Attached two files , one for the data you will work on in excel file and file discription for the data in PDF As a data scientist please study the data and answer the following questions? 1

HEALTHCARE COST AND UTILIZATION PROJECT — HCUP A FEDERAL-STATE-INDUSTRY PARTNERSHIP IN HEALTH DATA

Sponsored by the Agency for Healthcare Research and Quality

INTRODUCTION TO

THE HCUP NATIONAL INPATIENT SAMPLE (NIS) 2020

Issued September 2022 Agency for Healthcare Research and Quality

Healthcare Cost and Utilization Project (HCUP) Phone: (866) 290-HCUP (4287)

Email: [email protected] Website: www.hcup-us.ahrq.gov

NIS Data and Documentation Distributed by:

HCUP Central Distributor Phone: (866) 290-HCUP (4287) (toll free)

Fax: (805) 979-3787 Email: [email protected]

These pages provide only an introduction to the 2016 NIS package.

For full documentation and notification of changes, visit the HCUP User Support (HCUP-US) web site at

www.hcup-us.ahrq.gov.

Please read all documentation carefully.

BEGINNING WITH DATA YEAR 2016, THE NIS CONTAINS A FULL YEAR OF ICD-10-CM/PCS

CODES.

Beginning with data year 2016, the NIS includes a full calendar year of data with diagnosis and

procedure codes reported using the ICD-10-CM/PCS1 coding system. The file structure is similar to

the file structure of the NIS in data years prior to 2015.

THE 2015 NIS CONTAINS ICD-9-CM AND ICD-10-CM/PCS CODES.

On October 1, 2015, hospital administrative data began using ICD-10-CM/PCS, so the first nine

months of 2015 contain ICD-9-CM codes and the last three months contain ICD-10-CM/PCS codes.

Data elements and data structure for the 2015 NIS are different. Trends based on diagnoses or

procedures will be affected.

Data elements derived from AHRQ software tools are not available for ICD-10-CM/PCS

data on the 2016-2017 NIS.

THE NIS WAS REDESIGNED BEGINNING WITH 2012

Starting in data year 2012, the NIS is a sample of discharges from all hospitals participating in

HCUP. For prior years, the NIS was a sample of hospitals. For details, see the 2012 NIS

Redesign Report.

HCUP 2020 NIS (8/22/22) i Introduction

Table of Contents

SUMMARY OF DATA USE RESTRICTIONS ………………………………………………………………….. 1

HCUP DATA USE AGREEMENT REQUIREMENTS ……………………………………………………….. 2

HCUP CONTACT INFORMATION ………………………………………………………………………………… 2

WHAT’S NEW IN THE 2020 NATIONAL INPATIENT SAMPLE (NIS)? ……………………………….. 3

UNDERSTANDING THE NIS ……………………………………………………………………………………….. 3

ABSTRACT ……………………………………………………………………………………………………………….. 4

INTRODUCTION TO THE HCUP NATIONAL INPATIENT SAMPLE (NIS) ………………………….. 6

Overview of NIS Data …………………………………………………………………………………………….. 6

NIS 2012 Redesign ……………………………………………………………………………………………….. 6 Impact of New Design on Estimates ………………………………………………………………….. 7

Types of Hospitals Included in the NIS ……………………………………………………………………… 7

Sample Design for the NIS ……………………………………………………………………………………… 8

Weighted Estimates ………………………………………………………………………………………………. 8

ICD-10-CM/PCS Started October 1, 2015, at the Beginning of Fiscal Year 2016 …………….. 9

NIS Data Sources, Hospitals, and Inpatient Stays ………………………………………………………. 9

Partner Restrictions ……………………………………………………………………………………………….. 9

File Structure of the NIS …………………………………………………………………………………………. 9 File Structure of the NIS Beginning with 2016 Data ……………………………………………..11 File Structure of the 2015 NIS ………………………………………………………………………….11 File Structure of the NIS Prior to 2015 ……………………………………………………………….11

NIS Data Elements………………………………………………………………………………………………. 11

Getting Started ……………………………………………………………………………………………………. 12 Computer Specifications Required for Using the NIS …………………………………………..12 Decompressing the NIS Files …………………………………………………………………………..12 Downloading and Running the Load Programs …………………………………………………..12 NIS Documentation ………………………………………………………………………………………..13 HCUP Online Tutorials ……………………………………………………………………………………13

HOW TO USE THE NIS FOR DATA ANALYSIS ……………………………………………………………..14

Data Use Agreement ……………………………………………………………………………………………. 14

Choosing Data Elements for Analysis …………………………………………………………………….. 14

Diagnosis-Related Groups ……………………………………………………………………………………. 15

Missing Values ……………………………………………………………………………………………………. 15

Hospital-Level Data Elements ……………………………………………………………………………….. 16

Longitudinal Hospital Analyses ……………………………………………………………………………… 16

Hospital Volume Estimates …………………………………………………………………………………… 16

Calculating National Estimates ………………………………………………………………………………. 17

Studying Trends ………………………………………………………………………………………………….. 17

HCUP 2020 NIS (8/22/22) ii Introduction

Studying Readmissions ………………………………………………………………………………………… 19

Variance Calculations ………………………………………………………………………………………….. 19

Computer Software for Variance Calculations ………………………………………………………….. 20

SAMPLING PROCEDURE …………………………………………………………………………………………..21

The NIS Hospital Universe ……………………………………………………………………………………. 21

Stratification Data Elements ………………………………………………………………………………….. 22

Design Considerations …………………………………………………………………………………………. 24

Overview of the Sampling Procedure ……………………………………………………………………… 25

WEIGHTS …………………………………………………………………………………………………………………25

APPENDIX I: TABLES AND FIGURES ………………………………………………………………………… I-1

Table 1: National Inpatient Sample (NIS) Design Changes Beginning in 2012 ……………… I-1

Table 2: States Participating in the 2020 NIS ………………………………………………………….. I-2

Table 3: Summary of NIS States, Hospitals, and Inpatient Stays, 1988-2020……………….. I-4

Table 4: Number of Hospitals and Discharges in 2020 Universe, Frame, and NIS, by Census Division …………………………………………………………………………………………………. I-7

Table 5: NIS Related Reports and Database Documentation Available on HCUP-US ……. I-8

Table 6: Hospital Size Categories (in Number of Beds), by Region …………………………….I-10

Figure 1: Percentage of U.S. Population Covered in the 2020 NIS by Census Division and Region, Calculated using the Estimated U.S. Population on July 1, 2020. ……………..I-11

Figure 2: NIS States, by Census Division ……………………………………………………………….I-12

Figure 3: Number of Discharges (in Thousands, Unweighted) in 2020 NIS by Census Division and Census Region ………………………………………………………………………………..I-14

APPENDIX II: STATE-SPECIFIC RESTRICTIONS ……………………………………………………….. II-1

APPENDIX III: DATA ELEMENTS …………………………………………………………………………….. III-1

Table 1: Data Elements in the 2020 NIS Inpatient Core Files …………………………………….III-1

Table 2: Data Elements in the 2020 NIS Hospital Files …………………………………………….III-5

Table 3: Data Elements in the 2020 NIS Disease Severity Measures Files ………………….III-6

Table 4: Data Elements in the 2020 NIS Diagnosis and Procedure Groups Files ………….III-7

APPENDIX IV: TEACHING HOSPITAL INDICATOR ASSIGNMENT ………………………………. IV-1

HCUP 2020 NIS (8/22/22) 1 Introduction

HCUP NATIONAL INPATIENT SAMPLE (NIS) SUMMARY OF DATA USE RESTRICTIONS

***** REMINDER *****

All users of the NIS must take the online HCUP Data Use Agreement (DUA) training

course, and read and sign a Data Use Agreement. Details and links may be found on the following page.

Authorized users of HCUP data agree to the following restrictions:a

• Will not use the data for any purpose other than research, analysis, and aggregate statistical reporting.

• Will not re-release any data to unauthorized users.

• Will not redistribute HCUP data by posting on any website or publishing in any other publicly accessible online repository. If a journal or publication requests access to data or analytic files, will cite restrictions on data sharing in the Data Use Agreement and direct them to AHRQ HCUP (www.hcup-us.ahrq.gov) for more information on accessing HCUP data.

• Will not identify or attempt to identify any individual, including by the use of vulnerability analysis or penetration testing. Methods that could be used to identify individuals directly or indirectly shall not be disclosed or published.

• Will not report any statistics where the number of observations (i.e., individual discharge records) in any given cell of tabulated data is less than or equal to 10 (≤10).

• Will not publish information that could identify individual establishments (e.g., hospitals) and will not contact establishments.

• Will not use the data concerning individual establishments for commercial or competitive purposes affecting establishments, or to determine rights, benefits, or privileges of establishments.

• Will not use the data for criminal and civil litigation, including expert witness testimony or for law enforcement activities.

• Will not use data elements from the proprietary severity adjustment software packages (e.g., 3MTM APR-DRGs) for any commercial purpose or to disassemble, decompile, or otherwise reverse engineer the proprietary software.

• Will acknowledge in reports that data from the "Healthcare Cost and Utilization Project (HCUP)" were used, including names of the specific databases used for analysis.b

Any violation of the limitations in the Data Use Agreement is punishable under Federal law by a fine, up to five years in prison, or both. Violations may also be subject to penalties under State statutes. a This is a summary of key terms of the Data Use Agreement for Nationwide Databases; please refer to the DUA for full terms and conditions. b Suggested citations for the HCUP databases are provided in the Requirements for Publishing with HCUP Data available at www.hcup-us.ahrq.gov/db/publishing.jsp.

HCUP 2020 NIS (8/22/22) 2 Introduction

HCUP DATA USE AGREEMENT REQUIREMENTS

All HCUP data users, including data purchasers and collaborators, must complete the online HCUP Data Use Agreement (DUA) Training Tool, and read and sign the HCUP Data Use Agreement. Proof of training completion and signed Data Use Agreements must be submitted to the HCUP Central Distributor.

Data purchasers will be required to provide their DUA training completion code and will execute their DUAs electronically as a part of the online ordering process. The DUAs and training certificates for collaborators and others with access to HCUP data should be submitted directly to the HCUP Central Distributor using the contact information below.

The on-line DUA training course is available at: www.hcup-us.ahrq.gov/tech_assist/dua.jsp.

The HCUP Data Use Agreement for the NIS is available on the HCUP User Support (HCUP- US) website at: https://www.hcup-us.ahrq.gov/team/NationwideDUA.jsp.

HCUP CONTACT INFORMATION

HCUP Central Distributor and HCUP User Support

Information about the content of the HCUP databases is available on the HCUP User Support (HCUP-US) website (www.hcup-us.ahrq.gov). If you have questions, please review the HCUP Frequently Asked Questions located at www.hcup-us.ahrq.gov/tech_assist/faq.jsp. If you need further technical assistance, please contact the HCUP Central Distributor and User Support team at:

Phone: 866-290-4287 (toll free) Email: [email protected] Fax: 805-979-3787 Mailing address: HCUP Central Distributor c/o IBM 5425 Hollister Avenue, Suite 140 Santa Barbara, CA 93111

We would like to receive your feedback on the HCUP data products.

Please send user feedback to [email protected].

HCUP 2020 NIS (8/22/22) 3 Introduction

WHAT’S NEW IN THE 2020 NATIONAL INPATIENT SAMPLE (NIS)?

• The overall number of discharges for data year 2020 decreased by almost 9 percent from 2019. The largest decrease was in the second quarter, which had almost 19 percent fewer discharges than the prior year. There were about 7 percent fewer discharges in the third and fourth quarters and 3 percent fewer discharges in the first quarter than the previous year. Also, the overall in-hospital mortality rate increased from 2.0 to 2.8 percent for 2020.

• Beginning with data year 2020, COVID-19-related hospitalizations may be identified by any-listed ICD-10-CM diagnosis code of “U071” (2019 novel coronavirus disease) on the discharge record. Per coding guidelines, the use of diagnosis code “U071” is based on documentation by the provider or documentation of a positive COVID-19 test result. The ICD-10-CM diagnosis code for COVID-19 was implemented beginning April 1, 2020. There may be other ICD-10-CM codes that reflect conditions related to COVID-19 stays.

UNDERSTANDING THE NIS

• This document, Introduction to the NIS, 2020, summarizes the content of the NIS and describes the development of the NIS sample and weights.

• In addition, the HCUP-US website has a section on ICD-10-CM/PCS Resources that summarizes key issues for researchers using HCUP and other administrative databases that include ICD-10-CM/PCS coding. The web page provides general guidance and forewarning to users analyzing outcomes that may be affected by the transition to the ICD-10-CM/PCS coding system and lists other related web resources.

• Important considerations for data analysis are provided along with references to detailed reports.

• In-depth documentation for the NIS is available on the HCUP User Support (HCUP- US) website (www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp). Please refer to detailed documentation before using the data.

HCUP 2020 NIS (8/22/22) 4 Introduction

HEALTHCARE COST AND UTILIZATION PROJECT — HCUP A FEDERAL-STATE-INDUSTRY PARTNERSHIP IN HEALTH DATA

Sponsored by the Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality and the staff of the Healthcare Cost and Utilization Project (HCUP) thank users for purchasing

the HCUP National Inpatient Sample (NIS).

HCUP National Inpatient Sample (NIS)

ABSTRACT

The National Inpatient Sample (NIS) is part of the Healthcare Cost and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality (AHRQ). The NIS is a database of hospital inpatient stays derived from billing data submitted by hospitals to statewide data organizations across the U.S. These inpatient data include clinical and resource use information typically available from discharge abstracts. Researchers and policymakers use the NIS to make national estimates of health care utilization, access, cost, quality, and outcomes. The NIS contains information on all hospital stays, regardless of expected payer for the hospital stay. For Medicare, the NIS includes Medicare Advantage patients, a population that is often missing from Medicare claims data but that comprises as much as 34 percent of Medicare beneficiaries.1 The NIS' large sample size enables analyses of rare conditions, uncommon treatments, and special patient populations. The NIS is sampled from the State Inpatient Databases (SID), which include all inpatient data that are currently contributed to HCUP. The 2020 NIS sampling frame includes data from 49 statewide data organizations (48 States plus the District of Columbia), covering 98 percent of the U.S. population (Appendix I, Figure 1) and including 97 percent of discharges from U.S. community hospitals (Appendix I, Table 4). A list of the 49 statewide data organizations participating in the NIS and a summary of NIS States, hospitals, and discharges by year are provided in Appendix 1 (Table 2 and Table 3). The NIS includes weights for calculating national estimates. The 2012 National Inpatient Sample (NIS) was redesigned to improve national estimates. To highlight the design change, beginning with 2012 data, AHRQ renamed the NIS from the “Nationwide Inpatient Sample” to the “National Inpatient Sample.” The redesign incorporates three major types of changes:

• Revisions to the sample design—the NIS is now a sample of discharge records from all HCUP-participating hospitals, rather than a sample of hospitals from which all discharges were retained.

1 Kaiser Family Foundation Medicare Advantage www.kff.org/medicare/fact-sheet/medicare-advantage/ (Accessed 8/11/2022).

HCUP 2020 NIS (8/22/22) 5 Introduction

• Revisions to how hospitals and discharges are defined—the NIS now uses the definitions of hospitals and discharges supplied by the statewide data organizations that contribute to HCUP, rather than the definitions used by the American Hospital Association (AHA) Annual Survey.

• Revisions to enhance confidentiality—the NIS now eliminates State and hospital identifiers and other data elements that are not uniformly available across States. Also, ages over 89 are aggregated into a single category of 90 years or older in the HCUP nationwide databases starting in data year 2012.

The new sampling strategy produces more precise estimates than the previous NIS design by reducing sampling error. For many estimates, confidence intervals under the new design are about half the length of confidence intervals under the previous design. Key features of the most recent NIS (2020) include:

• The NIS is drawn from all States participating in HCUP, covering 98 percent of the U.S. population.

• The NIS approximates a 20-percent stratified sample of discharges from U.S. community hospitals, excluding rehabilitation and long-term acute care hospitals.

• The self-weighting design of the new NIS reduces the margin of error for estimates and delivers more stable and precise estimates than previous versions of the NIS.

• The NIS protects patient confidentiality because State and hospital identifiers are no longer provided.

• The new NIS retains a large sample size, which enables analyses of rare conditions, uncommon treatments, and special patient populations.

Changes to the NIS may impact some types of analyses. For example, the elimination of hospital identifiers means that hospital linkages can no longer be done with the NIS, and the sampling of discharges means that analyses relying on a census of discharges from sampled hospitals (e.g. hospital volume analysis) can no longer be performed. Because inpatient data are available for many individual States through the HCUP Central Distributor, State inpatient data can be used for those analyses that require a census of discharges from individual hospitals, local market areas, and States. A summary of design changes is provided in Table 1 in Appendix I, The National Inpatient Sample (NIS) Design Changes. For a detailed description of the NIS redesign, please see the 2012 NIS Redesign Report available on the HCUP-US website. The NIS is available yearly, beginning with 1988, allowing analysis of trends over time. Analyses of time trends using the HCUP NIS are recommended from 1993 forward because earlier samples were drawn from only 8 to 11 States, covering less than 50 percent of the hospital discharge population. For trends analysis using NIS data 2011 and earlier, revised weights should be used to make estimates comparable to the new 2012 design. Users should refer to 1993-2011 NIS Trend Weights Files and the report, Using the HCUP National Inpatient Sample to Estimate Trends, available on the HCUP-US website, for details. Because ICD-10-CM/PCS was introduced October 1, 2015, trends that rely on diagnosis and procedures may be interrupted. Analyses that do not rely on diagnosis and procedure coding should not be affected. HCUP has developed recommendations for reporting statistics (e.g.,

HCUP 2020 NIS (8/22/22) 6 Introduction

counts, rates, averages) that are based on HCUP data with a mixture of ICD-9-CM and ICD-10- CM/PCS codes. These recommendations apply to calendar year 2015 data (which includes both ICD-9-CM and ICD-10-CM/PCS codes), as well as reporting trends that span the October 1, 2015 transition date (before and after the introduction of ICD10-CM/PCS). In addition, the HCUP-US website has a section on ICD-10-CM/PCS Resources that summarizes key issues for researchers using HCUP and other administrative databases that include ICD-9-CM and ICD- 10-CM/PCS coding. Appendix III provides a summary of data elements and when they are effective. The data elements included in the NIS can vary across data years. Access to the NIS is open to users who sign Data Use Agreements. Uses are limited to research and aggregate statistical reporting. For more information on the NIS, please visit the AHRQ-sponsored HCUP-US website at www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp.

INTRODUCTION TO THE HCUP NATIONAL INPATIENT SAMPLE (NIS)

<

Collepals.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS

Why Hire Collepals.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.