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Sources of Errors in Estimating Community Health Center Physicians

Sources of Errors in Estimating Community Health Center Physicians. Catharine W. Burt , Ed.D. Esther Hing, M.P.H. Division of Health Care Statistics June 3, 2008. Centers for Disease Control and Prevention National Center for Health Statistics. Objectives.

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Sources of Errors in Estimating Community Health Center Physicians

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  1. Sources of Errors in Estimating Community Health Center Physicians Catharine W. Burt , Ed.D. Esther Hing, M.P.H. Division of Health Care Statistics June 3, 2008 Centers for Disease Control and Prevention National Center for Health Statistics

  2. Objectives • To assess coverage error among CHC physicians in the National Ambulatory Medical Care Survey (NAMCS) • To estimate bias and reliability in percentage of CHCs using electronic medical records

  3. NAMCS

  4. NAMCS Methodology • National probability sample survey of office-based physicians • Complex sample design • 112 geographic PSUs • Physicians stratified by specialty • Sample of visits within physicians • Sample frame: AMA and AOA masterfiles • Data collected by Census Bureau

  5. Scope of the NAMCS • Physicians must be: • Primarily engaged in office-based, patient care • Nonfederally employed • Not in anesthesiology, radiology, or pathology

  6. In-Scope NAMCS Locations • Freestanding private solo or group practice • Freestanding clinic/urgicenter • Neighborhood medical and mental health centers • Privately operated clinics • Non-Federal government clinic • Health maintenance organization • Community health center • Faculty practice plan

  7. Methods • In 2006, dual sample of physicians: traditional + separate stratum of 104 CHCs • Sampling frame: NACHC and IHS • Random selection of 3 providers within each CHC • Physicians and midlevel providers • After selection of providers, normal NAMCS procedures are followed • In-person induction interview • Sample of ~30 visits during sample week

  8. Coverage error • Compare the traditional sample of CHC physicians with the separate stratum of CHC physicians on physician characteristics Separate Stratum Traditional

  9. Content bias and consistency • Use separate stratum to estimate EMR use • We have multiple providers in the sampled CHCs to answer the EMR questions • Measure the reliability of the item response with Cohen’s kappa statistic

  10. Results Traditional sample (n=1,311) Separate Stratum (n=156) 6,775 Traditional sample MDs who work in CHCs (n=31) 8,596 (non-office-based) 39.4% 60.6%

  11. Comparison of percent distributions

  12. EMR use among CHC physicians No significant difference @ p=.05

  13. Response consistency of physicians reporting use of electronic health record systems in their CHC n=62 CHCs with multiple providers who answered the EMR items

  14. The test-retest counts yield an I =“Index of inconsistency” =0.214It can be shown that Cohen’s kappa statistic=1-I =0.786indicating moderate reliability.

  15. Summary • Separate stratum of CHCs • increases sheer volume of CHC providers (reduces RSE by 23.8%) • Indicates little bias in key characteristics in the traditional NAMCS • Allows for a consistency measure of item response for EMR use

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