Evaluation of techniques for handling missing cost-to-charge ratios in the USA Nationwide Inpatient Sample: a simulation study

Yu, Tzy-Chyi; Zhou, Huanxue

doi:10.2217/cer.15.28

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…To estimate costs, we multiplied charges by the hospital-specific cost-to-charge ratios provided by HCUP, which are based on all-payer, inpatient costs. Combining validated techniques, 43 where no hospital-specific ratio was available, the HCUP group average ratio based on hospital category was substituted. When neither was available, the state average was used.…”

Section: Methodsmentioning

confidence: 99%

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

Kaufman

Rising

Wiebe

et al. 2016

The American Journal of Emergency Medicine

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Introduction Though preventing recurrent violent injury is an important component of a public health approach to interpersonal violence, and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established. Methods We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and estimated time to recurrence with the Kaplan-Meier method. We tabulated hospital charges and costs for index and recurrent visits. Results Of 53,908 patients presenting for violent injury in 2010, 11.1% had a recurrent violent injury during the study period. Trauma centers treated 31.8%, including 55.9% of severe injuries. Among recurrers, 58.9% went to a different hospital for their second injury. Low income, homelessness, Medicaid or uninsurance, and Black race were associated with increased odds of recurrence. Patients with visits for mental and behavioral health and unintentional injury also had increased odds of recurrence. Index injuries accounted for $105 million in costs, and recurrent injuries accounted for another $25.3 million. Conclusions Recurrent violent injury is a common and costly phenomenon, and effective violence prevention programs are needed. Prevention must include the non-trauma centers where many patients seek care.

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Section: Methodsmentioning

confidence: 99%

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

Kaufman

Rising

Wiebe

et al. 2016

The American Journal of Emergency Medicine

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“…11 Missing insurance status for those aged $65 years was imputed to Medicare. Missing cost data were handled using reweighting technique recommended by HCUP 12 and missing hospital variables such as teaching status (0.46%) and number of beds (0.46%) were excluded. Participants with missing race data were excluded in subgroup analysis stratified by race, but all multivariate models contained imputed race data.…”

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confidence: 99%

Increasing atrial fibrillation prevalence in acute ischemic stroke and TIA

et al. 2016

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Objective: To evaluate trends in atrial fibrillation (AF) prevalence in acute ischemic stroke (AIS) and TIA in the United States.Methods: We used the Nationwide Inpatient Sample to retrospectively compute weighted prevalence of AF in AIS (n 5 4,355,140) and TIA (n 5 1,816,459) patients admitted to US hospitals from 2004 to 2013. Multivariate-adjusted models were used to evaluate the association of AF with clinical factors, mortality, length of stay, and cost.Results: From 2004 to 2013, AF prevalence increased by 22% in AIS (20%-24%) and by 38% in TIA (12%-17%). AF prevalence varied by age (AIS: 6% in 50-59 vs 37% in $80 years; TIA: 4% in 50-59 vs 24% in $80 years), sex (AIS: male 19% vs female 25%; TIA: male 15% vs female 14%), race (AIS: white 26% vs black 12%), and region (AIS: Northeast 25% vs South 20%). Advancing age, female sex, white race, high income, and large hospital size were associated with increased odds of AF in AIS. AF in AIS was a risk factor for in-hospital death (odds ratio 1.93, 95% confidence interval 1.89-1.98) but mortality in AIS with AF decreased from 11.6% to 8.3% (p , 0.001). Compared to no AF, AF was associated with increased cost of $2,310 and length of stay 1.1 days in AIS.Conclusions: AF prevalence in AIS and TIA has continued to increase. Disparity in AF prevalence in AIS and TIA exists by patient and hospital factors. AF is associated with increased mortality in AIS. Innovative AIS preventive strategies are needed in patients with AF, especially in the elderly. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia 1 and is associated with a 5-fold increased risk of acute ischemic stroke (AIS).2 Between 2.7 and 6.1 million people in the United States have AF and as the US population ages, this number is projected to more than double by 2050.3 Accurate understanding of variations in AF prevalence in AIS is important for discerning changes in the epidemiologic, clinical, and social characteristics of AIS over time, but contemporary large-scale data on the burden of AF-associated AIS in the United States are lacking. While AF-related hospitalizations in the United States increased over the last decade, 4 it remains unclear what direction and by how much AF-associated AIS changed over this period.The primary aim of our study is to quantify and describe trends in the prevalence of AF in hospitalized AIS and TIA patients in the United States from 2004 to 2013. We secondarily evaluated the association of AF with other socioeconomic and hospital-level factors in AIS and evaluated the current association of comorbid AF with in-hospital mortality, length of stay (LOS), and hospitalization cost in AIS. all-payer inpatient care database in the United States and comprises a 20% stratified random sample of all US hospital discharges. Each discharge in the NIS is de-identified so all discharges were considered to be independent. The unit for this analysis was each discharge rather than each individual. Further details on the NIS design are available at hcup-us.ahrq....

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Prevalence of Atrial Fibrillation in Hospital Encounters With End-Stage COPD on Home Oxygen

Xiao

Han

et al. 2019

Chest

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Evaluation of techniques for handling missing cost-to-charge ratios in the USA Nationwide Inpatient Sample: a simulation study

Abstract: Similar mean cost estimates would be obtained with any of the four techniques when the percentage of missing data is low (<10%). When total cost is the outcome of interest, a reweighting technique to avoid underestimation from dropping observations with missing data should be adopted.

Cited by 5 publications

References 14 publications

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

Increasing atrial fibrillation prevalence in acute ischemic stroke and TIA

Prevalence of Atrial Fibrillation in Hospital Encounters With End-Stage COPD on Home Oxygen

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