Toward a National Health Care Survey A Data System for the 21st Century (1992) / Chapter Skim
Currently Skimming:
Review of the NCHS Plan for the National Health Care Survey
Review of the NCHS Plan for the National Health Care Survey
Pages 41-61
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From page 41... ...
in 1986 undertook a review of its existing surveys of health care providers. As a result of this review, NCHS has developed a plan for restructuring its existing health care provider surveys into a new National Health Care Survey with the aim of providing a more complete and useful picture than now exists of the medical care provided in the United States.
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From page 42... ...
. The provider surveys are the National Hospital Discharge Survey, the National Ambulatory Medical Care Survey, the National Nursing Home Survey, and the National Master Facility Inventory.
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From page 43... ...
In order to offset the increased costs of conducting the provider surveys annually, however, the center clans to reduce their sample sizes. Reducing It points to several advantages -berm- By , ample sizes obviously works against solving the general problem of producing data for subdomains of the population.
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From page 46... ...
SCOPE AND COVERAGE . Current NCHS plans call for extending the coverage of the National Health Care Survey beyond the current four major health care provider surveys to include collection of national data for selected alternative sites of the three major types of health care and health care providers hospital care, ambulatory care, and long-term care: · The Hospital and Surgical Care Component, based on the National Hospital Discharge Survey (NHDS)
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From page 47... ...
The panel endorses the center's efforts to extend the coverage of the provider surveys to include a range of the alternative health care settings that have emerged in recent years. The proposed extensions constitute an important step in extending the coverage of these surveys.
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From page 48... ...
The omission of federal hospitals and long-term care hospitals from the hospital care component is a significant deficiency. NCHS has made efforts in the past to obtain data on federal hospital discharges, and the task has proven difficult.
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From page 49... ...
The provider surveys that serve as the basis for the National Health Care Survey proposed by NCHS currently collect data only on events, such as individual physician visits or individual hospital discharges. Historically, NCHS has provided basic information for a broad range of issues related to the supply and volume of health care, but has lacked person-based information on health care received by individuals over time or over the entire progression of an illness episode, from onset to completion.
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From page 50... ...
The panel recognizes that the feasibility issues with respect to measuring functional status of hospitalized patients are numerous, but, if they could be overcome, research on outcomes of hospital care would be greatly strengthened. This need for more information on health and functional status of the patient for the purpose of evaluating outcomes extends, of course, to all provider sites and should be recognized in all the provider surveys.
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From page 51... ...
An important new data collection activity that NCHS should explore is the addition of data from medical records or charts to the content of the National Health Care Survey. As mentioned previously, a major limitation, not only of NCHS surveys, but also of virtually all data sets about health care services, is the lack of detailed information on the tests and services performed during the various treatment events.
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From page 52... ...
DESIGN FEATURES Cluster Survey Design A central feature of the center's plan for the National Health Care Survey is to move from the existing four independently designed provider surveys to a three-stage cluster sample designs and to link the sample selection of these surveys geographically with the sampling design of the National Health Interview Survey (NHIS)
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From page 53... ...
Research is currently under way for the next cycle of the NHIS redesign based on the 1990 census, including not only issues related to the NCHS population surveys, but also particular requirements of the NCHS provider surveys. Factors related to subdomain statistics, alternative design options, including the redefinition of PSUs in terms of health service areas, the effect of conducting the National Health Care Survey components in a subsample of the NHIS PSUs, and the analytical utility of such a design are being explored as part of the redesign effort.
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From page 54... ...
Definition of Primary Sampling Units The panel is skeptical about the assumption of increased analytic utility resulting from geographic linkage and by defining the PSUs in teas of health service areas. NCHS defines health service areas as one or more counties that are relatively self-contained with respect to the provision of routine hospital care.
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From page 55... ...
Makuc presents some examples of the kinds of analyses that could be undertaken based on the first-stage area design. Each area can be characterized by census variables and variables from other sources, such as the Area Resource File.4 Health care data can be produced for the same areas so that such questions as the following could be answered: to what extent is one subcomponent of care being substituted for another, e.g., ambulatory surgical centers as a substitute for inpatient hospital care, hospice and home care for nursing home care?
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From page 56... ...
The panel, however, supports the center's intention to continue the needed research in this area. Recommendation 3-5: The panel endorses the NCHS decision to use the primary sampling units from the National Health Interview Survey for the National Health Care Survey, to retain their existing definition at this time, and to continue the needed research in this area.
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From page 57... ...
NCHS also anticipates linking these data with other data sources, just as the National Nursing Home Survey is being linked to the National Death Index to obtain mortality status information on former patients. Discussed below are some of the potential values of the design involving follow-up of patients whose visits and discharges are sampled for the provider surveys; some of the methodological, legal, and feasibility issues that will need to be resolved before such studies can be undertaken; and the limitations of such an event-based approach to obtain the kinds of health care data needed.
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From page 58... ...
ambulatory care providers could be asked ex post facto to contact the sample patients to gain permission for subsequent follow-up or to allow for their patients to be contacted directly for follow-up and (2) interviewers could interact with the patient directly in the physician's office.
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From page 59... ...
In the ambulatory care component of the survey, for instance, people are sampled proportionate to their use of ambulatory services in physicians' offices. Although Hat may be a s~ghdorward way to sample events, it is not an efficient design for producing personbased statistics.
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From page 60... ...
Although NCHS provider surveys have considerable strengths in measuring the health services provided in traditional medical care settings and in some alternative care settings in the near future, they reflect only part of the care provided in the United States today. Each of the NCHS provider
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From page 61... ...
NCHS has proposed strategies to address some of the gaps in the data from its existing provider-based surveys. The panel supports these initiatives; however, the panel believes that the center's vision for a National Health Care Survey falls short of a plan for meeting anticipated health care information needs today and into the next century, even with the suggestions contained in this chapter for changes and improvements.
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