Severe nonresponse has prevented the NHCS from producing nationally representative estimates on hospital utilization.

The National Hospital Care Survey (NHCS) is designed to provide timely and reliable statistics on hospital care utilization in the U.S. to inform health care policy and serve a variety of research needs. The biggest challenge for the NHCS has been hospital recruitment. NHCS faces stiff competition for participation from other mandatory data collection and surveillance systems, which, in part, contributes to low hospital participation rates. As such, the NHCS has yet to produce nationally representative estimates on hospital utilization.

Because of the desire for NHCS representative estimates from 2020 when the COVID-19 pandemic was overwhelming hospitals, the NCHS wanted to design and develop a methodology for creating nationally representative estimates of hospital utilization using the participating NHCS hospital data and similar hospital data obtained from a commercial vendor. This would provide a means to create a public-use NHCS hospital data file that could be used by researchers examining the effects that COVID-19 had on hospital utilization.

NORC used external data to create model-based estimates and representative data files.

NORC’s solution involved the design, development, and implementation of a methodology to create a nationally representative file of hospital utilization by using information from the participating NHCS hospitals and the commercial hospital database. Innovative weighting methods were required to permit construction of restricted use and public use data files that improved on the NHCS data while releasing none of the commercial microdata. In addition, NORC’s solution entailed the implementation of a pilot study to design and develop synthetic data using the NHCS collected data and commercial hospital database. The synthetic data file can produce nationally representative estimates of hospital utilization while maintaining confidentiality and statistical integrity.