Toward a National Health Care Survey A Data System for the 21st Century (1992) / Chapter Skim
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Appendix A: NCHS Plan for a National Health Care Survey
Appendix A: NCHS Plan for a National Health Care Survey
Pages 93-110
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APPENDIX A The NCHS Plan for a National Health Care Survey
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THE NATIONAL HEALTH CARE SURVEY Division of Health Care Statistics National Center for Health Statistics Centers for Disease Control December 1990
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Under this plan, four NCHS surveys of health care providers, the National Ambulatory Medical Care Survey, the National Hospital Discharge Survey, the National Nursing Home Survey, and the National Master Facility Inventory, are being merged and expanded, over time, into an ongoing, integrated National Health Care Survey (NHCS)
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Dynamics of the Health Care Delivery System B Impact on the Health Care Delivery System C
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Medical effectiveness Recent legislative and departmental health care initiatives, mirroring the feeling of many health care professionals, have focused on the effectiveness and outcomes of health care. Several activities indicating the importance of this emerging issue have occurred in the past year: Congress has enacted legislation to expand the Federal program of medical effectiveness research; and the Department of Health and Human Services, as part of its Medical Treatment Effectiveness Program, has awarded approximately $6 million in research grants to study patient outcomes and effectiveness of medical treatment.
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During the 1980's, as a result of some of the factors outlined above, there has been a growing trend toward greater diversification in organization, financing, and delivery of health care. Evidence of this diversity includes the proliferation of insurance and benefit alternatives for individuals; new forms of physician group practice; and growth in the number of alternative sites of care, such as surgical centers, walk-in ambulatory care facilities, and home health agencies.
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The demand for long-term care services is exemplified by the dramatic rise in the number of nursing home beds in the 70s and 80s and an occupancy rate which has remained fairly constant over that time. And while home health care is often promoted as a cost-efficient alternative to institutionalization, there are concerns that more ready access to home health care will increase overall costs as new demand surfaces from individuals not currently receiving such assistance from organized providers.
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, conducted annually from 1973-81, in 1985, and again on a continuous basis beginning in 1989, collects inflation about ambulatory medical care provided by office-based physicians. This survey provides statistics on the demographic characteristics of patients, reasons for visit, diagnoses, diagnostic procedures, services provided, drug therapy, and disposition.
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D Implications for Health Care Data NClIS provider-based surveys have considerable strengths in measuring the care provided in traditional settings, including physicians' offices, acute care hospitals, and nursing homes.
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Many of the problems of provider coverage described above have been compounded by the periodic schedule of data collection of some NCHS surveys of health care providers, for example, only the NHDS has been conducted on an annual basis during its entire history. Due to resource limitations, the scheduled interval between data collection periods in the NAMCS and NNHS were increased in 1981: the NAMCS from an annual to a triennial survey, the NNHS from triennial to sexennial.
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These data will describe the patient population, medical care provided, financing, and provider characteristics. The NHCS has five components based on the Center's current health care provider surveys: The Ambulatory Care Component has as its base the National Ambulatory Medical Care Survey.
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The Long-Term Care Component is based on the National Nursing Home Survey and is being restructured and expanded to include home health agencies and hospices. The Long-Term Care Component will provide data from smaller annual surveys, rather than periodic surveys with larger samples.
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of the National Health Interview Survey. The advantages to this type of design include: the increased analytical utility as health care utilization is examined in relation to health status indicators; the reduced interviewing costs as sample providers are concentrated in specific geographic areas; the increased potential for record-linkage across settings which aids in tracking patients and in differentiating multiple episodes of the same condition; and the possibility of producing local area statistics, at least for some areas or communities.
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From page 106... ...
This flexibility in an on-going national survey is important for providing data on changes in health care delivery such as new technologies, new procedures, and new approaches to organization or payment for care. Dimensions for expansion include: Provider coverage Coverage of health care providers can be expanded to include additional ambulatory and long-term care providers of interest, e.g., community health centers, walk-in acute care centers, adult day care centers, mental health facilities, or institutions for the mentally retarded.
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F Integrated Survey Design As mentioned earlier, the components of the NHCS are being fielded in a subsample of the Primary Sampling Units selected for the National Health Interview Survey (NHIS)
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Data content and data collection procedures are being developed and a field test is currently underway. This work follows earlier work on the evaluation of the Long-Term Care Minimum Data Set which provided information on the establishment of sampling frames and on the content and availability of minimum data set items in agency records.
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From page 109... ...
The information collected will be used to construct sampling frames for the 1992 home health agency/ hospice client survey and the 1992 National Nursing Home Survey. Recommendations from a 1983-85 evaluation of the NMFI which addressed issues of definition, content, and data collection procedures for nursing homes and the experience from the centralized collection activities used in the 1986 Inventory of Long-Term Care Places conducted by NCHS are being incorporated in the 1991 NHPI.
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