increasing the sample: how can state-based estimates help monitor healthcare reform?
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Increasing the sample: How can state-based estimates help monitor healthcare reform?. 2012 National Conference on Health Statistics Monitoring Health Care Reform through Provider-based Surveys: New Initiatives from the NAMCS & NHAMCS August 8, 2012 Farida A. Bhuiya, MPH - PowerPoint PPT PresentationTRANSCRIPT
Increasing the sample: How can state-based estimates help
monitor healthcare reform?
2012 National Conference on Health StatisticsMonitoring Health Care Reform through Provider-
based Surveys: New Initiatives from the NAMCS & NHAMCS
August 8, 2012
Farida A. Bhuiya, MPHNational Center for Health Statistics
Ambulatory and Hospital Care Statistics Branch
Overview• Survey goals• NHAMCS
– Background– State-based ED estimates– Data uses
• NAMCS– Background– State-based physician estimates– Data Uses
• Summary
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Survey Goals
• Produce national statistics on ambulatory care utilization
• Provide data for health policy formulation
• Provide comparative data for medical practice management
Ability to monitor changes in …
• The performance of the U.S. health care system
• Care for the rapidly aging population• Changes in health insurance coverage• The introduction of new medical
technologies• The adoption of electronic health records
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National Hospital Ambulatory Medical Care Survey
(NHAMCS)
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NHAMCS History
• 1992-present• Patient visits to:
• Emergency departments (EDs) • Outpatient departments (OPDs) • Ambulatory surgery locations (ASLs)
• 600 hospitals and 246 freestanding ASCs distributed over a 16-month panel– Non-institutional general and short-stay– Non Federal, military, or Veterans Administration facilities
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NHAMCS & Healthcare Reform
• Sponsor – DHHS, Assistant Secretary for Preparedness and Response
• Purpose – To monitor role of ED care as it relates to health care reform– Establish baseline of information about the status
of ED care– Support state activities to monitor the effects of the
expansion of Medicaid programs on ED crowding
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Obtaining State Estimates• Increase sample to add 167 hospitals• Collect data from the ED of new hospitals• Focus on the 5 most populous states:
• California• Florida• Illinois• New York• Texas
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Specific Measures
1. Length of visit: Median length of visit among all patients seen in ED
2. Visits per population: Number of visits per population in each state
3. Wait time: Among patients who are seen by a physician, the median wait time to
see a physician
4. Visits by payer: Number of visits by payer (private, Medicare, Medicaid, uninsured)
5. Admission: Median length of visit for patients admitted to the hospital through the ED
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Examples of NHAMCS Estimates
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Figure 1. Annual number of ED visits, with 95% confidence intervals: United States, 1997-2007
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1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 20070
20
40
60
80
100
120
140
94.9100.4 102.8
108.0 107.5110.2
113.9 110.2115.3 119.2 116.8
Year
Num
ber o
f vis
its
Source: CDC/NCHS, National Hospital Ambulatory Medical Care Survey
Figure 2. Average time spent waiting to be seen at ED: United States, 1999-2008
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1999 2000 2001* 2002* 2003 2004 2005 2006 2007 20080
10
20
30
40
50
60
70
Year
Tim
e (m
inut
es)
*Data not available
SOURCE: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 1999-2008.
Figure 3. Distribution of ambulatory visits by source of payment: United States, 2009
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Private insurance
Medicaid or CHIP
Medicare Medicare and Med-
icaid
No in-surance
Other Unknown or blank
0
10,000
20,000
30,000
40,000
50,000
60,000
52,528
39,860
23,076
4,859
21,151
6,1369,123
Source of Payment
Num
ber o
f Vis
its (t
hous
ands
)
Source: National Hospital Ambulatory Medical Care Survey, 2009
Figure 4. Emergency department strategies to reduce crowding: United States, 2007
Citation: McCaig LF et al. “Estimates of Emergency Department Capacity: United States, 2007, NCHS Health E-Stat 2009, http://www.cdc.gov/nchs/data/hestat/ed_capacity/ED_capacity.htm
Source: National Hospital Ambulatory Medical Care Survey, 2007
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National Ambulatory Medical Care Survey
(NAMCS)
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NAMCS History
• 1973-present
• Patient visits to:• Office-based physicians • Community health centers (CHCs)
• Sample• 3,000 non-federal office-based physicians• 104 community health centers (CHCs)
• With up to 3 physicians and mid-level providers within each
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NAMCS & Healthcare Reform
• Sponsor – CDC– Funding from Patient Protection and Affordable
Care Act 2010
• Purpose– Monitor the effect of expanded health coverage on
the use of appropriate preventive services – Allow states to compare visits to their physician
offices and CHCs against national estimates
Obtaining State Estimates
• State-based estimates for the 34 most populous states
• Increase sample size– Physicians - ~20,000 (5-fold increase)– CHCs - ~2,000 service delivery sites
• ~6,000 providers
• Modify NAMCS sampling methodology– Stratified list sample
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State-based Estimates
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Alaska Iowa Missouri Pennsylvania
Alabama Illinois Mississippi South Carolina
Arkansas Indiana North Carolina Tennessee
Arizona Kansas New Jersey Texas
California Kentucky New York Utah
Colorado Massachusetts Ohio Virginia
Connecticut Maryland Oklahoma Washington
Florida Michigan Oregon Wisconsin
Georgia Minnesota
Specific Measures
• Payment status • Reason for visit• Continuity of care• Services/tests ordered or performed• Medications prescribed
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Examples of NAMCS Estimates
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Figure 5. Expected sources of payment at physician office visits: United States, 2009
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64.0
25.3
13.5
3.98.8
Private InsuranceMedicareMedicaid or CHIPNo insuranceOther/Unknown/Blank
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Figure 6. Major reason for CHC visit by type of provider: United States, 2006-2008
Nurse midwife
Nurse practitioner
Physician assis-tant
Physician
0 10 20 30 40 50 60 70 80 90 100
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3
1
1
82
38
17
30
21
21
36
31
151
38
45
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New problem Chronic problem Preventive care Other or unknown
Percent of visitsNOTE: Data are from the 2006-08 NAMCS. 1 Estimate does not meet standard of reliability or precision.
Table 1. Selected services ordered or provided by primary care setting: United States, 2008
Services ordered or provided
Physician offices Community health centers
Outpatient departments
Age-adjusted percentage of visitsDrug or immunization
mentioned80 83 81
Lab and other tests 50 49 52
Health education service
39 40 46
Any imaging 14 11 18
Nonmedication treatment
10 10 16
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SOURCES: CDC/NCHS, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.
Summary
• NHAMCS estimates will allow states to monitor the effects of expansion of Medicaid programs on crowding in emergency departments
• NAMCS estimates will allow CDC and its state health department partners to monitor the effect of expanded health coverage on the use of appropriate preventive services.
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Contact Information
Farida A. Bhuiya, MPHNational Center for Health StatisticsAmbulatory & Hospital Care Statistics Branch3311 Toledo Road, Room 3329Hyattsville, Maryland 20782
Phone: 301-458-4801
Email: [email protected]
NAMCS & NHAMCS website: http://www.cdc.gov/nchs/ahcd.htm
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