Evaluation of the American Hospital Association Annual Survey for health services research in emergency medicine

Abstract

Objectives Emergency department (ED) data are often used to address questions about access to and quality of emergency care. Our objective was to compare one of the most commonly used data sources for national ED information, the American Hospital Association (AHA) Annual Survey, with a criterion database: the National Emergency Department Inventory (NEDI)–USA data set. Methods We compared the 2015 and 2016 AHA surveys to the following 3 criterion standards: (1) the 2015 and 2016 NEDI‐USA databases, which have information about all US EDs, including merged data from (2) Council of Teaching Hospitals (COTH) and (3) the Critical Access Hospital (CAH) program. We present descriptive results about the number of EDs in each data set; total and median visit volumes; locations in rural areas; and COTH, CAH, and freestanding ED (FSED) status. Results The AHA survey identified 3893 US EDs in 2015. These EDs had a total annual visit volume of 129,197,493 visits, with a median of 22,772 visits (interquartile range, 8311–47,938). Compared with the NEDI‐USA, the AHA included 1433 fewer EDs (−27%; 95% confidence interval [CI], −28% to −26%) and 23,615,163 (−15%) fewer visits. Specifically, AHA was missing 245 (−22%; 95% CI, −24% to −19%) of those located in rural areas, 268 (−20%; 95% CI, −22% to −18%) in a CAH, and 240 (−47%; 95% CI, −51% to −42%) FSEDs. We saw similar results using 2016 data. Conclusions Although several aggregated results were similar between the compared data sources, the AHA data set excluded many US EDs, including many rural EDs and FSEDs. Consequently, the AHA underreported total ED visits by 15%. We encourage data users to be cautious when interpreting results from any 1 ED data source, including the AHA.

Availability of hospital‐based cancer services before and after rural hospital closure, 2008‐2017

“…However, missing data were imputed using historical data from hospitals. For studies on other service lines, researchers have identified that hospitals may group services under a single ID which may affect the attribution of facility characteristics to that service line 38 . Second, our study only considers the closures of rural hospitals, while urban areas also experienced closures during the study period.…”

The association of the emergency department work environment on patient care and nurse job outcomes

“…This study used a cross‐sectional research design and linked survey data from 2 sources: the 2021 RN4CAST‐NY/IL 2 and the American Hospital Association (AHA) Annual Hospital Survey. 6 , 34 The RN4CAST‐NY/IL nurse survey included data on the nurse‐reported work environment, patient outcomes, and nurse job outcomes (eg, burnout). .…”

“…. The AHA Annual Survey 34 provided information on hospitals’ technology capabilities, teaching status, bed size, ED volume, and trauma center designation.…”

“…Hospital‐level covariates from the AHA Annual Hospital Survey 34 included teaching status (non‐teaching: no residents/fellows; minor teaching: <1 fellow/resident per 4 beds; major teaching: ≥1 fellow/resident to 4 beds), technology capabilities (high technology can perform open‐heart surgery or major organ transplantation), bed size category (≤100 beds, 101–250 beds, 251–500 beds, >500 beds), trauma designation, and annual ED patient volume (0–20,000 visits to >100,000 visits). Individual nurse level covariates included age, sex, education level, and years of experience.…”