Overview of the National Health Care Survey

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Overview of the National Health Care Survey

• Linda K. Demlo, Ph.D.
• Amy Bernstein, Sc.D.
• Division of Health Care Statistics
• National Center for Health Statistics
• July 16, 2002
• 2002 NCHS Data Users Conference

National Center for Health Statistics
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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

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Overview of National Health Care Survey Components
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 facilities 120,000 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 hospitals 21,000-36,000 ED encounters 29,000-35,000 outpatient visits
National Home and Hospice Care Survey (NHHCS) Agency characteristics, current patients and discharges 1992-1994, 1996, 1998, 2000 1,100-1,800 agencies 3,400-5,400 current patients 3,000-4,900 discharges
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Overview of NHCS Components (cont)
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 residents 6,000-6,900 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).
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Commonality Across NHCS

• Begin with sample of providers and then patients
• Focus on encounters
• Selected provider information
• Widely used
• Many strengths-especially trend data

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NHCS Common Methodology

• 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

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Public File Access

• Website www.cdc.gov/nchs
• SETS - CD/ROM
• Mainframe cartridge tapes
• Research Data Center

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(No Transcript)
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National Health Care SurveyTrends 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 43? 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 plt.05 level x 1996
only 1999 only Denotes average NAMCS, NHAMCS,
and NHDS rates for these years ? 1997
only 2000 only
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Distribution of ambulatory care visits by setting
for 1999 with percent change since 1992
Physician office
80.0
ED
11.0
60
50
OPD
50
9.0
40
30
Percent change
20
10
10
0
-5
-10
Physician Office
OPD
ED
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Percent of live hospital discharges transferred
to long term care institutions United States,
1985-1999
50-64 years
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19.8
20
17.7
14
15
12.4
10
4.9
3.6
5
2.4
2
0
1985
1990
1995
1999
Year
Note Percentages exclude deaths and unknown
disposition
Source NCHS/CDC National Hospital Discharge
Survey
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Rate of current nursing home use by persons age
65 and older United States 1985-1999
Source National Nursing Home Survey
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Continuing reassessment of NHCS in Context of
Current Health Care System

• Expert meetings
• Targeted consultations and evaluations

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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

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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

• 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

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Ambulatory Care Developmental Work

• NAMCS/NHAMCS (OPD)
• Test of short vs. longer forms with expanded
  content
• Test of incentives

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Whats 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

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Whats 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

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Whats 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

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New Variables for NHDS

• Available for Year 2001 NHDS
• Source of Admission
• Type of Admission

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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

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Type of Admission

• Emergency
• Urgent
• Elective
• Newborn
• Not Available/Unknown

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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

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NHDS Linked Files

• NHDS - American Hospital Association (AHA)
• NHDS Area Resource File (ARF)
• Linkage is with contextual not personal/demographi
  c information
• Contextual data include
• Hospital characteristics, services (AHA)
• County level information (ARF)

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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

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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

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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

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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

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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

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Long-Term Care Development Work (continued)

• 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

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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