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 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

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 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).

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 2.43.6

4.9

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 p

er 1

,000

per

son

s

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 NHDS

Source of Admission

Type 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