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, 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

SurveyType of DataYears fielded Approximate sample size National Hospital Discharge Survey (NHDS) Hospital Discharges1965-presentAbout 500 hospitals 300,000 discharges National Survey of Ambulatory Surgery (NSAS) Ambulatory Surgery Discharges facilities 120,000 discharges National Ambulatory Medical Care Survey (NAMCS) Visits to office- based physicians , 1985, 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-present500 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 , 1996, 1998, ,100-1,800 agencies 3,400-5,400 current patients 3,000-4,900 discharges Overview of National Health Care Survey Components

SurveyType of DataYears fielded Approximate sample size National Nursing Home Survey (NNHS) Characteristics of nursing homes with 3 or more beds, sample of current patients and discharges , 1977, 1985, 1995, 1997, ,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, , 1986, ,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: 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, Rate per 1,000 population ** ** ** Office-based Physician visits*4,8485,4555,4956, Outpatient Department visits*… Emergency Department visits*… Hospital discharges Nursing Home current residents* 46…43 ⃟ 43 ⊚ 43 # Nursing Home discharges*38……63 ⊚ 65 # Home Health Agency patients* …3053 x 38 ^ 28 + Hospice patients… x 1.8 ^ … 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 only

Distribution of ambulatory care visits by setting for 1999 with percent change since 1992 Physician office 80.0% OPD 9.0% ED 11.0% Physician OfficeOPDED Percent change

Percent of live hospital discharges transferred to long term care institutions: United States, Year 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

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 timeduration 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