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National Center for Health Statistics

National Hospital Care Survey: 

Redesigning the Annual Hospital Interview

Catherine Rappole, Geoffrey Jackson

Division of Health Care Statistics

Federal Committee on Statistical Methodology 2023 Research and Policy Conference

October 25, 2023

Session G-1: If We Modernize the Survey, Will They Respond?

Disclaimer: All views expressed in this presentation are those of the authors, and do not necessarily reflect those of the Centers for Disease Control and Prevention or National Center for Health Statistics.
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Presentation Overview

1. Overview of National Hospital Care Survey (NHCS)

2. Overview of Annual Hospital Interview (AHI)

3. Redesign of AHI Questionnaire and Online Portal

4. Overview of AHI Response Rate
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Overview of 

National Hospital Care Survey (NHCS)
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NHCS – Goal and Objectives

 Goal:

– Provide reliable and timely healthcare utilization data for hospitalbased settings.

 Objectives:

– Provide national data for benchmarking.

– Link episodes of care across hospital units as well as link to other data 

sources, including the National Death Index; Centers for Medicare & 

Medicaid Services data such as the Master Beneficiary Summary File; 

and U.S. Department of Housing and Urban Development data.
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NHCS – Sample Design and Data Collection

 Sample Design: 

– Hospitals are randomly selected and each hospital selected for the survey 

uniquely represents facilities of similar size, service type, and/or geographic 

location and cannot be replaced. 

– The 2020-2022 NHCS sample consisted of 608 non-institutional, non-federal 

hospitals with six or more staffed inpatient beds.

– Participation is voluntary and there is no penalty for not participating. 

 Data collection:

– All inpatient discharges and emergency department (ED) visits for up to a 12-

month period, including patient personally identifiable information.

– Hospitals can submit electronic health records, Uniform Bill-04 administrative 

claims, state files, or data from third party sources (e.g. Vizient and American 

College of Emergency Physicians). 
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Overview of 

Annual Hospital Interview (AHI)
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AHI Purpose & History

 The AHI is an annual supplemental component of NHCS that collects 

hospital summary information to be used as adjustment factors in the 

creation of weights to produce reliable national estimates. 

– The AHI is a retrospective survey that collects information on the 

previous calendar year.

 Prior to 2017, the AHI was administered by an interviewer.

– Due to budget restraints, the AHI was pulled out of the field in 2017.

 When the AHI was reinstated in 2020, it was implemented as a selfresponse web survey. However, the question wording and interview 

structure were not updated for the new mode of collection. 
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AHI Eligibility and Respondents

 All eligible sampled NHCS hospitals are requested to complete the AHI.

– Sampled hospitals with a recruitment status of “ineligible,” “soft 

refusal,” or “firm refusal” are not eligible to complete the AHI.

 A respondent may be responsible for completing the AHI for more than 

one hospital.

 The AHI for a hospital may only be completed by one respondent.

Hospital Count Respondent Count

Year Eligible Not Eligible Total

2020 533 75 608 378

2021 496 112 608 371

2022 482 126 608 368
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AHI Fielding

March April May June July

Invitation 

email

Email 

reminder #1

Email 

reminder #2

Email 

reminder #3

Email 

reminders #4-6

Phone 

reminder #1

Phone 

reminder #2

Phone 

reminder #3
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Redesign of AHI Questionnaire 

and Online Portal
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Issues with 2020 AHI

 Questions and answer categories were not designed for web collection.

 Collected information retrospectively and prospectively. 

 Reporting time frame varied by question.

– e.g., monthly inpatient discharge counts vs quarterly ED visit counts 

 Confusing options for providing data. 

– e.g., separate inpatient discharge counts from live birth counts

– e.g., separate counts by insurance status

 Multiple versions of the questionnaire caused confusion for developers.

 Blue question text. 

 Skipped questions were greyed out but remained visible.

 Low number of hospitals completed. 
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AHI Redesign Goals

 Increase the number of 

hospitals completing the survey

 Reduce respondent burden and 

improve respondent experience

 Collect information pertinent to 

weighting of NHCS and selected 

special topics

 Restructure questions to only 

collect retrospective 

information

 Paginate questions based on 

topic

 Change question visibility based 

on skip pattern

 Add hard and soft edit checks

 Add links to support documents 

to assist respondents 
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AHI Questionnaire Redesign 2020 to 2021-2022

 Removed questions that collected information already available to NHCS 

in other data sources (e.g. hospital sample frame)

 Removed questions that collected information not pertinent to weighting 

NHCS

 Simplified questions that collected information on inpatient discharge and 

ED visit counts

 Reduced six COVID-19 questions into one COVID-19 question

 Added questions about use of telemedicine
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AHI Portal Redesign 2020 to 2021-2022: Login Page

2020

2021-2022
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AHI Portal Redesign 2020 to 2021-2022:

Start Page

2020

2021-2022
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AHI Portal Redesign 2020 to 2021-2022:

Questions Page

2020

2021-2022
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AHI Portal Redesign 2020 to 2021-2022:

Functionality

 Help Text pop-up  Saving progress pop-up
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AHI Portal Redesign 2020 to 2021-2022:

Functionality (cont’d)

 Skip pattern  Submission pop-up
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AHI Website
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Overview of AHI Response Rate
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Number and percentage of eligible hospitals that 

responded to the AHI, by year

107

134 134

20%

27% 28%

0%

5%

10%

15%

20%

25%

30%

0

20

40

60

80

100

120

140

160

2020 2021 2022

Response rate

Number of hospitals

Year
22

Completeness of AHI responses, by year

68%

95% 90%

32%

5% 10%

0%

20%

40%

60%

80%

100%

2020 2021 2022

Percent of responses

Year

Complete Partial Complete
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AHI Next Steps

 2020 AHI inpatient discharge and ED visit counts used in creation of 

weights for the 2020 NHCS public use file

 2021 and 2022 AHI inpatient discharge and ED visit counts will be used for 

the creation of weights for their respective NHCS public use files

 Currently building the 2023 AHI Portal

 Expect to field 2023 AHI from March through July 2024
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Thank you!

Contact information

Catherine Rappole, Health Statistician

catherine.rappole@cdc.hhs.gov

Geoff Jackson, Hospital Care Team Lead

gjackson@cdc.gov