Overview of the National Health Care Survey

1. 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

2. 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

3. Overview of National Health Care Survey Components

4. Overview of NHCS Components (cont)

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

6. 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

7. Public File Access • Website: www.cdc.gov/nchs • SETS - CD/ROM • Mainframe cartridge tapes • Research Data Center

9. National Health Care Survey:Trends in Rates of Use of Health Care Services for Persons Age 65 and Older, 1985-1999 … 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

10. 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

11. 65 years and over Percent of live hospital discharges transferred to long term care institutions: United States, 1985-1999 50-64 years 25 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

12. Rate of current nursing home use by persons age 65 and older: United States 1985-1999 Source: National Nursing Home Survey

13. Continuing reassessment of NHCS in Context of Current Health Care System • Expert meetings • Targeted consultations and evaluations

14. 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

15. 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

16. Ambulatory Care Developmental Work NAMCS/NHAMCS (OPD): Test of short vs. longer forms with expanded content Test of incentives

17. 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

18. 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

19. 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

20. New Variables for NHDS Available for Year 2001 NHDS Source of Admission Type of Admission

21. 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

22. Type of Admission • Emergency • Urgent • Elective • Newborn • Not Available/Unknown

23. 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

24. 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)

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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