Toward a National Health Care Survey A Data System for the 21st Century (1992) / Chapter Skim
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Design for a National Health Care Data System
Design for a National Health Care Data System
Pages 62-82
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From page 62... ...
The panel's appraisal has demonstrated that, as currently conceived, the center's plan does not provide the capacity to address important questions about the interrelationships between the health status of individuals and the patterns and cost of health care services they receive from a broad range of providers and service settings over time. The long-term agenda, therefore, requires consideration of further, more fundamental restructuring.
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From page 63... ...
A simple statement then of the objectives of a National Health Care Survey would be to provide statistics on a continuing basis that reflect the condition of health care in the United States, particularly with respect to the critical issues of access, quality, and cost. Such a survey should have the capability of obtaining data related to the characteristics and health status of individuals and their demand for, and use of, health care over time and across a broad range of providers and service settings that can be linked at the individual rather than the aggregate level.
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From page 64... ...
Care should be taken to ensure that health care surveys carried out by NCHS and the other agencies use standard definitions and classifications and do not unnecessarily duplicate information and that other needed steps are taken to facilitate integration of data sets for analysis and dissemination. DESIGN CONSIDERATIONS The panel was guided by three basic considerations in proposing a design framework for a National Health Care Data System: (1)
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From page 65... ...
. As stated in the preceding chapter, the event-based follow-up design proposed by NCHS, as an extension of existing NCHS provider surveys, would allow NCHS to expand its provider-based data gathering to include outcomes of hospital and private practice physician care, two important and currently unmet data needs.
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From page 66... ...
(3) Modify the sampling design of the National Nursing Home Survey to collect longitudinal data on health care utilization by the institutionalized population not presently covered by the NHIS.
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From page 67... ...
, the panel proposes that appropriate national samples of "other provider" categories be identified by screening National Health Interview Survey respondents for the names and addresses of the health care providers and settings they visited in a very recent period, such as a defined two-week reference period. The essence of the proposed design is the identification by NHIS respondents of providers to be sampled for the expanded National Health Care Data System.
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From page 68... ...
It relies on complete reporting of visits by NHIS respondents; significant underreporting of certain types of visits (such as those for less socially acceptable diseases) could create serious problems.
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From page 69... ...
Research would be needed, however, to find creative yet practical ways to administer these surveys for providers outside the PSU, for whom field staff might have to commute some distance. Recommendation 4-1: The panel recommends that providers other than those currently covered i.e., short-term hospitals, office-based physicians, and nursing homes- be surveyed using provider samples generated from the list of providers visited by respondents to the National Health Interview Survey as identified through the survey screening.
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From page 70... ...
Specifically, the panel proposes a prospective design in which the NHIS will be used to identify cohorts of individuals to be interviewed periodically over specified time periods to provide longitudinal data on their health care utilization and expenditures.2 The national health care statistics on key policy-related items generated by these cohort surveys should be published annually. The cohorts based on subsamples of NHIS respondents should be selected so as to permit provision of national statistics that would best address health care policy issues.
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From page 71... ...
One problem that arises in selecting the samples for follow-up from NHIS respondents is the potential for a sizable time interval between the NHIS interviews and the initiation of the follow-up interviews and the attendant loss of sampled individuals who have moved in the interval. To minimize recall errors, the follow-up interviews should be conducted frequently, say once a quarter, or even more frequently if suggested by the findings of the 1987 NMES, conducted by the Agency for Health Care Policy and Research.
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From page 72... ...
Recommendation 4-3: The panel recommends that NCHS develop and implement, as a component of the National Health Care Data System, a continuous, longitudinal survey of health care utilization and expenditures and their health care providers, using cohorts of individuals selected from among National Health Interview Survey respondents. The panel believes that it is essential that NCHS work in coordination with the Agency for Health Care Policy and Research in implementing this recommendation, which it sees as a natural next step in the development of routine collection of health care cost data.
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From page 73... ...
NHIS-NN~S-Based Surveying of Episodes of Illness An important feature of the proposed National Health Care Data System is the capability of collecting longitudinal data on the health status and health care utilization of a population-based sample of individuals and linking them with the associated information on the health care providers. The design strategy recommended in the previous sections represents a major step forward by linking information on the individuals with visits to health care providers, thus enabling important policy-related data on the condition of the health care system to be collected and reported continuously.
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From page 74... ...
The episode model focuses on the observed patterns of care as a reflection of the care sought and received in conjunction with an episode of illness through possible treatment and outcome. Thus an alternative approach to gathering population-based statistics on health care services, wherein one follows a cohort of individuals, could be to limit the longitudinal data collection to those persons reporting art illness episode.
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From page 75... ...
For example, experience would range from no episodes during the specified reference period through minor episodes of relatively short duration, that require no provider care, to acute episodes that would require provider care and end in either death or recovery. Some individuals may experience more than one illness episode (possibly overlapping)
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From page 76... ...
The NHIS respondents first would be screened to determine those who began an episode of illness during a short reference period immediately prior to the interview. Thus, a representative sample of the group of illness episodes occurring to individuals over a time period of interest would be defined, then repeat contacts would be made tO chart the course of the episode arid to determine when it was completed.
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From page 77... ...
Recommendation 4-5: The panel recommends that NCHS undertake research in collaboration with the Agency for Health Care Policy and Research to examine the methodological issues of definitions and classifications and to determine the feasibility of using the National Health Interview Survey and the National Nursing Home Survey to generate a sample of episodes of illness; the sample should be followed longitudinally to collect data on the associated medical care use for the episode from both the sample of individuals and the health care providers. Effectiveness and Efficiency In the face of rapidly rising health care costs, there is growing interest in treatment effectiveness in relation to cost.
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From page 78... ...
Recommendation 4-6: The panel recommends that NCHS conduct research and develop procedures for data systems that enable linkage of health care outcomes to health care received and health care costs. The panel further urges NCHS to examine the feasibility of collecting health insurance claims files from both private and public insurers for individuals included in the samples selected from the National Health Interview Survey and the National Nursing Home Survey to study health care utilization and costs.
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From page 79... ...
Minor episodes not requinug provider visits are also reported by respondents to the National Health Interview Survey. are tied to meeting unmet information needs (Table 2~.
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From page 80... ...
Current NCHS scheduling plans to field the existing provider surveys annually would not be altered if the panel's recommended design framework is adopted. Finally, the timing is right to make the kinds of changes required by this design, since in recent years design integration involving the NHIS has been given a priority within NCHS and since significant redesign work is currently under way for the two surveys in which the greatest impact of change would be felt (i.e., the NHIS and the NNHS)
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From page 81... ...
In effect, this plan envisions a collection of slightly modified provider surveys with follow-up components as the National Health Care Survey. The panel believes this course falls short of meeting anticipated health inflation needs for the next century.
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From page 82... ...
Phase IV: 1997-2000 NCHS commences implementation of all components of the panel's proposed design framework for a comprehensive National Health Care Data System.
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