70: Upper gastrointestinal endoscopy; biopsy 706 (18) 692 (35) 5.40 (0.03) 5.24 (0.40) 1.40 (0.03) 1.23 (0.08)
140: Repair of current obstetric laceration 694 (41) 829* (41) 2.15 (0.01) 2.11 (0.16) 0.00 (0.00) 0.00 (0.00)
216: Respiratory intubation and mechanical ventilation 667 (15) 634 (32) 10.72 (0.19) 10.34 (0.79) 26.97 (0.41) 24.38 (1.76)
222: Blood transfusion 614 (20) 579 (29) 5.77 (0.05) 5.78 (0.45) 5.04 (0.10) 4.43 (0.32)
47: Diagnostic cardiac catheterization; coronary arteriography 603 (23) 514* (26) 3.60 (0.04) 3.71 (0.29) 0.83 (0.03) 0.53** (0.03)
228: Prophylactic vaccinations and inoculations 570 (58) 587 (30) 2.57 (0.08) 2.59 (0.20) 0.02 (0.01) 0.00 (0.00)
124: Hysterectomy; abdominal and vaginal 567 (18) 552 (28) 2.66 (0.02) 2.74 (0.22) 0.07 (0.00) 0.10* (0.00)
152: Arthroplasty knee 549 (22) 558 (28) 3.81 (0.03) 3.79 (0.30) 0.11 (0.01) 0.06** (0.00)
231: Other therapeutic procedures 512 (37) 578 (29) 5.25 (0.10) 4.80 (0.37) 2.89 (0.20) 2.50 (0.18)
54: Other vascular catheterization; not heart 497 (14) 480 (25) 9.22 (0.11) 9.42 (0.74) 8.31 (0.22) 7.73 (0.57)
84: Cholecystectomy and common duct exploration 388 (10) 346 (19) 4.71 (0.04) 4.45 (0.36) 0.75 (0.03) 0.74 (0.05)
153: Hip replacement; total and partial 381 (14) 369 (20) 4.86 (0.05) 5.03 (0.41) 0.89 (0.04) 1.22** (0.09)
158: Spinal fusion 332 (18) 306 (17) 3.94 (0.08) 4.14 (0.34) 0.24 (0.02) 0.15** (0.01)
48: Insertion; revision; replacement; removal of cardiac pacemaker or cardioverter/defibrillator 325 (14) 294 (16) 4.76 (0.07) 4.54 (0.38) 0.97 (0.04) 1.00 (0.08)
133: Episiotomy 308 (18) 326 (18) 2.17 (0.01) 2.17 (0.18) 0.00 (0.00) 0.00 (0.00)
80: Appendectomy 308 (9) 317 (17) 2.88 (0.03) 2.78 (0.23) 0.12 (0.01) 0.08* (0.00)
58: Hemodialysis 303 (10) 258* (15) 5.55 (0.07) 5.49 (0.46) 3.42 (0.10) 3.40 (0.28)
219: Alcohol and drug rehabilitation/detoxification 294 (31) 309 (17) 5.59 (0.47) 5.74 (0.47) 0.11 (0.01) 0.19** (0.01)
78: Colorectal resection 284 (8) 269 (15) 999 (0.07) 10.07 (0.83) 3.93 (0.10) 3.90 (0.31)
146: Treatment; fracture or dislocation of hip and femur 276 (6) 260 (15) 6.03 (0.05) 5.93 (0.50) 1.86 (0.06) 2.24 (0.18)
61: Other OR procedures on vessels other than head and neck 272 (9) 238* (14) 8.88 (0.23) 9.09 (0.76) 4.38 (0.13) 3.34** (0.28)

* Significant at a 5 percent level.
** Significant at a 1 percent level.
1 A significance test was not performed because a valid standard error was not available.
(a) Because of very small sample size, the NHDS estimate and standard error were unreliable and not reported.
(c) A valid standard error could not be calculated.

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NIS-MEDPAR COMPARISONS

With the exception of discharge counts, NIS estimates of Medicare measures were generally consistent with MedPAR statistics. NIS discharge estimates were uniformly higher than the MedPAR numbers by approximately 10 percent, consistent with the omission of most managed care enrollees from the MedPAR. While 13.3 percent of Medicare patients were enrolled in managed care programs, the MedPAR data contain virtually no managed care discharges (only 485 out of 13,544,670 total discharges, or 0.004 percent).

The NIS provides a large sample of Medicare discharges both in managed care and fee-for-service plans; it would therefore be the choice of researchers who wished to include all discharges regardless of payment type. Inclusion of Medicare managed care discharges leads to discrepancies in estimated discharge counts, but most other NIS Medicare estimates were similar to MedPAR statistics, particularly with respect to comparisons by hospital characteristics. For analyses involving charges on all payers, the NIS is the only choice.

The NIS also contains significant numbers of discharges for which race was missing (26 percent). While the NHDS also suffers from this problem (24 percent of discharges without race), race information is present for nearly all MedPAR discharges.

Table 14. NIS and MedPAR Comparisons by Overall, 2005
  Number of Discharges in Thousands (Standard Error) Percentage of Discharges (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error) Average Total Hospital charge (Standard Error)
NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR
U.S. 14,556 (336) 13,178** n/a n/a 5.77 (0.04) 5.90** 3.89 (0.06) 3.74* $28,174 (673) $28,301
Region
Northeast 2,936 (154) 2,565* 20.17 (0.94) 19.46 6.61 (0.12) 6.58 4.67 (0.24) 4.17* $31,512 (2,069) $32,844
South 3,534 (134) 3,572 24.27 (0.86) 27.10** 5.30 (0.06) 5.43* 3.39 (0.07) 3.34 $21,784 (586) $23,063*
Midwest 5,688 (236) 5,255 39.08 (1.18) 39.88 5.75 (0.06) 6.02** 3.81 (0.07) 3.79 $25,309 (646) $26,231
West 2,396 (125) 1,784** 16.46 (0.80) 13.54** 5.48 (0.12) 5.55 3.88 (0.13) 3.77 $41,283 (2,461) $38,351

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.

Table 15. NIS and MedPAR Comparisons by Hospital Control, 2005
Control Number of Discharges in Thousands (Standard Error) Percentage of Discharges (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error) Average Total Hospital charge (Standard Error)
NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR
Total Public 1,822 (178) 1,563 12.52 (1.22) 11.86 5.57 (0.11) 5.55 3.91 (0.10) 3.77 $22,320 (1,252) $22,408
1-99 Beds 568 (30) 441** 31.19 (2.61) 28.25 4.51 (0.09) 4.29* 3.82 (0.11) 3.44** $10,006 (355) $10,120
100-199 Beds 245 (39) 294 13.46 (2.35) 18.85* 5.04 (0.13) 5.39** 3.74 (0.17) 3.69 $18,878 (1,322) $18,841
200-299 Beds 164 (48) 213 9.01 (2.63) 13.63 6.30 (0.21) 5.79* 4.40 (0.39) 3.86 $23,996 (2,024) $25,132
300-499 Beds 376 (80) 312 20.66 (4.44) 20.00 6.22 (0.18) 6.34 3.74 (0.28) 4.03 $32,719 (1,888) $31,047
500+ Beds 467 (133) 300 25.64 (5.99) 19.24 6.38 (0.21) 6.57 4.05 (0.19) 4.00 $30,126 (4,520) $33,029
Total Private Non-Profit 10,653 (367) 9,683** 73.18 (1.46) 73.48 5.74 (0.05) 5.75 3.91 (0.08) 3.75 $27,693 (876) $27,703
1-99 Beds 1,271 (69) 1,073** 11.93 (0.71) 11.08 4.74 (0.08) 4.85 3.69 (0.09) 3.45* $15,476 (636) $14,924
100-199 Beds 2,041 (126) 1,798 19.16 (1.18) 18.57 5.46 (0.08) 5.52 3.92 (0.11) 3.72 $22,925 (1,382) $22,347
200-299 Beds 2,070 (196) 1,941 19.43 (1.92) 20.04 5.87 (0.11) 5.72 4.21 (0.32) 3.77 $29,935 (1,900) $27,334
300-499 Beds 3,244 (304) 2,794 30.45 (2.73) 28.86 5.79 (0.08) 5.83 3.84 (0.11) 3.73 $28,269 (1,204) $29,950
500+ Beds 2,024 (301) 2,075 19.00 (2.56) 21.43 6.44 (0.18) 6.34 3.83 (0.19) 3.93 $37,078 (3,273) $36,272
Total Proprietary 2,080 (120) 1,931 14.29 (0.85) 14.65 6.10 (0.14) 6.96** 3.81 (0.11) 3.68 $35,750 (1,471) $36,070
1-99 Beds 385 (32) 486** 18.50 (1.56) 25.20** 7.35 (0.60) 8.98** 4.19 (0.36) 3.52 $28,324 (2,249) $29,673
100-199 Beds 676 (49) 598 32.50 (2.09) 30.97 5.68 (0.20) 6.18* 3.54 (0.17) 3.64 $31,606 (1,891) $33,108
200-299 Beds 627 (85) 456* 30.14 (3.84) 23.64 5.79 (0.20) 6.21* 3.86 (0.22) 3.88 $43,115 (3,543) $38,915
300-499 Beds 257 (68) 271 12.39 (3.28) 14.03 5.97 (0.18) 6.53** 3.79 (0.22) 3.65 $40,200 (2,192) $46,975**
500+ Beds 134 (40) 118 6.45 (1.91) 6.13 6.26 (0.35) 6.46 3.84 (0.25) 3.87 $34,759 (3,230) $41,393*

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.

Table 16. NIS and MedPAR Comparisons by Hospital Type, 2005
Hospital Type Number of Discharges in Thousands (Standard Error) Percentage of Discharges (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error) Average Total Hospital charge (Standard Error)
NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR
Rural 2,433 (84) 2,208** 16.71 (0.61) 16.75 4.88 (0.06) 4.81 3.90 (0.07) 3.59** $14,619 (494) $14,865
small 669 (26) 555** 27.49 (1.33) 25.13 4.18 (0.07) 3.99* 3.70 (0.10) 3.27** $9,584 (327) $9,371
medium 680 (59) 565 27.95 (2.65) 25.61 4.63 (0.07) 4.61 3.81 (0.10) 3.53** $13,854 (468) $13,922
large 1,084 (101) 1,087 44.55 (3.07) 49.25 5.46 (0.10) 5.33 4.07 (0.12) 3.78* $18,204 (955) $18,159
Urban, Non-teaching 7,130 (200) 6,297** 48.98 (1.15) 47.78 5.85 (0.06) 6.10** 3.96 (0.10) 3.75 $29,763 (809) $29,376
small 832 (52) 854 11.67 (0.75) 13.56* 6.33 (0.29) 7.59** 3.98 (0.19) 3.61 $23,598 (1,271) $24,911
medium 1,791 (87) 1,672 25.12 (1.22) 26.55 5.56 (0.09) 5.83** 3.89 (0.11) 3.74 $27,148 (1,459) $26,926
large 4,506 (187) 3,770** 63.20 (1.31) 59.87* 5.88 (0.07) 5.88 3.98 (0.16) 3.79 $31,960 (1,143) $31,474
Urban, Teaching 4,992 (257) 4,673 34.29 (1.26) 35.46 6.08 (0.08) 6.16 3.80 (0.10) 3.80 $32,661 (1,562) $33,201
small 746 (116) 567 14.94 (2.31) 12.14 5.57 (0.18) 6.00* 3.49 (0.25) 3.55 $28,781 (3,689) $29,985
medium 1,430 (191) 1,248 28.64 (3.98) 26.71 5.89 (0.14) 6.02 4.07 (0.18) 3.78 $27,304 (1,574) $30,391*
large 2,816 (295) 2,857 56.40 (4.26) 61.14 6.32 (0.13) 6.25 3.73 (0.13) 3.86 $36,143 (2,377) $35,068

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.

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Table 17 NIS and MedPAR Comparisons by Patient Characteristics, 2005
Hospital Type Number of Discharges in Thousands (Standard Error) Percentage of Discharges (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error) Average Total Hospital charge (Standard Error)
NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR
Age Group
0-64 Years 2,397 (63) 2,329 16.47 (0.30) 17.67** 6.08 (0.06) 6.21* 1.98 (0.04) 1.94 $27,228 (664) $28,174
65-74 Years 4,243 (103) 3,885** 29.15 (0.17) 29.48 5.47 (0.04) 5.66** 2.96 (0.06) 2.93 $30,396 (698) $30,802
75-84 Years 5,145 (129) 4,429** 35.35 (0.19) 33.61** 5.81 (0.04) 5.93* 4.21 (0.07) 4.01** $28,897 (720) $28,678
85+ Years 2,765 (70) 2,533** 18.99 (0.21) 19.22 5.88 (0.05) 5.95 6.41 (0.10) 6.16* $24,259 (711) $23,930
Gender
Female 8,266 (188) 7,422** 56.79 (0.15) 56.32** 5.74 (0.04) 5.88** 3.62 (0.06) 3.49* $26,492 (628) $26,574
Male 6,279 (150) 5,756** 43.14 (0.15) 43.67** 5.81 (0.04) 5.93** 4.26 (0.06) 4.06** $30,389 (748) $30,532
Race
White 8,681 (347) 10,902** 59.64 (1.67) 82.72** 5.79 (0.05) 5.75 4.06 (0.07) 3.76** $29,337 (830) $27,606*
Black 1,007 (66) 1,616** 6.92 (0.43) 12.26** 6.67 (0.12) 6.79 3.74 (0.14) 3.68 $30,997 (1,357) $30,085
Other 1,056 (78) 610** 7.25 (0.52) 4.63** 6.41 (0.13) 6.34 3.98 (0.14) 3.67* $38,341 (1,607) $36,028
Unknown 3,810 (273) 48** 26.17 (1.87) 0.37** 5.32 (0.06) 5.79** 3.53 (0.07) 2.79** $22,109 (711) $28,136**

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.

Table 18 NIS and MedPAR Comparisons by DRG, 2005
DRG Number of Discharges in Thousands (Standard Error) Percentage of Discharges (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error) Average Total Hospital charge (Standard Error)
NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR
127: Heart failure & shock 769 (18) 679** 5.28 (0.05) 5.15* 5.05 (0.03) 5.09 3.92 (0.07) 3.81 $19,563 (518) $19,276
89: Simple pneumonia & pleurisy age >17 w/CC 664 (15) 577** 4.56 (0.05) 4.38** 5.47 (0.04) 5.50 4.24 (0.09) 4.15 $19,059 (449) $18,874
88: Chronic obstructive pulmonary disease 498 (11) 444** 3.42 (0.05) 3.37 4.84 (0.04) 4.91 1.46 (0.05) 1.41 $16,692 (409) $16,638
209: Major joint & limb reattachment procedures of lower extremity 415 (16) 368** 2.85 (0.08) 2.79 4.43 (0.04) 4.43 0.58 (0.02) 0.59 $37,165 (799) $37,022
462: Rehabilitation 373 (25) 309* 2.56 (0.17) 2.34 11.79 (0.15) 12.38** 0.86 (0.11) 0.28** $24,806 (860) $26,771*
182: Esophagitis 350 (8) 310** 2.40 (0.02) 2.35 4.49 (0.03) 4.49 1.47 (0.05) 1.34* $16,513 (428) $16,158
416: Septicemia age >17 337 (11) 300** 2.31 (0.05) 2.28 7.57 (0.08) 7.55 20.47 (0.32) 19.59** $35,507 (1,133) $33,879
430: Psychoses 332 (21) 339 2.28 (0.14) 2.57* 10.48 (0.26) 10.54 0.08 (0.01) 0.08 $18,275 (769) $18,108
14: Specific cerebrovascular disorders except TIA 319 (8) 298* 2.19 (0.02) 2.26** 5.32 (0.05) 6.13** 10.18 (0.19) 9.63** $22,872 (584) $23,188
174: G.I. hemorrhage w/CC 299 (7) 262** 2.05 (0.02) 1.98** 4.62 (0.03) 4.64 2.84 (0.07) 2.80 $19,872 (478) $19,348
296: Nutritional & misc metabolic disorders age >17 w/CC 279 (6) 249** 1.92 (0.02) 1.89 4.64 (0.04) 4.63 3.22 (0.10) 3.25 $15,507 (392) $15,273
143: Chest pain 277 (9) 238** 1.90 (0.04) 1.81* 2.03 (0.02) 2.08* 0.10 (0.01) 0.11 $11,001 (267) $10,905
320: Kidney & urinary tract infections age >17 w/CC 270 (6) 235** 1.85 (0.02) 1.78* 4.99 (0.05) 5.00 1.90 (0.07) 1.85 $16,409 (427) $16,143
138: Cardiac arrhythmia & conduction disorders w/CC 242 (6) 212** 1.66 (0.01) 1.61** 3.85 (0.03) 3.88 2.41 (0.08) 2.44 $15,804 (406) $15,547
316: Renal failure 238 (8) 215** 1.64 (0.03) 1.63 6.24 (0.05) 6.23 7.03 (0.17) 6.87 $24,078 (632) $23,728
79: Respiratory infections & inflammations age >17 w/CC 193 (6) 166** 1.33 (0.02) 1.26** 8.24 (0.09) 8.29 11.14 (0.24) 10.93 $30,713 (929) $30,096
527 192 (13) 179 1.32 (0.07) 1.36 2.23 (0.04) 2.17 0.27 (0.02) 0.25 $44,942 (1,525) $43,506
121: Circulatory disorders w/ ami & major comp 172 (5) 147** 1.18 (0.02) 1.11** 6.08 (0.06) 6.07 0.00 (0.00) 0.001 $29,246 (844) $28,746
148: Major small & large bowel procedures w/CC 148 (4) 132** 1.02 (0.01) 1.00 11.87 (0.08) 11.82 6.96 (0.17) 7.03 $64,851 (1,647) $63,968
210: Hip & femur procedures except major joint age >17 w/CC 148 (4) 127** 1.02 (0.01) 0.96** 6.59 (0.05) 6.58 2.68 (0.09) 2.63 $35,532 (836) $34,758
475: Respiratory system diagnosis with ventilator support 145 (4) 134* 1.00 (0.01) 1.02 11.54 (0.24) 12.26** 33.03 (0.44) 32.79 $70,242 (1,905) $72,598
141: Syncope & collapse w/CC 143 (4) 126** 0.98 (0.01) 0.95 3.39 (0.04) 3.40 0.38 (0.03) 0.42 $14,780 (401) $14,508
277: Cellulitis age >17 w/CC 140 (3) 124** 0.96 (0.01) 0.94 5.53 (0.05) 5.53 0.80 (0.05) 0.80 $17,345 (490) $16,841
395: Red blood cell disorders age >17 136 (3) 118** 0.93 (0.01) 0.90* 4.14 (0.05) 4.23 1.35 (0.07) 1.36 $16,144 (447) $16,478
524 124 (3) 109** 0.85 (0.01) 0.83 3.09 (0.03) 3.10 0.20 (0.03) 0.19 $14,277 (363) $13,961

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.

Table 19 NIS and MedPAR Comparisons by Principal Diagnosis, 2005
Principal Diagnosis Number of Discharges in Thousands (Standard Error) Percentage of Discharges (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error) Average Total Hospital charge (Standard Error)
NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR
108: Congestive heart failure; nonhypertensive 840 (21) 745** 5.77 (0.05) 5.65* 5.44 (0.04) 5.48 4.18 (0.08) 4.06 $26,918 (779) $27,444
122: Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 815 (18) 708** 5.60 (0.06) 5.37** 6.10 (0.05) 6.14 5.41 (0.09) 5.31 $23,141 (575) $23,098
101: Coronary atherosclerosis and other heart disease 617 (28) 580 4.24 (0.14) 4.40 3.61 (0.05) 3.63 0.72 (0.03) 0.77 $42,519 (1,304) $41,265
106: Cardiac dysrhythmias 460 (13) 411** 3.16 (0.04) 3.12 3.85 (0.03) 3.85 1.36 (0.04) 1.34 $25,423 (681) $25,502
127: Chronic obstructive pulmonary disease and bronchiectasis 452 (10) 404** 3.10 (0.05) 3.06 5.07 (0.04) 5.15 2.24 (0.06) 2.19 $18,545 (466) $18,554
203: Osteoarthritis 438 (17) 415 3.01 (0.09) 3.15 3.84 (0.03) 4.20** 0.15 (0.01) 0.14 $34,993 (737) $39,380**
100: Acute myocardial infarction 391 (13) 346** 2.68 (0.06) 2.63 5.89 (0.06) 5.89 9.27 (0.16) 9.21 $46,896 (1,338) $46,877
254: Rehabilitation care; fitting of prostheses; and adjustment of devices 377 (25) 313* 2.59 (0.17) 2.37 11.86 (0.15) 12.46** 0.86 (0.11) 0.28** $25,117 (873) $27,125*
2: Septicemia (except in labor) 375 (12) 335** 2.57 (0.06) 2.54 8.77 (0.12) 8.77 20.25 (0.32) 19.39** $44,216 (1,439) $42,983
109: Acute cerebrovascular disease 354 (9) 332* 2.43 (0.03) 2.52** 5.93 (0.06) 6.69** 10.41 (0.19) 9.90** $28,206 (810) $28,259
237: Complication of device; implant or graft 351 (12) 336 2.41 (0.05) 2.54* 6.14 (0.07) 6.20 2.21 (0.07) 2.15 $41,238 (1,192) $42,565
159: Urinary tract infections 323 (7) 281** 2.22 (0.03) 2.13** 4.99 (0.05) 5.02 1.75 (0.06) 1.72 $16,813 (448) $16,679
102: Nonspecific chest pain 322 (10) 283** 2.21 (0.04) 2.15 2.16 (0.02) 2.19 0.12 (0.01) 0.11 $12,613 (297) $12,583
55: Fluid and electrolyte disorders 307 (6) 273** 2.11 (0.02) 2.07 4.43 (0.03) 4.41 2.80 (0.09) 2.81 $15,191 (378) $15,022
226: Fracture of neck of femur (hip) 268 (7) 238** 1.84 (0.02) 1.80 6.30 (0.05) 6.81** 3.00 (0.08) 2.92 $33,962 (730) $35,866**
205: Spondylosis; intervertebral disc disorders; other back problems 231 (8) 225 1.58 (0.04) 1.70** 3.90 (0.05) 4.11** 0.34 (0.02) 0.32 $30,371 (1,142) $29,821
131: Respiratory failure; insufficiency; arrest (adult) 221 (8) 212 1.52 (0.04) 1.61* 10.31 (0.26) 10.98* 21.87 (0.40) 21.09 $56,286 (1,680) $58,673
50: Diabetes mellitus with complications 213 (5) 195** 1.46 (0.02) 1.48 6.32 (0.08) 6.36 1.67 (0.07) 1.54 $26,784 (823) $26,826
153: Gastrointestinal hemorrhage 212 (5) 186** 1.45 (0.01) 1.41** 4.84 (0.03) 4.87 3.88 (0.10) 3.88 $22,295 (529) $21,892
157: Acute and unspecified renal failure 205 (7) 182** 1.40 (0.03) 1.38 7.01 (0.07) 6.99 7.79 (0.20) 7.56 $28,408 (850) $27,968
238: Complications of surgical procedures or medical care 201 (5) 189* 1.38 (0.02) 1.43* 7.13 (0.10) 7.31 2.27 (0.08) 2.36 $31,750 (867) $32,005
197: Skin and subcutaneous tissue infections 200 (4) 178** 1.37 (0.01) 1.35 5.56 (0.05) 5.61 0.71 (0.04) 0.73 $18,009 (503) $17,721
69: Affective disorders 176 (11) 179 1.21 (0.07) 1.36* 9.62 (0.23) 9.59 0.09 (0.01) 0.09 $17,554 (855) $16,902
145: Intestinal obstruction without hernia 175 (4) 155** 1.20 (0.01) 1.18 6.71 (0.05) 6.77 3.82 (0.11) 4.01 $28,552 (719) $28,639
149: Biliary tract disease 171 (4) 151** 1.17 (0.01) 1.14* 5.45 (0.04) 5.43 1.56 (0.07) 1.55 $30,373 (700) $29,641

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.

Table 20 NIS and MedPAR Comparisons by Principal Procedure, 2005
Principal Procedure Number of Discharges in Thousands (Standard Error) Percentage of Discharges (Standard Error) Average Length of Stay in Days (Standard Error) In-Hospital Mortality Rate Percent (Standard Error) Average Total Hospital charge (Standard Error)
NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR NIS MedPAR
70: Upper gastrointestinal endoscopy; biopsy 403 (11) 359** 2.77 (0.04) 2.72 5.89 (0.04) 5.97 1.81 (0.05) 1.84 $25,076 (684) $24,495
222: Blood transfusion 396 (13) 322** 2.72 (0.08) 2.44** 5.99 (0.06) 6.05 5.72 (0.12) 5.67 $23,109 (646) $23,384
45: Percutaneous transluminal coronary angioplasty (PTCA) 388 (24) 364 2.66 (0.13) 2.76 3.00 (0.04) 2.96 1.07 (0.05) 1.09 $49,533 (1,599) $46,535
152: Arthroplasty knee 321 (13) 292* 2.20 (0.07) 2.22 3.94 (0.03) 3.95 0.17 (0.01) 0.16 $36,581 (803) $40,840**
216: Respiratory intubation and mechanical ventilation 315 (8) 287** 2.16 (0.03) 2.17 9.51 (0.16) 9.90* 37.20 (0.40) 36.69 $58,491 (1,670) $59,717
47: Diagnostic cardiac catheterization; coronary arteriography 300 (12) 283 2.06 (0.05) 2.15 4.12 (0.05) 4.12 1.21 (0.05) 1.28 $28,151 (734) $27,760
54: Other vascular catheterization; not heart 255 (8) 240 1.75 (0.03) 1.82 9.38 (0.11) 9.25 11.75 (0.29) 11.36 $38,695 (914) $38,369
153: Hip replacement; total and partial 250 (8) 219** 1.72 (0.04) 1.66 5.26 (0.05) 5.26 1.24 (0.05) 1.27 $40,638 (911) $50,218**
48: Insertion; revision; replacement; removal of cardiac pacemaker or cardioverter/defibrillator 247 (11) 232 1.69 (0.05) 1.76 4.83 (0.08) 4.75 1.09 (0.05) 1.14 $64,078 (1,725) $66,065
58: Hemodialysis 232 (7) 218 1.59 (0.04) 1.65 5.64 (0.07) 5.73 3.73 (0.12) 3.50 $24,563 (774) $24,356
146: Treatment; fracture or dislocation of hip and femur 192 (5) 163** 1.31 (0.02) 1.24** 6.21 (0.05) 6.24 2.37 (0.07) 2.34 $33,483 (783) $33,013
231: Other therapeutic procedures 188 (19) 158 1.29 (0.13) 1.20 5.85 (0.14) 5.69 6.21 (0.37) 5.63 $23,738 (1,705) $22,484
61: Other OR procedures on vessels other than head and neck 170 (6) 166 1.17 (0.03) 1.26** 7.63 (0.14) 7.36 4.52 (0.17) 4.26 $54,556 (1,640) $53,398
76: Colonoscopy and biopsy 157 (4) 138** 1.07 (0.01) 1.04 5.94 (0.05) 6.01 1.32 (0.06) 1.29 $23,486 (613) $23,117
78: Colorectal resection 145 (4) 128** 0.99 (0.01) 0.97 10.97 (0.08) 10.98 6.06 (0.16) 6.22 $61,693 (1,566) $61,351
84: Cholecystectomy and common duct exploration 134 (3) 119** 0.92 (0.01) 0.90 6.38 (0.06) 6.37 1.75 (0.08) 1.76 $37,772 (859) $36,877
193: Diagnostic ultrasound of heart (echocardiogram) 124 (12) 115 0.85 (0.08) 0.87 5.45 (0.15) 5.37 2.39 (0.15) 2.26 $23,476 (1,569) $22,222
213: Physical therapy exercises; manipulation; and other procedures 122 (16) 101 0.84 (0.11) 0.77 11.24 (0.44) 11.70 0.96 (0.14) 0.63* $24,961 (1,418) $28,377*
44: Coronary artery bypass graft (CABG) 120 (8) 115 0.82 (0.04) 0.87 10.33 (0.13) 9.99* 3.00 (0.14) 3.11 104,295 (3,723) $98,670
39: Incision of pleura; thoracentesis; chest drainage 107 (3) 95** 0.74 (0.01) 0.72 8.07 (0.07) 8.12 7.09 (0.20) 7.44 $33,113 (977) $32,546
169: Debridement of wound; infection or burn 107 (2) 100* 0.73 (0.01) 0.76 12.14 (0.31) 12.44 4.37 (0.18) 4.40 $47,356 (1,448) $48,716
37: Diagnostic bronchoscopy and biopsy of bronchus 88 (3) 82 0.60 (0.01) 0.62 9.31 (0.10) 9.22 6.24 (0.23) 5.95 $43,465 (1,501) $41,532
158: Spinal fusion 88 (5) 88 0.60 (0.03) 0.67* 4.80 (0.10) 4.77 0.58 (0.06) 0.57 $65,063 (2,591) $63,077
3: Laminectomy; excision intervertebral disc 87 (4) 84 0.59 (0.02) 0.64 3.41 (0.07) 3.37 0.27 (0.04) 0.34 $24,621 (1,120) $23,875
51: Endarterectomy; vessel of head and neck 85 (3) 78 0.59 (0.01) 0.59 2.79 (0.06) 2.78 0.37 (0.05) 0.40 $24,234 (697) $24,327

*Significant at a 5 percent level.
**Significant at a 1 percent level.
1A significance test was not performed because a valid standard error was not available.

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References

Centers for Medicare & Medicaid Services (2006). CMS State County File, 2002-2005. Washington, DC: CMS. http://www.cms.hhs.gov/HealthPlanRepFileData/Downloads/SC-2005.zip (Accessed August 22, 2007.)

National Center for Health Statistics (2007). National Hospital Discharge Survey Public Use Data File Documentation: 2005. Washington, DC: U.S. Department of Health and Human Services, National Center for Health Statistics.

U.S. Agency for Healthcare Research and Quality (2007). Design of the Nationwide Inpatient Sample (NIS), 2005. Rockville, MD. http://hcup-us.ahrq.gov/db/nation/nis/reports/NIS_2003_Design_Report_Edited_012506.pdf (Accessed August 21, 2007.)

U.S. Census Bureau (2007). Table 3: Annual Estimates of the Population by Sex, Race and Hispanic or Latino Origin for the United States: April 1, 2000 to July 1, 2005 (NC-EST2005-03). Washington, DC: Population Division, U.S. Census Bureau (2007).

U.S. Census Bureau (2007). Table 1: Annual Estimates of the Population for the United States, Regions, and States and for Puerto Rico: April 1, 2000 to July 1, 2006 (NST-EST2006-01). Washington, DC: Population Division, U.S. Census Bureau (2007).

U.S. Census Bureau (2007). State and Metropolitan Area Data Book – 5th Edition. Washington, DC: U.S. Bureau of the Census.

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Internet Citation: HCUP NIS 2005 NIS Comparison Report. Healthcare Cost and Utilization Project (HCUP). November 2015. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/nation/nis/reports/2005niscomparisonrpt.jsp.
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