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Scientific Data Documentation
National Hospital Discharge Survey, 1984
DSN: CC36.NHDS84


ABSTRACT


 THIS MATERIAL PROVIDES DOCUMENTATION FOR USERS OF THE DATA TAPES OF
 THE NHDS CONDUCTED BY THE NATIONAL CENTER FOR HEALTH STATISTICS (NCHS).
 SECTION I, DESCRIPTION OF THE NATIONAL HOSPITAL DISCHARGE SURVEY,
 INCLUDES INFORMATION ON THE HISTORY OF THE NHDS, THE SCOPE OF THE SURVEY,
 THE SAMPLE, DATA COLLECTION PROCEDURES, MEDICAL CODING PROCEDURES,
 POPULATION ESTIMATES, MEASUREMENT ERRORS AND SAMPLING ERRORS.  SECTION II
 PROVIDES TECHNICAL DETAILS OF THE TAPE (NUMBER OF TRACKS, RECORD LENGTH,
 ETC.).  SECTION III PROVIDES A DETAILED DESCRIPTION OF THE CONTENTS OF EACH
 DATA RECORD, BY LOCATION.  APPENDIX A DEFINES CERTAIN TERMS USED IN THIS
 DOCUMENT, APPENDIX B PROVIDES POPULATION ESTIMATES TO ALLOW THE USER TO
 CALCULATE RATES, AND APPENDIX C LISTS THE CLASS 4 PROCEDURES NOT CODED BY
 THE NHDS.
DESCRIPTION OF THE NATIONAL HOSPITAL DISCHARGE SURVEY

INTRODUCTION

 INTRODUCTION.--THIS DOCUMENT AND ITS ATTACHMENTS ALLOW ONE TO USE THE 1984
 DATA TAPE WHICH CONTAINS THE DATA COLLECTED BY THE NATIONAL HOSPITAL
 DISCHARGE SURVEY CONDUCTED BY THE NATIONAL CENTER FOR HEALTH STATISTICS.
 THE NATIONAL HOSPITAL DISCHARGE SURVEY PROVIDES A CONTINUOUS SAMPLE OF
 HOSPITAL DISCHARGE RECORDS, COLLECTING MEDICAL AND DEMOGRAPHIC INFORMATION
 FOR CALCULATING STATISTICS ON HOSPITAL UTILIZATION.  THE SURVEY CONSISTS OF
 DATA ABSTRACTED FROM THE FACE SHEETS OF THE MEDICAL RECORDS FOR SAMPLED
 INPATIENTS DISCHARGED FROM A NATIONAL SAMPLE OF NON-FEDERAL SHORT-STAY
 HOSPITALS.  FOR A DESCRIPTION OF THE SURVEY DESIGN AND DATA COLLECTION
 PROCEDURES, SEE BELOW.  FOR A MORE DETAILED DESCRIPTION OF THE SURVEY
 DESIGN, DATA COLLECTION PROCEDURES, AND THE ESTIMATION PROCESS, SEE
 REFERENCE I.

HISTORY

 HISTORY.--TO PROVIDE MORE COMPLETE AND PRECISE INFORMATION ON THE
 UTILIZATION OF THE NATION'S HOSPITALS AND ON THE NATURE AND TREATMENT OF
 ILLNESS AMONG THE HOSPITALIZED POPULATION, THE NCHS IN 1962 BEGAN EXPLORING
 POSSIBILITIES FOR SURVEYING MORBIDITY IN HOSPITALS.  A NATIONAL ADVISORY
 GROUP WAS ESTABLISHED.  THE NCHS CONDUCTED PLANNING DISCUSSIONS WITH OTHER
 ELEMENTS OF THE PUBLIC HEALTH SERVICE.  HOSPITALIZATION MATERIAL FROM THE
 SURVEY RESEARCH CENTER OF THE UNIVERSITY OF MICHIGAN, THE AMERICAN HOSPITAL
 ASSOCIATION, AND THE PROFESSIONAL ACTIVITIES STUDY WAS EXAMINED AND
 EVALUATED.  IN 1963, A STUDY BY THE SCHOOL OF PUBLIC HEALTH OF THE
 UNIVERSITY OF PITTSBURGH UNDER CONTRACT TO THE HCHS DEMONSTRATED THE
 FEASIBILITY OF AN NHDS TYPE OF PROGRAM.  AN ADDITIONAL PILOT STUDY USING
 ENUMERATORS FROM THE BUREAU OF THE CENSUS WAS CONDUCTED IN LATE 1964 AND
 CONFIRMED THE UNIVERSITY OF PITTSBURGH'S FINDINGS.

 FINALLY, WITH ADVICE AND SUPPORT FROM THE AMERICAN HOSPITAL ASSOCIATION,
 THE AMERICAN MEDICAL ASSOCIATION, INDIVIDUAL EXPERTS, OTHER PROFESSIONAL
 GROUPS, AND ELEMENTS OF THE U.S. PUBLIC HEALTH SERVICE, THE NCHS INITIATED
 THE NATIONAL HOSPITAL DISCHARGE SURVEY IN 1964.

SCOPE OF THE SURVEY

 SCOPE OF THE SURVEY.--THE NATIONAL HOSPITAL DISCHARGE SURVEY ENCOMPASSES
 PATIENTS DISCHARGED FROM NONINSTITUTIONAL HOSPITALS, EXCLUSIVE OF FEDERAL
 HOSPITALS, LOCATED IN THE SO STATES AND THE DISTRICT OF COLUMBIA.  FOR
 PURPOSES OF THE NHDS, A FACILITY IS CONSIDERED A SHORT-STAY HOSPITAL ONLY
 IF IT MEETS THE FOLLOWING CRITERIA:

   I.  AT LEAST SIX BEDS ARE MAINTAINED FOR USE BY INPATIENTS.

   2.  IT IS LICENSED AS A HOSPITAL IN STATES WITH LICENSURE LAWS.

   3.  INPATIENT MEDICAL CARE IS PROVIDED UNDER THE SUPERVISION OF A
       LICENSED DOCTOR OF MEDICINE OR OSTEOPATHY.

   4.  NURSING SERVICE IS PROVIDED 24 HOURS A DAY UNDER SUPERVISION OF A
       REGISTERED NURSE.

   5.  SEPARATE MEDICAL RECORDS ARE MAINTAINED FOR EACH PATIENT ADMITTED.

   6.  THE AVERAGE LENGTH OF STAY FOR ALL PATIENTS IS LESS THAN 30 DAYS.

SAMPLING FRAME AND SIZE OF SAMPLE

 SAMPLING FRAME AND SIZE OF SAMPLE.--THE NATIONAL MASTER FACILITY INVENTORY
 OF HOSPITALS AND INSTITUTIONS (NMFI) CONSTITUTES THE SAMPLING FRAME
 (UNIVERSE) FOR HOSPITAL5 IN THE NHDS.  THE NCHS HAS PUBLISHED A DETAILED
 DESCRIPTION OF THE NHFI, ITS CONTENTS, PLANS FOR MAINTAINING IT, AND
 PROCEDURES FOR ASSESSING THE COMPLETENESS OF ITS COVERAGE (SEE REFERENCE 2).
 THE UNIVERSE FOR THE SURVEY CONSISTED ORIGINALLY OF 6,965 SHORT STAY
 HOSPITALS, EXCLUDING MILITARY AND VA HOSPITALS CONTAINED IN THE NMFI IN
 1963.

 THE SAMPLE OF HOSPITALS FOR 1984 IS SHOWN IN TABLE 1.  SOME HOSPITALS
 REFUSED TO PARTICIPATE AND SOME WERE DEEMED OUT OF SCOPE, EITHER BECAUSE
 THE HOSPITAL HAD GONE OUT OF BUSINESS OR BECAUSE IT FAILED TO MEET THE NHDS
 DEFINITION OF A SHORT-STAY HOSPITAL.  THE NUMBER OF HOSPITALS WHICH REFUSED
 TO PARTICIPATE OR WERE OUT OF SCOPE ARE GIVEN IN TABLE I, ALONG WITH THE
 NUMBER OF PARTICIPATING HOSPITALS.


                                 TABLE 1

                               NUMBER OF HOSPITALS

  YEAR       SAMPLED      REFUSED     OUT OF SCOPE      SURVEYED

   1984       553           86            60               407


SAMPLE DESIGN

 SAMPLE DESIGN. ALL HOSPITAL5 WITH 1,000 BEDS OR MORE IN THE UNIVERSE OF
 SHORT-STAY HOSPITAL5 WERE SELECTED WITH CERTAINTY IN THE SAMPLE.  ALL
 HOSPITALS WITH FEWER THAN 1,000 BEDS WERE STRATIFIED, THE PRIMARY STRATUM
 BEING THE 24 SIZE-BY-REGION CLASSES SHOWN IN TABLE 2.  WITHIN EACH OF THESE
 24 PRIMARY STRATA, THE ALLOCATION OF THE HOSPITAL5 WAS MADE THROUGH A
 CONTROLLED SELECTION TECHNIQUE SO THAT HOSPITALS IN THE SAMPLE WOULD BE
 PROPERLY DISTRIBUTED WITH REGARD TO TYPE OF OWNERSHIP AND GEOGRAPHIC
 DIVISION.  SAMPLE HOSPITAL5 WERE DRAWN WITH PROBABILITIES RANGING FROM
 CERTAINTY FOR THE LARGEST HOSPITALS TO 1 IN 40 FOR THE SMALLEST HOSPITALS.

 THE WITHIN HOSPITAL SAMPLING RATIO FOR SELECTING SAMPLE DISCHARGES VARIED
 INVERSELY WITH THE PROBABILITY OF SELECTION OF THE HOSPITAL THE SMALLEST
 SAMPLING FRACTION OF DISCHARGED PATIENTS WAS TAKEN IN THE LARGEST
 HOSPITALS, AND THE LARGEST FRACTION WAS TAKEN IN THE SMALLEST HOSPITALS.
 THIS WAS DONE TO COMPENSATE FOR THE FACT THAT HOSPITALS WERE SELECTED WITH
 PROBABILITIES PROPORTIONATE TO THEIR SIZE CLASS AND TO ASSURE THAT THE
 OVERALL PROBABILITY OF SELECTING A DISCHARGE WOULD BE APPROXIMATELY THE
 SAME IN EACH SIZE CLASS.

 TABLE 1.  DISTRIBUTION OF NON-FEDERAL SHORT-STAY HOSPITALS IN THE UNIVERSE
 AND NATIONAL HOSPITAL DISCHARGE SURVEY IN-SLOPE SAMPLE BY GEOGRAPHIC REGION
 AND BED SIZE OF HOSPITAL:  UNITED STATES, 1984

   BED SIZE OF           ALL                  NORTH
    HOSPITAL          REGIONS    NORTHEAST   CENTRAL     SOUTH    WEST


    ALL SIZES                       NUMBER OF HOSPITALS

 UNIVERSE...............6,023        902        1.704     2.291     1.126
 SAMPLE...................493        115          140       164        74

    6-49 BEDS
 UNIVERSE...............1,372         78          415       535       344
 SAMPLE                    39          6           11        13         9

   50-99 BEDS
 UNIVERSE...............1,467        160          427       611       269
 SAMPLE                    62         10           14        30         8

 100-199    BEDS
 UNIVERSE...............1,398        203          373       571       251
 SAMPLE                    93         16           22        43        12

 200-299    BEDS
 UNIVERSE                `733        196          177       237       123
 SAMPLE                    72         18           21        20        13

 300-499    BEDS
 UNIVERSE                 715        176          202       224       113
 SAMPLE...................119         37           35        25        22

  500-999 BEDS
 UNIVERSE                 309         78          101       105        25
 SAMPLE                    95         23           34        29         9

   1,000 BEDS
     OR MORE
 UNIVERSE                                           9         8         1
                                                    3         4         1

 IN NEARLY ALL HOSPITALS, THE DAILY LISTING SHEET OF DISCHARGES WAS THE
 FRAME FROM WHICH THE SUBSAMPLES OF DISCHARGES WERE SELECTED WITHIN THE
 SAMPLE HOSPITALS.  THE SAMPLE DISCHARGES WERE SELECTED BY A RANDOM
 TECHNIQUE, USUALLY ON THE BASIS OF THE TERMINAL DIGIT(S) OF THE PATIENT'S
 MEDICAL RECORD NUMBERA NUMBER ASSI BED WHEN THE PATIENT WAS ADMITTED TO
 THE HOSPITAL.  IF THE HOSPITAL'S DAILY DISCHARGE LISTING DID NOT SHOW THE
 MEDICAL RECORD NUMBER, THE SAMPLE WAS SELECTED BY STARTING WITH A RANDOMLY
 SELECTED DISCHARGE AND TAKING EVERY KTH DISCHARGE THEREAFTER.

DATA COLLECTION

 DATA COLLECTION. DEPENDING ON THE STUDY PROCEDURE AGREED ON WITH THE
 HOSPITAL ADMINISTRATOR, EITHER HOSPITAL STAFF OR REPRESENTATIVES OF THE
 NCHS PERFORMED THE SAMPLE SELECTION AND THE TRANSCRIPTION OF INFORMATION
 FROM THE HOSPITAL RECORDS TO ABSTRACT FORMS.  THE ABSTRACT FORM USED FOR
 1983 IS SHOWN IN FIGURE 1.  IN ABOUT TWO-THIRDS OF THE HOSPITALS THAT
 PARTICIPATE IN THE NHDS, THE MEDICAL RECORDS DEPARTMENT OF THE HOSPITAL
 PERFORMED THIS WORK.  IN THE REMAINING HOSPITALS, PERSONNEL OF THE U.S.
 BUREAU OF THE CENSUS ACTING FOR THE NCHS PERFORMED THE WORK.

 SURVEY HOSPITALS USED AN ABSTRACT FORM TO TRANSCRIBE DATA FROM THE HOSPITAL
 RECORDS.  THE ABSTRACT FORM PROVIDES FOR RECORDING DEMOGRAPHIC DATA, ADMIS-
 SION AND DISCHARGE DATES, DISCHARGE STATUS, AND INFORMATION ON DISCHARGE
 DIAGNOSES AND SURGICAL OPERATIONS OR PROCEDURES.  ALL DISCHARGE DIAGNOSES
 WERE LISTED ON THE ABSTRACT FORM IN THE ORDER OF PRINCIPAL DIAGNOSIS, OR
 FIRST LISTED DIAGNOSIS IF THE PRINCIPAL DIAGNOSIS WAS NOT IDENTIFIED,
 FOLLOWED BY THE ORDER IN WHICH ALL OTHER DIAGNOSES WERE ENTERED ON THE FACE
 SHEET OF THE MEDICAL RECORD.  ALL OPERATIONS WERE LISTED IN THE ORDER IN
 WHICH THEY WERE RECORDED ON THE FACE SHEET.

 SHIPMENTS OF COMPLETED ABSTRACT FORMS FOR EACH SAMPLE HOSPITAL WERE
 TRANSMITTED, ALONG WITH SAMPLE SELECTION CONTROL SHEETS, TO A CENSUS
 REGIONAL OFFICE.  EVERY SHIPMENT OF ABSTRACTS WAS REVIEWED AND EACH
 ABSTRACT FORM WAS CHECKED FOR COMPLETENES5 ABSTRACTS WERE THEN SENT TO
 THE NCHS FOR PROCESSING.

MEIDCAL CODING AND EDIT

 MEDICAL CODING AND EDIT. THE MEDICAL INFORMATION RECORDED ON THE SAMPLE
 PATIENT ABSTRACTS WAS CODED CENTRALLY BY THE NCHS STAFF.  A MAXIMUM OF
 SEVEN DIAGNOSTIC CODES WAS ASSIGNED FOR EACH SAMPLE ABSTRACT; IN ADDITION,
 IF THE MEDICAL INFORMATION INCLUDED SURGERY, A MAXIMUM OF FOUR CODES FOR
 SURGICAL OPERATIONS AND PROCEDURES WAS ASSIGNED.  FOLLOWING THE CONVERSION
 OF THE DATA ON THE MEDICAL ABSTRACT TO COMPUTER TAPE, A FINAL MEDICAL EDIT
 WAS ACCOMPLISHED BY COMPUTER INSPECTION RUNS AND A REVIEW OF REJECTED
 ABSTRACTS.  IF SEX OR AGE OF PATIENT WAS INCOMPATIBLE WITH THE RECORDED
 MEDICAL INFORMATION, PRIORITY WAS GIVEN TO THE MEDICAL INFORMATION IN THE
 EDITING DECISION.

 NHHDS MEDICAL CODERS CODE FROM ABSTRACTS OF MEDICAL RECORDS IN THE ORDER THE
 DIAGNOSES AND PROCEDURES ARE ENTERED.  FOR MOST ABSTRACTS, THIS CODING
 PROCEDURE IS RELATIVELY FREE OF PROBLEMS.  IT WAS NOTED, HOWEVER, THAT ACUTE
 CARDIAL INFARCTION FREQUENTLY WAS NOT THE LEAD ENTRY IN A GROUP OF
 CIRCULATORY DIAGNOSES FOR EXAMPLE, THE PATIENT'S RECORD MAY HAVE
 ARTERIOSCLEROSOS LISTED FIRST AND ARTERIOSCLEROTIC HEART DISEASE LISTED
 SECOND WITH ACUTE MYOCARDIAL LNFARCTLON LISTED THIRD.  A DECISION WAS MADE
 TO REORDER SOME ACUTE MYOCARDIAL INFARCTION DIAGNOSES.  THE NEW PROCEDURE,
 BASED ON ACCEPTED MEDICAL CODING PRACTICE, STATES THAT WHENEVER AN ACUTE
 MYOCARDIAL INFARCTION IN ENCOUNTERED WITH OTHER CIRCULATORY DIAGNOSES AND
 IS OTHER THAN THE FIRST ENTRY, IT SHOULD BE REORDERED TO FIRST POSITION.

 THE BASIC SYSTEM FOR CODING THE DIAGNOSES ON THE NHDS SAMPLE PATIENT
 ABSTRACTS IS THE INTERNATIONAL CLASSIFICATION OF DISEASES, 9TH REVISION,
 CLINICAL MODIFICATION (ICD-9-CM) (SEE REFERENCE 3).  THE ICD-9-CM SECTION
 FOR SURGICAL OPERATIONS, DIAGNOSTIC AND OTHER THERAPEUTIC PROCEDURES IS THE
 CODING SYSTEM USED FOR SURGICAL PROCEDURES AND OPERATIONS.

 THE UNIFORM HOSPITAL DISCHARGE DATA SET (UHDDS) CLASSIFIES ICD-9-CM
 PROCEDURES INTO FOUR CLASSES.  CLASSES 1.3 CONSIST OF "SIGNIFICANT
 PROCEDURES" - THAT IS, PROCEDURES WHICH CARRY AN OPERATIVE OR ANESTHETIC
 RISK OR REQUIRE HIGHLY TRAINED PERSONNEL, SPECIAL FACILITIES, OR SPECIAL
 EQUIPMENT.  CLASS 4 PROCEDURES ARE NOT CONSIDERED SIGNIFICANT; THEREFORE,
 REPORTING THEM IS CONSIDERED OPTIONAL.  THE CLASS 4 PROCEDURES NOT CODED
 BY THE NHDS ARE LISTED IN APPENDIX C.

POPULATION ESTIMATES

 POPULATION ESTIMATES.--APPENDIX B CONTAINS POPULATION ESTIMATES PROVIDED BY
 THE U.S. BUREAU OF THE CENSUS.  THE ESTIMATES COVER THE U.S. CIVILIAN
 RESIDENT POPULATION ON JULY I OF THE DATA YEAR.  THESE POPULATION ESTIMATES
 ARE CONSISTENT WITH THOSE PUBLISHED IN CURRENT POPULATION REPORTS,
 SERIES P-25; HOWEVER, THESE TABLES ARE NOT OFFICIAL POPULATION ESTIMATES OF
 THE BUREAU OF THE CENSUS.

MEASUREMENT ERRORS

 MEASUREMENT ERRORS.--AS IN ANY SURVEY, RESULTS ARE SUBJECT TO NONSAMPLING
 OR MEASUREMENT ERRORS, WHICH INCLUDE ERRORS DUE TO HOSPITAL NONRESPONSE,
 MISSING ABSTRACTS, INFORMATION INCOMPLETELY OR INACCURATELY RECORDED ON
 ABSTRACT FORMS, AND PROCESSING ERRORS.  LESS THAN I PERCENT OF THE DIS-
 CHARGE RECORDS FAILED TO INCLUDE AGE OR SEX OF PATIENT OR DATE OF ADMISSION
 OR DISCHARGE.  IF THE HOSPITAL RECORD DID NOT STATE AGE OR SEX OF PATIENT,
 IT WAS IMPUTED BY ASSIGNING THE PATIENT AN AGE OR SEX CONSISTENT WITH THE
 AGE OR SEX OF OTHER PATIENTS WITH THE SAME DIAGNOSTIC CODES.  IF THE DATES
 OF ADMISSION OR DISCHARGE WERE NOT GIVEN, AND IF THEY COULD NOT BE OBTAINED
 FROM THE MONTHLY SAMPLE LISTING SHEET TRANSMITTED BY THE SAMPLE HOSPITAL, A
 LENGTH OF STAY WAS IMPUTED BY ASSIGNING THE PATIENT A STAY CHARACTERISTIC
 OF THE STAYS OF OTHER PATIENTS OF THE SAME AGE.  IN ADDITION, NONRESPONSE
 (ABOUT 6 PERCENT) FOR PRINCIPAL EXPECTED SOURCE OF PAYMENT WAS IMPUTED TO
 REFLECT SIMILARITIES IN SEX AND AGE.

SAMPLING ERRORS

 SAMPLING ERRORS.--PROCEDURES FOR CALCULATING SAMPLING ERRORS ARE DESCRIBED
 IN DETAIL IN REFERENCE I.  ESTIMATES OF STANDARD ERRORS FOR A PARTICULAR
 YEAR CALCULATED FROM NHDS DATA ARE AVAILABLE IN THE APPENDIX OF THE NHDS
 PUBLICATIONS FOR THAT YEAR.

HOW TO USE THE DATA TAPE

 HOW TO USE THE DATA TAPE.--THE NHDS RECORDS ARE WEIGHTED TO ALLOW INFLATION
 TO NATIONAL OR REGIONAL ESTIMATES.  THE WEIGHT APPLIED TO EACH RECORD IS
 FOUND IN TAPE LOCATION ILL-I IS.  TO PRODUCE AN ESTIMATE OF THE NUMBER OF
 DISCHARGES, THE WEIGHTS FOR THE DESIRED RECORDS MUST BE SUMMED.  TO PRODUCE
 AN ESTIMATE FOR NUMBER OF DAYS OF CARE, THE WEIGHT MUST BE MULTIPLIED BY
 THE LENGTH OF STAY (TAPE LOCATION 101-104) AND THESE PRODUCTS ARE SUMMED.
 LENGTH OF STAY DATA CAN BE OBTAINED BY USING RECODES ALREADY ON THE TAPE
 (SEE ITEMS 19 AND 23 IN THE TAPE LAYOUT), OR BY DIVIDING DAYS OF CARE BY
 NUMBER OF DISCHARGES AS CALCULATED ABOVE.

DIAGNOSIS-RELATED GROUPS

 DIAGNOSIS-RELATED GROUPS (DRGS)..-MANY USERS OF THE NHDS DATA TAPES HAVE
 EXPRESSED AN INTEREST IN CONVERTING THESE DATA TO DRGS.  THIS HAS BEEN DONE
 USING THE DRG GROUPER PROGRAM OBTAINED FROM THE HEALTH CARE FINANCING
 ADMINISTRATION IN AUGUST 1983.  THE DRGS AND THE DRG GROUPER PROGRAM WERE
 DEVELOPED OUTSIDE OF THE NATIONAL CENTER FOR HEALTH STATISTICS; ANY
 QUESTIONS ABOUT DRGS, OTHER THAN SPECIFIC QUESTIONS ABOUT HOW THEY RELATE
 TO NHDS DATA, SHOULD BE ADDRESSED ELSEWHERE.

QUESTIONS

 QUESTIONS.--QUESTIONS CONCERNING DATA ON THE TAPE SHOULD BE DIRECTED TO THE
 HOSPITAL CARE STATISTICS BRANCH, DIVISION OF HEALTH CARE STATISTICS, NATIONAL
 CENTER FOR HEALTH STATISTICS, CENTER BUILDING, ROOM 2-43, 3700 EAST-WEST
 HIGHWAY, HYATTSVILLE, MARYLAND 20782.


REFERENCES                                

 NATIONAL CENTER FOR HEALTH STATISTICS:  DEVELOPMENT OF THE DESIGN OF THE
 NCHS HOSPITAL DISCHARGE SURVEY, BY W. R. SIMMONS.  VITAL AND HEALTH
 STATISTICS.  PHS PUB. NO. 1000, SERIES 2-NO. 39.  PUBLIC HEALTH SERVICE.
 WASHINGTON.  U.S. GOVERNMENT PRINTING OFFICE, SEPT. 1970.

 NATIONAL CENTER FOR HEALTH STATISTICS:  DEVELOPMENT AND MAINTENANCE OF A
 NATIONAL INVENTORY OF HOSPITALS AND INSTITUTIONS.  VITAL AND HEALTH
 STATISTICS.  PHS PUB. NO. 1000, SERIES 1-NO. 3.  PUBLIC HEALTH SERVICE.
 WASHINGTON.  U.S. GOVERNMENT PRINTING OFFICE, FEB. 1965.

 NATIONAL CENTER FOR HEALTH STATISTICS:  INTERNATIONAL CLASSIFICATION OF
 DISEASES, 9TH REVISION, CLINICAL MODIFICATION.  DHHS PUB. NO. (PHS)
 80-1260.  PUBLIC HEALTH SERVICE.  WASHINGTON.  U.S. GOVERNMENT PRINTING
 OFFICE, SEPT. 1980.
RECORD LAYOUT

  NATIONAL HOSPITAL DISCHARGE SURVEY - 1984 OUTLINE OF ITEMS AND CODES
  ARRANGED BY LOCATION IN THE FINAL MEDICAL TAPE RECORD

  ITEM     TAPE       NUMBER OF
 NUMBER LOCATION     POSITIONS     ITEM DESCRIPTION AND CODES

  1          1            1         SAMPLE FRAME

                                     1:  ADNISSION LIST
                                     2:  DISCHARGE LIST

             2            1          BLANK

 2           3            1          DISCHARGE STATUS RECODE

                                     1: ALIVE
                                     2:DEAD
                                     3:NOT STATED

             4            1          BLANK

 3         5-7            3          DIAGNOSIS-RELATED GROUP CODE*

             8            1          BLANK

 4        9-10            2          CONTROL MONTH

                                      THIS CODE IS EITHER THE MONTH OF
                                      ADMISSION OR DISCHARGE DEPENDING UPON
                                      THE SAMPLE FRAME USED IN A HOSPITAL AS
                                      CODED IN LOCATION 1.

                                       01:  JANUARY THROUGH
                                       12:  DECEMBER

        11-12            2         BLANK
 5      13-14            2         CENTURY OF BIRTH (18 OR 10)
        15-24           10         BLANK
 6      25-30            6         DATE OF BIRTH

                                      THIS ITEM IS USED TO CALCULATE AGE
                                      AT DATE OF ADMISSION, IF IT PASSES THE
                                      EDIT.  (THIS ITEM APPEARS IN THE
                                      OUTPUT RECORD AS IT WAS IN THE INPUT
                                      RECORD EXCEPT IN THE CASE OF MONTH
                                      IMPUTED AS 06 AND/OR DAY IMPUTED AS
                                      15.)

 *SEE TEXT SECTION, "DIAGNOSIS-RELATED GROUPS."


  6.1     25-26           2            MONTH OF BIRTH
  6.2     27-28           2            DAY OF BIRTH
  6.3     29-30           2            YEAR OF BIRTH

                                       03-84:  1900-1984
                                       85-99:  1885-1899

  7       31-33           3         AGE

                                        UNITS             NUMBER
                                   (LOCATION 33)    (LOCATION 31-32)

                                    1:   YEARS            01-99
                                    2:   MONTHS           01-11
                                    3:   DAYS             00-28

 8          34           1         SEX

                                      1:  MALE
                                      2:  FEMALE

            35           1         BLANK

 9          36           1         MARITAL STATUS

                                      1:  MARRIED
                                      2:  SINGLE
                                      3:  WIDOWED
                                      4:  DIVORCED
                                      5:  SEPARATED
                                      6:  NOT STATED
                                      7:  UNKNOWN

 10       37-41           5         DATE OF ADMISSION

                                      (IMPUTED ACCORDING TO AGE IF INVALID
                                      OR BLANK.)

 10.1    37-38            2'            MONTH OF ADMISSION

                                       01:  JANUARY THROUGH
                                       12:  DECEMBER

 10.2    39-40            2            DAY OF ADMISSION

                                       01-31


 10.3       41           1            YEAR OF ADMISSION

                                             1983
                                             1984

 11      42-46           5         DATE OF DISCHARGE

                                      (IMPUTED ACCORDING TO AGE IF INVALID
                                      OR BLANK.)

 11.1    42-43           2            MONTH OF DISCHARGE

                                       01:  JANUARY THROUGH
                                       12:  DECEMBER

 11.2    44-45           2            DAY OF DISCHARGE
                                        01-31
 11.3       46           1            YEAR OF DISCHARGE

                                            1984
                                            1985

 12          47           1         DISCHARGE STATUS

                                    1:   ROUTINE DISCHARGE/DISCHARGED HOME
                                    2:   LEFT AGAINST MEDICAL ADVICE
                                    3:   DISCHARGED/TRANSFERRED TO ANOTHER
                                         SHORT-TERM HOSPITAL
                                    4:   DISCHARGED/TRANSFERRED TO LONG-
                                         TERM CARE INSTITUTION
                                    5:   ALIVE, DISPOSITION NOT STATED
                                    6:   DEAD
                                    7:   STATUS NOT STATED

             48           1         BLANK
 13          49           1         AGE RECODE

                                    1:   LESS THAN 15 YEARS
                                    2:   15-44 YEARS
                                    3:   45-64 YEARS
                                    4:   65 YEARS AND OVER

 14          50           1         NUMBER OF DIAGNOSTIC CODES RECORDED

                                     1  - MINIMUM
                                     7  - MAXIMUM

 15          51           1         NUMBER OF SURGICAL CODES RECORDED
                                     0  - MINIMUM
                                     4  - MAXIMUM

 16       52-56           5         DATE OF SURGERY #3
 16.1     52-53           2            MONTH OF SURGERY
                                        01-12
 16.2    54-55            2            DAY OF SURGERY
                                        01-31
 16.3.      56            1            YEAR OF SURGERY
                                       2:  1983
                                       3:  1984
                                       4:  1985

 17       57-61           5         DATE OF SURGERY #4
                                     SAME FORMAT AS ABOVE (52-56)
          62-77          16         BLANK
 18       78-81           4.        LENGTH OF STAY IN DAYS

                                      THIS ITEM WAS GENERATED IN THE
                                      COMPUTER ON THE BASIS OF DATE OF
                                      ADMISSION AND DATE OF DISCHARGE.
                                      IN CASE OF BLANK OR INVALID DATE OF
                                      ADMISSION AND/OR DATE OF DISCHARGE,
                                      THIS ITEM WAS IMPUTED ACCORDING TO
                                      AGE.  CODES RANGE FROM
                                      0000 TO 0730.

 19       82-83           2         LENGTH OF STAY RECODE  -1 (COMPUTER
                                    GENERATED)

                                      00:  00 DAYS
                                      01:  01 DAYS
                                       .    .
                                       .    .
                                       .    .
                                      31:  31 DAYS AND OVER

 20       84-85           2        AGE RECODE (COMPUTER GENERATED)

                                     00:   NEWBORN
                                     01:   UNDER 1 YEAR
                                     02:   01-04 YEARS
                                     03:   05-14 YEARS
                                     04:   15-24 YEARS
                                     05:   25-34 YEARS
                                     06:   35-44 YEARS
                                     07:   45.54 YEARS
                                     08:   55-64 YEARS
                                     09:   65-74 YEARS
                                     10:   75 YEARS AND OVER

 21          86           1          RACE RECODE (COMPUTER GENERATED)

                                      1:  WHITE
                                      2:  OTHER
                                      3:  NOT STATED

 22          87           1          MARITAL STATUS RECODE (COMPUTER
                                     GENERATED)

                                       1:  MARRIED
                                       2:  NOT MARRIED
                                       3:  NOT STATED

 23          88           1.         LENGTH OF STAY RECODE #2 (COMPUTER
                                     GENERATED)

                                      1:   00-07 DAYS
                                      2:   08-14 DAYS
                                      3:   15-21 DAYS
                                      4:   22.28 DAYS
                                      5:   29 DAYS AND OVER

          89-90           2          BLANK
 24          91           1          GEOGRAPHIC REGION (NMFI)

                                       1:  NORTHEAST
                                       2:  NORTH CENTRAL
                                       3:  SOUTH
                                       4:  WEST

             92           1          BLANK

 25          93           1         GEOGRAPHIC DIVISION
                                      NORTHEAST REGION

                                       1:  NEW ENGLAND
                                       2:  MIDDLE ATLANTIC

                                      NORTH CENTRAL REGION

                                       3:  EAST NORTH CENTRAL
                                       4:  WEST NORTH CENTRAL

                                      SOUTH REGION

                                       5:  SOUTH ATLANTIC
                                       6:  EAST SOUTH CENTRAL
                                       7:  WEST SOUTH CENTRAL

                                      WEST REGION

                                       8:  MOUNTAIN
                                       9:  PACIFIC

          94-98           5         BLANK
 26          99           1         NUMBER OF BEDS RECODE (INTERVIEW)

                                  1:   6-49 BEDS
                                  2:   50-99 BEDS
                                  3:   100-199 BEDS
                                  4:   200-299 BEDS
                                  5:   300-499 BEDS
                                  6:   500-999 BEDS
                                  7:   1,000 BEDS OR MORE

 27          100          1         HOSPITAL OWNERSHIP (INTERVIEW)

                                      1:  PROPRIETARY
                                      2:  CHURCH
                                      3:  GOVERNMENT
                                      4:  NONPROFIT, EXCLUDING CHURCH

 28      101-104          4         LENGTH OF STAY IN DAYS

                                      DATA IN 78-81 HAS BEEN TRANSFERRED
                                      TO THIS DATA FIELD WITH 0000 DAYS
                                      RECODED TO 0001.

         105-110          6         BLANK
 29      111-115          5         WEIGHT

                                      FINAL ADJUSTED WEIGHT (WHOLE
                                      NUMBER--USED IN TABLE PREPARATION)

         116-130         IS           BLANK

 30      131-136          6         EXPECTED SOURCE(S) OF PAYMENT

 30.1        131          1           PRINCIPAL NO. 1
 30.2        132          1           PRINCIPAL NO. 2
 30.3        133          1           OTHER NO. 1
 30.4        134          1           OTHER NO. 2
 30.5        135          1           OTHER NO. 3
 30.6        136          1           OTHER NO. 4

                                  CODE  SOURCE OF PAYMENT

                                    I:   WORKMEN'S COMPENSATION
                                    2:   MEDICARE
                                    3:   MEDICAID
                                    4:   TITLE V
                                    5:   OTHER GOVERNMENT PAYMENT
                                    6:   BLUE CROSS
                                    7:   OTHER PRIVATE OR COMMERCIAL
                                         INSURANCE
                                    8:   SELF-PAY
                                    9:   NO CHARGE
                                    0:   OTHER

 31      137-141          5         DATE OF SURGERY #1

 31.1    137-138          2           MONTH OF SURGERY
                                      01-12
 31.2    139-140          2           DAY OF SURGERY
                                       01-31
 31.3        141          1           YEAR OF SURGERY

                                       2:  1983
                                       3:  1984
                                       4:  1985

 32     142-146           5        DATE OF SURGERY #2
                                     SAME FORMAT AS ABOVE (137-141)
        147-148           2        BLANK
 33     149-183          35        DIAGNOSTIC CODES** (FIVE-DIGIT CODES)

 33.1   149-153           5          DIAGNOSIS NO.  1
 33.2   154-158           5          DIAGNOSIS NO.  2
 33.3   159-163           5          DIAGNOSIS NO.  3
 33.4   164-168           5          DIAGNOSIS NO.  4
 33.5   169-173           5          DIAGNOSIS NO.  5
 33.6   174-178           5          DIAGNOSIS NO.  6
 33.7.  179-183           5          DIAGNOSIS NO.  7

 34     184-199          16        SURGICAL CODES * (FOUR-DIGIT CODES)

 34.1   184-187           4          SURGERY NO.  1
 34.2   188-191           4          SURGERY NO.  2
 34.3   192-195           4          SURGERY NO.  3
 34.4   196-199           4          SURGERY NO.  4

            200           I        BLANK



   CODES ARE IN COMPLIANCE WITH THE ICD-9-CM.  THERE IS AN IMPLIED
 DECIMAL BETWEEN POSITIONS 3 AND 4 FOR EACH DIAGNOSTIC CODE AND BETWEEN
 POSITIONS 2 AND 3 FOR EACH SURGICAL CODE.
APPENDICES

APPENDIX A
                             
DEFINITIONS OF CERTAIN TERMS USED IN THIS DOCUMENT

 HOSPITALS.--SHORT-STAY SPECIAL AND GENERAL HOSPITALS HAVING SIX BEDS OR
 MORE FOR INPATIENT USE AND AN AVERAGE LENGTH OF STAY OF LESS THAN 30 DAYS.
 FEDERAL HOSPITALS AND HOSPITAL UNITS OF INSTITUTIONS ARE NOT INCLUDED.

 BED SIZE OF HOSPITAL.--MEASURED BY THE NUMBER OF BEDS, CRIBS, AND PEDIATRIC
 BASSINETS REGULARLY MAINTAINED (SET UP AND STAFFED FOR USE) FOR PATIENTS;
 BASSINETS FOR NEWBORN INFANTS ARE NOT INCLUDED.

 TYPE OF OWNERSHIP OF HOSPITAL.--THE TYPE OF ORGANIZATION THAT CONTROLS AND
 OPERATES THE HOSPITAL.  HOSPITALS ARE GROUPED AS FOLLOWS:

    VOLUNTARY NONPROFIT.--HOSPITALS OPERATED BY A CHURCH OR ANOTHER NONPROFIT
    ORGANIZATION.

    GOVERNMENT.--HOSPITALS OPERATED BY STATE OR LOCAL GOVERNMENTS.

    PROPRIETARY.--HOSPITALS OPERATED BY INDIVIDUALS, PARTNERSHIPS, OR
    CORPORATIONS FOR PROFIT.

 PATIENT.--A PERSON WHO IS FORMALLY ADMITTED TO THE INPATIENT SERVICE OF A
 SHORT-STAY HOSPITAL FOR OBSERVATION, CARE, DIAGNOSIS, OR TREATMENT.

 DISCHARGE.--THE FORMAL RELEASE OF A PATIENT BY A HOSPITAL, THAT IS, THE
 TERMINATION OF A PERIOD OF HOSPITALIZATION BY DEATH OR BY DISPOSITION TO
 PLACE OF RESIDENCE, NURSING HOME, OR ANOTHER HOSPITAL.

 DISCHARGE DIAGNOSIS.--ONE OR MORE DISEASES OR INJURIES (OR SPECIAL CONDITIONS
 AND EXAMINATIONS WITHOUT SICKNESS OR TESTS WITH NEGATIVE FINDINGS) THAT THE
 ATTENDING PHYSICIAN ASSIGNS' TO THE MEDICAL RECORD OF PATIENTS.  (SEE "MEDICAL
 CODING AND EDIT," PAGE 5.)

 OPERATION.--ONE OR MORE SURGICAL OPERATIONS, PROCEDURES, OR SPECIAL TREATMENTS
 THAT ARE ASSIGNED BY THE PHYSICIAN TO THE MEDICAL RECORD OF PATIENTS DISCHARGED
 FROM THE INPATIENT SERVICE OF SHORT-STAY HOSPITALS.  (SEE "MEDICAL CODING AND
 EDIT," PAGE 5.)

 AGE.--PATIENT'S AGE REFERS TO AGE AT BIRTHDAY PRIOR TO ADMISSION TO THE HOSPITA
 INPATIENT SERVICE.

 RACE.--PATIENTS ARE CLASSIFIED INTO THE THREE GROUPS LISTED IN THE TAPE RECORD
 FORMAT UNDER RACE (ITEM 21).

 GEOGRAPHIC REGION AND DIVISION.--HOSPITALS ARE CLASSIFIED BY LOCATION INTO
 ONE OF THE FOUR GEOGRAPHIC REGIONS AND NINE GEOGRAPHIC DIVISIONS OF THE UNITED
 STATES (ITEMS 24 AND 25 IN THE TAPE RECORD FORMAT), WHICH CORRESPOND TO THOSE
 USED BY THE U.S. BUREAU OF THE CENSUS.
APPENDIX B
                 
CIVILIAN POPULATION* BY SEX, AGE, GEOGRAPHIC RAGION, AND RACE:
                  UNITED STATES, JULY 1, 1984

     (POPULATION ESTIMATES CONSISTENT WITH SERIES P-25,
     CURRENT POPULATION REPORTS, U.S. BUREAU OF THE CENSUS)

 AGE, GEOGRAPHIC REGION,
   AND RACE                     BOTH SEXES        MALE        FEMALE

                         POPULATION IN THOUSANDS

  ALL AGES...................    234,443          113,199       121,244
  NORTHEAST..................     49,617           23,646        25,971
  NORTH CENTRAL..............     58,965           28,950        30,375
  SOUTH......................     79,678           38,310        41,368
  WEST.......................     46,182           22,653        23,529

  WHITE......................    199,641           96,775       102,867
  ALL OTHER..................     34,801           16,424        18,377

  0-14 YEARS.................     51,733           26,475        25,259
  UNDER 1 YEAR...............      3,637            1,861         1,755
  1-4 YEARS..................     14,179            7,254         6,927
  5-14 YEARS.................     33,917           17,360        16,557

  NORTHEAST..................      9,850            5,041         4,809
  NORTH CENTRAL..............     13,188            6,757         6,431
  SOUTH......................     18,055            9,234         8,822
  WEST.......................     10,640            5,444         5,196

  WHITE......................     42,045           21,572        20,473
  ALL OTHER..................      9,689            4,904         4,786

  15-44 YEARS................    109,958           54,096        55,862
  15-24 YEARS................     39,230           19,471        19,759
  25-34 YEARS................     40,328           19,803        20,523
  35-44 YEARS................     30,401           14,821        15,580

  NORTHEAST..................     23,047           11,248        11,798
  NORTH CENTRAL..............     27,511           13,625        13,885
  SOUTH......................     37,140           18,136        19,005
  WEST.......................     22,262           11,087        11,175

  WHITE......................     92,995           46,132        46,863
  ALL OTHER..................     16,963            7,963         8,999
  45-64 YEARS................     44,712           21,329        23,382
  45-54 YEARS................     22,397           10,856        11,540
  55-64 YEARS................     22,315           10,473        11,842

  NORTHEAST..................     10,205            4,818         5,388
  NORTH CENTRAL..............     11,044            5,314         5,730
  SOUTH......................     15,069            7,118         7,951
  WEST.......................      8,392            4,081         4,313

  WHITE......................     39,280           18,880        20,403
  ALL OTHER..................      5,430            2,450         2,979
  65 YEARS AND OVER..........     28,040           11,299        16,741
  65-74 YEARS................     16,746            7,318         9,429
  75 YEARS AND OVER..........     11,294            3,981         7,313

  NORTHEAST..................      6,515            2,539         3,976
  NORTH CENTRAL..............      7,223            2,895         4,327
  SOUTH......................      9,414            3,823         5,591
  WEST.......................      4,888            2,041         2,846

  WHITE......................     25,321           10,193        15,129
  ALL OTHER..................      2,719            1,107         1,612

 *THE NHDS USED THE CIVIALIAN NONINSTITUTIONALIZED POPULATION TO CALCULATE
 HOSPITAL UTILIZATION RATES FROM 1965 THROUGH 1980.  BEGINING IN 1981,
 THE CIVIALIAN RESIDENT POPULATION IS BEING USED TO CALCULATE RATES.  IF
 YOU HAVE PURCHASED NHDS TAPES BEFORE YEARS 1981 AND CALCULATED RATES
 USING THE CIVILIAN NONINSTITUTIONALIZED POPULATION PROVIDED IN THE DOCU-
 MENTATION, THESE RATES WILL HAVE TO BE ADJUSTED TO BE COMPRABLE TO 1984
 RATES USING THE CIVILIAN RESIDENT POPULATION.
APPENDIX C
                 
 UHDDS CLASS 4 PROCEDURES NOT CODED BY THE NHDS

       08.19              87.43-87.49
       16.21              87.69
       18.01              87.79
       18.11              87.85-87.89
       18.19              87.92
       21.21              87.95-87.99
       21.29              88.09
       22.19              88.16-88.31
       24.19              88.33
       25.09              88.35
       25.91              88.37
       26.19              88.39
       27.29              89.01-89.13
       27.91              89.15-89.16
       28.19              89.26-89.31
       29.19              89.33-89.39
       31.48-31.49        89.45-89.53
       41.38-41.39        89.55-89.59
       42.29              89.66
       44.19              89.7
       45.19              90.01-91.99
       45.28-45.29        93.01-93.25
       48.23              93.27-93.28
       48.29              93.31-93.39
       49.21              93.42-93.44
       49.29              93.61-93.91
       49.41              93.94
       58.29              93.96
       61.19              93.99-94.23
       64.19              94.25
       64.91              94.29-95.03
       64.94              95.05-95.11
       69.92              95.14-95.15
       70.21              95.31-95.49
       73.91-73.92        96.'09-96.19
       75.35              96.26-96.28
       85.19              96.34-97.04
       86.19              97.14-97.69
       86.92              97.72-97.89
       87.09-87.12        99.02-99.24
       87.16-87.17        99.26-99.59
       87.22-87.29        99.71-99.79
       87.36-87.37        99.82-99.99
       87.39




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