Injury-related Hospitalizations Module Definitions

Age Adjustment: Age adjustment (exit DHS) enhances the comparability of populations by controlling for the effects of their differing age compositions. It does this by applying age-specific rates in a population of interest to a standardized age distribution. The age-adjusted rates for two populations can be compared at the same point in time or the age-adjusted rates for the same population may be compared at different points in time. Age-adjusted rates in WISH are calculated using the direct method and are based on the year 2000 Standard U.S. Population.

Discharge Status: The discharge status indicates the place or circumstances to which the inpatient is discharged or transferred when released. It is coded by the hospital.

E-code or External Cause of Injury: The external underlying cause of injury is the way in which the person sustained the injury; how the person was injured; or the process by which the injury occurred. External causes for injuries are coded from the medical record by hospital staff according to the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) http://www.cdc.gov/nchs/about/otheract/icd9/abticd9.htm (exit DHS).

Expected Primary Payer: The payer who is expected by the hospital to be the primary payer of the inpatient stay. This payer will be the first one billed. There also may be a secondary payer.

Hospital Charges: Total and average charges include only the hospital's charges. They do not include any separate fees for physicians, anesthetists, and other professionals. This is not the same as the costs to the payer, since private insurers, Medicaid and Medicare only reimburse the hospital for some fraction of the charges billed.

Injury-Related Hospitalization: An "injury-related hospitalization" is an inpatient stay at a hospital for which an external cause of injury ("E-code") was coded from the medical record and reported. Records with E-codes indicating adverse effects of medical care or therapeutic drugs were excluded. An injured person may have multiple inpatient stays in the same or different hospitals for treatment of the same injury, including being transferred from one hospital to another. This module counts each stay, not each patient.

Injury Hospitalization Rate: The injury hospitalization rate is calculated by dividing the number of injury-related hospitalizations per year by the population. It is usually expressed as the number of injuries per 100,000 population. The rate may refer to injury hospitalizations in a specific group, or to injury hospitalizations from a specific cause, or to all injury hospitalizations in the entire population. The rate may be adjusted for the age composition of the group or it may be the observed (or "crude") rate. This module uses the patient's county of residence for the population base.

Rates by Race/Ethnicity: The population estimates used as denominators for the injury hospitalization rates in WISH are based on the bridged race estimates (exit DHS) provided by the U.S. Census Bureau and the National Center for Health Statistics (NCHS). The estimates have been controlled so they sum to the annual estimates published by the Bureau of Health Information and Policy.

Producing the bridged race estimates was necessary because race categories in Census 2000 differed from those used in previous years. Specifically, data on race from Census 2000 were not directly comparable to data from previous years due, in large part, to giving respondents the option to report more than one race.

As a result, NCHS and the Census Bureau produced bridged race estimates that allow calculation of rates by race/ethnicity across years. These estimates distribute (or "bridge") the "more than one race" and "some other race" populations into one of four major race groups (American Indian/Alaska Native, Asian/Pacific Islander, Black, and White) and two ethnicity groups (Hispanic/Latino, non-Hispanic/Latino).

NCHS and the Census Bureau have produced this set of bridged race estimates extending back to the 1990 Census, and plan to produce these estimates on an annual basis in the future. WISH will be updated each year as these estimates become available.

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