1. Recurring Survey Data Sets Christopher McCarty PHC6716 June 29, 2011

2. Surveys Behavioral Risk Factor Surveillance System (BRFSS) National Health Interview Survey (NHIS) National Immunization Survey (NIS) National Health Care Surveys (NHCS) Medicare Health Outcomes Survey (HOS) National Health and Nutrition Examination Survey (NHANES) Medical Expenditure Panel Survey (MEPS) Current Population Survey (CPS) American Community Survey (ACS)

3. Behavioral Risk Factor Surveillance Survey (BRFSS)

4. Overview Sponsored by the Centers for Disease Control (CDC) and each state or territory Link: http://www.cdc.gov/BRFSS/http://www.cdc.gov/BRFSS/ Established in 1984 – 1984-1993 monthly data on 15 states – 1994-present monthly data on all states, Washington D.C., Puerto Rico, Guam and U.S. Virgin Islands

5. Purpose Core questions collect information about: – Health risk behaviors – Preventive health practices – Health care access – Core module averages 18 minutes States use this information to: – Identify emerging health problems Example – Hurricane preparedness after 2004 – Establish and track health objectives – Develop and evaluate public health programs – State modules add additional 5-10 miunutes

6. Data Collection CDC does sample generation (Marketing Systems Group) technical oversight and data analysis State Departments of Health oversee actual data collection (five year contract) – In 2010, 9 health departments collected the data in-house and 45 contracted universities or commercial firms – Interview is presented as though from the state’s health department with assistance from CDC Random digit dial of landline U.S. households with cell phone supplement for selected states collected monthly Interviewer elicits names of all adult males in order of age, then adult females in order of age and randomly selects one Interviews done in English and in Spanish More than 350,000 interviews are done each year, with a minimum of 4,000 per state 46 states have disproportionate strata while 8 have one stratum

7. Sample size

8. BRFSS Response Rates

9. Funding Minimum funding of 4,000 completes per state For Florida maximum funding for last contract was $4 million over three years – 30,946 (2010), 11,040 (2009), 9,953 (2008) – Total 51,939 – $77/complete (We charged $75/complete for cell complete) – Approximate cost of 2010 BRFSS $32,726,001 State Added Questions – 1999 Arkansas charged $0.32 per question per respondent – 2010 Virginia charged $3,000 per question

10. National Health Interview Survey (NHIS)

11. Overview Started in 1957 and overseen by CDC Cross-sectional face-to-face and telephone survey conducted by the Census Bureau using CAPI – 400 interviewers in 12 regions Covers non-institutionalized population People excluded from the survey – Patients in long-term care facilities – Persons on active duty in the Armed forces – Citizens living in foreign countries Conducted in English and Spanish Interview covers all household members rather than a single respondent Interview averages one hour – About 20 minutes are supplemental questions – Most supplements are from federal agencies and NIH institutes Cost – Who knows?

12. Sampling Multistage area probability design – First stage- 428 primary sampling units (drawn from 1,900 geographically defined primary sampling units (PSUs) – PSU is a county, cluster of counties, or a metropolitan area Within PSU- two segments – Area segments of 8 to 12 addresses – Permit area segments (housing units built after the 1990 census) identified using building permits Permit areas consist of 4 addresses Occupied households in the sample addresses, within each segment are targeted Sample consists of approximately 7,000 segments 35,000-40,000 households interviewed Data about 75,000-100,000 people

13. Data collection Three modules Basic (core) module – Family core- everyone in the family included, all adult members answer for themselves – Adult sample core- one adult from the household – Child sample core-one child from the household with adult as proxy Periodic module Supplemental module Data available at http://www.cdc.gov/nchs/nhis/nhis_questionnaires.htm http://www.cdc.gov/nchs/nhis/nhis_questionnaires.htm

14. Sample Size

15. NHIS Response Rates

16. How does NHIS differ from BRFSS? Face-to-face versus telephone Smaller sample Less coverage (only about 25% of counties) Higher response rate Longer interview NHIS currently used as benchmark to gauge effects of cell phones

17. National Immunization Survey (NIS)

18. Overview Sponsored by the CDC Conducted by National Opinion Research Center (NORC) Purpose: Monitor vaccinations among children in all 50 states, Washington, DC, and 27 urban areas – Goal is 90% of all two-years-olds with all vacciniations Targets: – Children 19-35 months – Teens 13-17 years old

19. Data Collection List assisted RDD landline survey of households with pre-notification letter when possible – Screener for children – Respondent is adult most familiar with child immunization – Roster of all eligible children – Parents are asked to retrieve shot records This is followed by mail survey to health care provider if parents consent – Parent reports are checked against provider records to improve accuracy – Average of 1.3 providers per child In 2000 there were 10 million calls made to identify 35,000 children Survey is administered quarterly but reported annually Data available at http://www.cdc.gov/nis/datafiles.htmhttp://www.cdc.gov/nis/datafiles.htm

20. Sample Size and Response Rates In 2009 there were 24,068 completes out of 28,913 eligible households (RR 83.2%) 24,809 completed child interviews 17,053 completed child and provider interviews (68.7%)

21. NIS and SLAITS State and Local Area Integrated Telephone Survey Designed to collect data at state and local level RDD telephone survey NIS uses the same sampling frame as NIS

22. National Health Care Surveys (NHCS)

23. Overview Set of provider surveys covering different health care settings Sponsored by National Center for Health Statistics/CDC Data available at http://www.cdc.gov/nchs/dhcs/dhcs_products.htm http://www.cdc.gov/nchs/dhcs/dhcs_products.htm

24. NCHS Surveys National Ambulatory Medical Care Survey (NAMCS) Purpose is to monitor types of and quality of medical visit – Necessary with electronic records? Annual since 1989 Records based survey Target are non-federally employed physicians involved in direct patient care Census Bureau oversight of data collected by physicians and their staff Data available at : http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm#Micro-data http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm#Micro-data

25. Sampling 112 Primary Sampling Units (PSUs) 3,000 Physicians divided into 15 specialties Physicians randomly assigned reporting week Each reports on 30 patient visits About 25,000 visits covered (units are visits) In 2004 response rate was 64.7 percent Attempt to use incentives in 2002 resulted in no difference between control, gift and monetary incentive

26. 26 NAMCS Response rate (Source: Overview of the NAMCS and NHAMCS, Linda McCaig and David Woodwell)

27. NCHS Surveys National Hospital Ambulatory Medical Care Survey (NHAMCS) Purpose is to monitor medical visits to emergency departments and outpatient departments Records based survey Annual since 1992 Target sample size: – 400 Emergency Departments and 37,000 visits – 250 Outpatient Departments and 35,000 visits Departments monitor records over four week period

28. 28 NHAMCS Response rates (Source: Overview of the NAMCS and NHAMCS, Linda McCaig and David Woodwell) ED OPD

29. Other NCHS Surveys These surveys are not conducted annually – National Survey of Ambulatory Surgery (NSAS) National Hospital Discharge Survey (NHDS) – National Nursing Home Survey (NNHS) – National Home and Hospice Care Survey (NHHCS) – National Survey of Residential Care Facilities (NSRCF)

30. Medicare Health Outcomes Survey (HOS)

31. Overview Developed by Centers for Medicare and Medicaid Services (CMS) as a way to monitor managed care, particularly for Medicare beneficiaries In response to increasing enrollment of Medicare beneficiaries in managed care in the 1990s CMS worked with National Committee for Quality Assurance (NCQA) to adapt Healthcare Effectiveness Data and Information Set (HEDIS®) measures to Medicare Goal is to monitor health issues with Medicare beneficiaries to make managed care plan adjustments Survey work is contracted by NCQA with independent vendor Use NCQA protocol, a series of mail surveys followed by telephone conducted annually Respondents pulled using NCQA protocol and oversight Data available at http://www.hosonline.org/Content/DataFiles.aspxhttp://www.hosonline.org/Content/DataFiles.aspx

32. Data Collection Baseline conducted annually with two-year follow-up From 1998-2006 target was 1,000 respondents for each Medicare Advantage Plan This was increased to 1,200 in 2007 From 1998-2008 respondent had to be a member for six months (HEDIS and CAHPS) 2009-present the six month requirement was waived

33. Sample Size

34. Response Rates

35. National Health and Nutrition Examination Survey (NHANES)

36. Overview Purpose is to assess health and nutrition of adults and children – This is the source for many health benchmarks Growth charts Cholesterol Glucose levels BMI charts Combines interview with physical exam Conducted annually since 1999, and sporadically since the 1960s Data available at http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm

37. Data Collection Mobile health data collection centers Interview team consists of physician, nurses, dietician, interviewer Blood samples taken except for very young Target is 5,000 respondents a year over a two year data cycle, about 15 PSUs each year Pre-notification letter and local media ads (e.g. newspaper and radio) Uses Current Population Survey total to calculate weights since sampling is clustered and relatively small

38. Sample Size

39. Response Rates

40. Medical Expenditure Panel Survey (MEPS)

41. Overview Sponsored by the Agency for Healthcare and Research Quality (AHRQ) Purpose is to assess the types of health services Americans pay for, how much they cost and how they are paid Unique because it includes both a household and an insurance component – Household component includes data from respondent in household and medical provider – Insurance component is a survey of insurance providers Conducted annually since 1996 Other expenditure surveys conducted sporadically before then since 1977 Data available at http://www.meps.ahrq.gov/mepsweb/data_stats/download_data_files.jsp http://www.meps.ahrq.gov/mepsweb/data_stats/download_data_files.jsp

42. Data Collection for Household Survey To reduce costs MEPS uses NHIS respondents as the sample frame Mode is Face-to-face and phone Overlapping panel design Each Two-year panel consists of five rounds over 2.5 years Each round refers to a specific reference period Survey covers all people in household

43. Sample Sizes

44. Response Rate (Combines NHIS response rate with MEPS panel response rate)

45. Current Population Survey (CPS)

46. Overview Joint effort between Census Bureau and Bureau of Labor Statistics (BLS) Fieldwork conducted by Census Bureau Purpose is to measure unemployment and labor participation U.S. population over age 15 Covers all 50 states and Washington DC Also oversamples to create reliable estimates for some sub-state regions and urban areas Conducted monthly since 1940 Given its size and frequency the CPS is often used in survey power calculations and weighting between Census years Data available at http://www.bls.gov/cps/data.htmhttp://www.bls.gov/cps/data.htm

47. Data Collection Until 2001 target was 50,000 households each month In 2001 was increased to 60,000 households Mixed mode Face-to-face and telephone Sample size is based on achieving accuracy on unemployment rate (tolerable margin of error) Divides country into PSUs with at least 7,500 in each PSUs are aggregated into strata based on demographic characteristics 754 PSUs are selected out of 2,025

48. Data Collection (Continued) PSUs for all 150 MSAs are sampled, remainder are divided into units of 45- 60 housing units From PSUs a sample of Ultimate Sampling Units (USUs) of about four households are selected Uses Census addresses supplemented with Building Permits Covers all people in the household over age 15 4-8-4 sampling strategy increases continuity and reduces respondent burden: – Households are in the sample frame for 4 months – Out for 8 – In again for 4 months then out permanently Respondent is person who owns or rents unit

49. Response rate and sample size 7.5 percent typically not interviewed – 92.5% response rate

50. American Community Survey (ACS)

51. Overview Purpose is to provide much of the information contained on the Census long form Data for small area analyses, particularly between Census years The ACS is now used more than CPS to do power analyses and weighting between Census years

52. Data Collection Conducted by the U.S. Census Both telephone and face-to-face follow-up Beginning in 2010 the ACS aggregated 5 year intervals to create small area estimates

53. Sampling Sampling occurs in two phases – First phase assigns blocks to five strata Approximately 3 million addresses sampled each year since 2005 – Prototype surveys conducted from 2000-2005 Includes group quarters About 250,000 mail surveys are sent out each month

54. Sample Size

55. Response Rate