1. Women’s health: Data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) Esther Hing, Ambulatory Care Statistics Branch, Division of Health Care Statistics U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics

2. Outline  Provide overview of NAMCS  Provide overview of NHAMCS Emergency Departments (EDs) Emergency Departments (EDs) Outpatient Departments (OPDs) Outpatient Departments (OPDs)  Content of NAMCS and NHAMCS (OPD and ED) Patient Record form (PRF)  Examples research on women’s health using NAMCS and NHAMCS data

3. Related NAMCS/NHAMCS sessions  Overview of NAMCS/NHAMCS (10)  Using Past Visits information to Enhance NAMCS Data (25)  Hands on NAMCS/NHAMC Workshop (39,44)  Prescription Drug Use (48)

4. National Ambulatory Medical Care Survey (NAMCS)  Nationally representative survey of patient visits to non-federally employed physicians providing office-based patient care  The NAMCS is a three-stage probability design 112 NHIS PSUs 112 NHIS PSUs 3,000 physicians 3,000 physicians 25,000 visits sampled 25,000 visits sampled 1-week reporting period 1-week reporting period

5. National Hospital Ambulatory Medical Care Survey (NHAMCS)  Nationally representative survey of visits made to emergency departments (EDs) and outpatient departments (OPDs) of non-Federal, short-stay hospitals  The NHAMCS is a four-stage probability design 112 NHIS PSUs 112 NHIS PSUs 500 hospitals 500 hospitals 400 EDs and 250 OPDs 400 EDs and 250 OPDs 37,000 ED visits and 35,000 OPD visits 37,000 ED visits and 35,000 OPD visits 4-week reporting period. 4-week reporting period.

6. NAMCS and NHAMCS Data  NAMCS and NHAMCS are record-based surveys  Data abstracted from the patient’s medical record by the physician and/or his staff, hospital staff, or interviewer  Estimates are in terms of visits and not persons  Population-based surveys (NHIS) estimates persons

7.  NAMCS/NHAMCS provide information from the physician’s perspective Diagnoses and services provided have high validity Diagnoses and services provided have high validity Data less subject to respondent recall Data less subject to respondent recall  Public use files released on the internet include input statements to assist users creating files in SAS, SPSS, and STATA software

8. Content of NAMCS and NHAMCS  Data collection instrument: Patient Record form (PRF)  PRFs are revised every 2-3 years  Items collected every year include demographics, payment source, reason for visit, diagnoses, services received, medications, providers seen, and disposition  Service and other data items may change with each PRF revision

9. Content of NAMCS and NHAMCS  Physician diagnoses  Medications prescribed or ordered  Mammography (PO/OPD:1992, 1997-present)  Pap test (PO/OPD:1997 to present)  Breast and pelvic exam (PO/OPD:1997-2000)  Pregnancy test (ED:1995-present, PO/OPD:1997-2000)  STD/HIV prevention education (PO/OPD:1993- 2000)  Preventive care visits (PO/OPD:2001 to present)

11. Previous research on women’s health using NAMCS and NHAMCS data  Preventive services practice patterns in general medical and gynecological examinations  Hormone replacement therapy prescribing patterns  Gender bias in psychotropic drug prescribing patterns  Use of EDs by sexually assaulted females

12. Annual rate of hospital outpatient department visits for preventive care by sex and patient's age: United States, 2001 2.6 6.4 0.9 0.8 1.8 3.3 5 6.6 6.5 4.7 3.9 3.7 1.6 6.7 2.2 All agesUnder 1515-2425-4445-6465 and over Patient's age in years 0 2 4 6 8 10 12 14 Number of visits per 100 persons Male Female, non-pregnant Female, pregnant

13. Services ordered or provided for women aged 18-64 years during general medical examination or gynecological examination visits: United States, 1997 Source: Tao, Zhang, Qian, Services Provided to Nonpregnant Women During General Medical and Gynecological Examinations in the United States. Am J Prev Med.21(4): 291-297. 2001.

14. Trends in estrogen/progestin drug mention rates at physician office visits by patient’s age: United States, 1995-2002 65 years and over 1 45-64 years Number of drug mentions per 100 females. Increasing trend is significant (p<0.05). NOTE: Rates based on visits made by females.

15. Summary  The NAMCS/NHAMCS are important tools for policy research on outpatient practice Nationally representative sampling strategies Nationally representative sampling strategies Data based on either physician/hospital self-report or medical record abstraction by interviewers Data based on either physician/hospital self-report or medical record abstraction by interviewers  NAMCS/NHAMCS and women’s health Understand health care practice Understand health care practice Examine quality of care Examine quality of care Track changes in utilization Track changes in utilization