1. Session5 OVERVIEW OF THE NATIONAL HEALTH CARE SURVEY

2. Session Overview Provide an overview of the National Health Care Survey Provide an overview of the National Health Care Survey Review developments in the National Nursing Home Survey Review developments in the National Nursing Home Survey Illustrate the use of NHCS data Illustrate the use of NHCS data

3. Overview of the National Health Care Survey U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Data Users Conference July 12, 2004 Thomas McLemore Division of Health Care Statistics

4. ObjectivesObjectives Provide an overview of the NHCS Provide an overview of the NHCS Highlight recent survey developments Highlight recent survey developments Future challenges Future challenges How and where to find out more about the NHCS How and where to find out more about the NHCS

5. National Health Care Survey Family of health care establishment and provider-based surveys Family of health care establishment and provider-based surveys Primary goal is to provide nationally representative data on the use of health care resources in the major sectors of the U.S. health care delivery system Primary goal is to provide nationally representative data on the use of health care resources in the major sectors of the U.S. health care delivery system

6. National Health Care Survey Collects information on the Collects information on the characteristics of providers, facilities, and health care establishments characteristics of providers, facilities, and health care establishments health care utilization and the characteristics of patients served health care utilization and the characteristics of patients served Encounter, rather than person-based, estimates Encounter, rather than person-based, estimates

7. NHCS data are used to… Measure the use of health care services Measure the use of health care services Understand who uses the health care system and why Understand who uses the health care system and why Examine the practice of medical care Examine the practice of medical care Establish national priorities and benchmarks Establish national priorities and benchmarks Track changes in utilization and practice Track changes in utilization and practice

8. NHCS Data Users Other Federal agencies Other Federal agencies Health and medical professional associations Health and medical professional associations State and federal policy makers State and federal policy makers Health services and public health researchers Health services and public health researchers Universities and medical schools Universities and medical schools Broadcast and print media Broadcast and print media

9. NHCS Component Surveys National Ambulatory Medical Care Survey National Ambulatory Medical Care Survey National Hospital Ambulatory Medical Care Survey National Hospital Ambulatory Medical Care Survey National Hospital Discharge Survey National Hospital Discharge Survey National Survey of Ambulatory Surgery National Survey of Ambulatory Surgery National Nursing Home Survey National Nursing Home Survey National Home and Hospice Care Survey National Home and Hospice Care Survey

10. Ambulatory Care Component National Visits to1973-1981,2,500-3,400 Ambulatoryoffice-based1985, 1989-physicians, Medical Carephysicianspresent21,000- Survey 36,000 (NAMCS) encounters National Visits to hospital 1992-500 hospitals, Hospitalemergency andpresent21,000- Ambulatoryoutpatient 36,000 ED Medical Caredepartmentsvisits, Survey 27,000- (NHAMCS)35,000 OPD visits SurveyType of data Years fielded Sample size (approximate)

11. Hospital and Surgical Care Component National Hospital1965-500 hospitals Hospitaldischargespresent300,000 Dischargedischarges Survey (NHDS) National Ambulatory 1994-1996751 facilities Survey ofsurgery visits120,000 Ambulatory discharges Surgery (NSAS) SurveyType of data Years fielded Sample size (approximate)

12. Long-term Care Component National Nursing home1973-74,1,100-1,900 Nursingcharacteristics,1977,nursing homes, Home Surveycurrent1985, 5,200-8,200 (NNHS) residents,1995, current residents discharges1997,6,000-6,900 1999discharges National HomeAgency 1992-1994,1,100-1,800 and Hospicecharacteristics1996,agencies, Care Survey current patients 1998,3,400-5,400 (NHHCS)discharges2000current patients, 3,000-4,900 discharges SurveyType of data Years fielded Sample size (approximate)

13. Trends in Rates of Use of Health Care Services … Data not collected during that time period *Denotes statistically significant trend at the p<.05 level **Denotes average NAMCS, NHAMCS, and NHDS rates for these years Office-based physician visits*4,8485,4555,4956,0256,468 Outpatient department visits*…288.1326.9380.1413.6 Emergency department visits*…411.7432.9470.1489.4 Hospital discharges 369.8336.5345.4363.2365.0 Nursing Home current46.2…42.843.442.9 residents* Nursing Home discharges*38.2 ……62.265.1 Home Health Agency…71.4153.5155.5143.9 discharges* Hospice discharges*…4.97.911.114.3 Rate per 1,000 Population 65+ 19851992 1995- 96** 1997- 98** 1999- 2000**

14. NHCS Commonalities National probability sample surveys Complex sample designs National and regional estimates Common data items, definitions, sampling frames Medical diagnoses High response rates

15. Strengths Data are collected directly from health care providers Data are collected directly from health care providers Data include characteristics of the health care provider and user Data include characteristics of the health care provider and user Effect of burden of illness Effect of burden of illness Treatment patterns Treatment patterns Trends over time Trends over time

16. Limitations Few outcome measures Few outcome measures Episode of illness Episode of illness Longitudinal analysis Longitudinal analysis Process/outcome link Process/outcome link Community measures Community measures Rare event estimation Rare event estimation

17. DriversDrivers Increase relevance and timeliness of NHCS data Increase relevance and timeliness of NHCS data Be more responsive to data needs for public health, health services research, health policy, and DHHS initiatives 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 (first step – eliminate major data gaps) Expand surveys to include the full spectrum of health care providers (first step – eliminate major data gaps)

18. Recent Developments – Ambulatory Care Component Supplements Supplements ED pediatric services and equipment ED pediatric services and equipment ED staffing and ambulance diversion ED staffing and ambulance diversion Supplemental sample of rural and proprietary hospitals Supplemental sample of rural and proprietary hospitals Bioterrorism preparedness items Bioterrorism preparedness items

19. Recent Developments – National Hospital Discharge Survey Addition of data items on admission type and source Addition of data items on admission type and source Creation of linked files (AHA and ARF) for trend analysis Creation of linked files (AHA and ARF) for trend analysis Research to evaluate the collection of drug data Research to evaluate the collection of drug data

20. Recent Developments – Long-term Care Component Fielding of the National Nursing Home Survey including the National Nursing Assistant Survey in August 2004 Fielding of the National Nursing Home Survey including the National Nursing Assistant Survey in August 2004 Long-term care residential places Long-term care residential places State regulations State regulations Investigation of lists Investigation of lists Typology development Typology development

21. Future Challenges Establishing priorities among competing data needs and interests Establishing priorities among competing data needs and interests Balancing data needs and respondent burden Balancing data needs and respondent burden Developing new initiatives while maintaining necessary trend data Developing new initiatives while maintaining necessary trend data Balancing public release of data with disclosure risk Balancing public release of data with disclosure risk Resource management Resource management

22. NHCS in the news Over 150 journal articles in last 2 years

25. NHCS Data Dissemination Website Website www.cdc.gov/nchs/nhcs.htm www.cdc.gov/nchs/nhcs.htmwww.cdc.gov/nchs/nhcs.htm NHCS and component survey websites NHCS and component survey websites Publications and information products Publications and information products Data warehouse Data warehouse CD/ROMs CD/ROMs LISTSERVs LISTSERVs Research Data Center Research Data Center

26. Component Overviews NAMCS/NHAMCS NAMCS/NHAMCS Session 10, Monday 1:30-3:30 Session 10, Monday 1:30-3:30 NHDS/NSAS NHDS/NSAS Session 15, Monday 3:30-5:00 Session 15, Monday 3:30-5:00

27. Hands-on Sessions NNHS – Session 9, Monday, 1:30-3:00 NNHS – Session 9, Monday, 1:30-3:00 NHHCS – Session 14, 3:30-5:00 NHHCS – Session 14, 3:30-5:00 NAMCS/NHAMCS, Part I – Session 39, Wednesday 8:30-10:00 NAMCS/NHAMCS, Part I – Session 39, Wednesday 8:30-10:00 NAMCS/NHAMCS, Part II - Session 44, Wednesday 10:30-12:00 NAMCS/NHAMCS, Part II - Session 44, Wednesday 10:30-12:00

28. Topical Presentations Reporting on health care quality and health care disparities – Session 12, Monday 3:30-5:00 Reporting on health care quality and health care disparities – Session 12, Monday 3:30-5:00 Focus on priority population – Session 17, Tuesday 8:30-10:00 Focus on priority population – Session 17, Tuesday 8:30-10:00 Using past visit information to enhance analysis of NAMCS data - Session 25, Tuesday 10:30-12:00 Using past visit information to enhance analysis of NAMCS data - Session 25, Tuesday 10:30-12:00

29. Topical Presentations cont’d Methodological issues in analyzing trend data – Session 37, Wednesday 8:30-10:00 Methodological issues in analyzing trend data – Session 37, Wednesday 8:30-10:00 Methodological issues in the analysis of injury data – Session 42, Wednesday 10:30- 12:00 Methodological issues in the analysis of injury data – Session 42, Wednesday 10:30- 12:00 Women’s health – Session 45, Wednesday 10:30 -12:00 Women’s health – Session 45, Wednesday 10:30 -12:00 Prescription drug use – Session 48, Wednesday 1:30-3:00 Prescription drug use – Session 48, Wednesday 1:30-3:00

30. Poster Sessions Tuesday, July 13 1:00 – 5:00 Tuesday, July 13 1:00 – 5:00

31. NHCS Exhibit Ambulatory care – Booth 2 Ambulatory care – Booth 2 Long-term care – Booth 3 Long-term care – Booth 3 Hospital and surgical care – Booth 4 Hospital and surgical care – Booth 4