Ambulatory and Hospital CareAmbulatory and Hospital Care Statistics Branch OverviewNCHS Board of
C lScientific
Counselors
Paul Beatty and Jane Sisk
January 22 2009January 22, 2009U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and PreventionNational Center for Health Statistics
TopicsTopics• Mission• Surveys• DatD ta prodductst• Dissesseminaatio
dataon aandd usesuses oof ouour
• Key challenges and future plansKey challenges and future plans
Role of AHCSB within the Division
• The Division’s Missiono co ecT ll t, analyze, an d dissem nai e at d ta on htT ll t l d di i t d t the use, access, quality, and cost of health care provided inprovided in the United States, and thethe United States, healthand the health care organizations who deliver that care.
• The Branch’s RoleTo collect,To collect, analyze, and disseminate thoseanalyze, and disseminate those datadata
that specifically relate to ambulatory and
th l thhospital care providers, their services, and the people they serve.
National Health Care Surveyys• Ambulatory and hospital care surveys
National Ambulatory Medical Care Survey– National Ambulatory Medical Care Survey (NAMCS)
–S (NHAMCS)National Hospital Ambulatory Medical Care Survey (NHAMCS)
– National Survey of Ambulatory Surgery (NSAS)– National Hospital Discharge Survey (NHDS)National Hospital Discharge Survey (NHDS)
• Long-term care surveysNational Nursing Home Survey (NNHS)– National Nursing Home Survey (NNHS)
– National Home and Hospice Care Survey (NHHCS)– National Surveyy of Residential Care Facilities
(NSRCF)
SDistinctive Aspects of the
Surveys• Surveys of establishments (notSurveys of establishments (not
households)• Encounter level• Encounter-level datadata• S
ti l l f ilit l lome data collected through interview,
particularly facility-level• Patient-level data abstracted directly from
medical records
C ll ti 1965Ambulatory Hospital Care
2008Survey Data
Collection, 1965 - 2008
N
NAMCS
NSAS
NAMCS
HAMCS
NHDS
’65 ’70 ’75 ’80 ’85 ’90 ’95 ’00 ’05 ’10
Year
CC S (NAMCS)National Ambulatory Medical
are Survey (NAMCS)• Visits to non-federal,, office-based
physicians primarily engaged in patient care
• Data at practice, clinician, and patient level • Flexible content: questions added and• Flexible content: questions added and
deleted, with supplemental modules
NHAMCS and NSASNHAMCS and NSAS• National Hospital Ambulatory Medical CareNational Hospital Ambulatory Medical Care
Survey (NHAMCS) parallels NAMCS with data from emergency and outpatient departments
• National Survey of Ambulatory Surgery (NSAS) covers this growing segment of health care. Incorporation into NHAMCS:– Hospital based ambulatory surgery centers in 2009
F t di b l t t i 2010– Free-standing ambulatory surgery centers in 2010
SNational Hospital Discharge
Survey• Inpatient visitsInpatient visits to non-federal short-stayto non federal short stay
hospitals• Need for an updated survey:• Need for an updated survey:
– Incorporation of clinical dataMore flexibility of cont t– M fl ibilit f tent
– Identifiers to link to other data sources
Steps in Redesign of NHDSSteps in Redesign of NHDS• Concepptual Framework
development – Spring 2006
}}• Feasibility Study• Feasibility Study
– Winter 2006-2007}}Contract with RANDRAND
• Pilot Study– Spring 2008
• Pre test• Pre-test– Fall/Winter 2008-2009
}}
• Redesigned National Survey– 2010?
g y}}Contract with RTI International
Response Rates for NAMCS, NHAMCS, and NDHS
100NAMCSEDOPDNHDS
859095
t
NHDS
758085
Perc
ent
606570
60'92 '94 '96 '98 '00 '02 '04 '06
Survey Year
Note: ED & OPD response rates for the years 1992-96 were calculated as one rate. Response rates are unweighted.
Data Release
Institute of Medicine ReportInstitute of Medicine Report
Fi l Y 2004 2008Reimbursable (Sponsorship) Funds,
Fiscal Years 2004-2008
2 31$3
1.44
2.31
$2
ions
0.71.04
0.39$1$
Mill
0.39
$02004 2005 2006 2007 20082004 2005 2006 2007 2008
Fiscal Years
NAMCS + NHAMCS Redesigned NHDS
Expenditures on Ambulatory and Hospital Surveys,Hospital
Fiscal Years, Surveys,
2004-200914
12.5
8
10
12
ons
9.710.7 9.9
12.5
8.2
4
6
8
$ M
illio 6.2 6.9
0
2
2004 200 2006 200 2008 2009 20092004 2005 2006 2007 2008 2009Expected,with NHDS
2009Expected,no NHDS
Fiscal YearsFiscal Years
NAMCS + NHAMCS NSAS Current NHDS Redesigned NHDS
BudgetBudgetChallenges• NHDS 2009 and redesigned NHDS on
hold• Funding for improvements to ambulatory
surveyys uncertainFuture Plans• Continued outreach to potential sponsors• Continued outreach to potential sponsors• S
t i ititrategic planning process underway to
set priorities
StaffinggChallenges• Filling acancies promotionsFilling v fromacancies from promotions,
retirements, and resignations on hold• More clinical expertise neededFuture Plans• Survey operations priority over analyses• Recruitment of physician or other clinician• Recruitment of physician or other clinician• Investment in training current staff
Timeliness of Data ReleaseTimeliness of Data ReleaseChallengesChallenges• Time to data release lengthening• Staff vacancies and survey changesStaff vacancies and survey changes Future Plans• Release of selected ambulatory provider-
level estimates earlier• Exploration of electronic data collection
and transmission over time
Keepingp g Surveyys RelevantChallenges• C ti ll d ti d i t tContinually updating survey design, content,
and analyses to address policy and research needsneeds
• Improving coverage of providers and clinical managgement
Future Plans• Strategic planning processStrategic planning process• Continued outreach• More emphasis on provider-level estimatesMore emphasis on provider level estimates• Updating surveys as resources permit
Response RatesResponse RatesChallengesChallenges• NAMCS response rates falling• Recruiting hospitals for redesigned• Recruiting hospitals for redesigned NHDSNHDSFuture Plans• N f ll t diNon-response follow-up studies• Further outreach to provider associations• Possible electronic data sampling and
transmission to reduce hospital burden
Data QualityyChallenges• No recent reabstraction to assess data• No recent reabstraction to assess data
quality because of funding constraints• Infrequent training of field representatives• Infrequent training of field representativesFuture Plans• Improvement in developing new survey items• Reabstraction of redesigned NHCS sample• Development of long-term methodological
agenda
Electronic Medical RecordsChallenges• Data collection duringg providers’ transition
from paper to electronic medical records• Extracting data of acceptable qualityg p from
electronic systemsq y
Future Plans• Working with selected providers to gain
experienceexperience withwith electronicelectronic systemssystems• Exploration of electronic data collection for
redesigned NHDSredesigned NHDS• Addition of HIT staff person when permitted
Questions andQuestions and Comments?Comments?
