Download - Overview of the National Health Care Survey
Overview of the National Health Care Survey
Linda K. Demlo, Ph.D.Amy Bernstein, Sc.D.
Division of Health Care StatisticsNational Center for Health Statistics
July 16, 20022002 NCHS Data Users Conference
National Center for Health Statistics
Session Objectives
• Provide an overview of the NHCS
• Illustrate its value for characterizing the delivery system
• Highlight new developments for ambulatory, inpatient, and long-term care surveys
Survey Type of Data Years fielded
Approximate sample size
National Hospital Discharge Survey (NHDS)
Hospital Discharges 1965-present About 500 hospitals 300,000 discharges
National Survey of Ambulatory Surgery (NSAS)
Ambulatory Surgery Discharges
1994-1996 500 facilities120,000 discharges
National Ambulatory Medical Care Survey (NAMCS)
Visits to office-based physicians
1973-1981, 1985, 1989-present
2,500-3,400 physicians 21,000-36,000 encounters
National Hospital Ambulatory Medical Care Survey (NHAMCS)
Visits to Hospital Emergency and Outpatient Departments
1992-present 500 hospitals21,000-36,000 ED encounters29,000-35,000 outpatient visits
National Home and Hospice Care Survey (NHHCS)
Agency characteristics, current patients and discharges
1992-1994, 1996, 1998, 2000
1,100-1,800 agencies3,400-5,400 current patients3,000-4,900 discharges
Overview of National Health Care Survey Components
Survey Type of Data Years fielded
Approximate sample size
National Nursing Home Survey (NNHS)
Characteristics of nursing homes with 3 or more beds, sample of current patients and discharges
1973-74, 1977, 1985, 1995, 1997, 1999
1,100-1,900 nursing homes 5,200-8,200 current residents6,000-6,900 discharges
National Health Provider Inventory (NHPI)
Comprehensive listing of facilities including nursing homes, home health agencies, hospice, and residential care facilities
1963, 1971-1976, 1986, 1991
84,000 facilities (nursing homes, home and hospice agencies, and board and care facilities in 1991).
Overview of NHCS Components (cont)
• Begin with sample of providers and then patients
• Focus on encounters
• Selected provider information
• Widely used
• Many strengths-especially trend data
Commonality Across NHCS
• National probability sample surveys
• Complex sample designs
• Common definitions, data items, sampling frames
• High response rates
• Medical diagnoses coded by NCHS
• Most data collected by Census Bureau
• Data processed by private contractor
NHCS Common Methodology
Public File Access
• Website: www.cdc.gov/nchs
• SETS - CD/ROM
• Mainframe cartridge tapes
• Research Data Center
National Health Care Survey:Trends in Rates of Use of Health Care Services for Persons Age 65 and Older,
1985-1999
Rate per 1,000 population 65+
1985 1992 1995-96 **
1997-98 **
1999-00**
Office-based Physician visits* 4,848 5,455 5,495 6,025 6023
Outpatient Department visits* … 288 327 380 414
Emergency Department visits* … 412 433 470 489
Hospital discharges 370 337 345 363 365
Nursing Home current residents*
46 … 43⃟ 43⊚ 43#
Nursing Home discharges* 38 … … 63⊚ 65#
Home Health Agency patients*
… 30 53x 38^ 28+
Hospice patients … 1.3 1.4x 1.8^ 2.5+
… Data not collected during that time period ⃟ 1995 only ^1998 only
*Denotes statistically significant trend at the p<.05 level x 1996 only #1999 only
**Denotes average NAMCS, NHAMCS, and NHDS rates for these years ⊚ 1997 only +2000 only
Distribution of ambulatory care visits by setting for 1999 with percent change since 1992
Physician office80.0%
OPD9.0%
ED11.0%
-5
50
10
Physician Office OPD ED
0
10
20
30
40
50
60
-10
Per
cent
cha
nge
Percent of live hospital discharges transferred to long term care institutions: United States,
1985-1999
2 2.4 3.64.9
12.414
17.719.8
0
5
10
15
20
25
1985 1990 1995 1999Year
50-64 years 65 years and over
Note: Percentages exclude deaths and unknown disposition Source: NCHS/CDC: National Hospital Discharge Survey
Source: National Nursing Home Survey
Rate of current nursing home use by persons age 65 and older: United States 1985-1999
0
10
20
30
40
50
60
70
1985 1995 1997 1999
Rat
e pe
r 1,
000
pers
ons
White, male White, female Black, male Black, female
Continuing reassessment of NHCS in Context of Current Health Care System
• Expert meetings
• Targeted consultations and evaluations
Long-Term NHCS Objectives
• Increase relevance and timeliness of NHCS data
• Be more responsive to data needs for public health, health services research, health policy, and DHHS initiatives
• Expand surveys to include the full spectrum of health care providers
• Achieved by:– Better capturing system dynamics– Moving beyond individual encounters to
approximate episodes of care and outcomes– Better characterizing providers and their
interrelationships– Larger and/or targeted samples
Future Directions
• More emphasis on:– Changing health care delivery system– Effects on health care and health of people using
the system – Ability to better examine subpopulations
Ambulatory Care Developmental Work
NAMCS/NHAMCS (OPD):
Test of short vs. longer forms with expanded content
Test of incentives
What’s new in the NAMCS for 2001?
• Tobacco use• Past visits within 12 months• Initial vs. follow-up visit• Physicians sharing care• Specific cultures and scope procedures• Asthma education
What’s new in the NHAMCS for 2001?
• Institutional Residence • Discharge time duration• Alcohol use • Seen within 72 hours in ED• Initial visit vs. follow-up visit• Adverse drug event• Vital signs• Type of Emergency Service Area
What’s new in 2002 and beyond?
• Pediatric services and equipment supplement
• ED staffing and ambulance diversion• Supplemental sample of rural and
proprietary hospitals for better facility estimates
New Variables for NHDS
Available for Year 2001 NHDSSource of AdmissionType of Admission
Source of Admission
• Physician Referral• Clinical Referral• HMO Referral• Transfer from a Hospital• Transfer from a Skilled Nursing Facility• Transfer from other health facility• Emergency Room• Court/Law Enforcement• Other• Not Available
Type of Admission
• Emergency• Urgent• Elective• Newborn• Not Available/Unknown
Added Value of New Variables in NHDS
• Will allow for better analysis of issues related to movement of patients between various health care settings
• For example, patients admitted from the ER; transfers to/from other types of facilities
NHDS Linked Files
• NHDS - American Hospital Association (AHA)• NHDS – Area Resource File (ARF)• Linkage is with contextual not personal/demographic
information• Contextual data include
– Hospital characteristics, services (AHA)– County level information (ARF)
Evaluation of Collecting Pharmaceutical Data in NHDS
• Phase II of evaluation project to determine feasibility of collecting drug data
• Field test to be conducted in 2003, using methods and materials developed in Phase I
• Will collect names of drugs administered during the hospital stay from medical records
Advantages of drug data in NHDS
• Valuable addition to drug data currently collected for outpatients
• Addresses need for data pertaining to patient safety, over-prescribing, rise in drug resistance, etc.
• Phase II will help decide whether collecting drug data in NHDS is feasible and cost-effective
Goals of Long-Term Care Redesign
• Flexible content appropriate for a range of LTC settings
• Multiple sampling frames
• Increased ability for linkage to administrative and other databases
• Capability for rolling family of LTC surveys across the spectrum of care
Long-Term Care Developmental Work
• Nursing home survey redesign:– Expanded content: more data on clinical quality, health
status, services provided, and facility characteristics– Convert to CAPI– Additional components:
• Link to MDS• CDC/NIP questions on immunization policies/practices• Interest in medications/adverse drug reactions
• Flexibility to expand to other residential long-term care settings
Long-Term Care Development Work (continued)
• Home and Hospice Care Survey redesign
– Provider characteristics
– Separate vs. integrated surveys and transitions
– Palliative care and end of life
• Sampling frame activities– “Inventory of Inventories” project
• Collects information on available lists and their characteristics
– List of LTC residential places• Obtain lists of facilities from states, associations, web sites, etc.• Review and compile state LTC regulations• Create unduplicated electronic list of universe of LTC residential
places for which no sampling frame currently exists• Report on sampling issues and options for survey of all residential
LTC places
Long-Term Care Development Work (continued)
NHCS Long-Term Goals
• Enlarge and expand NAMCS/NHAMCS samples– Additional settings/providers– Enhance policy-relevant analysis
• Obtain nationally generalizable ambulatory surgery data• Eliminate gaps in long-term care data• Resolve data linkage issues• Long-term developmental work on sampling strategies
and state-of-the-art information technologies• Schedule surveys based on research and policy needs
rather than budget constraints