Vital and

Health Statistics

Evaluation of 2-week

Doctor Visit Reporting in the

National Health Interview

Survey

Series 2:

Data Eval!

Research

No. 122

Jation and Methods

This report includes a review of previous research on the reporting of

ambulatory medical visits in household surveys, describes the methods used

in the Heaith Interview Evaluation Survey, and presents resuits relating to the

reporting of 2-week doctor visits.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsville, Maryland

August 1996

DHHS Publlcatlon No. (PHS) 96-1396
Copyright Information

All materiel appearing in this report is in the public domain and may be

reproduced or mpied without permission, citation as to source, however, is

appreciated.

Suggested Cttation

Edwards WS, Wmn DM, Collins JG. Evaluation ot 2-week doctor visit refmrting

in the National Heaiih Interview Survey. National Center for Health Statistics.

Viii Health Stat 2(122). 1996.

Ubrwy of Congress Cataloging-in-publkatlon Date

Edwards, W. Sherman.

Evaluation of 2-week doctor visit reporting in the National Health Interview

%Ney.

p. cm. — (VIII and health atatistii. Series 2, Date evaluation and

methods research ; no. 122) (DHHS publication ; no. (PHS) 96-1S96)

Written by W. Sherman Edwards, Deborah M. Winn, and John Gary

Collins.

“A~st 1S96”

includes bibliographical references.

ISBN 0-6406-0615-3

1. Ambulatory medical care -Utilizetio~Reporting-United States. 2.

National Health Interview Survey (U.S.) 1.Collins, John Gary. Il. National Heaith

Interview Survey (U.S.) Ill. National Center for Health Statistics (U.S.) IV. Tile.

V. Series. V1. Serfea: DHHS publication ; no. (PHS) S6-1 396.

[DNLM: 1. Ambulatory Care Faciliii~liiation-United States.

2. Data Coll+lo~ethods. W2 A N148vb no. 122 1966]

RA40S.U45 no. 122

[RA40s.61

362.1 ‘0723 S-dc20

[362.1’2]

DNLkVDLC

for Library of Congress 96-16763

CIP

For sale by the U.S. Government Printing Oflice

Superintendent of Documents

Mail stop SSDP

Washington, DC 20402-9S26
National Center for Health Statistics

Edward J. Sondi~ Ph.D., Director

Jack R. Anderson, Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Jack R. Anderson, Acting Associate Director for

International Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology

Division of Health Interview Statistics

Owen T. Thomberry, Jr., Ph.D., Director

Gerry E. Hendershot, Ph.D., Assistant to the Director for

Data Analysis and Dissemination

Ann M. Hardy, Dr.P.H., Chief Illness and Disability

Statistics Branch

John W. Horm, Chie$ Survey Planning and Development

Branch

Robert S. Krasowski, Chiej Systems and Programming

Branch

Robert A. Wright, Chiej Utilization and Expenditure

Statistics Branch
Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..”. .””s 1

Highlights . . . . . ,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Previous research and design ofrecord-check studies for ambulatory rnedicalcare visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................. 6

Sample design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......” 6

Data collection . . . . . . . . . . . . . ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .! . . . . . . . . . . . . . . . . . . . . . . ... 8

Matching interview and medical record reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Overview of presentation ofresuhs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2-week contacts inthe interview and medical record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Person-level results ofmatching. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~~

Contact-level match . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reporting number ofvisitsin 2-week period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Effects of timing ofinterview and physician contact on reporting accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Differences in reporting by respondent characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . 17

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

List of detailed tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 20

Appendix

Health Interview Evaluation Questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Texttables

A,

B.

c,

D,

E.

F.

G.

H.

J.

Marquis’ basic record-check matrix for binary variable with no missing data, by survey response and notation of

condition in medical records.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Comparisonbehveen National Health Interview Survey procedures and Health Interview Evaluation Survey design

elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analytic sampleby age and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Planned allocation of list-sample persons cooperating in the Health Interview Evaluation Survey, by event history,

age, and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Planned allocation of list-sample persons cooperating in Health Interview Evaluation Survey, byevent history

revised to analyze telescoping, age, andsex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Actual number of list-sample persons available for analysis by event history, according to the medical record, age,

and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Actual number of supplementary-sample persons available for analysis, by event history according to the

medical record, age, and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .

Number and percent ofinitial draw and response rates for Health Interview Evaluation Survey, by utilization group . . .

Results of matching interview and medical record reports, by steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Text figures

1. Agreement on number ofvisits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.,.

Ill

29

3

6

7

7

7

8

8

8

9

14
Evaluation of 2-week Doctor

Visit Reporting in the

National Health Interview

Survey

by W. Sherman Edwards, M. B.A., Westat, Inc.; Deborah

M. VVinn, Ph. D., and John Gary Collins, M.B.A.,

National Center for Health Statistics

Introduction

The National Health Interview Survey (NHIS) is a continuous, cross-sectional survey of the civilian noninstitutionalized population of the United States, conducted by the National

Center for Health Statistics. The NHIS core interview provides

national estimates of, for example, the use of physician and

hospital services, and of functional limitations and restrictions

of everyday activities for health reasons. Annual supplements

provide timely information on other topics of health policy

interest.

This report describes the study methodology and presents

findings for an evaluation of the reporting of ambulatory

medical care visits in the NHIS 2-week reference period, part

of a larger evaluation effort called the Health Interview

Evaluation Survey (HIES). The NIES had two purposes, the

first of which was to examine the reporting of chronic

conditions by household respondents and the second to evaluate the reporting of medical care visits, which is the focus of

this report. Findings from the reporting of chronic conditions

may bc found in the NCHS report, “Evaluation of National

Health Interview Survey Diagnostic Reporting” (l). Comparing household interview reports and medicrd records can

improve our understanding of data from both sources and may

also shed light on people’s understanding of their own health

and how well the health care system meets their needs for

information.

Evaluations using record-check designs are difliculc if

one simply interviews persons and checks the sources they

mention, it is likely that sources will be missed. Similarly, a

design starting with medical records and following up with

interviews will miss persons who have not sought professional

medical care, Like the previous studies of the reporting of

chronic conditions in the NHIS (24), the HIES drew its

subjects from the membership of a health maintenance organization (HMO) to allow as complete a verification of reports

of chronic conditions as possible, The selection of an HMO as

a source of the sample has its limitations, however. The

evaluation cannot examine differences by provider in the

phenomena under study, since there is in essence only one

provider, nor can it examine the effects of variations in

persons’ access to care. Further, persons belonging to an HMO

may exhibit different care-seeking behavior from the general

population, and they may difler in other ways as well.

The HIES was designed to meet multiple research objectives. Because of interest in possible reporting differences by

race, the study population included a larger proportion of

black persons than the U.S. population as a whole. The sample

design included stratification by age and sex, with oversamples of older persons. Because chronic conditions generally are far less prevalent among children than among adults,

the selection of list sample persons was limited to persons 18

years of age or older. To accommodate the examination of

doctor visits within 2 weeks of the interview and hospitalizations within 13 months, persons identified in the medical

record as having recent utilization were oversampled. The

questionnaire comprised a slightly modified core NHIS, with a

composite condition list including the most prevalent chronic

conditions and impairments. To avoid confounding examination of data on list-sample persons by whether a self-or proxy

report was obtained, all list sample persons responded for

themselves.

In addition to collecting data on the sample persons, data

were also collected on other members of the sample persons’

household, including children. These members were identified

by the sample person on the household composition page of

the NIES questionnaire, paralleling, procedures used in the

NHIS. Data on other household members are useful since they

allow some comparisons between self-respondents (the sample

persons) and other household persons for whom both self- and

proxy responses are included as in the NH(S. To the extent

that these persons were members of the HMO and permitted

access to their medicrd records, they are included in some

analyses. Other survey procedures were modeled as closely as

possible to the NHIS.

This report includes a review of previous research on the

reporting of ambulatory medical visits in household surveys,

describes the methods used in the HIES, and presents results

relating to the reporting of 2-week doctor visits.

The HIES was conceived and mandated by NCHS. It was

conducted by Westat, Inc.; the Project HOPE Center for

Health Affairs shared the design and analysis responsibilities.

The study sample was drawn horn the membership rolk of the

Group Health Association (GHA), whose stti provided essential assistance in identifying the sample and in making available participants’ medical records.
Highlights

The IXHESis one of many research studies that have

examined the accuracy of household survey reports of ambulatory medical visits through record checks. ‘IWOaspects of

reporting errors have been examined: failure to report visits

present in the medical record (underreporting relative to the

medical record) and reporting visits not present in the medical

record (relative overreporting). Although medical records are

not without error and almost every study examined in this

research noted some difficulties in the process of matching

interview reports and medical records, this report generally

assumes that the medical record is “truth” and survey responses

that do not agree with the record are in error.

At the person level, the HIES found that about 78 percent

of list-sample persons with one or more GHA visits in the

medical record reported at least one visit in the interview, with

almost the same proportion (80 percent) of list-sample persons

reporting visits having them confirmed by the medical record.

(“List-sample persons,” those selected from the GHA records,

all responded for themselves. Other persons included in the

interview are referred to as “household members,” some of

whom reported for themselves and some of whom had proxy

respondents.) For list-sample persons, there was virtually no

net difference between the interview and medical record in the

number of people with visits. For adult household members

not present for the interview, however, less than one-half of

the persons with visits in the medical record had visits

reported in the interview. This finding suggests poorer reporting by proxy respondents but should be viewed with caution

because of design limitations.

Compared with the findings for visits, the findings for

telephone calls show a considerable net underreport of GHA

telephone calls by all participants. Only about one-third of

list-sample persons with calls in the record reported a call in

the interview, while about 60 percent of persons with telephone contact reported in the interview had it confirmed by

the medical record. The pattern was the same for household

members, although the percentages were all lower.

The overall rates of agreement for visits were relatively

consistent with the findings of previous studies, given that

these studies varied in sample design, question wording, and

reference period Ien@h. Little previous research had examined

the reporting of telephone calls to doctors.

The HIES, like several previous studies, examined the

reporting of visits with respect to when the interview occurred,

and when in the 2-week reference period the visit occurred.

Interview reporting was better for the week preceding the

interview (77 percent of medical record visits reported in the

interview) than for the prior week (63.5 percent), a finding

similar to that of an earlier study. Within weeks, there was

little ditTerence for different days of the week. Underreporting

was constant for interviews conducted Monday through Friday

b~t higher for interviews conducted on a Saturday or Sunday,

with more time elapsed since the reference period and perhaps

more confusion about which weeks composed the reference

period. Finally, an analysis of overreporting suggested that

between one-quarter and one-half of overreported visits were

“telescoped” into the reference period from an earlier date,

The HIES found dii%erencesin reporting by respondent

characteristics. Younger people were less likely to underreport

and more likely to overreport than older people, leading to a

net overreport of about 14 percent as compared with the

medical record for persons 18-44, while all other age groups

had a net underreport of between 4 and 9 percent. Men were

more likely to underreport than women. College graduates

were less likely to underreport and more likely to overreport

than persons with less education, leading to a net overreport of

ahnost 11 percent against the medical record for persons with

college degrees as compared with a net underreport of about

9 percent for persons with a high school education or less, The

only one of these findings clearly confirmed by previous

research was that men underreport more than women.
Previous research and

design of record-check

studies for ambulatory

medical care visits

Survey reports of behavior are subject to various types of

error. Generally, randomly distributed reporting error can

affect the variance of estimates made horn survey data, while

systematic error can bias survey estimates.

As examples of systematic error for survey reports of

behavior, respondents may forget relevant episodes or they

may report an episode from outside the period of interest as if

it had happened within the period (telescoping); they may

report episodes that do not meet the survey definition or they

may fail to report relevant episodes because they decide that

these do not meet survey criteri% they may fail to report

socially undesirable or embarrassing episodes or they may

report socially desirable episodes that did not occur. Surveys

that collect reports of behavior sometimes seek verification of

these reports tlom other sources, either at an episode level or

in some aggregated form. Administrative records are often

used in both ways in what is called “record-check studies.”

While some researchers consider such record data as “truth,”

considerable evidence suggests that this view oversimplifies

the relationship between data from sample surveys and from

administrative records. For example, administrative records

are maintained for purposes other than verification of survey

data, and therefore may use different rules for inclusion or

exclusion of events than the survey with whose data they are

being compared, Even if administrative records did represent

“truth,” record checking does not explain why respondents

give incorrect answers.

Marquis (5) described limitations of particular recordcheck methodologies, illustrating his arguments with a review

of record-check studies of reports of hospitalizations and

ambulatory health care visits. Marquis was particularly concerned with response bias, the systematic overreporting or

underreporting of some behavior—such as health service use.

He described a basic record-check typology in terms of the

values obtained for a binary variable (that is, a variable with

two possible values) from two difterent sources, specifically

household interviews and medical records. This typology is

reproduced as table 1. Cells A and D represent agreement

between the two sources—positive match and negative match,

respectively. Cells B and C represent disagreement if the

record is taken as truth, cell B would be considered a false

positive or overreport, while cell C would be a false negative

or underreport.

Note that survey response error, according to this model,

comprises both underreporting and overreporting. A more

simplistic model might compare only A and B (survey reports)

Table A. Marquis’ basic record-check matrix for binary variable

with no missing data, by survey response and notation of

condition in medical records

Survey response

Both

Condition noted in medical record Yes No responses

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . A c A+C

No . . . . . . . . . . . . . . . . . . . . . . . . . . B D . .

Allcondtions . . . . . . . . . . . . . . . . . . . . A+B . . A+B+C+D

. . . Category not applicable.

NOTES A is positive match, B is false posifive, C is false negative, and D is negstive match.

and A and C (record reports) and derive a single error term,

either overreporting or underreporting, that represents the net

effect of both kinds of response error. This comparison could

lead to an unduly optimistic view of reporting error if, for

example, both underreporting and overreporting were high but

of relatively equal magnitude. In such a case, estimates of

population totals would be relatively accurate but subpopulation estimates or multivariate analyses might be biased.

Marquis extended this model to describe the design of

record-check surveys overall. He labeled “AC” a design in

which a sample of persons with a particular characteristic

(such as the presence of a doctor visit within a specified

reference period) is drawn from records. The characteristic is

then tested for in a survey, noting that such a design would not

capture overreports (that is, responses in cell B). On the other

hand, a design in which a survey is conducted first and record

checks are performed on persons reporting a characteristic of

interest (“AB” design) would fail to capture underreports (that

is, responses in cell C). Record checks of either AB or AC

design would thus not measure response bias accurately;

estimates of bias would be skewed by the limitations of the

design. Fully designed record checks (ABCD designs) identify

a population and sample from it independently of records,

obtain survey and record information for each sampled element, and compare the two data sources. Thus, Marquis

believes that cognitive research on health surveys should

contain externrd validation features, such as fully designed

record checks or other careful strategies, to measure the

comelation of survey responses with true values. Furthermore,

because of the problems inherent with certain types of record

checking, it cannot be assumed that respondent forgetfulness

is the dominant response problem in health surveys.

3
Marquis cited a number of prior record-check studies that

examined the reporting of ambulatory medical care visits.

These and other related studies are introduced in the following

paragraphs. These studies include some with incomplete designs,

where either the medical providers reported by a household

sample composed the record source or individuals selected

from medical records composed the interview sample. A

full-design record check with an area probability sample in

any substantial portion of the United States would be prohibitively expensive, if not impossible, because of the need to

include either all providers or all population members (depending on the direction of the study) to ensure the accuracy of

negative reports. In general, full-design record-check studies

of ambulatory care use have had to rely on relatively closed

systems of care, such as HMOS, or on small communities with

a manageable number of medical providers to include all in

the record check or on a closed payment system, such as the

Canadian national health plan.

In addition to variations in record-check design, the

studies varied in many other ways:

● in question wording and approach

. in the length of the reference period

● in the number of interviews (and consequently whether

recall was “bounded” by a previous interview or not)

. in the composition of the sample (age, race, urban/rural

location, etc.)

These differences make all direct comparisons across

studies risky at best. Those studies that most resemble the

NHIS will be given greater emphasis in subsequent discussion

of findings. However, to the extent that patterns persist across

the dissimilar studies, these patterns are useful in drawing

conclusions about the NHIS.

In an evaluation of the National Health Survey, predecessor to the NHIS, Canrtell and Fowler (6) examined the

reporting of doctor visits in a 2-week reference period. Using

a modified “AC” design, according to Marquis’ terminology,

the Cannell and Fowler study interviewed persons identified

from medical records at an urban hospital as having recent

doctor visits. Most of the hospital’s patients were members of

a subscription medical plan and about 50 percent of the study

sample were black persons. Persons with visits in the 2 weeks

preceding the interview week and persons with visits in the

prior 2 weeks (third and fourth weeks before the interview)

were included in the study. Cannell and Fowler matched

individual visits to the hospital clinic between interview

reports and administrative records, using doctor’s name, visit

date, and reason for visit as match criteria.

Cartvvright (7) reported on record-check results in the

Hertfordshire Morbidity Survey, which was conducted in a

post-war housing estate just outside London. Adults were

interviewed about themselves and their children in two in-person

interviews, The second of these interviews asked about CCmedical cOnsuItations” since the previous interview, a period

ranging from 3 to 6 weeks. Independent reports of medical

consultations were obtained from physicians in the estate for

all persons in the interview sample. Thus, this study is a

full-design record check, (Cartwright does not specifically

address the question of out-of-estate medical care use in the

cited article; the implicit assumption is that such use was

nonexistent or trivial.) Unlike the Cannell and Fowler study,

Cartwright’s work did not match interview and record reports

at the event level; rather, her study compared reports at the

person level, comparing the number of visits reported for each

person by each source.

Balamuth (2) reported on a study of Health Insurance

Plan (HIP) members, an HMO based in New York, in an

evaluation of reporting on the National Health Survey. Like

the Cannell and Fowler design, this study could only measure

underreporting, since it sampled only persons with visits from

the HMO records. The HIP study matched only on whether a

visit was reported within the 2-week period from both sources,

No attempt was made to match specific reports or the number

of reports during the 2-week period.

L.oewenstein (8) reported on a record-check study in the

Washington Heights area of New York City, whose primary

purpose was to compare two approaches to collecting health

care utilization data. The community sample for this survey

included persons seeing private doctors, persons going to

clinics, and HMO members. Respondents were asked about

ambulatory visits in the past year, and verification data were

obtained from providers mentioned in the interview. Marquis

termed this record check an “ABC” design, although it

approached a full design for the HMO members; the study

collected information from providers about medical visits not

reported in the interview (“C” visits) but only from providers

mentioned in the interview. There was no verification of

negative interview reports, so the record check includes no

“D” component and an incomplete “C” component. Matching

was done at the person-provider level, comparing numbers of

visits reported, but not at the visit level. Feather (9) reported

on a study of 3,727 Saskatchewan residents selected from the

rolls of the government-operated health insurance plan, which

covered 99 percent of residents. An interview very similar to

the NHIS was conducted, including questions about doctor

visits in the 2 weeks before the interview week. Record-check

data were obtained for all persons interviewed.

This study thus employed a full ABCD design and

matched reports of doctor visits at the visit level. However, the

records appear to have been diflicult to disa~egate, affecting

their completeness as verification data,

The RAND Health Insurance Experiment, as described by

Marquis et al. (10), included a record check of dental visits

reported in a l-year-recall interview. The record check was of

dentists named by survey participants as having been seen

during the year, as a “usual” dentist, or as seeing someone

else in the family. Thus, the design is nearly of the full

“ABCD” type. Vkit reports were matched at the persondentist pair level not at the event level.

The 1970 Center for Health Administration Studies—

National Opinion Research Center of the University of Chicago (CHAWNORC) survey collected information from a

national household sample on medical care utilization and

expenditures for a calendar year, using a single retrospective

interview (Andersen et rd. (11)). The medical providers named

by interview respondents were subsequently contacted for

4
verification data. Like the Loewenstein study, Marquis termed

this an “ABC” design. Matching of visit reports was at the

person-provider pair level not at the visit level.

The Medical Economics Study (12) examined the reporting of outpatient medical visits as well other utilization

measures using a variety of procedures. The procedures included

a series of interviews, either in person or over the telephone,

monthly or bimonthly over a 6-month period. The interviews

used the basic NHIS questions but added additional probes for

utilization and a diary after the first interview. Medical providers mentioned in the interview for which permission forms

were obtained were contacted for verification data. This design

is similar to the “ABC” type of the CHAS/NORC study

described previously. It is not clear from the cited article

whether data were matched at a person or visit level.

Cleary and Jette (13) employed a full design to evaluate

self-reports of ambulatory medical care utilization over a

l-year recall period. Their sample was drawn horn a rural

area, and nearly all possible medical providers in the area were

included in the verification. Medical providers outside the area

were excluded, as were some local providers mentioned by

very few survey participants. The sample included both HMO

members and fee-for-sewice patients. The design approaches a

full “ABCD” type. Vkit reports were matched at a person

level not a visit level.

Edwards, Berk, and Ward (14) compared reports of ambulatory medical provider visits from household interviews and a

medical provider verification survey in a 1986 NCHSsponsored evaluation of medical expenditure surveys. Their

primary purpose was to evaluate different verification and

matching strategies. The survey included two interviews,

covering a total reference period of about 6 months. Like the

preceding two studies, the design would be classified as

“ABC.” Vkits were matched both at a person-provider pair

level and at a visit level within person-provider pairs, using

only reported visit dates as an additional match criterion.

In examining the processes survey respondents use to

recall events and the effects of an experimental procedure

intended to improve recall, Means and Loftus (15) conducted

two studies of HMO members with three or more medical

visits in the year preceding an interview. For this population,

the study would constitute a full design for care received at the

HMO; however, appropriate to the purposes of the study, the

design would not capture overreports by persons without visits

in the record. Matching of visit reports was done at the visit

level for HMO office visits and emergency room visits, using

criteria similar to those of Cannell and Fowler described

earlier.

The next section describes the sample design and procedures for the I-DES. Some results from the studies described

previously are interspersed with results from the IDES in the

section that follows. Finally, the last section discusses the

HIES findings comparatively with previous studies and their

implications for the NHIS.

5
This section describes the methodology used to conduct

the Health Interview Evaluation Survey (HIES). A complete

description of the study design and the questionnaire may be

found in the NCHS Series 2 report, “Evaluation of National

Health Interview Survey Diagnostic Reporting” (l). Generally, the evaluation was designed to mimic the content and

procedures of the NHIS as closely as possible within certain

design and analytic constraints. The differences in design and

conduct between the HIES and the NHIS are presented in

table B.

Sample design

The HIES was conceived as a full-design records check

study. That is, following Marquis’ (5) typology described

earlier, the intent was to examine the reporting of chronic

medical conditions and medicrd utilization by interview respondents so both apparent interview overreports (cell Bin table A)

and underreports (cell C in table A) could be detected. Further,

the design was to allow interpretation of the absence of report

of a visit from both sources as agreement that no visit had

occurred. The study universe was members of Group Health

Association (GHA), a staff model health maintenance organization (HMO) in the greater Washington, D.C., area. The

sample was selected fkom persons associated with one urban

and one suburban medical center, and was restricted to individuals who had been GHA members for at least 3 years

before selection to maximize the completeness of participants’

medicrd records for the chronic condition analysis.

Because of cost considerations early in the planning of the

HIES, the target sample size was 1,000 self-responding adults

selected from the GHA membership rolls. Children were

omitted from this list sample because of their relatively low

prevalence rates of chronic conditions. Since the NHIS is a

household interview, HIES interview data were also collected

for other household members, including children, as well as

the list-sample persons. Many of these household members

were also GHA members. The total sample available for

analysis thus includes, in addition to the list sample, all such

household members who signed permission forms allowing

access to their GHA medical records and for whom records

were located. This group is called the “supplementary” sample

or “household members,” as distinguished from the “primary” sample or “list sample persons.” The study design was

further guided by the desire to evaluate interview reporting by

age, race, and sex.

The number of Federal employees in the list sample was

limited, and employees of G~ Westat, NCHS, and the U.S.

Bureau of the Census were excluded from the list sample.

List-sample persons came from two sources within GH.A

from the membership rolls, a general sample of membem was

selected as well as a sample of persons with records of

hospital stays; horn the ambulatory care appointment records,

persons with recent doctor visits were selected. These samples

were stratified by age, sex, and employer group (Federal

Government or not). Although some separate analyses were

planned for each of these subgroups, the intent was not to

create a fully crossed design for analysis but to ensure that the

distribution of list-sample persons would be uniform within

subgroups by other key characteristics.

Persons in older age groups were oversampled. The

sample was divided between two major age groups (persons

Table B. Comparison between National Health Interview Survey procedures and Health Interview Evaluation Survey design elements

Area National Health Interview Survey Practice Health Interview Evaluation Survey Ptvcedure

Sample frame Area probabilii nationally representative List of members of Washington, D.C., area health maintenance organization

Sample design Multistage selection, oversampling of areas with higher Disproportionate sampling by age, whather recent doctor visitor hespltal stay

proportion of black residents

Intewiew selection Census stat mostly experienced Weetat etafi many new hires

interview training Verbatim training by Census staff Verbatim training by Census staff

Data collection period Continuous survey cases targeted for 2-week field period Field work lasted 6 monthq cases targeted for 2-week field period

Contact procedures in person; seek household informant Telephone appointment allowed sample person only

Respondent selection Knowledgeable adult in household Sample person only

Questionnaire content Core and supplement(s) Modiied mre only

Data prepsration Census/NCHS staff rules for resolving discrepancies WeStat stafi same procedures except refer to questionnaire for reeoiving

discrepancies

6
Table C. Analytic sample by age and sex

List sample Supp/ementarj sample

Age Male Female Male Female

Number of persons

Alleges . . . . . . . . . . . . . . . . 460 545 310 393

0-17yeare . . . . . . . . . . . . . . – – 147 138

16-44 years . . . . . . . . . . . . . 145 164 69 104

45-84 years . . . . . . . . . . . . . 171 202 50 88

65-74 yeare . . . . . . . . . . . . . 85 108 30 41

75years andover . . . . . . . . . . 59 71 14 22

- Quantity zero.

1S-64 years and persons 65 years and over) so that each

subsample would be expected to yield at least 40 reports of the

10 most prevalent chronic conditions for that age group.

Within the younger group, persons 45-64 years of age were

selected at a higher rate than those in the general population to

increase the number of chronic condition reports expected for

the overall group. Equal numbers of males and females were

selected in each age group. Table C presents the actual distribution of the analytic sample by age and sex. The first two

columns represent list-sample persons, and the second two

represent household members.

Since a random sample of the GHA membership would be

unlikely to yield suilicient reports of doctor visits within the

2-week NHIS reference period for meaningful analysis, the

study design oversampled persons with recent ambulatory

visits. To identify persons with recent doctor visits, a sample

was drawn weekly from the encounter forms filled out for

each patient visit. GHA’s central records system provided the

sampling ilame for the remaining sample. The sample of

persons with recent doctor visits was fiuther stratified so that

approximately equal numbers of persons would be recalling

visits over given time intervals. Because the sampling groups

overlapped and the study was not intended to represent the

GHA membership, probabilities of selection were not crdculated and the sample was not weighted for analysis.

Table D presents the planned allocation of the list sample

by whether the person had a recent doctor visit or whether

he/she was selected for another reason (recent hospital stay,

general sample). The supplementary sample was expected

largely to fall in the “other” category.

The reporting of the number and timing of medical events

is subject to recall error of various kinds. ‘Rvo complementary

kinds of recall error are forgetting and “telescoping,” or

drawing in events from outside a reference period. In the

NHIS and HIES, the reference period for reporting of doctor

visits is the 2 calendar weeks preceding the week in which the

interview is conducted. Thus, telescoping could occur if a visit

from before the reference period was reported as within it

(forward telescoping), or if a visit during the interview week

was reported as occurring during the reference period (backward telescoping). The study design as described so far would

allow analysis of forgetting or of misplacing an event within

the reference period. It would not allow any meaningful

analysis of the extent to which telescoping atfects NHIS

Table D. Planned allocation of list-sample persons cooperating in

the Health Interview Evaluation Survey, by event history, age,

and sex

Persons with

All racent

Age and sex persons doctor visits Other

All age groups, both sexes . . 1,000 600 400

Age

18-44 years.. . . . . 292 175 117

4E-64years. . . . . . . . . . . . . . . . . . 375 225 150

65-74 years . . . . . . . . . . . . . . . . . . . . 200 120 80

75years and over . . . . . . . . . . . . . . 133 80 53

Sex

Male . . . . . . . . . . . . . . . . . . . . . . 500 300 200

Female . . . . . . . . . . . . . . . . . . . . . . . 500 300 200

reporting of medical visits. To analyze forward telescoping,

the sample of recent doctor visits was extended to include

patients who had visits just outside the reference period, in the

preceding 2 weeks. This strategy resulted in the allocation

presented in table E. Again, the categories are not mutually

exclusive, since persons may visit the doctor in both 2-week

periods.

The actual analytic sample was affected by practical

difficulties ininterviewing persons promptly. That is, persons

selected because of a doctor visit within the 2-week reference

period were often not interviewed in the week for which they

were designated. The reference period for such interviews thus

might no longer include the visit for which person was

selected. However, this problem was offset by adjustments in

the sampling procedures (described earlier) and by list-sample

persons with visits other than those for which they were

selected, so that the recent visit cell targets were virtually all

met or exceeded. Tables F and G present, respectively, the

actual list and supplementary samples available for analysis,

by event history as noted in the medical record.

The list sample cases were selected and fielded over a

period of weeks beginning in June 1990. Each week, a sample

of recent doctor visits and other samples were fielded. The

recent visit cases were stratified so that equal numbers were

Table E. Planned allocation of list-sample persons cooperating in

Health Interview Evaluation Survey, by event history revised to

analyze telescoping, age, and sex

Pereons with recent visits

All o–2 24

Age and sex persons weeks weeks Other

All age groups, both sexes . . . . 1,000 400 200 400

Age

l&44years . . . . . . . . . . . . . 292 117 58 117

45-84 years . . . . . . . . . . . . . 375 150 75 150

65-74 years . . . . . . . . . . . . . 200 80 40 80

75years And over . . . . . . . . . . 133 53 27 53

Sex

Male . . . . . . . . . . . . . . . . . . 500 2oil 100 200

Female . . . . . . . . . . . . . . . . 500 200 100 200

7
Table F.Actual number of list-sample persons available for

analysis, by event history according to the medical record, age,

and sex

Persons with recant visits

Ail o-2 24 weeks but

Age and sex persons weeks not O-2 weeks Other

All age groups, both sexes . . . . 1,005 433 233 339

Age

18-44 years . . . . . . . . . . . . . 309 116 77 116

45-64 years . . . . . . . . . . . . . 373 164 73 136

65-74 years . . . . . . . . . . . . . 193 66 50 57

75yearsand over . . . . . . . . . . 130 67 33 30

Sex

Male . . . . . . . . . . . . . . . . . . 460 167 114 159

Female . . . . . . . . . . . . . . . . 545 246 119 160

Table G. Actual number of supplementary-sample persons

available for analysis, by event history according to the medical

record, age,and sex

Persons with reoent visits

All o-2 2-4weeksbut

Age and sex parsons weeks not O-2 weeks Other

Allagegroups, both sexes . . . . 703 103 79 521

Age

3-16years . . . . . . . . . . . . . . 285 29 35 221

16-44yeara . . . . . . . . . . . . . 173 21 12 140

45-64yeare . . . . . . . . . . . . . 136 27 24 67

66-74years . . . . . . . . . . . . . 71 14 6 51

75yearsandover . . . . . . . . . . 36 12 2 22

Sex

Male . . . . . . . . . . . . . . . . . . 310 40 38 232

Female . . . . . . . . . . . . . . . . 393 63 41 269

from theprevious week and from the week before, and equal

numbers were ffom each ofthepreceding 2weeks. Thus, each

interview wave included members from all sampling cells,

with the timing of recent visit groups spread across the

reference periods and the extended reference periods for

analysis of telescoping. Interviewers were expected to complete their assignment in each wave within 1 week however,

as described earlier, many cases in each wave slid into the

second week or later. NHIS rules show that such “holdover”

cases have the reference period updated to the 2 weeks

preceding the interview week the FIIES followed this procedure. The adjustment of selection rates during the field period

meant that more persons than originally anticipated were

selected in the “recent doctor visit” group.

Interviews were conducted with list-sample persons and

any household members who happened to be present. Following NHIS procedures, proxy responses were obtained for other

household members not present during the interview. At the

conclusion of the interview, list-sample persons and any

household members also belonging to GHA were asked for

written permission to abstract information from medieal records.

Table H presents the cooperation rates for list-sample

persons at each stage of the locating, interviewing, and

permission form process. The refusal rate was higher than

anticipated (all interviews were conducted in metropolitan

Washington, D.C., a traditionally diflicult area in which to

interview), but the locating and permission form rates were

higher than expected. Ineligible persons included those who

had died, moved from the Washington area, or ended their

GHA membership.

From the households of the 1,017 “usable cases,” an

additional 773 household members 18 years of age or over

signed permission forms to allow access to GHA records. Of

these, 11 were not GHA members, 5 refused to sign second

permission forms required by G~ and medical records were

not located for 54 persons. Thus, 703 supplemental sample

persons were available for analysis. Other identified household

members not included in the analysis are those under age 18,

non-GHA members, persons in households where the listsample person refused to sign a permission form, and persons

refusing or unavailable to sign a permission form.

Data collection

The selected GHA members were administered the NHIS

Core questiomaire, with several modifications. Although the

sampled GHA members were selected as individuals, the

Table H. Number and percent of initial draw and response rates for Health Interview Evaluation Survey by utilization group

Utilization group

Recant

Item

Recant No recant

Total doctor visit hospital stay utilization

Initial draw...............,.. . . . . . . . . . . . . .

Locrrting rate(in percent) . . . . . . . . . . . . . . . . . . . . . .

Numbarlocatad . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ineligible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interview requested . . . . . . . . . . . . . . . . . . . . . . . . . .

Interview response rate (in parcant) . . . . . . . . . . . . . . . .

Permission form requested . . . . . . . . . . . . . . . . . . . . .

Cooperation rate for permission forms (in percent) . . . . . . .

Usable cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,615

95

1,640

130

1,410

76

1,077

94

1,017

1,132

96

1,080

70

1,020

76

775

94

726

277

93

258

34

224

7a

174

95

166

206

93

192

26

166

77

128

95

123

NOTE Twehe add~sl saseswars droppedbecausethsy refusedto signa eesondperrnlssioirformrequiredby GroupHeakhAssociationforcerfeh pathfe.

8
NHIS questionnaire is a household interview. Thus, the interview included the households of the sampled individuals.

Three kinds of changes were made to this core interview for

the HIES:

. The six categories under “Condition lists” in Section H

were abridged and condensed into one list asked of every

respondent

. To assist in matching visits reported by household respondents with visits in the medical records, questions on the

location of each visit were added to the “Doctor visits

details” section.

. The HIES household composition put the list-sample

person in the first column and collected relationships to

this person.

The HIES questionnaire maybe found in appendix I.

All HIES interviewers were trained as if they were new

interviewers for the NHIS. An experienced Census trainer

conducted the session, using NHIS materials.

The HIES included two advance contacts by mail. The

first was a letter from GHA mailed to all members at the two

selected medical centers. It gave a very brief description of the

research and included a postpaid return postcard for members

to return if they did not want their name released. The second

letter, from the Director of NCHS, was sent to persons

selected for an interview.

Unlike NHIS procedures, in which interviewers approach

addresses from an area probability sampling frame, intewiewers contacted HIES sample members directly, having knowledge of their names. The initial contact was made by telephone

(when a phone number was available). HIES required the

sample person to be present for the interview. Other family

members present could respond for themselves; the sample

person answered for family members not present.

Following the interview, the interviewer asked all GHA

members in the family (and parents for children) for written

permission to review their medical records. Medical records

were obtained for most list-sample persons and other household members who signed permission forms.

Abstracting of participants’ medical records was done

from photocopies of the past 3 years’ hard-copy records. The

abstracting identified all doctor visits within the 4 weeks

before the interview. Abstracted information included the date

of the visit, the provider (GHA or not), the type of visit within

GIL% and conditions reported on the visit encounter form.

Telephone calls for advice or prescriptions were also recorded

in the medical record and information about them was

abstracted. Those forms are shown in NCHS Series 2, No. 120

(l).

Matching interview and medical record

reports

The process for matching interview and medical record

reports of 2-week physician contacts included several steps.

Table J summarizes the results of these steps, which are

described in the following text.

Step 1. Several rules were devised to begin matching

reported contacts between the two sources

Contacts would be matched only within provider (GHA

vs. non-GHA) and type (telephone vs. in-person), that is,

GHA visits with GHA visits and so on.

If one source reported more than one contact of a given

type and provider on the same date, only one would be

considered for the initial match.

If the medical record and interview reported the same

number of contacts for a given provider and type, all

contacts of that provider and type from both sources

would be considered matched.

If one source reported contacts and the other reported none

for a given provider and type, all reported contacts of that

provider and type would be considered nonmatches.

These rules ignored the date of contact as a match

criterion (so long as the contact was within the 2-week

reference period), and did not attempt to match contact by

contact. That is, if the interview and medical record each

reported two GHA visits in the 2-week period, all would be

considered matched, but no effort was made to identify

matching pairs. These rules were programmed and applied to

the interview and medical record files. As shown in table J,

430 contacts were matched in each file, while 353 contacts in

the medical record and 389 contacts in the interview file were

determined not to match. The remaining visits included those

for persons with unequal, nonzero numbers of visits from the

two sources, and duplicate visits (the second and any subsequent visit of the same provider and type on the same date).

Table J. Results of matching intsrvisw and medical record reports, by steps

Medical Household

Steps record Normatch Match interview Nonnrafch Match

Total repotted . . . . . . . . . . . . . . . . . . . 1,072 447 625 1,141 516 625

1, Fket automated match’ . . . . . . . . . . . . 783 353 430 819 389 430

2. Second automated matchz . . . . . . . . . . 179 71 108 168 60 108

3. Manual match . . . . . . . . . . . . . . . . . . 110 39 71 154 83 71

4. Crossover match . . . . . . . . . . . . . . . . . . . -16 16 . . . -16 16

. . . Category notapplicable.

NOTESeven medical record rsporta and 31 Intewkaw repark wers missing information on type of omfsot.

‘Remaining ffret automated match wes 305 for medical record and 322 for household interview.

‘Remaining aacond automated match waa 110 for madloal record and 1S4 fw hauaehold intem”aw.
Step 2. The second matching pass matched remaining

contacts of the same provider and type with the same date in

both files, An additional 108 matches were identified, with an

additional 71 reports from the medical record and 60 from the

interview being classified as nonmatches.

Step 3. The remaining contacts (those not classified as

match or nonmatch in the first two passes) were reviewed

manually, as were all cases with multiple contacts of the same

type on the same day (duplicates). The manual review considered date of contact, reason for contact, and name or type of

provider. Fifteen duplicate contacts were matched that is, both

the interview and medical record showed more than one

contact on the given day. Three contacts with missing dates in

the medical record were matched to interview-reported contacts. In addition, 53 contacts were matched for persons with

unequal numbers of contacts from the two sources. The

remaining 39 contacts in the medical record file and 83

contacts in the interview file were considered nonmatches.

Step 4. The manual review showed some misclassiilcation

of visits by interview respondents; that is, some contacts

reported as non-GHA were recorded in the medical record as

GHA contacts. This typically occurred when a person was

referred to a GHA provider practicing outside a GHA medical

center. About fifteen visits and one telephone call were

matched across providers. Also, some visits reported in the

interview may have been coded as telephone contacts in the

medical record. This would occur when, for example, a person

showed up at a medical center for renewal of a prescription.

Since there was inadequate documentation to justify individual

match decisions of this type, any such misclassification remained

as nonmatches.

Step 4 and to some extent step 3 represent tenuous

extensions of matching logic. While it is highly likely that the

matches made in step 4 are “true” matches, additional “true”

matches across visit types may have been missed because of

lack of information. Multiple visits on the same day (matched

in step 3) may be perceived quite diEerently by medical staff

and patients, so mismatches of this type may not be “fair” to

interview respondents. However, the net effect of these matching decisions was small, and does not affect analyses that

follow. Hence, all data presented will include matches made at

each step.

10
Overview of presentation of results

The HIES sample, as described in the previous section,

was not desi~ed to produce estimates for any particular

population. The sample is not representative of the GHA

membership, nor is the GHA membership representative of the

population of the greater Washington, D.C., area. Thus, the

data presented in this report are unweighed, that is, there are

no adjustments for differing probabilities of selection or for

nonresponse. To the extent that idiosyncrasies of the sample

are known (for example, universal access to care, overrepresentation of older persons), these are considered in the

analysis and discussion of the results. Care should be taken in

making inferences from the study findings to another survey,

such as the NHIS, since the methodology is di17erent. However, it still provides a useful guide for the accuracy of doctor

visit reporting.

Mere t&ts of statistical significance (Chi-square, z) are

used, they are applied to comparisons of subgroups within the

HIES sample. It is not appropriate to infer from these tests that

similar differences would appear in any other survey sample.

The analysis presented here draws heavily from previous

record-check studies of doctor visit reporting, most of which

have similar limitations of generalizability. Where consistent

findings occur across studies, one can be more confident in

suggesting that a response effect may be present in the NHIS.

2-week contacts in the interview and

medical record

Physician contacts reported in the HIES interview and

recorded in the medical record were classified by provider

(GHA or non-GHA) and by type of contact (telephone or

~

in-person), creating four categories, The agreement between

interview and medical record reports for each category is

examined both at the person level and at the contact (visit and

call) level, This section describes aggregate agreement between

the data sources, while subsequent sections examine the

results of matching, first at the person level and then at the

contact level.

Table 1 shows the number of persons with 2-week contacts reported by each source by sample type, the total number

of contacts, and the mean number of contactsper person.The

sample types comprisethe followingcategories:

● Li.w-sample persons are those selected from the GHA

membership roles and appointment schedules, as described

●

●

●

in the “Methods section, sample design.” All list-sample

persons were self-respondents.

Household members, present, are those persons in the

household of list-sample persons who were GHA members

present for the IDES interview.

Household members, not present, were GHA members not

present for the HIES interview.

Household members, under 1Z were GHA members not

allowed to respond for themselves by NHIS rules. It

should be noted that in these analyses, one list-sample

person was categorized as a household member present.

Overall, for 532 persons, or 31 percent of the entire

sample, GHA visits within the 2-week reference period were

noted in the medical record. The bulk of these persons, and

visits, was from the list sample, which is not surprising given

that the list included a heavy oversimple of persons with

visits. Household members under 17 had the fewest visits per

person. The medical record indicated about the same rate of

visits (18 percent) for adult household members whether present

for the interview or not, but in the interview, visits were

reported by twice as many household members who were

present as for household members not present (23 percent

versus 11.5 percent, respectively). The mean number of visits

per person in the medical record was also identical (0.25) for

household members whether present or not, but in the interview the rate was greater for household members present

(0.32) than for those not present (0.18). These differences

suggest a proxy reporting effect, which will be explored

further in a subsequent section.

Telephone calls to GHA (also shown in table 1) followed

very similar patterns to GHA visits: most were for list-sample

persons, very few were for children, and interview reporting

was noticeably less for adult household members not present

during the interview than for those present, although the latter

numbers are very small. Overall, fewer telephone calls were

reported in the interview than were present in the medical

record, suggesting that such calls may be very easily forgotten.

Very few non-GHA visits were recorded in the medical

record, particularly compared with the number reported in the

interview. In many cases, the record indicated a referral to or

ongoing treatment by a non-GHA provider, but specific visit

dates were not noted. The medical records included no notations of telephone calls to non-GHA providers and only six

were reported in the interview. Because of the lack of documentation of non-GHA visits in the medical record and the

11
very small number of non-GHA telephone calls, most analyses

will examine only GHA contacts (visits and telephone calls).

Person-level results of matching

Table 2 presents a person-level summag of the match

between the medical record and interview report for the GHA

visits and telephone calls by four categories of survey participant, according to their sample selection status and their

presence during the interview. After a review of other studies’

findings on person-level match rates, this section will describe

table 2 results in detail.

Most of the previous studies cited earlier with 2-week

reference periods present only visit-level data. Balamuth et al.

(2), who did present person-level data, found that 64 percent

of persons with one or more visits in the medical record had

some visit reported in the interview, a lower number than that

obtained in the HIES. (The design of the Balamuth et al. study

did not permit calculation of the rate of confirmation of

interview-reported visits.)

Among studies with longer reference periods reporting

person-level data (all studies cover at least one year), Loewenstein (8) found that 89percent of persons with medical record

visits had some visit reported in the interview and Madow (4)

found 94 percent of persons in this category. Loewenstein’s

study showed confirmation in the medical record for 86 percent of persons for whom a visit was reported in the interview

Madow found 95 percent of persons in this category and

Andersen et al. (16) 87 percent. Cleary and Jette (13), in

contrast, found only 65 percent of persons with visits in the

medical record had some interview report and 71 percent of

persons with reported visits had confirmation in the medical

record. The dMerences among these studies are in part attributable to differences in sample selection (studies selecting

known utilizers tend to have higher rates of agreement at the

person level), survey procedures, and the content of and

procedures for using medical record data.

Group Health Association visits

Table 2 shows that between the intemiew and medical record

the number of persons reported as having GHA visits are

comparable. Overall, about 78 percent of the persons reported as

having one or more visits from the medical record were also

reported as having at least one visit in the interview. Almost the

same proportion of interview reports were confirmed by the

medical record. Thus, there is no evidence of general net over- or

underreporting of GHA visits at the pemcmlevel,

However, some indications of differences appear for other

household members (nonsample persons). The most notable

departure horn the general pattern is for household members

not present during the interview, that is, adults with proxy

respondents. Although the number of visits is small, less than

half of the persons in this group with visits in the medical

record had visits reported in the interview. The difference

between the proportion of medical record visits reported in the

interview for household members present for the interview

(84.4 percent) and the proportion for those not present (46,9 percent) is statistically significant (z=3.00, p<.01), The GHA

visit, medical record report table is also significantly different

from that expected (Chi-square=19.96, df=3, p<.001), mairdy

due to the poorer reporting for household members not

present. This difference suggests some underreporting for

adults by proxy respondents. The generalizability of this

finding is unclear because the proxy respondents (almost all

list-sample persons) were not selected according to NHIS

procedures and many more of them had visits of their own to

report than typical NHIS respondents.

For adult household members present during the interview and for children, on the other hand, the interview shows

about 25 percent more people with GHA visits than does the

medical record. The proportion of present adult household

members with visits is 23 percent from the interview (57 out

of 248 persons) versus 18 percent from the medical record (45

out of 248), while for children it is 11.4 percent (31 out of

273) versus 9.1 percent (25 out of 273). These differences are

not statistically significant, however.

Other household members reporting for themselves and

persons reporting for household members under 17 were more

likely than list-sample persons to report having had a GHA

visit when the medical record indicated one or more visits

(84.4 percent for adult household members and 88.0 percent

for household members under 17 versus 78.1 percent for

list-sample persons). These members were also more likely to

report having had a visit when the medical record did not

include one. The difference between list-sample persons and

household members reporting for themselves in proportion of

interview-reported visits confirmed by the medical record

(79.6 percent versus 66.7 percent, respectively) is significant

at the .05 level (2=2.21).

These differences in reporting between the adult household members and the list-sample persons may be due to the

higher rarity, and perhaps greater salience, that physician visits

have for the former group. That is, because they had less to

report than the list-sample persons, there may have been more

of a tendency for household members to “telescope” in visits

from outside the reference period. This hypothesis was first

advanced by Carmen and Fowler (6) when comparing reports

of visits between one group of persons selected because of

known visits and a second group of whom about one-third had

visits. One may argue that HIES household members are more

like the typical NHtS participant than the list-sample persons,

and thus these tendencies may be particularly important in

interpreting the results for list-sample persons. Further exploration of telescoping will be presented in a later section.

Non-Group Health Association visits

Only nine persons were reported in the medical record as

having non-GHA visits in the 2-week reference period, as

opposed to 83 in the interview. As described earlier, about 15

non-GHA visits reported in the interview were “matched”

with GHA visits in the medical record, showing a disagreement between the two sources about classifying visits. For

other persons, the medical record indicated that they were

being treated outside GH& but did not give specific visit

12
dates. Other interview reports appeared to indicate out-of-plan

use, such as nonphysician specialties and for out-of-town care.

Therefore, the medical record does not seem to provide

adequate verification for these visits.

Group HealthAssociationtelephonecalls

The GHA medical record includes notation of telephone

calls made about the patient. Only about one-third of the

list-sample persons with calls noted in the medical record had

calls reported for them in the interview. The numbers of

household members with calls are small, but the proportion of

interview reports are even lower than for list-sample persons.

On the other hand, almost 60 percent of the persons for whom

calls were reported in the interview had the reports confirmed

by the medical record, with lower proportions for household

members, These findings indicate a notable underreport of

telephone calls in the HIES interview.

Non-GHA telephone calls

These contacts are not recorded

records, and the interview produced

in the GHA medical

only five reports. No

analysis of this contact type will be offered. -

Contact-1evel match

Table 3 presents the match results at the contact (visit and

call) level. Whereas table 2 and the previous section examined

whether one or more contacts of a particular type (GHA or

non-G~ visitor call) were reported for a person, this section

examines the match for all contacts reported. Contacts were

matched within type (with certain exceptions described earlier), and globally within person. That is, if both the medical

record and the interview showed two GHA visits, all were

considered “matched,” without regard to which interview

report matched with which contact in the medical record.

As shown in table 3, the pattern of reporting for GHA

visits is very similar to the person-level figures of table 2:

nearly identical levels of reporting between the interview and

medical record for list-sample persons, with evidence of

underreporting for adult household members not present during the interview, and slight overreporting for other household

members. Rates of confirmation for interview reports are

lower than those at the person level for all groups, suggesting

that visits by persons with multiple reports in either source

may be less likely to match than those of persons with one

visit in the reference period, This possibility will be examined

further in the following section. The similarities between

contact-level and person-level figures hold for non-GHA visits

and GHA telephone calls as well.

One minus the “percent reported in interview” is also

referred to as “percent underreport,” and one minus the

“percent confirmed by medical record” as “percent overreport.” These terms imply that the medical record represents

truth, which is contestable. However, the medical record does

provide a standard against which to evaluate the interview

report, and the measures of overreport and underreport are

useful in comparing record-check studies.

Among other studies using a 2-week reference period,

Cannell and Fowler (6) found an underreporting rate of

23 percent for adult self-respondents, as compared with that of

the HIES for list-sample persons (28 percent) and household

members present for the interview (23 percent). Feather (9)

found only a 14 percent underreporting rate (16 percent for

adult self-respondents and 9 percent for children with adult

proxy respondents), but an initial 46 percent overreporting rate

(48 percent for adults and 39 percent for children). Further

investigation reported by Feather of the apparent overreports

showed that nearly half were probably attributable to the

nature of the records. Applying this analysis to the rate (not

calculated by Feather) of overreporting reduces it to about

26 percent. The HIES overreporting rates are 29 percent for

list-sample persons, 41 percent for household members present

for the interview, and 32 percent for children. Except for

Feather’s underreporting rate, which is suspect because of the

records, these results are consistent across the 2-week studies.

Cartwright (7), describing a study with a bounded 4-week

reference period (“bounded” here means that one interview

was conducted at the beginning of the reference period, a

second, to obtain the reports of physician contacts, at the end),

found both underreporting and overreporting from adult selfrespondents to be about 21 percent. Sudman et al. (17), using

a combined interview and diary procedure with a 3-month

reference period, found an overreporting rate of 24 percent

and an undeneporting rate of 17 percent. Edwards, Berk, and

Ward (14), reporting on a study with two interviews each

covering about a 3-month reference period (with a diary used

by some respondents between the first and second interviews),

found overreporting rates of about 24 percent when comparing

only numbers of visits, and of between 30 and 40 percent

when individual visits were matched between the interview

and medical record. These studies suggest that the expected

effects of a longer reference period on accuracy of reporting

may be mitigated by using diaries and recall bounding. The

Medical Economics Study (12), using repeated interviews

with both 1- and 2-month intervals, found an underreporting

rate of about 34 percent, with the l-month interval showing

about a 7 percent improvement over the 2-month interval.

Means and L&us (15), in a pair of studies exploring the

cognitive processes of recall of medical visits (including

hospital stays), found rates of underreporting and overreporting in excess of 50 percent with conventional questionnaires

using a l-year reference period. When supplementing the

traditional questions with a more detailed set of questions, the

underreporting rate dropped from 59 to 37 percent, and the

overreporting rate from 36 to 27 percent. Persons receiving

only the more detailed questions had an underreporting rate of

43 percent and an overreporting rate of 38 percent. This study

suggests that the use of cognitively-based questionnaire design

may increase the accuracy of reporting of medical visits.

Reporting number of visits in 2-week period

Tables 4 and 5 show the distribution of list-sample

persons and household members, respectively, by number of

2-week visits reported from the interview and from the

13
50

[

- US sample persons = Household membeffi

“-5 -4 -3 -2 -1 0 1 2 3 4 5

Medical record minus interview

Figure 1. Agreement on number of visits

medical record. Most people cluster along the diagonal representing agreement between the two sources. Figure 1 presents

the same data in another way. For all persons with one or more

visits reported by either source, it shows the proportion of

persons according to the difference in number of visits between

the two sources. For both list-sample persons and household

members, more than 40 percent of persons with visits had the

same number reported by both the interview and medical

record, while for both groups 89 percent either agreed or were

off by one visit, The symmetry of figure 1 indicates that for

both sample groups the over- and underreporting are distributed similarly.

Another view of the symmetry of this distribution is

presented in tables 6 and 7. For list-sample persons, the more

visits in the medical record, the more likely the interview is to

underreport the number (25 percent for one visit, 48 percent

for two, and 82 percent for three or more). However, for O-2

visits in the record, the overreporting rate stays nearly constant

(12-15 percent). Conversely, the more visits are reported in

the interview, the more likely that the number is an overreport

(22 percent for one visit, 50 percent for two, 68 percent for

three or more). From the perspective of interview reporting,

the overreporting rate stays constant (12–16 percent). Nearly

identical patterns hold for household members, although the

“constant” rates are lower (6-9 percent overreporting from

the perspective of medical record reports and 4-12 percent

underreporting from the interview standpoint) than for listsample persons, and the escalating error rates rise more

steeply. The last observation may be due to proxy reporting for

some household members. This evidence indicates that if one

were to consider household interview data only (from the

NHIS, for example), the expected rate of underreporting may

not be related to the number of visits reported.

Cartwright (7) presents a table much like tables 4 and 5,

and from it can be derived the information in table 8. Cannell

and Fowler (6) present similar data for underreporting only,

14

which is also shown in table 8. Cartwright’s data look similar

to those from the HIES, except a jump in overreporting for

persons with three or more visits in the medical record

(23.6 percent) as opposed to persons with fewer visits (4.6-

8.2 percent). The data from Cannell and Fowler, on the other

hand, do not parallel those of the HIES. They show a decline

in underreporting against the medical record the more visits

the sample person had the decline is more pronounced when

considering visits reported to a standard question plus special

probes than to the standard question alone. Like the H(ES and

Carhvright findings, Feather (9) and Cleary and Jette (13)

found more underreporting for persons with more utilization

during the reference period, according to the medical record.

Effects of timing of interview and physician

contact on reporting accuracy

The NHIS 2-week doctor visit reference period, also used

for the IDES, runs through the Sunday immediately preceding

the day of interview and begins on the Monday 2 weeke

earlier. Thus, if the interview is conducted on a Monday, the

2-week reference period runs until “yesterday.” If the interview is conducted on a Saturday, there are 5 intervening days,

This design raises several questions about the effects of recall

on reporting accuracy. The first set of questions concerns the

likelihood of respondents to report physician contacts that

actually (according to the medical record) occurred, or, conversely, the likelihood of underreporting. Are contacts in the

second (later) week of the reference period more likely to be

reported than those in the first (earlier) week because respondents are more likely to forget the earlier visits? Do interviews

conducted later in the interview week lead to poorer reporting

than those conducted earlier in the interview week because

more time has elapsed since the contacts?

The second set of questions concerns the likelihood that

interview-reported visits actually occurred, or, conversely, the

likelihood of overreporting, For example, how likely are

survey respondents to “telescope” contacts into the reference

period, either from before, or, for interviews conducted later in

the interview week horn after the reference period?

Underreporting

Table 9 presents data related to the first set of questions.

The first column shows the days of the 2-week reference

period, arrayed from earliest (top) to most recent. The second

column shows the number of GHA visits recorded in the

medical record for HIES list-sample persons on each day of

the reference period. The third column gives the percentage of

these visits matched with an interview-reported visit. Overall,

almost 77 percent of the second-week visits were matched, as

opposed to 63.5 percent of the first-week visits, a statistically

significant difference (z=3.61, pc.01. Within the first week

there is no particular pattern of reporting accuracy. In the

seeond weelq the more recent visits are slightly better reported

than the earlier ones, but the pattern is not statistically

significant. Very few visits were made Saturday or Sunday of

either week (days 6, 7, 13, and 14).
The next pair of columns in table 9 shows the same

information for household members. The differential between

reporting of week 1 andweek2 visits for household members

(59.7 percent versus 72.6percent) is very similar to that for

list-sample persons. Thenumbers ofvisitsby day for household members are too small to support meaningful interpretation. Thus, there may be more forgetting of visits in the earlier

week of the reference period but the data present no evidence

for day-by-day “memory decay.”

Cannell and Fowler (6) found a similar pattern of underreporting between weeks of the reference period. Of visits in

the medical record for the earlier week, 70 percent were

reported in the interview; for the later week, 85 percent were

reported in the interview. The authors believe forgetting may

not be the dominant problem and that confusion about the

reference period and “deliberate” misdating of events out of

the reference period may be other important factors. However,

Feather (9) found that only 13 of 380 visits (3.4 percent) in the

medical record for a 2-week reference period were reported as

occurring in the week before the interview, suggesting that

deliberate “backward telescoping” is not common.

The HIES pattern of better interview reporting in the

second week does not hold for telephone calls. The numbers

for list-sample persons are shown in the last two columns of

table 9, with 29 percent of first week calls matching an

interview report and only 28 percent of the second week calls

matching. Household members had too few telephone calls for

analysis.

Table 10 presents the same statistics as table 9, but by the

day of the week the interview took place for GHA visits and

GHA telephone calls, respectively. For sample persons and

household members, and for GHA visits and GHA telephone

calls, a similar pattern holds: reporting in the interview is

consistent on weekdays across the wee~ but drops off on

Saturday and Sunday. For GHA visits, the percentage of visits

in the medical record reported in Saturday and Sunday interviews combined drops to 59 percent from over 70 percent on

weekdays for list-sample persons (2=3,19, PC.01), and to 57

percent on Saturday and Sunday from nea~ly 70 percent on

weekdays for household members (z=l.46, ns). For GHA

telephone calls, the weekend interview rate (17 percent) is half

the weekday rate (34percent) for list-sample persons, and

none of the 10 GHA telephone calls in the medical record for

household members was reported in a weekend interview

while 29 percent were reported in weekday interviews.

Overreporting

Thming to the interview report, table 11 presents the

number of GHA visits reported and the percentage of interview reports confirmed by the medical record, by week and

day of the reference period on which the respondent said they

occurred, The percentage confirmed by the medical record was

lower for the first week (67.9 percent) than for the second

week (71.9 percent) for list-sample persons, but higher in the

first week for household members. Thus, this table does not

present any conclusive evidence about the tendency of respondents to “telescope” from outside the reference period by

what part of the reference period in which a visit was reported

as taking place.

In table 12, we see the percent of interview reports

confirmed by the medical record remaining constant across the

days on which the interview was conducted. Apparently, net

telescoping from outside the reference period is unaffected by

the length of time between the end of the reference period and

the date of the interview.

Table 13 presents another view of possible telescoping

from outside the reference period. For list-sample persons,

table 13 shows the number of persons with GHA visits in the 2

weeks before the reference period and in the time between the

reference period and the date of interview, by person-level

match status. “Match status” means the type of agreement or

disagreement between the interview and medical record on

whether the person had a GHA visit or not (regardless of the

number) in the reference period. Just over half the overreports

had visits in the prior 2 weeks, about five points more than

persons with positive matches. Thus, if one assumes that

overreports and positive matches would be equally likely to

have a visit in the prior 2 weeks, telescoping horn the prior 2

weeks would explain only about 5 percent of the overreports,

with the remainder due to telescoping from farther back or

other causes. Cartwright (7) found that 47 percent of overreporting persons had a visit in the medical record 1 month or

less before the reference period, a figure similar to the

51 percent in table 13; these numbers probably represent an

upper bound for the proportion of overreports due to forward

telescoping. Feather (9) attributed about 23 percent of “true”

overreports (visits) to telescoping from the week immediately

preceding the reference period.

Camell and Fowler (6) report on apparent telescoping at

the visit level. Of visits from the 2 weeks before the reference

period, 2 percent were apparently telescoped in by one sample

(persons selected because of one or more visits), while 6 percent were telescoped in by the general sample. The Cannell

and Fowler study does not present totals of overreports. They

suggest that persons without a visit in the reference period

may be more prone to telescope than those with a visit to

report.

Looking at the columns in table 13 for visits in the time

after the reference period but before the interview, only

8 percent of the persons overreporting had visits, the same

percentage as the negative matches and half the rate of the

people with a 2-week reference period visit (positive matches

and underreports). Thus, backward telescoping into the reference period may not be a particular problem in reporting of

2-week doctor visits.

Telescoping within the reference period

Comparing the weekly totals between tables 9 and 11 for

list-sample persons, there was an interview net underreport of

about 7 percent in the first (earlier) week as compared with the

medical record (293 visits versus 315 visits), and a net

overreport of about 2 percent in the second week (302 visits

versus 295 visits). For household members, the Week 1 net

15
underreport was 6 percent (68 versus 72 visits), and the Week

2 net overreport was 15 percent (73 versus 62 visits). These

differences could indicate forgetting of the earlier visits or

reporting of Week 1 visits as if they were in Week 2 (forward

telescoping), Backward telescoping from Week 2 to Week 1 is

also possible.

Looking at 241 list-sample persons and household members with one and only one visit reported in both the interview

and medical record (data not shown in a table), 7 percent of

Week 1 visits were apparently reported in the interview as

Week 2, and 10 percent of Week 2 visits were apparently

reported as Week 1. “Apparently” is appropriate because the

reported visit may not have been the same as the one in the

medical record. However, this analysis does show the magnitude of week-to-week telescoping, and suggests that backward

telescoping was more common than forward telescoping. This

rate of backward telescoping is higher than the 3,4 percent

reported by Feather (9) mentioned in the previous section, and

again suggests that Cannell and Fowler’s hypothesis of backward telescoping may explain some portion of the higher

Week 1 underreport.

Differences in reporting by respondent

characteristics

Table 14 presents the agreement on 2-week doctor visits

between interview and medical record reports by person

characteristics for list-sample persons only. These persons

were all self-responding adults. The person characteristics

reported on here are different from those for which NHIS

statistics are published because of idiosyncrasies in the HIES

sample. For each set of characteristics, table 14 presents

percent of medical record contacts reported in the interview,

percent of interview reports confirmed by the medical record,

and the net overreport, defined as the difference between the

interview reported contacts and medicrd record contacts divided

by the number of contacts in the medical record.

The youngest group of list-sample persons, those 18-44

years of age, was the least likely to underreport (81 percent of

medical record contacts reported in the interview) and the

most likely to overreport (71 percent of interview reports

cofirmed by the medical record). The latter finding is statistically signiilcant for the sample at the .05 level. These two

tendencies led to a net overreport of almost 14 percent by the

youngest age group, as opposed to net underreports by the

older age groups.

Men (72 percent of medical record visits reported in the

interview) were more likely than women (84 percent) to

underreport, a significant difference, and were more likely to

overreport. Men had a net underreport of almost 9 percent,

while women had a net overreport of 4.5 percent, There were

virtually no differences in reporting by race of respondent.

Persons in lower-income families (under $20,000) were

least likely to underreport (ahnost 84 percent of medical

record visits reported in the interview) and most likely to

overreport (76 percent of interview reports were confirmed by

the medical record). Persons in families with incomesbetween

$30,000 and $50,000 had the opposite pattern. Although

neither of these patterns was statistically significant, the

lowest-income persons had a net overreport of 10 percent,

while those in the next-to-highest income category had a net

underreport of almost 10 percent.

List-sample persons with the most education (college

graduates) were least likely to underreport (86 percent of

medical record visits were reported in the interview), while

persons with less than a high school education were the least

likely to overreport (87 percent of interview reports were

confirmed by the medicrd record). The former finding was

statistically significant at the .05 level. The combination of

these two trends led to a net underreporting of 9 percent

among the least educated and a net overreporting of almost

11 percent by the most educated.

There were no significant differences in reporting by

employment status, either among persons under 65 or over 65

years of age, although in three out of four pairs the employed

reported better than the not employed. Employed persons over

and under 65 years of age had virtually the same net underreport (’just over 1 percent) while among those not employed,

persons over 65 years of age had a net 6 percent overreport

and persons under 65 years of age had a net 7.5 percent

underreport. Comparing list-sample persons by self-reported

health status, there was a trend for those in poorer health to

underreport less.

Table 15 presents a summary of significant dfierences in

reporting ambulatory medical visits by respondent characteristics across studies. Generally, the findings are scattered and

inconsistent. One consistent finding (HIES and two other

studies) is that women are less likely to underreport doctor

visits than men. A finding of two other studies, Andersen et al.

(11) and Cleary and Jette (13), shows that persons with poorer

health status are more likely to overreport was not confirmed

by the IIIES, although the health status measures differ across

the three studies. Several studies find differences by age of

respondent, although the results are inconsistent. Feather’s (9)

finding that older women had less underreporting than younger

women was inconsistent with three other studies where advancing age was associated with more underreporting, although the

other findings included both men and women. Feather’s

finding that persons 65 years of age and over overreported less

was inconsistent with the finding of Andersen et al. (11) that

households, including persons 65 years of age and over, had

more overreporting but somewhat consistent with the I-DES

finding that persons 18-44 years of age overreported more

than older persons.

16
Discussion

Both the reporting and the verification of ambulatory

medical visits are subject to various kinds of error. As

described by Marquis (5), comparing aggregate totals from

interview and medical record reports is insufficient to determine the nature and extent of reporting error. Both sources of

data are subject to error and the sources often differ on how

“visits” are defined. In the HIES analysis, the very low rates

of agreement between survey interviews and medical records

on visits to providers outside GHA and telephone calls to

GHA show that the medical records are probably not comparable to the interview in important ways. Even within the

classification of” GHA visits,” some ambiguities of definition

could not be fully resolved between sources. Most other

verification studies of reporting of ambulatory medical visits

in the literature describe similar problems in matching between

the two sources. Despite these difficulties, it is useful to

consider the medical record as “truth” in comparing reports

from the two sources. While some error remains in this

verification source, it is more nearly “true” when analyzing

reports of visits than when analyzing reports of chronic

conditions, for example, the subject of the previous report

from the HIES (1).

Reporting error in a verification study can be broken into

two components: underreporting, or the failure of an interview

to report a visit in the medical record, and overreporting, or

the reporting of a visit in an interview that is not confirmed by

the medical record, Only record-check studies using a “full

design” (Marquis (5)) can examine both aspects of reporting

error. The HIES, like several prior studies of ambulatory visit

reporting, employed a full design. Like most of these other

studies, the HIES found little difference in aggregate reporting

of visits between the two data sources, except for adults not

present for the interview, for whom the interview provided a

considerable net underreport. Reporting of telephone calls to

doctors in the HIES had much greater error than reporting of

visits, with many more calls found in the medical record than

were reported in the interview and, among calls reported in the

interview, only about half being confmmed by the medical

record,

The underreporting and overreporting rates in the HIES

are consistent with rates reported in the literature, both for

2-week reference periods and for longer reference periods

with bounded recall or other enhancements. These rates range

about 17-35 percent for underreporting and 20-40 percent for

overreporting. Differences in sample frames and selection

procedures and in interview and matching procedures affect

the comparability of these results across studies, and care

should be taken in applying the rates to any other survey, such

as the HIES. Although the HIES followed NHIS procedures as

closely as possible, many differences remained that could

affect reporting accuracy. Most notable is the difference between

a sample representative of the civilian noninstitutionalized

U.S. population (NHIS) and a sample of HMO members in the

Washington, D.C., area. Other differences include respondent

selection procedures and the relative experience of the interviewers and supervisors with the study.

The HIES confirmed an earlier finding (Camell and

Fowler (6)) that underreports are about 13-15 percent more

prevalent for visits in the earlier week of the reference period

than for those in the later week. It also supported the Iindings

of several other studies that underreporting is greater for

persons with more visits in the reference period. These

findings may be framed in the context of the respondent’s

cognitive processes: motivation to report may decrease with

increasing numbers of visits, for example, or respondents may

deliberately or inadvertently telescope visits backwards, remembering them as more distant than they are. Deliberate telescoping would be possible, for example, if the respondent wished

to shorten the interview (more reports mean more questions),

or if the respondent felt some stigma associated with a doctor

visit. Neither the HIES nor previous studies have shown

definitively what processes contribute to these kinds of reporting error, but have provided evidence for informed speculation. The HIES also found a significant increase in

underreporting for interviews conducted on Saturday and

Sunday, suggesting some confusion about “the last 2 weeks”

in such interviews.

Overreporting presents a different set of problems. It

appears that overreporting is greater for persons reporting

more visits, but may not be related to the actual number of

visits. Several authors have attributed overreports to forward

telescoping, or recalling visits earlier than the reference period

as occurring within the reference period. However, the estimates of overreports attributable to telescoping in the HIES

and other studies range up to half of all overreport~ in fact,

the number is probably less than that. The question of what the

other overreports represent remain. Errors in the medical

record, telescoping from further back than has been examined,

differences in definition of “visit,” and respondent errors in

identifying the provider are all possibilities.

Mostly, the HIES and previous literature point to few

consistent patterns of under- or overreporting by respondents’

17
demographic characteristics. Males seem to underreport consistently more than females, findings about age and health

status are not consistent, and other demographic characteristics are typically not associated with significant differences in

reporting.

The implications of these findings for the NHIS are not

clear. The NHIS is subject to both overreporting and underreporting of 2-week doctor visits. Some research shows that

reporting of doctor visits can be improved through recall

bounding or the use of additional probes. The difference

between reporting in the 2 weeks of the reference period

suggests that estimates might better be made from the more

recent week only, or that the interview reference period might

be extended and truncated to 2 weeks for analysis. Such steps

should be thoroughly investigated before considering them for

the NHIS. Despite the manner of asking questions or the

reference period employed, however, some reporting error will

remain. Reporting error through record checks will itself

remain an imperfect process. Nonetheless, data from the HIES

and other record check studies may help persons using survey

data about health care utilization to understand and to interpret

these data.

18
References

1.

2.

3.

4.

5.

6.

7.

8.

9.

Edwards WS, Wirm DM, Kurkmtzick V, et al. Evaluation of

National Interview Survey diagnostic reporting. National Center

for Herdth Statistics. Vital Health Stat 2(120). 1994.

Balamuth E. Health interview responses compared with medical

records. National Center for Health Statistics. Vital Health Stat

2(7). 1965.

Madow W. Interview data on chronic conditions compared with

information derived from medical records. National Center for

Health Statistics. Vital Health Stat 2(23). 1967.

Madow W. Net differences in interview data on chronic conditions and information derived from medical records. National

Center for Health Statistics. Vital Health Stat 2(57). 1973.

Marquis K. Record checks for sample surveys. In: Jabine T,

Loftus E, Strsf M, et al, eds. Cognitive aspects of survey

methodology: Building a bridge between disciplines. Washington, DC National Academy Press. 1984.

Cannell CF, Fowler, FJ. A study of the reporting of visits to

doctors in the National Health Survey. Ann Arbor, IW Institute

for Social Research. 1963.

Cartwright, A. Memory errors in morbidity surveys. The Milbank Q 41:5–24. 1963.

L.oewenstein, R. ‘J%o approaches to Health Interview Surveys.

School of Public Health and Administrative Medicine, Columbia University. 1969.

Feather, J. A response/record discrepancy study. Saskatchewan

University, NTIS PB-226 327.1972.

10,

11.

12.

13.

14.

15.

16.

17.

Marquis KH, Marquis MS, and Newhouse JP. The measurement

of expenditures for outpatient physician and dental services:

Methodological findings from the Health Insurance Study. Med

Care 19:913.1976.

Andersen R, Kasper J, Frankel M, et al. Total survey error. San

Francisco: Jossey-Bass. 1979.

Yaffe R, Shapiro S, Fuchsberg RR, et al. Medical economics

survey methods study: Cost-effectiveness of alternative survey

strategies. Med Care 16641.1978.

CIeary PD, Jette, AM. The validity of se~-reported physician

utilization measures. Med Care 22(9):796803. 1984.

Edwards WS, Berk ML, Ward, EP. Missing data on medical

expenditure surveys: Matching household and provider reports.

hx 1988 Proceedings of the Section on Survey Methods Research.

Alexandria, VA American Statistical Association. 746-09.1988.

Means B, Loftus EF. When personal history repeats itself

Decomposing memories for recurring events. Applied Cognitive

Psycholo~ 5:297–318. 1991.

Andersen R, Kravits J, Mderson O, eds., Equi~ in health

services: Empirical analyses in social policy. Cambridge, MA

Ballinger. 1975.

Sudrnan S, Wallace W, and Ferber R. The cost-effectiveness of

using the diary as an instrument for collecting health data in

household surveys. Survey research laboratory, University of

Illinois. 1974.

19
List of detailed tables

1. Number of persons with 2-week doctor contacts and

number of contacts, by sample type . . . . . . . . . . . . . . .

2. Agreement between interview and medical record on

whether any physician contact in 2-week reference period,

bytype of contact . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Contact-level agreement between interview and medical

record, by contact type . . . . . . . . . . . . . . . . . . . . . . . . .

4. Person-level agreement between interview and medical

record on number of Group Health Association visits in

2-week reference period, by list-sample persons . . . . . . .

5. Person-level agreement between interview and medicrd

record on number of Group Health Association visits in

2-week reference period, by household members . . . . . .

6. Person-level agreement, overreporting, and underreporting

by number of visits reported, list-sample persons

only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Person-level agreement, overreporting, and underreporting by number of visits reported, household members

only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21

21

22

22

22

23

23

8. Person-level agreement, overreporting, and underreporting

by number of visits reported, previous studies . . . . . . . .

9. Interview reporting of physici~ contacts in medical record,

by day of reference period contact occurred . . . . . . . . .

10. Interview reporting of physician contacts in medical record,

bydayofweek of interview . . . . . . . . . . . . . . . . . . . . .

11. Medical record ccmlirmation of interview-reported physician visits to Group Health Association, by day of reference period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. Medical record confirmation of interview-reported physician visits, by day of week of interview . . . . . . . . . . . .

13. Persons with visits just outside of reference period, by

agreement on whether any visit in reference period . . . .

14. Agreement of interview and medical record on 2-week

Group Health Association visits, by list-sample person

characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15. Summary of diiTerences in reporting ambulatory medical

visits, by respondent characteristics . . . . . . . . . . . . . . . .

23

24

24

25

25

25

26

27

20
Table 1. Number of persons with 2-week doctor contacts and number of contacts, by sample type

Madkaf record Interview

Mean Mean

Number of Percent of number of Number of Percent of number of

Number persons persons Number

Sample type

cunfacfs persons persons Number of contacts

in sample with contact with cuntact of ounfacts per person wtih contact with contact contacts per parson

Total, all contacts . . . . . . . . . . 1,708 624 36.5 1,072 0.63 629 36.6 1,135 0.66

Group Health Association (GHA)

visit . . . . . . . . . . . . . . . . . . 1,708

Ust sample persons . . . . . . . 1,004

Household members, present . 246

Household members, not

present . . . . . . . . . . . . . . 133

Hou3ehold members under 17

years . . . . . . . . . . . . . . . 273

Non-GHAvM.... . . . . . . . . 1,708

List sample persons . . . . . . . 1,004

Household members, present . 246

Household members, not

present . . . . . . . . . . . . . . 183

Household members under 17

years . . . . . . . . . . . . . . . 273

GHA telephone call . . . . . . . . . 1,708

Liet sample persons . . . . . . . 1,004

Household members, present . 246

Household members, not

present . . . . . . . . . . . . . . 183

Household members under 17

years . . . . . . . . . . . . . . . 273

Non-GHA telephone call . . . . . . 1,708

Contacts missing type data . . . . 1,706

532 31.1

42.8

16.1

745

611

61

0.44

0.61

0.25

531 31.1

42.0

23.0

760 0.44

0.61

0.32

430 422 613

45 57 80

32 17.5 46 0.25 21 11.5 33 0.18

25

9

7

1

9.2

0.5

0.7

0.4

27

11

7

1

0.10

0.01

0.01

0.00

31

63

68

9

11.4

4.9

6.8

3.6

34

172

143

19

0.12

0.10

0.14

0.08

1 0.6 3 0.02 5 2.7 9 0.05

0

245

193

29

0.0

14.3

19.2

11.7

0

309

243

34

0.00

0.18

0.24

0.14

1

137

109

21

0.4

8.0

10.9

8.5

1

172

137

24

0.00

0.10

0.14

0.10

16 8.7 22 0.12 3 1.6 7 0.04

7

. . .

6

2.6

. . .

0.4

10

...

7

0.04

. . .

0.00

4

5

11

1.5

0.3

0.6

4

6

31

0.01

0.00

0.02

0,0 Quantiiy mora than zero but lass thsn 0.05.

. . . Catagory not applicable.

Table 2. Agreement between Interview and medical record on whether any physician contact in 2-week reference period, by type of

contact

Number Number Percent

of pe~ons Percent of parsons confirmed

with contact reported with contact by medical

Group Health Association Number in medial record in interview in inte~.ew record

Visit

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,708 1532 77.3 531 77.4

Ustsample persona . . . . . . . . . . . . . . . . . . . 1,004 4430 76.1 422 79.6

Household members, present . . . . . . . . . . . . . 243 145 84.4 57 66.7

Household members, not present . . . . . . . . . . . 163 ’32 46.9 21 71.4

Household members under 17 . . . . . . . . . . . . . 273 ‘ 25 88.0 31 71.0

Telephone CM

Alltelephone calls, . . . . . . . . . . . . . . . . . . . . . 1,708 245 31.0 137 55.5

Listsample peraons . . . . . . . . . . . . . . . . . . . 1,004 193 33.7 109 59.6

Household members, present . . . . . . . . . . . . . 243 29 31.0 21 42.9

Household members, not present . . . . . . . . . . . 163 16 6.3 3 33.3

Household members under 17 . . . . . . . . . . . . . 273 7 14.3 4 25.0

1X=19.96,P<.001.

21
Table 3. Contact-level agreement between interview and medical record, by contact type

Number of Percent

contacts Percent Number of confirmed

in medical reported in contacts by medical

Sample type record interview in interview record

Group Health Association (GHA) visits . . . . . . . . .

Listsample persons, . . . . . . . . . . . . . . . . . .

Household members, present . . . . . . . . . . . . .

Household members, not present . . . . . . . . . . .

Household members under 17 years . . . . . . . . .

GHAtelephone calls . . . . . . . . . . . . . . . . . . . .

Listsample persons . . . . . . . . . . . . . . . . . . .

Household members, present . . . . . . . . . . . . .

Household members, not present . . . . . . . . . . .

Household members under 17 years . . . . . . . . .

745

611

61

46

27

309

243

34

22

10

66.2

72.2

77.0

43.5

65.2

28.5

29.6

32.4

22.7

10.0

760

613

80

33

34

172

137

24

7

4

67.9

69.7

58.8

57.6

67.6

49.4

51.1

41.7

57.1

25.0

Table 4. Person-level agreement between interview and medical record on number of Group Health Association visits in 2-week

reference period, by list-sample persons

Number of Group Heafth Number of GHA visits recorded in medical record

Association (GHA) visits

reported in interview o 1 2 3 4 5 6 7 8 Total

Total persons . . . . . . . . . . . . . . . . . . . . 574 307 90 19 9 2 1 1 1 1,004

None . . . . . . . . . . . . . . . . . . . . . . . . . 468 77 10

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 193 33

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 28 35

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5 8

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 4 4

5 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0 0

6 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0 0

7 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0 0

3

3

10

2

1

0

0

0

0

2

0

4

3

0

0

0

1

0

0

0

0

1

0

0

0

0

0

0

0

1

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

1

579

297

91

20

13

3

0

1

Table 5. Person-1evel agreement between interview and medical record on number of Group Health Association visits in 2-week

reference period, by household members

Number of Group Heafth Number of GHA visits recorded in medical racurd

Association (GHA) visits

reportad in interview o 1 2 3 4 5 6 7 8 Total

Total persons . . . . . . . . . . . . . . . . . . . . 602 77 20 4 0 1 0 0 0 704

None . . . . . . . . . . . . . . . . . . . . . . . . . 568

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

5 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

8 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

7 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

22

48

6

0

0

0

0

1

5

8

6

1

0

0

0

0

0

2

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

595

84

19

4

0

0

1

1

22
Table 6. Person-level agreement, overreporting, and underreporting by number of visits reported, iist-sample persons oniy

Percent

Number of Group Health Number Agreeing with

Association visits of persons medical records Overreporting Underreporting

Medical record

None . . . . . . . . . . . . . . . . . . . . . . . . .

1 ,, . . . . . . . . . . . . . . . . . . . . . .

2 . . . ...! . . . . . . . . . . . . . . . . . . . .

3 ormore . . . . . . . . . . . . . . . . . . . . . .

Interview

None . . . . . . . . . . . . . . . . . . . . . . . . .

1 . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 . . . . . . . . . . . . . . . . . . . . . . . . .

3ormore . . . . . . . . . . . . . . . . . . . . . .

574

307

90

33

579

297

91

37

85.0

62.9

38.9

18.2

84.3

65.0

38.5

16.2

15.0

12.1

13.3

0.0

. . .

22.2

49.5

67.6

. .

25.1

47.8

81.6

15.7

12.8

12.1

16.2

. . . Category not applicable.

0.0 Quanllty more than zero but leas than 0.05

Tabls 7. Person-ievei agreement, overreporting, and underreporting by number of visits reported, household members oniy

Percent

Number of Group

Health Association visits

Agreeing

with

Number medical

of persons records Overrepoding Underreporting

Medioal record

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 602 94.4 5.6

1

. . .

,,, ,. ... . . . . . . . . . . . . . . . . . . . . . . . . 77 62.3 9.1 28.6

2ormore . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 28.0 8.0 64.0

Intewiew

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 595 95.5 . . . 4.5

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 57.1 31.0 11.9

2ormore . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 28.0 68.0 4.0

. . . Category not applicable.

Table 8, Person4evel agreement, overreporting, and underreporting bynumberofvisits reported, previous studies

Peroent’ PercenF

AgresingwM Underrepotiig With

Number of visits Number’ Overrepofling Underreporting medicalrewrds Numbe? one question probes

Medicel record

None . . . . . . . . . . . . . . . . . . . . . . . . . 1,618 4.6 . . . 95.4

i

. . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . 269 7.1 19.3 73.6 131 29 27

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 8.2 40.8 51.0 118 37 29

3ormore . . . . . . . . . . . . . . . . . . . . . . 55 23.6 36.2 38.2 154 25 15

Intetview

None . . . . . . . . . . . . . . . . . . . . . . . . . 1,604 . . . 3.7 96.3 . . . . . .

1

. . .

,, . . . . . . . . . . . . . . . . . . . . . . . . . 303 21.5 13.2 65.3 . . . . . .

2

. . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . 85 31.8 9.4 58.8

3ormore . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . .

48 45.8 10.4 43.8 . . . . . . . . .

... Cetegeryrvxappllcsble.

‘Certwright(7).

2CennellandFowler (6).

23
Table 9. Interview reporting of physician contacts in medical record, by day of reference period contact occurred

Group Health Assoclat[on

Group Health Association visits telephone calls

List sample parsons Household members List sample persons

Number of

contacts Percent Number of Percent Number of Percent

Day of reference in medical reported in contacts in reported in contacts in

period contact oocirrred

raportad In

record intenie w medical record interview medical record interview

Fketweek . . . . . . . . . . . . . . . . . . . . . .

Day I . . . . . . . . . . . . . . . . . . . . . . .

Day2 . . . . . . . . . . . . . . . . . . . . . . .

Day . . . . . . . . . . . . . . . . . . . . . . .

Day4 . . . . . . . . . . . . . . . . . . . . . . .

Day5 . . . . . . . . . . . . . . . . . . . . . . .

Day6 . . . . . . . . . . . . . . . . . . . . . . .

Day? . . . . . . . . . . . . . . . . . . . . . . .

Semndweek . . . . . . . . . . . . . . . . . . . .

Day8 . . . . . . . . . . . . . . . . . . . . . . .

Day9 . . . . . . . . . . . . . . . . . . . . . . .

Day 10 . . . . . . . . . . . . . . . . . . . . . .

Dayll . . . . . . . . . . . . . . . . . . . . . .

Day12 . . . . . . . . . . . . . . . . . . . . . .

Day i3 . . . . . . . . . . . . . . . . . . . . . .

Day14 . . . . . . . . . . . . . . . . . . . . . .

315

53

80

63

68

38

7

6

295

54

83

53

60

40

2

3

83.5

64.2

68.8

58.7

61.8

63.2

57.1

66.7

76.9

75.9

75.9

79.2

80.0

80.0

0.0

33.3

72

8

12

8

23

14

5

2

62

8

12

20

9

10

1

2

59.7

50.0

66.7

62.5

69.6

42.9

60.0

50.0

72.6

75.0

83.3

50.0

100.0

70.0

100.0

100.0

137

36

26

29

25

17

1

1

107

23

22

25

18

19

29.9

25.0

21.4

44.8

28.0

35.3

0.0

0.0

28.0

21.7

31.8

24.0

27.8

36.8

. . .

. . .

0.0 Quantity morethsn zero butleeethen O.05.

- Quantily zero.

--- Data notavai!able.

Table10.interview repotting ofphysician contacts in medical record, bydayof weekofinterview

Group Health Association visits Group Health Aa.sociation telephone ask

List sample persons Household members Listsampleperson.s Household membara

Number of

Numberof Percent Number of Percent Number of Percent contacts Percent

contacts in reported in contacts in reported in contacts in

Day of interview

reportedin inmadicsl reportedin

medicsfreoord interview medicalrscord interview medicslreoord inteniew record interview

Alldaya . . . . . . . . . . . . . . . . . . . . . . . 611 70.1 134 66.4 244 2e.1 66 24.2

Sunday . . . . . . . . . . . . . . . . . . . . . . . 34 50.0 8 75.0 28 14.3 2 0.0

Monday . . . . . . . . . . . . . . . . . . . . . . . 71 70.4 12 63.3 40 25.0 6

Tuesday . . . . . . . . . . . . . . . . . . . . . . .

16.7

101 74.3 22 77.3 11 27.3 15

Wednesday . . . . . . . . . . . . . . . . . . . . .

33.3

129 76.0 27 66.7 29 42.9 13

Thursday . . . . . . . . . . . . . . . . . . . . . .

30.6

103 69.9 20 60.0 44 31.8

Friday . . . . . . . . . . . . . . . . . . . . . . . .

14 21.4

73 74.0 16 68.6 50 40.0 8

Saturday . . . . . . . . . . . . . . . . . . . . . .

37.5

100 62.0 29 51.7 42 19.0 8 0.0

0.0 Quantity morethan zembutless than O.05.

24
Table 11. Medical record confirmation of Interview-reported phyeician visits to Group Health Aasoolstlon, by day of reference period

List sample parsons Household members

Number of Percent Number of Percent reportad

oontaota in reportad in oontaots in

Day of oontaot of reference period

in mediosi

interview medical record intervhw record

Fkstweek. . . . . . . . . . . . . . . . . . . . . .

Day . . . . . . . . . . . . . . . . . . . . . . .

Day . . . . . . . . . . . . . . . . . . . . . . .

Day . . . . . . . . . . . . . . . . . . . . . . .

Day . . . . . . . . . . . . . . . . . . . . . . .

Day . . . . . . . . . . . . . . . . . . . . . . .

Day . . . . . . . . . . . . . . . . . . . . . . .

Day, . . . . . . . . . . . . . . . . . . . . . .

Serxxsdwaek. . . . . . . . . . . . . . . . . . . .

Day . . . . . . . . . . . . . . . . . . . . . . .

Day . . . . . . . . . . . . . . . . . . . . . . .

DayIO . . . . . . . . . . . . . . . . . . . . . .

DayIl . . . . . . . . . . . . . . . . . . . . . .

Day 12 . . . . . . . . . ...!... . . . . . .

Day 13 0 .,,..,. . . . . . . . . . . . . . .

Day 14

293

58

72

59

WI

40

11

5

302

51

75

58

51

83

3

1

67.9

66.1

83.9

72.9

74.0

65.0

54.5

80.0

71.9

72.5

74.7

79.3

76.5

58.7

33.3

100.0

68

12

11

9

15

12

3

6

73

15

12

17

10

13

3

3

63.2

58.3

63.6

77.8

80.0

50.0

66.7

33.3

61.6

53.3

66.7

70.6

80.0

53.8

33.3

100.0

Table 12. Medical rscordconflrmation of intewiew-reported physlclanvlsits, bydayofweekof interview

Ustaamplepersons Householdmembera

Numberof Percent Number of Percent

mntacts in r8DOltHi in rwnticta in remrtad in

Day of interview interview medioalraoord interviiw mdicalrscord

Alldaya . . . . . . . . . . . . . . . . . . . . . . . 613 se.? 147 80.5

Sunday . . . . . . . . . . . . . . . . . . . . . . . 26 65.4 10 80.0

Monday . . . . . . . . . . . . . . . . . . . . . . . 76 85.8 16 62.5

Tuesday . . . . . . . . . . . . . . . . . . . . . . . 105 71.4 33 51.5

Wednesday . . . . . . . . . . . . . . . . . . . . . 133 72.9 29 62.1

Thursday . . . . . . . . . . . . . . . . . . . . . . el 79.1 17 70.6

Friday . . . . . . . . . . . . . . . . . . . . . . . . 93 58.1 19 57.9

Satwday . . . . . . . . . . . . . . . . . . . . . . 89 88.7 23 85.2

Table 13. Pereonswith vlsitsjustouteldeof reference period, by agreementonwhether anyvlsft inreferance period

Persona with a

Persons with a VM between end

visit in 2 weeks ofrer%mcapariod

barlwerafarancepariod and intem”ew

Agreamont Number Number Percent Number - Percent

Total . . . . . . . . . . . . . . . . . . . . . . . . . 1,004 427 42.5 111 11.1

Posltivematchl . . . . . . . . . . . . . . . . . . 339 168 48.0 64 15.9

Overrepotf . .,, . . . . . . . . . . . . . . . . . 86 44 51.2 7 6.1

UnderrapxF. . . . . . . . . . . . . . . . . . . . 91 40 44.0 13 14.3

Negativematch4 . . . . . . . . . . . . . . . . . . 488 187 38.3 37 7.6

l.pW~M~II ~a-ti~ orrnorevisitelnboth Interviewrepxtand medkalmcwd.

a~ove~~n ~ a m w onew mwevisttsInthe interviewandnoneinthe msdisal*.

~.u~-lsapmmwmti*lnti medktdreccdandnonein thehtetview.

*IN~~~~. Isa=tia vieithsnethreome.

25
Table 14. Agreement of interview and medical record on 2-week Group Heafth Association visita, by list-sample person characteristics

Number of Number of

parsons with Percent persons with Percent

oontaot in reported in cuntact in oonfirmed by Net overreport

Characteristic Number medioal record interview interview medicsl record by interview

Age

lS44years . . . . . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

75years and over . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . .

Race

Black . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . .

Inmme

$0-$19,889 . . . . . . . . . . . . . . . . . . . . .

$20,000-$29,989 . . . . . . . . . . . . . . . .

$30,000-$49,989 . . . . . . . . . . . . . . . . .

$50,000andover . . . . . . . . . . . . . . . . .

Eduoation

Lessthan 12years . . . . . . . . . . . . . . . .

Highschoolgraduate . . . . . . . . . . . . . . .

Somemllege . . . . . . . . . . . . . . . . . . .

CoIlegegraduate . . . . . . . . . . . . . . . . .

Employment and age

Employed

S5yearsandover . . . . . . . . . . . . . . .

lS-64yeara . . . . . . . . . . . . . . . . . . .

Notemployeck4

E5yearsandover . . . . . . . . . . . . . . .

lS-64years . . . . . . . . . . . . . . . . . . .

Health status

Excellent . . . . . . . . . . . . . . . . . . . . . .

Verygood . . . . . . . . . . . . . . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . . .

Fairorpoor . . . . . . . . . . . . . . . . . . . . .

311

372

191

130

116

162

85

67

81.0

78.4

78.8

76.1

132

14s

81

64

171.2

185.8

‘82.7

‘79.7

13.8

-8.6

-4.7

-4.5

459

545

185

245

271.9

=84.1

169

256

78.7

80.5

-8.6

4.5

674

330

281

149

79.0

78.5

280

145

79.3

80.7

-0.4

-2.7

141

113

236

284

68

57

102

112

83.6

82.5

74.5

78.6

75

58

92

109

76.0

8! .0

82.6

80.7

10.3

1.9

-9.8

-2.6

379.2

372.1

376.8

3s8.3

168

305

204

320

77

129

82

139

70

118

81

154

87.1

78.8

77.8

77.9

-9.1

-8.5

-1.2

10.8

544

218

232

95

80.2

77.9

229

94

81.2

78.7

-1.2

-1.0

121

117

48

53

79.2

73.6

51

49

74.5

79.8

8.3

-7.5

203

293

296

200

64

133

133

94

73.4

75.9

82.0

83.0

61

128

135

97

77.0

78.9

80.7

80.4

-4.7

-3.8

1.6

3.2

fchi-sq.=e.77,dr=3,lX.05,

%=3.07,p<.ol.

3Chl-sq.=8.40, df=3,w.05.

41ncludssretired, unemployed, and homsmsksra
Table 15. Summary of differences in reporting ambulatory medical visits, by respondent characteristics

Characteristic Effect Reference(s)

Age:

Advancing age . . . . . . . . . . . . . . . . . . . . .

Under age55 . . . . . . . . . . . . . . . . . . . . . .

0ver65females1 . . . . . . . . . . . . . . . . . . . . .

Sex

Femeles under45 . . . . . . . . . . . . . . . . . . . .

Females45-652 . . . . . . . . . . . . . . . . . . . . .

Education:

Collegegraduates . . . . . . . . . . . . . . . . . . . .

Health status

Peraonswith many health conditions . . . . . . . . .

Pereons with restricted activity . . . . . . . . . . . . .

Other

LoweretSES3category . . . . . . . . . . . . . . . . .

HM04memberehip . . . . . . . . . . . . . . . . . . . .

Age

Pereons65yearaandovar . . . . . . . . . . . . . . .

O1destadult inhousehold 650rover . . . . . . . . .

Pereons lS-45 . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

Non-white . . . . . . . . . . . . . . . . . . . . . . . . .

Healthatatuw

Saveral chronicoonditions . . . . . . . . . . . . . . .

Peraonslnfalrorpoorhaalfh . . . . . . . . . . . . .

Presence oflimitingillness . . . . . . . . . . . . . . .

Moredemoralizsd . . . . . . . . . . . . . . . . . . . .

Other:

Beliefin regularcheckups . . . . . . . . . . . . . . .

Underreporting

Mora

Less

Less

Less

Less

Less

Less

Less

Less

More

Overreporting

Clearyand Jette (1934)(13); Balamuth (1965)(2)

Cannell and Fowler (1363)(6)

Feather (1972)(9)

Cannell andFowler(1963); (6)HIES(I )

Feather (1972)(9)

HIES(I)

Cannell andFowler(1963)(6)

Cannelland Fowler(l 963)(6)

Feather (1972)(9)

ClearyandJafte (19S4)(l 3)

Lees Feethar (1972)(9)

More Andaraan et al. (1979)(11)

More HIES(I)

More Feafher(1972)(9)

More Arrdereen et al. (1979)(11)

More ClearyandJette (1964)(13)

More Andareen etal. (1979)(11)

More ClearyandJette (1964)(13)

More ClaaryandJstfe (1964)(l 3)

More ClaaryandJette (19B4)(13)

IrJompared with ywnger females.

Zcompamd with males 4S64 years of a9e.

sSES is s~doe~nom[~ stews.

4HM0 ISHealth Msintenanca0r9fMbW10fl.

27
Contents

Health Interview Evaluation Survey questionniare

............................................................. 29
Appendix I

Health Interview Evaluation

Survey Questionnaire

DC 64.01 OMB No. 09204239. Awrov.1 Expires 12/31 /S0

>TICE (ntornm,m cwt!,med cm Inl(s form Sullch Wuu!u penn” ,Mlflca,lgn II, any ,mwj”a, 0, .S,at’,,,mwan, ens been K&i-ti Wnn , *lwant@3 w,! “ v+,, be Md ,“ ,,nd Cc.maeme, w be “s0.5 my !Or pwpelu

,1* ml ,41B slur+? m W,l rm b d,sclased Cf ,.-,0 ‘,,/).” W#mJul me consent ., ,M ,Mw”., ., ,& ,#.b,,,”m, ,. Uccowula .((~ $6d0tl $@@) & ,M -k -h - *, ,42 USC wan, R,* [

).mIng Qwoen w 1“,, Cobdbn .1 Inlo’rndka” ,. .S,,rr,alti ,0 vary hun ,e 8035 Ir,,n”,e$ ~, ,espm,,, ..,i,n .“ .Mmge .3,28 m,””,,, per ,,,W,. SM ~mmnt, ,egm,rq ,M b- ●,,,tie C.rany mm mm

W, COlhCtlOn d Inlorrm!-m Ikludmq SGWeWJM 10, reWWlrJ mk LWmlen,!0 %+S Pqm+ts C19MP.”CUIMce,, ATTN PM HWWI H H“ro@Irey B!4g m 721-H.KM lwlew~- AwnLIOSW Wa$hlwton,K

201,and10me calm d E.w!awmenlandeua.gti,Pr’pmwOrkROwcuOnFTOpclp2520a239). Wash,t@Cm DC m

p~H13-1(Evaluation)

W2STAT.INC.

AC,moASCoufc,,)Jo AG,ln F(XI,“,

U.S.weuc liEALTH3mvIcE

HEALTH INTERVIEW EVALUATION SURVEY

}a. Whnt is your exact ●ddrams? (/nc/ude House No., Apt. No., or other identification,

county and ZIP Code)

1 I

1 1

b. Is this your mailing =ddmss? (Mark box or specify if different.

—

Include county and ZIP Code, )

D Same as 6a

~iG–-–- ––––– –.__.__ –13GG ___ :ZF-Ca; –

Items 7, 8. and 9 not apD/icab/.g this form.

10. CLASSIFICATION OF LIVING QUARTERS — Mark by obsemadon

Items 10a and b not applicable this form

c. HOUSING unit (Merk one, THEN page 2)

o! ❑ House, apartment, flat

02❑ HU i“ “cmtr.gnsient hotel, motel, etc.

03❑ HU — permanent in transient hotel, motel, etc.

MU HU in roorni”~ house

050 Mobile home or trailer with “o pemmnent mom added

060 Mobile home or trailer with one or more permanent rooms added

070 HU not specified above — Describe in footnotes

d. OTHER unit (Mark one)

08U Quarters not HU in rooming or boarding house

090 Unit not permanent in transient hotel, motel, etc.

100 Unoccupied site fw mobile home, trailer, or tent

! I u St”dent quarters in college dormitory

12❑ Other unit not Specified above — Describe i“ fOotnote=

GO TO HOUSEHOLD COMPOSITION PAGE

12. Interview observed?

numb.r h-? !

I

❑ None

1 DY.S 2 ON.

1

1

3tt. Interviewer’s name ~Code ~b. Language of interview

t I 1 DEn@sh 3 ❑ %th English and Spanish

I

2 ❑ Spanish 8 ❑ Other 1

1

Book —Of — books

-s. Not applicable this form

L Noninterview reason

TYPE A

7❑ Refuse.1- 0.3wmb.gInf.acltrwms

2a Noommhome, w+msted&

3❑ Tempocmilyabsent - Footnote

40 Odwr Eb2ifv) ~

5. Record of calls

Fi itm

t –6.3.

10. ●nd

12-15

1

I

corn

Month 1Date Segiiylg E“di”a plere

1

*ime Mad

I

(x)

1 I I I

1

1

P a.m. a.m.

I T p.m. p.m.

I

P . m. ..m.

I T p.m. p.m.

1

I

I

P a.m. a.m.

T p.m. pm,

—+

I

P a.m. *,m,

1 T p.m. P.m.

! ~

1 S,M, a.m.

I T mm. P.m.

1

I

1 P

a.m. am,

mm. ,’ 7p.m.

B. Not spp/icable this form

7. Record of addfiional contacts

~ 1

P a.m. a.m.

4

1 T p.m. p.m.

II 1P [ a.m. a.m.

EWE

29
m . ,“- U old ●k.

.-—. ,. . . --

m !+,5., ,,.d,!.,k”l ,,., .On, -–—– . . ... . .. ... i-age <.
●. What ●ra tha namac of ●ll pwsons living or stayhrs ham? Stirs with tho mama of tho pcrscm or 1. FM name - Mid. rnii 4Q*

ona of tho parsons who owns or rents this home. Enter name in REFERENCE PERSON column.

last.-

b. Whst ●m Uw rmmos of ●ll othw par.ons living or swying hara? Enternames in columns. N .V=,,. ~mc,

m , , ~ :’

“%IM

nzrmzincoromnz

F

2. Rdmlonztilp

c. I have Ihcd (read rramo~ . Havo 1missark Y; &o REFERENCE PER$ON

-any bdziacorsmall chlldtms? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. ~te$f birth

~Date :Yuc

-anylodgws,b ocrdars, orpatsotts you amploy wholivahwa? . . . . . . . . . . . . . . . . D ❑

- anyona who USUALLY Ilv*s horc but iE now ●way from horntravellrsgorinahospttcl? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •l ❑

HOSP. WORK fro 2+VK. w

-W’iyono olsastaylnghwa? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑

cl 00DNO”.

tow. 10 v,. ‘0’”’”

~ znwb 2D No Number

d. Do all of the parsons you hava ts~mad usually Iivo hers? ❑ Yes (2)

❑ No (APPLY HOUSEHOLD MEMBERSHIP

>-, . ... + .+:.,&A- .. ;> . . ,

Probe If necessary: RULES. Delete nonhousehold membem C2

by an “F from 1– C2 and enter reason.) Ir .

J3MS -- u,us[ly fke ~mowhor~ ●lse? y- -: Ev– iiNq. iaifll iismw

1111

, , , ,

Ask for all persons beghhg with column 2:

!. Whntis -- mlatlonahlp to (reference person)? LA-- -it@--l w- mm. m--m iwm

i. Whst 18-- data of bhth? (Enter dats and age and mark sex.)

111111

,

REFERENCE PERIODS

‘-LA - ~RK ‘16V- fiNi.it3-L~l fiS~C~N[

2-WEEK PERIOD

111111

ill

-------- ----- ----- ________ _______________ _______

12-MONTH DATE

—— --- -——-—————-

LA IRA 1ov IINJ. I aLTR; nslcow

----- ——--— —-- -— —----- —- ———-------------- ——— - --—- 1111

I ,

13-MONTH HOSPITAL DATE

A2 Asf(coNDjT,oNL,sTs ,,z,.~~.

LA‘– TRX -16V- TIN1.iu-LIF(i lsTc7N[

1111

111111

?-

,, .. --: “~,,’.

., ..”,

-.. , ..?,. .,=

..

,. -4 ~..-,..&. ‘ - :- ,

‘. -y, “ .&A . ...’ ...-.2. . . . .. ...+. -< ~,

., . . -.

y . . ,,> ~.,-,!”.

~3 RafartoagesofallmlatedHHmembem.

~3 ~$gn0ns136md0vw,6J

B. LIMITATION OF ACTIVITIES PAGE

B I Refer to age. B1 :: ;h;;;;

1, What was -- doing MOST OF THE PAST 12 MONTHS; working ●t ● Job or buaftmss, 1. I ❑ W.ack!w (2)

kaoplng houso, going to school, or sommhlng ciao? 2 ~ Keeping house {3)

Prlorxy if 2 or more acdwt;es reported: (1 JSpent the mosr time doing; (2) Considers the most important. 3 D G.mg to dwol 15)

4 ❑ Camethma else (5/

La. Does any Impalrmcnt or haalth problam NOW kaap -— from working ●t ● job w busitsass? 2a. , ❑ Y., (7) ~ No

----- ----- ----- ----- ----- ----- ----- ----- ----- _____ - ___ _____ _____ ----- _

b, Is -- Iimitcd in the kind OR ●mount of work -- can do ~~sum of any im@~w2f w Itcalth ~oblem? b. 2cl Yes (7/ 3 D No (e}

la. Doss ●ny Impairment or haclkh problam NOW kacp -- from doing =ny houmwo?ft ●t all? 38. 4 D Yes (4, ❑ No

----- ----- ----- ----- _____ ----- ___ ,____ _____ ______

b. is = :ilisliai inihi ~l~d-O-R~rn&zkt_o~ ~ouscwork –– cm do bcocuse of any Imptirmcnt

or haalth problam? b. 5 Cl Ye. (4) 6 ❑ No (5)

la. What [othw] condition cauaoa this?

Ask if injury or operation: When dld [the f@rJ occur?!-- hava the opcmtion?] 4a. (Entercond!tmn in C2. 7HEN4b)

Ask If operation over 3 months ago: For wh-t condition did -- hava klm opsratfon?

If pregnant ydelivery or 0-3 months injury or operation – 1 c1 omul$~~yti W!d *, . b.,

Reask question 3 where IImitetion reporred. saying: Except for –– Jcondltion), . ..?

OR reask 4btc.

---- ---- ---- --- ---- ---- ---- ----

b. Sasidos tconditfon/ is_tha;a k~y-o~h~r~~nd~i~n~~a~ &uses ~his-lirn~~ti-m-?- - b. ❑ Yes O?,l.k 4 ●db)

❑ No 14dJ

. . . . . . ----- ----- ----- ----- ------ - --- ----- ------ -----

c. Is this Iimltctlon caused by ●ny (othar) spcclflc condition? G. ❑ W. (Reask4a ●dbl

❑ No

----- ----- ----- ----- ----- ----- ----- - ~- ---- ---- ---- ---

Mark box #f only one condition. d. ❑ IOniy1c.mdtion

d. Which of thasa conditions would vou ssy 18tho MAIN cmzsa of this Ilmitdon?

Maincause

ia. Ooas ●ny impairment or health problam kaap -- from working ●t ● job or buslnoss? Sm 1 clYea (7) ❑ No

b. Is -- Ilmitod in th~ kind OR ●mount of work -“- could do &aocuse of any impa{m-o%-&-~*-M-&obhm? ‘b:

--- --- ---- ----- ---

2 ❑ Ye* (7I 3DN0

B2 Refe,totr..?stions 3aand3b.

BZ

2 ❑ Otha, (6I

1 cl%,- in,80,3b,NP,

la. Is -- Iimltad in ANY WAY in ●ny ●ctivities bccmma of m! impslrmctst or hcakth problam? 6-. 1 cl Yes 2 D No IMP)

------ ----- ----- —---- ------ —---- —-—. — ------- -- ---- ------ ------ ---

b. In what way is-- Ilmltad? Recorti hmitation. not condition. b.

Limnauon

‘a. What (othor) condltlon ccuses this?

Ask d IWW or operatfon Whan dld [tho wJoocur?/-- have tho ofsoradm?l 7a. lEnw cmd,wn m C2. lHEN 7b1

Ask /f operarmn over 3 monrhs ago For what condition dkd -- have th- opormfon?

If pregnant y delwery or 0-3 months mpuy or operaoon -

1 ❑ mlld~,:pti -ad *g... box.

Reask questmn 2.5. or 6 where Iimttation reDorted, saving: Except for -- {condition),.. .7

OR reask 7b. c.

b. Sasldas (condit,om is thara any ttthar condition thnt scusas this Ilmkation?

. . .

b. O-Yes &s; 7- ●dbi - -

0 NO 17dl

c. 18 this Ilmltction caused by ●ny (othar] spacifii condition?

. . . . .

c. -o .fe$,,qe**k,* ,~ b,

❑ No

. . . . . . . . .

Mark box if only one condition.

. . .

d. 00.w t condm..

d. Which of thaca conditions would you cay is tha MAIN ccusc cd dtla Nrnitction?

Man C8USe

❑ Old ago

A. HOUSEHOLD COMPOSITION PAGE 1

11

t

fl

i

r

e

<

&

2

\

9.

3

\

D.

i

\

D.

\

1

0.

-1

.’.

b

I

1

2

I

3

I

4

I

(

I

5

I

I

s

I

7<

I

1

1

conk!“Is.1!,.*.,mn,,z , m, Paw 4

31
❑ Old ●ge

A. HOUSEHOLD COMPOSITION PAGE 1

U. What are the rmmm of all persons living or maying here? Start with the name of the parson or 1. Firmname

0230of the persons who owns or rants this home. Enter name ;n REFERENCE PERSON COIumn.

Mrd. init. Age

I

L3st nnme

b. What me the names of all othar parsons l[vlng or staying here? Enternamesincolumns. (f ,.Y,S,,, enter

m ~~

‘33rA

namas h columnz 2fl F

B. I havelisted(read names). HaveI missed

2. Relationship

Y$ g

FtEFEnENcE 6wIsoN

— ●ny bablasor smallohlldrarr? 3. ~::,;f birth , Oate

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

- ●ny lodgers, boardors, or paraorra you employ who IIw hare? . . . . . . . . . . . . . . . . ❑ o

;Year

- ●nyorw who USUALLYlivesharebut1snowawayfmm home

travalingor hzabospital? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D ❑

HOSP. WORK RD 2-WK. OV

- ●nyorw ●laa staying hwa? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 0

c1 000 No”.

low. 10 Yes ‘n ‘0”’

d. Ooallof the persons you have nomad ummlly live here? ❑ Yes (2}

~ 20 Wb 2D No —Number

Probe if necessary:

D No (APPLYHOUSEHOLDMEMBERSHIP

RULES.Deletenonhouseholdmembers

~%! ?JiG#4%~,:: G ; .:: ?.&: ““-, ::

C2

by an ‘X’ from 1-C2 sndenter resson.) ir ____

Ooes –– usually [km somowhsr. ●lso?

I , , t 1 ,

Ask for sllperaons beginrdrrgwith column 2:

, What Is -- -relationshipto (referafrceperson)? L~ ---- — ---------

What is

IRA 10V IIN.( iCLLTRl HSIC&N&

-– data of bhth? (Enter date and age end mark sex.) 111111

REFERENCEPERiODS

Ir - -iRx-1m.- TirU.Tcc-LTKl r%mcm.

2-WEEK PERIOD

111111

_____________________ _________ ___________________

ml

12-MONTH DATE ------ ----------

-- —__________ _________________ __________________

LA tw ; w ;INJ. lcLLTRl H61c0t4D.

I Ill

1 1

13-MONTH HO$PITAL DATE

m2 ASKcoN~moM~,$T$1,2,,mf~.

LA‘- ~R~ ‘1 ~V- ilN~.iU-LT’l iiSiC6k),

11111

:11111

B. LIMITATION OF ACTIVITIES PAGE, Continuad

B3 Refer to ega.

B3 ; ::::; :/;(7 ;: :S; INPJ

over (e)

B. What WOE -- ,dOhg~OSTOFTHEPAST12 t40NTHs, working●t ●job or brmhwas,kaaphtg 8-

houca,goingto school, or aomotfring elsq?

1 U’Working

2 ❑ K&ing buts

Priorityif 2 or more activities reported: (1) Spent the most t!me doing; (2) Considersthe most Important. 3 ❑ Geina to school

4 !3 Something die

9a. Becau80 of ●ny Impalrmarrt or haalthprobkn, dOeE –– need tfw halp of othar persons with 9a.

-- personal aare mark, such ●E aatlng. bathhzg, droseing, or gattfrtg ●round tfriE homa? 1 •! Yes (73) n No

-——— ------ _________ _____ __________________________

__

b. Sacmzsa of ●nyImpalrmantorhealthproblam,doss

--- ———__________

-- noadthohalpof otlwrpwaorwinfrandlhrg

——routinerrs@d&such ?s cvwyday household choras, doingrmcessarybudrrese,shopping,or

b.

2 ❑ Y-s /13) 3 ❑ No (12)

gMting ●round for other purposas?

Om.Is -- ●bleto takapartAT ALL inthe uwra!kindsof play●ctivltlmdorwby moatchlldron-- ●ga7 100.

lJYe8 0 ❑ No (13)

b.is ---------------------- ‘ ----------------------------- IlmitcdIntfwkind OR ●mount of play aotivitlaa ‘- ~.--

--- ———_—_ —_____

- — can do baeauaa of any impdrnwnt

or haalthproblem? 1clYec (73) 2 ❑ No (12)

1=. Doss ●ny impairmmttor haalthproblamNO@ kaep-- from ●ttendingschool? 110. 1clYOs (13) ❑ No

---- —— ------ ---- — ---------- --- — ______________________ ___ ________________

b. DO-S -- .Wnd ● *pocIa[ s~h~l Or sp~lal r#aeea. ~eau.e of ●ny im~im.nt Or fr”itfr probf.m? b. 2 •1 Y., (13) O No

—----- —-----— —--- ------ ____ _______________________

c. Does —- rraui to ●ttmd ■ spseiai school or spaciai ciassos because of any impairmentor

-------- ———----

- G.

health probiam? 3 ❑ Ye* (13) ❑ No

----- -— — ___________ ____________________ ____________ __ _______________

d.ls -- IimitqdInaohool●ttondmtco bacausa of -- haafth? d.

4 nYas (f3] tiotfo

2a. la -- Ilmitid inANY WAY In●ny ●ctlvitfasbacauaaof an impairmentorhealthproblam? 12*. 1❑Yes 2 ❑ No /ffPJ

b.in-~;t&~yi8-~~ lim-h-d>-----------------;-.------:------------- ‘-&-

_______________

RecordIimttat!on, not cond!t!on.

Limitaficm

30, What (othar)condltloncmmaothis? 13a.

Ask if injury or operation:Whan did [tfra&&’) occur?l–– hava thooperation?] lEnterconditkmInC2,TNEN13b)

Ask if operadon over 3 months ago: Forwhatconditiondid -- havatfv.op.ration?

If pragnancy/delivery or O–3 months injury or operation – 1 clo!d ●aa(Mark-OMaga-2S2X,

Reaakquaation whare limitation repor&ed,saying: Exceptfor.- - {condition),...? TNEN13CI

OR reask 13b/c.

------ -------- ----- ---__ ----- —______________________ ___

b. S.ddaa fsondmon) la thorn●ny otharconditionthatcauaaathisiimttatlon?

------ —--------

b. ❑YES (flask 138andb)

--———— ---———- _________ ____________________________ ❑ NOf13dJ

c. is this iimitatirm caused by ●ny (otharl spacific condition? - z. ‘-0-YG7R=.I GF.GF) ‘–-–”

❑ No ---- ---- ---- ______________________________________ __ _______________

Merkbox if only one condition. d.

d. Which of thacormnrfitionawould you ●ay18ttmMAIN cauaaof Wa Nmftstlon?

❑only1 wndition

Main awm

‘OOTNOTES

m IU2-1Irmknsml12.1.301 Page 6
•1 oldaim

A. HOUSEHOLD COMPOSITION PAGE

● .What ●re tlw z’mmec of ●ll persons living or staying ham? Start with tho name of the parson o?

on- of sirs parsons who owns or rents this hokno. Enter name in REFERENCE PERSON column.

b. What ●m the tmmos of ●h otfrw parsons Iivlng or stayhg hcm? ,%ternames in columns. If ,,vm,,, ~nter

m

namssin columns

c. I havo Ihtad (reed rmm@sL Have I missed: Yes No

- ●ny bablcs or small chlldmn? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑

- ●ny Iodgom, fmerdere, or parsons you ●mploy who live hwa? . . . . . . . . . . . . . . . . :0

— ●tyorro who USUALLY lives ham but is now ●way from home

tmvallngorln ahospltsl? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 ❑

-anyono alaectcyingham? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IJ ❑

d. Do ●ll of thg parsons you have named usually live here? Q Yes (2)

•l No (APPLY HOUSEHOW MEMBERSHIP

Proba {f necessary: RULES. Delete norrhousehold members

by an ‘X” from 1- C2 and enter raasan.)

Does —– usually Ilva 8omowhore ok?

Ask for allpersons beglndng with column2:

. What is -- mlatlonship to (refarenca person)?

What Is -- data of bktfr? (Entar date and age and mark sax.)

I REFERENCE PERIODS

t

2-WEEK PERIOD

------- —----- ________ _____ ____ ______________ ____

Al

t

12-MONTH DATE

------------- --------— -— ___ _________ ____________

113-MONTH HOSPITAL DATE

B. LIMITATION OF ACTIVITIES PAGE, Continued

I

B 4 Refer to age.

Es Refer to “Oldage’’and “LA’’boxes. Mark firstapprop,izftebox.

4m Sacausa of ●ny impairmwrt or hsalth problem, doos –– rwod tho help of othw pomons with

-- pomonal care naads, such ●s sating, bathing, drasdrrg, or getting around thlaf’zome?

------ ------

If under 18, skip to next pa;s&~oihe~i~e~sk:- -- - - “ - ““

------ ----- -----

b. Because of any impairment or hsdth prcblcm, does -- nead *. httpof ~~or p-n, 1“ knd~

-- routizm needs, such ●s wwyday hormahold choras, doing rmcassary buslnaes, shopping, or

❑--—attino ●round.. far—.—. othw.——r ❑umom-? —..—...

6-. What (c.thar) condition causes this?

Ask if injury or operetion: Whmr did [the (in’u ) occur?l–– have tha opemtlon?l

Ask if operation over 3 months ago: For w+ at condition dld –– hava tho opwation?

If pregnencyldel;very or O-3 months Injury or operation –

Reask quastion 14 where Ilmitetion reported, saying: Except for -- (condition),. ..?

OR-. ------ ranek 1.--, rihlc.-.

----- ----- ---, ------- ----- ----— —-—————-____________ _

b. Bosldo8 (condition) isthwo ●ny othar condition that causes this limitation?

c.is_th_fs-ll%it&l&rcarked by ●ry ~o~her} spaciffc cond”ition?- - - - -

---- --

----- .. . . . . . . ----- ----- ----- -. —-—-—

Mark box if only one condition.

d. Which of thaso conditions would you say is the MAIN causa of this limitation?

1

1. mm name

L-f name

2. F#m:rlgE ,ER OH

3. Woza;f birzh , ~ate

~Yaar

!

:2 \

LA- - TnZ ‘1 bV– iiN~. T(iCtil i%iC&16

Iltlll

Ir – Tin —-lFiV- iitn.ra-m Hs,coscl

—— --

11 Iltl

I , 1

~ A‘- ~~ ‘; 6V- ~~.~sthl “S, CIJ+ILI

-- —--

II

1 , I I

- — ------------- .

LA IRA Iov IINJ. ICLL7EIHSICCU0

Ill Ill

1[.. ,(,.

-

04

E

ix

---

b.

K

——.

b.

--

c.’

;.

—

0 ❑ Unt+r 5 (NP) 2 •l 60–e9 (14/

I ❑ 5-se (a5i 3c!70snd

OvarfNm

•l .’OldWC,”boxmmksd[14)

❑ EIWIVin ,lA-, W. (14)

❑ Otlw fNP)

1 c1 Yes (16) D No

--- —— —----- --——.

2 ❑ Yes 2 •1 No (w)

(Ente, conditionh C2, THEN lab)

10 Old a (hf#rk W(dW#bOX,

THE#15cJ

-———-----———— ——,

❑ Y*s(Z7e.skT5, ,ndbj

❑ No (15d)

----- ----- —————

❑ Yes fR8#tk 16S●db)

❑ No

---- —--- --——-

❑ Onfy 1 umdii

Main csu:a

-I

XM H1l.1I1,SUW+N12.1.M) Page8

33
A. HOUSEHOLD COMPOSITION PAGE 1

B. What are the names of all persons living or staying hors? Start with the name of the person or

one of the parsons who owns or rants this home. Enter name in REFERENCE PERSON column.

>. What am the rramas of all othar pemcms fiving or staying hero? Enter names In columns.

m

{f ‘,Y4s,,8enter

names in columns

:. I have listed (read names). HrIve I missad: Yes No

- any babies or small children? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 0

– any lodgers, boardars, or parsons you employ who Iivo here? . . . . . . . . . . . . . . . . ❑ D

- anyone who USUALLY lives hero brrt is now away from home

travaling.or inaho8pita17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •l ❑

-anyono dsoatayinghere?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ •l

d. Do all of the poraona YOU hava namad rraually live here? ❑ Yes (2J

U No (APPLY HOUSEHOLD MEMBERSHIP

Probe if necessary: RULES. Oelete nonfrousehold members

by an “F from 1-C2 and enter reason.)

Does –– usually live somewhara also?

1. First name - Mid. init. Age

I 1 1 1 I 1

Ask for all persons beginn!ng with column 2:

What is –– ralationahip to (reference person)?

&

‘- TRF ‘16V- TIN~. ~C~L1~l ik~C~Ni

What is –– date of birth? (Enter dare and age and mark sex.)

REFERENCE PERlOOS

t

2-WEEK PERIOD

----- —— —-— ________ _____ _____ __________ __________

Al

12-MONTH DATE ———— ________ ______ ____ ______________ ___________ _ m

13-MONTH HOSPITAL DATE 1~

D. RESTRICTED ACTIVITY PAGE PERSON 1

Hand calendar.

{The next questions refer to the 2 weaks rurtllned in red on that calendar,

baginning Monday, (@@and anding this past Sundayf@eL}

Refer to age.

DI

n Under 5 (4) ❑ 5-17 (3) ~ 18 and over (1)

a. DURING THOSE 2 WEEKS, did —— work at anytime ata job or

business not counting work around tha housa? (include unpaid

work in tha family [farm/buslnaaal.)

I D Yes (Mark “Wa” box, THEN 2) 2DN0

b. Even though -– did not work during thoaa 2 waeka, did —–

have a job or businass?

I ❑ Yes (Mark “Wb” box, THEN 2) 2 ❑ No (4)

!a. During thosa 2 waeks, did —— miss any tima from a job

or business becauae of illness or injury?

Cl Yes OOa No (4}

b. During that 2-waak period, how many days dld–– iniaimo-ra

than half of tha day from -– job or buainaaa because of

illmrsa or injury?

00❑ None (4) n (4,

la. D“ri”g th~s~ 2 Waaka, did -- ~iSS ~“y tima from school bacau~a

of illnasa or injury?

❑ Yes 00❑ No (4)

b. During that 2-week periosi, ~o-w”many-d;y; id ~~ misi rn&o

than half of tha day from school bacausa of ilhtaaa or injury?

m ❑ None n

la. During thosa 2 waaks, did -– stay in bed bacausa of Illnasa or injury?

ElYea 00❑ No (6]

----- —-—-. _____ _____ ----- _____ _-

b. Durbrgthat 2-waak pariod, how many daysdld -- stay in bad mora

than half of tha day bacausa of Illnass or InJury?

m U None (6) D (L).?,

NAHIS!IE”amw,ll12.1.9EI

Page

I I

111111

. ---

Refer to 2b and 3b. D2 n No days in 2b .x 3b {6)

m 1 or more days in 2b or 3b (5)

5. On how many of the (number h 2b or 3b) days missed from

[work/school] did –- stay in bad mora than half of the day

because of illness or injury?

00D None No.of days

Ba.

b.

Refer to 2b, 3b, and 4b.

[

missed from work

(Not counting the day(s) missed from school 1

),

(and] in bed

Was thara any [OTHER) time during those 2 woaks that -– cut

down on the things –- usually does becauee of iilnaes or injury?

•l Yes 00U No (D3)

[

miaaad from work

(Again, not counting tha day(e) missed from school 1

1,

(and} in bad

During that period, how many (OTHER) days did –- cut down for

mora than half of tha day because of illnaas or injury?

mu None n

Refar to 2-6.

D3 ❑ NO days in 2–6 (Mark ‘,No’>;n RD, THENNP)

❑ 1 or more day. in 2-6 (Mark “Yes” in ffD, THEN 7)

I

Refer to 2b, 3b, 4b, and 6b.

~work I

miss school during thos 7a. What (other) condition cau*ad ‘– *0 (or) stay in b~ 2 waeke?

[or) cut down

(Enter condition in C2, THEN ?LU

. .

[1miss work

miss school b. Did any othar condition cauaa –– to ~or)stay In ~d ~o~~hat

(or] cut down

I ❑Yes(Reask 7a and b) 2i3N0

‘OOTNOTES

10
❑ Old age

A. HOUSEHOLD COMPOSITION ——..—.. PAGE . 1

I●. Whst ●a tho namw of all pwsorw living m staying hem? Start with the name of tha parson or

.

1. First name

on- of the parsons who owns or rants this home. Entername in REFERENCE PERSON column. I

Lsst name

b. What ●ra tho names of ●ll othor persons living or atayi”g hwm? Enter names in columns. If -y”,,. ante,

m ON:

%!

namez in columns

c. I hava Iiatad (read names). Have I mISSnA

2. Relatlonshlp

Y; t&o REFERENcE PERS

- ●y bablw or small chlldrwi? 3. ~te~f birth , Date

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~Yeat

- ●ny Iodgws, boardwa, or perwns you ●mploy who live hare? . . . . . . . . . . . . . . . . ❑ ❑

— wryona who USUALLY lives here brrt Is now ●way from home

trmwlhrgorirrahospltal? .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IJ Q

HOSP. WORK RD 2-WK. DV

-anyone alwstaylng ha?.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑

c1 000 None

low. 1 •1 Y*S ‘UN”””

d. Do dl of the paraono you hava named usually live hem?

~ 2nWb 20 No —

•l Yes (2J Numb.r

❑ No (APPLY HOUSEHOLD MEMBERSHIP ‘-’ “- ‘- ““ ‘

Probe if necessary: RULES. Delete nonhousehold members

by an %“ from ; –C2 and enter reason.)

C2

D~s -- “~u~llyIlvaao~awh.~also? L~ --------------- IRA I DV I INJ. I CLL7RI HSICONQ.

1111 II

t 1

Ask for all persons beginnkrg with column 2:

!. What ID —- relatlcmship to (reference per-son)? ————— —-

LA

.—_— ——

IRA I C.V i’iN3 lCLLTRIHSICOND.

1. What Is -- data of birth? (Enter date and age and mark sex.] 1181!1

I ,

REFERENCE PERIODS

L~-–-----–––-––– IRA I DV IINJ. lCLITfll HSICOND

2-WEEK PERIOD

111111

_— —_______ ___________ _________ __________________

Al I

12-MONTH DATE

—--— - -——— -—-— ——

------------ --——---—- ____ _________ ____ __________

LA IRA I DV IINJ. 1CLLTRI HSICOND.

111811

13-MONTH HOSPITAL DATE

I

A2 ASKCON~,~,oNLIsTS1,2,●nd3.

LA‘— ~Ri ‘1 6V- ii N~. ~U—Lfil ik~C6i/D.

11! 111

1111 II

,,- . .

E. 2-WEEK DOCTOR VISITS PROBE PAGE

- ,. ~.~:;:..-”:.:. ““. “

Read to respondent(s):

Thsss nmxt quastlorm US dmut haeltfr cam rmxlvad during tho 2 waoks outlined in rod on that calmwfsr.

EI Refer to age.

El ❑ LM.r 14 (1M

❑ 14 and ov.r (1.s)

1a.During those 2 wscks, how many timw did -- ~~e or ~lk ~~ * m~i~l d~~r? {l”cl”de ●il typ-.

of doctors, such ●s dermatologists, psychiatrlsta, ●nd ophthalmologists, ●s wall ●s general :;~ w ❑ None

practltlonors ●nd osteopaths.} (Do not count tlmos while ●n ovemlght patient in a hospital.) b.

..-. ----- ---—. _____ _____ ______ ______ _____ _____ _ m]

(NP)

b. During thoso 2 waoks, how many timas did ●yone sae or talk to a medical doctor about ––?

(Do not count times whila ●n ovarnlght patiant in a hospital.)

Numbar of times

,, .-. ,>--

2a. (Basldaa tha tima(s) you just told ma about) During thosa 2 weeks, did anymra in tha family receivs , .-

hoalth caro ●t homa or go to a doctor’s office, clinic, hospital or some other placa? Includo care .“..

from ● nurse or anyona working with or for a madical dootor. Do not count tlmea whila an

overnight patient in a hospital. ❑ Yes

“.. .,A. ..:-. ,’

---- ---- —---- ---- ---- ____ ______ ____ _______ __

b. Who racelvad this cwa? Mark “DR Visit” box in person’s column. 2b. ❑ DR Wsir

c. Arryona alaa? ❑ yea iReask 2b and C) ❑ NO .:, ~.. ~~ ‘“2!

---- ---- ________ _____ _________ ____ ____ ________ ____ --- _-, ___ ____ ---- -.:<

Ask for each person with “DR Visit” in 2b:

d. How many timaa did –- reccrlva this cara durlfrg that pmiod? ‘“ n

Number of Iilll,.

Sa. {Sasld.s tha tlma(s) you already told ma about) During those 2 weaks, dId anyone in th~ famIiY “7 .- “;$” ,,,. ~ : .. f”:

got any madlcal advice, preacriptlons or taat reardta ovar the PHONE from o doctor. nu~a, or +-! , -. - ,-

●nyono working with or for ● medical doctor?

---

❑ Yes ❑ NO iE2) :::’ =,a~--- . ,’””.:;’” ,,:-

—---- ----- --- .----— — _________ _____ ______

b. Who was ~ho phona call about? Mark “Phone cal~ box in person’s column.

--<-—-—- “4..--,=+- ---A,-

3b.

•l Phone call

------ ------ --. __ —_____ _______________________

c. ‘Were ~h;re any calla ●bout ●ryona else?

-- ..*-=.— ,Y,-—-= - --., -- ---, -

❑ Yes fReask 3b andc) ❑ No .’- ““ ‘-.--’- “ -:--- -–: -

------ ---- ____ . ________ ____ —-————— ——-—— -——————— .+ ._--_., - .:. ., ; & -_

A;k for ;a;h parson with “Phone cal/” in 3b:

d. How many talaphorw calls wers made ●bout -–? ‘. a

Numberof wlk

. . . . .

‘.. . ..-. ,,- .: ,“ : --:-- -,, ..’ ‘. ... . .-.”:,. .,-. -’

Ez Add rrumbars in 1, 2d, snd 3d foreachpersoh. Record totalnurnberof visits and calls i“ “Z-WK. DV” box in item Cl.

‘OOTNOTES

,“.....,......... ....... ... . . .. . . . .

,E..,u., m”, ,’. ,.w, mgO Ie

35
❑ Old s..

A. HOUSEHOLD COMPOSITION PAGE 1

a.What ●re tha namss of ●ll persons fivlng or staying hare? Stint wkfr tho name of tfw pwaora or 1. Firsttume

one of the parsons who owns or rents this homo. Enter name in REFERENCE PERSON cokmrn. I

lass name

b. What 8s’sttm namas of ●ll othar parsons Ilvhrg or staying hors? Enter names in columns. If ,,YM,,, ~n~,

m ~ _ r’n

%3M

names in cofumnz

F

2. Relti”onship

c. I have Nstaat (read names). Have I mismxk Y; g

REPERENCEPERCON

— ●ny bcbiae or small chlldrmr? 3. ~te~f birth, ~ate

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

— ●ny fodgees, bowdors, or parsons you ●mpfoy who Iiva hsm? . . . . . . . . . . . . . . . . ❑ ❑

~Year

- ●ryorw who USUALLY lives hors but i8 now ●way from Imma

trarralIrw w in ● hospftal?

HOSP.

❑ n

WORK RD 2-WK. DV

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

cl C-2n.ma ,~wa , f-J ye, ODD Nom

- ●cyona alto 8taying hwc? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 0

~ ZD wb ZO NO Numbm

d. Do ●ll of tho parsons you hwc named usually live here? ❑ Yes (2)

n No (APPLY HOUSEHOLD MEMBERSHIP = ‘~~~ ‘

Probe if nacasamy: RULES. Delete nonhoussfmld mambem C2

by an “~ from 1–C2 and arrterreason.) i= – ~Rx -1 ~v- ~N7.ia_Lm, ~~icm

DO-S -— “,”.lly fin. so~.wh.,. .!’.? 1111

, I t ! I 1

Ask for all persona begkming with column 2:

!. What is –- ralaticmship to(reference person)7

LJJ-Jl

LA- - %x ‘1 ~V- ‘ii NT. iC~Ll%i %TC6ii

1. What is –- date of birth? (Enter date and age and mark sex.)

REFERENCEPERIODS

~ H

LA‘- ~~ ‘~ ~v- ~i.~~?fl ~S~C~N .

2-WEEK PERIOD

II

———— ------ ______________________________________

Al

12-MONTH DATE

------ ---------

LA IRA ; ov ;INJ.: CLLTR; HS; CONO.

------------ ----------— -- — -- — ----------- —-------

13-MONTH HOSPITAL DATE

A2 ASKCONDITION Llsrs ,,2. ●“(f &

LA‘-‘p —:=..- ~ m. ~q Ksp-NO.

,,, , ,,

1

. .

I r

,, !,, ,

I

F. 2-WEEK DOCTOR VISITS PAGE I

OR

Refer to Cl, “2-WK. DV” box. I PE

FI I Refer to age, IF1

1a. On-wjq (gt~er!d~tg(s!dgd!o~hos! ?w.@w.d@ --. sea Or talk to ●msdlad docto,r,yma-, o-r#@or’s aasiatmt? _ la<

b, On what (other] date(s) during those 2 weeks did anyone sea o; talk to a medical doctor, nur&, •~

or doctor’s assistant about --? .

~;k ;’;r ~s; 0> ;Js;t ~ol~m> ror th;s perjon: -

. ---- ----- --- - .

c. Warn thare any other visits or calls for --

c.

during that osriod? Mske necessary correction to 2- Wk. DVboxin Cl,

2a. Where did –– roceiva haalth care on (date in 1) — at a GHA medical carrtar 2a<

or somewhera alsa, or was thh a talaphona call?

/f te/aphone ca//: Was this call to GHA or somawhrwa else?

----- ----- ---- ----- ----- ---- -.

b. Which GHA mmfical cantor was that? b.

----- . ..-. ----- ----- -.. .

c. Whara was that? Rsccvd ful/ name of p/ace.

--- --

c.

----- ----- ----- .-. . ----- ----- _____ ----- _____ --- __

d. What kind of placa is that – a doctor’s office, clinic, hospital, or soma othar kind of pIaca? d.

Ask 3b if under 14. 3a

3a. Oid -- actually talk to a medical doctor7

b. b;d ~;y&~ ;c~u-all y_taik-trj a-rne~~al do&&-ab&a~ ~ = > “ - - - - - - - - - - - - - - -

_- am

b.

----- ----- -.. .

c. What type of medical person or os&rs~ W& taiked to? - - - - . - - - - - - - - -c:

d. What was the doctor’s nema? - - - -

----- ----- ---

1-’:

e. Is that doctor a ganeral practitiormr or a specialist?

.--—. ..---

● .

f. ‘What ~ind” of specialist?

. . . .- . . . . . --

“f.-

1

Ask 4b ;f under 14. 4a

4a. For whst condition did -- sae or talk to the [doctor/(entry in 3cfl on /date in 1)7 Mark first appropriate box. a-m

b. For wha; condition did anyone sarr or talk to the [doctor/(entry in 3cJl ●bout -- on-fdate jr-r 7)?

b.

Mark first acmroiyriate box.

c, Was a condition found as a result of the [tast(s)/axaminaticm]7 c.

d. Wim this [test/examination] because of a specific condition -- had> d.

e. During tha past 2 weeks was —— sick because of har pragrmncy? % :

f. What was the mattar?

. .

f.

g. During this [visit/call] was the [dcrctor/(antrv h 3cjl talkad to about any (othar) corrdition7 9-

h. What was the crmdition7 h.

I

Mark box if “Telephone” in 2.

6a. Did -- have ●ny kind of surgary or oparation during this visit, including bona sattlngs ●nd stitches

6a

b. What was the nama of the surgery or operation? If name of operation not known, b.

dascribe what was done.

c. Was thara any other surgary or opcmtion during thla vlsit7 c.

Go to next DV if “Home” or “GHA madical center” in 2. s.

6. in what city (town], county, and State is tha (place in 2) located?

IRM IUS 1 !E,,kJ.,,w,, ,2 I SO,

36

Page 18

E1❑ GHA Med. Center lb) s ❑ Pimne cd to GHA lb!

(3I

----- ----- ----- --- J

iioc-h-i&&- - - - !i*[Jrri:- - - - -

02n H0me 080 O.P. dim

03 ❑ Omof’s ome 09 ❑ Emqrrsy morn

040 Ca u lti. chic 10 ❑ Dmmf% Offkr

050 Othcl dirk

%B&sm!f”)z

llOLzb

’20 %:%%%%,

m ❑ Olkr LSe#c,f”)~

1 !3 YesWI e ❑ DK i M.O. m

2 D NO(2CJ 9 ❑ DK* WISSeSOf41

----- ----- ---- --- J

141 991J lx (4)

. . . . . . . . . . . . . --- J

1 u Cmdllm mm C2 TNEN4gl

2 ❑ Prrenmq (4#

3 ❑ Tat(s) or exmuman 14CI I

L=-?-l

CltvCoumv~

Stale ZIP Cede ~

I
❑ Old ●m

A. HOUSEHOLD COMPOSITION PAGE

& What am thenamesof ●llparsonsliving or staying hem?StSftwithtlIenameof theparsonor

ormof ths parsonswho ownsor rantsthishome. Enter name in REFERENCEPERSON cohmm.

b. What●m ttwnamesof allotherparaomlivingor staying how? Enter names in columns. If -y”,,. ~nter

m

names h columns

o. I havolisted(read names). HaveI mimad Y; &o

- ●nybablasor @mail children? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

- ●ny Iodgarqbom’dars,or pwsonsyou●mploywholivehare?. . . . . . . . . . . . . . . . a o

—●nyonowhoUSUALLYlives ham but is now away from home

tmvalingor israhospltai? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑

-anyono also staying ham? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑

d. Do ●Iiof theparaonayou havenamedusuailyiivehem? ❑ Yes(2J

❑ NO (APPLYHOUSEHOLOMEMBERSHIP

Probe if necessary: RULES. Delete nonhousehold members

by an “X” from 1–C2 and enter reason.)

Do-s -— “’”ally live =~ma~hem else?

Ask for all persons beghr!ng with column 2:

. What Is -- miationahlpto (referance p8mOn)?

What la -- dataof bifih? {Enter date and age and merk sex.)

REFERENCEPERiODS

2-WEEK PERiOD

--------------- ,_______________ _________ _____ ____

Al

t

12.MONTH DATE ------------ _____ _. ————__ _____ _____ ____________ .

13.MONTH HOSPITAL DATE

A2 ASK~oN~i~ioNLis~s1,~,.n~3.

... . .. . . . ..

G. HEALTH INDICATOR PAGE

1●. During tha 2-weakparlor!outilnedin radon thatcalandar,has●ryorminthofamilyhad ●n injury

from ●n ●xidont or othorcausothatyou havenotyettoid maabout?

i3Yes •l No (2)

____________________________ ______ _____ ___________

b. Who wasthis? Mark “Injury” box/n person’s column.

----- _____________________ ~_______________________

c. What was -- injusy?

Enter krjury(;es) in person’s column.

------ —–.——______ _____ ____________________________

d. Did ●nyonehava●ny othw injuriesduringthatpariod?

❑ Yes(Reask lb, c, and d) ❑ N.

--------- ----- _______________ _______________________

Aak for aach injury in lc:

●. As ● rawlt of tho (injury in 7c) did [-—/anyone] sacor talktoa medicaldootoror assistant

(about- -) or did -- cutdown on --- uauai●ctivitiesfor morothan haifof ● day?

,,.

. . .

,’ ,, . . . -,.’

2, Ourlngths past12 months,{that is,sinca(lZ-month date) ● yam ●go} ABOUT how manydayadid

iiinmaor inJufykaop -- in bad morathanhalf of thaday?(Inciudedayawhiiman ovamlghtpatiant

in ● hospital.]

3-. Duringthapaat12 months,ABOUT how manytimesdid [-–/anyone] seeor taikto ● madical

doctoror ●ssistant(about --)? (Do notcountdoctors●oemwhiiean ovamightpatientina

hospital.}(Ittcludttho (nurnberln 2-WK DVbox) visit(a) you●lraadytoldmm●bout.)

----- ------—- _____________________________________

b. fi~o::how longhaak baemsinca[--hnyon.] last saw ortalkadto ● madicaldoctoror assistant

--)7 Inciudadoctorsaaanwhile● patientin a hospitci.

,’.’ ., :.:,’” . : ’, ....’....

Q. Would you ●ay -- hmlth ingarwmlisaxcalient,varygood, good,fair, or poor?

Merk box if under 18.

5@.At)out how ~11 ig _ _ without ah-,?

--------------- ----- _____ _____ _____ _______ ________

b. Abom how much da, -- weigh with~”t ,ho~s?

T==a 1. Firs name Mid. WE. ge

L8st “am. ax

lDM

20

2. Relationship

REFER NCE PERaON

3. ~::t~f blnh , ~ste

peat

1 1

HOSP. WORK RD z-w. Ov

;1 20El f40ne ,~wa ,f-J ye, OODfSOne

~ 2nWb 2D No —Numbm

“* .,-, .- ~.,’> % .,

- : - .% .K . ..

:2

L~ – ~- ‘: 6V- iiN7. Ta-Lml HSICCWD.

——-

1!11

I 1 I

Es

l-r–—–--–---––—–– IRA I DV IINJ. I SLL7RI HSICOHD.

111111

LA

—-- —--

– – TRK ‘8 Ev– iiti. I CLLTRI w ICONO.

II 1111

—----- —--- —— —--

LA IRA / DV ;]NJ. I CILTRl HSICONO.

1 II

.—.

c.

4..’, “ .,

.-

●✎

2.

3a.

--

b.

-

4.

——

b.

:OOTNOTES

—

.: ---’- ----.--.-4.

❑ In].fy

---- ——— ——— —— —--

Injury “1 ‘ -= - --- :-*T; -..7- T.-..

. . “~,.;..+

--,-:“ :+ .-Fe.. ,, ;.

... . . . ., ,: .-

.,:. . . . . .

.— --4 -.-----,- ---

❑ Y#~I~in## C2, TNEN

-

❑ No (1. fornsxrinJwy)

000 DNone

No. of days

0000 Nom f3bJ

ooon Onlv whsn overnight

patient In hospisal

}

(NP)

No. of Visii

---------- -— ---

I ❑lntatiw week (Ressk3b)

2❑Less thsn 1 w. Olrssk 24

3 •l 1 yr., kmsthsn 2 vs.

402 WS.. lessthsn S yrs.

5 •l 6 WS. or mora

oDNovor

,.:;, -“ ,...,.:. “< .“

1 ❑Excelie”t 4D Fair

Znvawgwd 50 P&r

3oa0.A

❑ Under 1S (NP)

Feet _ Inches

—--- ——— —— —-----

Pounds

I

RMHIS.! [E,,lwlord ,2. 1.WI Page 20

37
A. HOUSEHOLD COMPOSITION PAGE 1

ii

I

(

4

A

A

m“” .,? , ,,,.—, ,.. ,.au, P*ge22

D. What ●re the names of ●ll peracms living or staying hem? Stati with the name of tha person or 1. FM name

one of ths persons who owns or rants this home. Enter name /n REFERENCE PERSON column. 1

lam nnme

L What ●re the names of ●ll other persons living or staying hcm? Enter names in ccdumns.

:. I have fisted (read namea). Have I mlssesk

-imybsbim orsmallchildrsm?. . . . . . . . . . . . . . . . . . . . . . .

- any lodgers, boar&rs, ot persons you employ who live hare?

— ●nyone who USUALLY lirms hem but is now away from home

traveling orinaho8pkal? . . . . . . . . . . . . . . . . . . . . . . . . .

wORK RO 2.WK. OV

-wryonaolse staying hwa? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

cl mown. ,~we ,~ ~,, 000 Non.

L Do alI of the pwaons you have named usually Iiva hem?

~ 2DWb 20 No —

❑ Yes (21 Number

Probe if necessary: RULES. Delete nonhouaeho/d membara

by cm “X” from 1 -C2 and enter reason.) ~r -

Does -– usually live somowhera else?

1 I

Ask for 8// persona beginning with column 2:

What is –- relationship to (refarence p8rson)?

What iS -- data of birth? (Enter data and age and merk sex.)

REFERENCE PERIODS

‘-–LA -iRx -1 w- iiu3. rcwlil

2-WEEK PERIOD

[11111

------- ----—- — ------ — - — -------------------------

Al

12-MONTHDATE

-— ---- -- —— --—---

LA tRA : w ;INJ.; cLL711;na; cmm.

—-------—— ---- —— -- -—- ——-—---- ——— —-- ——-— —--------

I t f , t I

13. MONTH HOSPITAL DATE

A2 ASKcofJDmoNLISTS,,2,,.ds.

-- —------------

LA IRA 10V I INJ. I CLLTR; HS; COUO.

1111

111111

H. CONDITION LISTS

Read to respondent:

Now I ●m going to mad you ssvaral lists of medical conditions. Tall me if ●nyona In thofamlly has ●ach condition I raad, ovan If

You hava mantionad it bafora.

. .... . .. . .. —....-.
n -.>

u u. age

A. HOUSEHOLD COMPOSITION PAGE 1

● .What ●re the names of all persons living or stqing ham? Stsrr with the name of the person or 1. Firsxname

on. Of the parsons who owns or rents this home. Enter name h REFERENCE PERSON co/umn.

Mfld Init. Age

Last name

b. What ●e the namm of all other persons living or stqlng here? Enter nemes m co/umns. If ,,ycg,,. snter

sex

a ,,,,

lDM

names in columns

20F

2. RelaucmhiP

c. I havo listed (read names). Have I missed Yes No REFERENCE PERSON

- ●ny babies or small children? ❑ 0

3. ~$t;f birth

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~Date

- ●ny lodgers, hoarders, or persons you employ who live ham? . . . . . . . . . . . . . . . . •l

;Year

❑

- anyone who USUALLY lives hare but Is now away from home

travellffg orlnahospltal? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ C.

HOSP WORK RD 2-WK. DV

- anyone also staying here? ❑ 0

cl mm None ,~wa ,~ ~e= 00DNme

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d. Do all of the petrsons you have named usually live here? IJ Yes (2)

~ 2DWb 20 No —Number

❑ No (APPLYHOUSEHOLDMEMBERSHIP “ - ‘: ,.

Probe If necesssry; RULES.Delete nonhousehold members

by an ‘X” from 1 -C2 end enter reaaon.)

C2

Doaa —— usually live somewhere else? LA—— %x ‘1 ~V- ~lNi iCL—L1~l~S~CO-iti

11111,

! r I r 1 f

Ask for all persons beginning wfth column 2:

. What i. --- r~latlon~hip to (r~feren~e person)?

LA ————.

(RZ ‘16V– ilN~, iCi-LTRl Hal CONO

. What Is –- dataof bitth?(Enter dete and age arid mark sex.) 111111

t

REFERENCE PERIOOS —. --—--

LA

-——

IRA 1DV ii~.TCL~lRl Hal C6iiLi

2-WEEK PERIOD

11111[

----- -------- ____ ______ ____________ ________ ____ _

ml

12-MONTH DATE

--------- ____ —— -

---- ____ _____ __________ _______________________ __

LA IRA ; w ItNJ. I aLrsl HslcONO,

1111

1 I

13.MONTHHOSPITAL DATE

K2 ASK CONDITION LISTS 1,2, and 3.

Lr – ;mA--, I---------- DV ;INJ.; csLm; H9;COMD,

111111

J. HOSPITAL PAGE HOSPITAL STAY 1

Refer to C 1, , ‘HOSP. ” box. 1. PERSON NUMBER_

You said ●arllw that –– was a patient in tho hospital since ~) - ● ymmr Month Date Year

OgO, on what date did -- .ntar the hospital ([tha lasttime/the time before that])?

Record each entry date in a separate ~ospita/ Stay column. 2. 19_

. How manynights was –- letthe hospital? 3. oosa ❑ Nom (Next HS)

Nights

1. For what condition did –– enter the hospltml? 4. 1❑ Normalddivmy

● Fordeliverv ask: ● For ne wborn aak: ● For inirisl “No condition” ask: 2❑ Normal ●t birth

)W;:h!:a;mrmd ddiwry? }

(5I

Was the baby normal at birth? Why dii –- anter tfm hospkal? 3 ❑ No condition

If “No,” ask:

What was tho matwr?

● For tests, ask: ❑ C.a”ditlon ~

What was the matter? What W*FO the WWhe of tho tasts?

/f no results, ask:

Why were the tests penfornwd?

J1 ❑ At least one night In 2.week

JI Refer to questions 2,3, end 2-week reference per!od.

reference oerlod (Enter condirlon

m C2. THEN 5)

❑ Nonights in Z.wmk refermmm @rlod (5)

;a. Did -- have ●ny kind of surgery or oparation during this stay inthehospital, 5a.

Includlngbona sattlrtgs and stitches? 1Cl Yes 2 ❑ No (a)

., . ---- ---._- -— _____ _____ ________ --,

b. What wm tho nama of tho surgary or oporation? b.

[f name of operation not kno wn, describe what waa done.

11)

(2)

[31

---- - -- ---- ---- ______ -— ---

c. Was thara any othar surgaty or operation during this stay? c. ❑. Y., (ff#askeb ●ldc) ❑ No

1. What is tho name and addsoss of this hospital? 6. Name

Numbsr nnd street

Cw w Co””ty state

001’NOTES

IMHIS1K“.!u,!km,2 ,.w

.

..-. . .

39
❑ old am

A. HOUSEHOLD COMPOSITION PAGE 1

●.What ●re the rmmas of ●ll persons living or staying here? Stert with the name of the parson or 1. First name Mid. Ink. AQa

one of the parsons who owns or rants this home. Enter name/n REFERENCE PERSON column.

Last name

%.4

z What am the rmmos of all other persons living or staying here? Enter names in cokrmns.

a ~ , *: ~ ‘n’

If “YOe,’8 enter

names in columns

c. I have listed (re~d names). Have I missed:

2. Relatiomhip

Y~ ~

REFERENCE PElfSON

-any babies orsmall children? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. ~ta:f birth, ~ate

- any lodgers, brmrdafs, or persons you tmploy who live here? . . . . . . . . . . . . . . . . ❑ ❑

:Year

- ●nyone who USUALLY Ifves here but is now away from homa

tmuellngori nahospftsl? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑

HOSP. WORK RD 2-WK, DV

-anyona&esfa yinghare7.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 0

cl 000 Nom

Iowa 1n Yes

000 Nom

d. Do all of the persons you havo named usually live hare?

~ 2D Wb 20 No —

❑ Yes (2) Numbnr

❑ No (APPLY HOUSEHOLD MEMBERSHIP ;-’”> ‘-’ “ “ ‘“”’*”~

Probe if necessary.’ RULES. Delete nonhousehold members

by an “X” from 1 -C2 and enter reason.)

C2

Does –– usually live somewhare elsa? -LA‘– ~K ‘:6V– iiN3.rC~17W]R’S~6hd

II

t I ! I

Ask for al!persons beghrnlng with column 2:

. what is -— relad~nahip to (refemn~e p~~on)? ————— LA IRA 1bV- TiM3.rU~TIfl ~S~6!16

. Whet la -– dcto of birth? (Ertterdateand age and mark sex.) 111111

I I \

Al

REFERENCE PERIODS

w

L~ - W‘1 W TIti3.RiT?7il %R6kd

2-WEEK PERIOD

--- —— ----- ______________________________________

t

12-MONTH DATE

- — ---------- - . -------- — ------ —--- _______________

13-MONTH HOSPITAL OATE m

~2 ASKCONDITION LISTS1,2,●nd3.

J

It

\

------- —------- .

LA, IRA I DV IINJ. / CLLTlt;HS;CONO

111

CONDITION 1 i PERSON NO. —

Name of condition

Mark “Z-wk. ref. pd. ” box without asking If “DV” or “HS”

in C2 as source.

. When did [––/anyone] Imstsee or talk to ● doctor or ●ssistant

●bout -— (cond!tiord?

O ❑ Interview weak (Reask 2) 6 El 2 WS., 10ssthm 6 ym.

1❑ 2.wk. ref. pd. S •l 5 yra. or mom

20 Over 2 weeks, less thm 6 mos. 7 ❑ Dr. seen, OK whm ---------------

3 ❑ 6 mm.. lessthan 1 W. B❑ DK If Dr. men

4 ❑ 1 y,., less,hm 2 y,,, 9 El Or. never seen )

13bl

la. (Earlier you told me about -–j condkiodl Did the doctor or ●ssistant

call the (corral/t/on/ by ● mom tachnicd or spsoific name?

1 ❑ Yes 2DN0 sODK

-———-- ___________________________

Ask 3b if “Yes” !n 3s, otherwise rranscdbe condition name from

;tem 1 without ask;ng:

b. What did ha or ehe call It?

(Specify)

1❑ Color SlindnossWC) 2 ❑ Cmc’sr (3u)

3•l t.lomml wegnmcy,

}

4 ❑ Old aga WC)

normaldelivery. (5)

vasectomy a ❑ CNh9r(3c)

----— — ___________________________

c. What was the csu8e of -— [cond;tion In 3bR LSpeclfy) ~

---------- ___ —-- _________ ________

Mark box if accident or in]ury. o ❑ Accldentkirrjury (5J

d. Did the (condition in 3b) result from ●n accident or Injufy?

10 Yes (5/ 2DN0

~s~ ~e~f;h; ;o;&;;n;;e;n-3; r%%~&&~ ;f<h; ;~o;~~;o>;.

AIlmont Cmmr Ohasw Pmb!mm

Anemia CondNlon Olsorrhr Ftuptur*

Asthma cy*t Orowth Troubfe

Atfack Omfact Maadaa Tumor

Bad Ulc9r

●. What kind of (condition in 3b) is it?

C%ecifvl

----- ------- ----- ---- --_:_ _“___ ----

Aak 3f only if allergy or stroke in 3b-e:

f. How doss the [allergy/stroke] NOW ●ffact --7 (Specify) ~

For Stroke, fill remainder of this condition page for the first present

effact. Enter in item C2 and complata a separate condition page for

each additional present effect.

W HI$.112V,WUOIII 1%1.W,I Page

I I

Ill Ill

Ask 3g if there is an impairment (refar to Card C72) or any of the

following entrias in 3b–f:

Ab8cass

Acha lmcapl haad or car)

Blaadlnif (axzcpt mmmtnml)

Blood Olot

Boll

Cane.r

Crampa [*xwpf rnumtnml)

cyst

Oamaea

Qmwth

H*morrhaga

Infutton

Inflammation

N*u,As18

Nunitfs

P*ln

Pak8y

●ardy81*

Rupturm

Somlmaa)

SNH lnsm)

Tumor

IN-r

Vmboaa Wlrla

Woak(nasa}

g. What part of the body is affected?

(Specify)

Show the fo//owing data//:

Hm.d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..skull. scatP. faoo

Sddspfnaivmtdasa. . . . . . . . . . . . . . . . . . . . . . . . . . ..uppar. mFddfa. Fdwac

Srde . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..kart0frkok4

Em . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..rnnar Or OufaGtsff,lf@tf#OrkW’h

Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..ldGrfaftt. of bofh

Arm . . . . . . . . . . . . ..sho.ld.r. uppar. aftraw.lowaforwfFat. fafLdaht. z.fbeSEt

Hind. . . . . . . . . . . . . . . . . . . . . . arlfrra hmd or finger’ Only; I* tf@S, or both

w . . . . . . . . . . . . . . . . . ..hlp. ups-w. kma. faww. arankl*. ktt. rh#it.rsboth

F.M . . . . . . . . . . . . . . . . . . ..mtimfoc4. arch. ortoaccmty.lcFt. rfghGerbeth

---- —-—--- ————-- ———-------------- .

Excapt for eyaa, eara, or internal organs, ask 3h if thare are any of tha

fo//owing entries in 3b–f:

Infasflon Sara Sommw

h. What part of thejosti of bodv in 3b–g/ II ●ffected by the Ihrfeotlotd

sordsorenessl - the skin, musole, bon-, or some other pati?

(Spacify)

Aak If there are an y of the following entriua In 3b–f:

Tumor Cwt Grow2h

1. Is this [tumor/cysVgrowthl malignant or benign?

I ❑ Malignmt 2 •l Ewnign 9 ❑ OK

[

●. When was —— (condition in 3b/3f

‘1

1 ❑ 2-wk. ref. @.

5

first noticed? 2 ❑ Over 2 weeks to 3 mcmfhi

----- -— --— -— --- ----

b. When did -- (name of Injury in 3b)?

2 ❑ Over 3 montheto 1 yaw

4 •l Over 1 yearto Syews

5 ❑ over 5 Vem

Aak probes as necessary:

(Was iton or ●lnce (first date of 2-waek ref. period)

or was it before that date?]

(Wn$ it less than 3 months or snore than 3 months ego?)

(Was It le8s th=n 1 year or mttrethan 1 yew •go~)

(Was it less than S years or more than S yams ago?)
n,.,. --- n.. m-

,“.,. , . . . . . . . . . . . . . ,. . -,

41

,“. ,>>”. , ,6,.,.,,.,,, ,.. ,.w, Page 27
A. HOUSEHOLD COMPOSITION PAGE 1 ---

●.What twotfronamesof ●ll personslivingor etsyinghere?Starswiththenameof theparsonor 1. First name Mid, init. Aga

OLWof thaparsonswho ownsor rantsthishome. .Enterrrame in REFERENCEPERSON columrr.

L3stname

‘:bhr

J.What●a thermmmof ●ll rrthwporsorwIlvlrtgor stayinghem?Enter namesin columns.

m _ ~, ‘n

If “YEs,“enter F

namas in columns 2. Relationship

:. I havaIlatad(readnames). HavaI missed: Yg ~

REFERENCE PERSON

– any bablas or small children? 3. ~tec~{binh

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~Date \Yeaf

- ●ny Iorfgars, boardara, or pwamw you ●mploywhoIivahero?. . . , , . . , . . . . . . . . a ❑

— ●nyonowhoUSUALLYIivo.horsbuth now●wayfromhome

travollrrgorirrahospital?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •l ❑

HOSP, WORK Ro 2-WK. DV

—msyorreelmatyhrghsm?.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 0

cl 00 DN.ane 000 Nom

Iowa 1c1 Yes

r,Jum~er =1 wb ZU NO Number

d. Do ●ll of thapsraonaYOUhmrarmmaduarmllyIlvehara? IJ Yes(2)

❑ No(APPLYHOUSEHOLDMEMBERSHIP

Probe if necsasary:

:<.:2$~ .% ., A, ,%, .J.;-!. .7..;

RULES.Deletenonfrouseho/dmembers C2 by an “X” from 1–C2 andanterreason.) ~r -------------

Doaa –– usuallylive●omawharaa!ao?

IRA ~OV ;lNJ. ~CLLTR;HS~C~Nti

I

t o t , I

Ask for allparsonsbeginning with column 2:

what IS -- ralatfonshipto (reference PeBOn)?

What h

Lo-––-–-––--––- IRA I DV IINJ. ICLLTRIHSICON6–

-- dot. of birth? {Enterdare and age and mark sex.)

REFERENCEPERIODS I ii - ~R~ ‘Y ‘1 ~V– iiNi. iiCii77il RSTb~

2-WEEK PERIOO

Ill Ill

----------------------- ———---------- ——— ——— —----—

Al

12-MONTH DATE

------ ——-—------

LA IRA ~DV ;INJ.; CLLm; HS~tOND

—- —— —---—---- ---—————----------——— ——— ——-— —------

1 0 , I I 1

13-MONTH HOSPITAL DATE

A2 As~~ofJ~l~lo~f.[s~sl,z,ands, LA‘- _iR~ –16V- iirll ici-i7FlfisicTso

[1111!

Illllt

L. DEMOGRAPHIC BACKGROUND PAGE

11 ❑ Under 5 (NP)

LI Refer to age. ❑ ia-17 fz)

❑ Ieand over (1)

la. Did -- EVERsawa on ●ctlvaduty itsthoArmed Fomaaoftha UnitedStat..? la. 1 •1 Yes

2 ❑ No (2)

-------------------------------------------------- ---- -- ——— ——---— —---

f). wh~n did -- s-w.?

{

Vietnam Era (Aug. ’64 to April ’75) . . . . . . . . VN b. IOVN 5a PVN

KoreanWar (Jurm‘50to Jan. ’55) . . . . . . . . . KW zDKW 800s

Mark box in daacandhrgordar of priority. World War II (Sapt. ’40 to July ’47) . . . . . . WWll

Thus, if personserved in Vietnam and in Korea World Warl (April ‘17to Nov. ’18) . . . . . . . .WW1 3CJWWN sDDK

mark VN. PostVietnam (May ’75 to pressntl . . . . . . . . WN 4CIWWI

Othar Sarvica (all other periods) . . . . . . . . . . . OS

-------------------------------------------------- .. —- ..------- ——------ C.wan-- EVER●n ●ctivomambarof ● NationalGuardor militarysaearvaunit? c. ❑ Y.. 2QNo{2) 7nDKf2J

—------- ------ ---- ----— ---------------- — ---------- ---- --------- —-----

d. l#as ALL Of-- ~~~a d~ sawl~ ra]~t~~ Nat[O”~lGrr@ osmil~ry “~a~- t~~lning? d.

lDYes 3DN0 sDOK

2a. What isttmhighastgradaor yaarof rsgularschool -- haa●varattandad? 2m. w ❑ Nawr attended or

khdarw2ao (NPI

Elem: 12345678

Hialu 9 10 11 12

college: 1 2 3 4 5 6 +

-------------------------------------------------- ---- .- —--- —— —--------

b. Dkt -- flrrbhtha (number(n2a) [grafdyaar]? b.

lnYas 2 ❑ NO

,,, ,., -....%, .,, *,

~~~r ~1 :: .+, —.. . . .. .:. , ., ~,=, .; ! .. . .&. .7 , ,: ‘.;,.:-.:: .,> !

. . ...”.””

Hand Card R. Ask first alternative for firatparaon; ask second akamativa forotharpersons.

3a What ie~_nru~~ of tbogroup or gmupa whkh rapramstts-- mr?o?

fWhatIs 1

38. 12346=

Ckc/e all that apply

1- Aleut, Eskimo,or American Indien 4- Whiie

2 – Asian or Pacific Ielander

3 – Black

5 – Another groupnot Ilated – Specify

(Specify)

-- =-- ~__-------- _—______________ —_----- ___ —______ ----

Ask If mult{p(eentrlas:

--------- ———---

b. Which of time. groups;that is, (antrlaa in 3s) would you aay SE8T reprasonta-- MC.?

b. 1234 63

(Spacifyl

------------------------------------------------- ---- .-__--_----------

C. Mark obaewed rasa of raapondt?nt(s)only. c.

low 2CI12 300

Hand Card O. 4a. t ❑ Y9S

qa. Am ●nyof lh~~ gmupa -- national-In or ¤w~? (wham did -- •~~~ COMSfMM?) 2 ❑ No (NP)

__________________________________________________ ----- ---------------

b. Pfaamglvamathanumfmrof thagroup. b.

Circleall that appl~

1- PueRo Rican 5- Chicano

2- Cuban 8- Other Lstin American 1234567

3- Mexicen/Mexlcano 7 – Other Spanish

4- Mexican Amaricsm

-. ,“. . . ..... ...,. . . .

Pqla 40
❑ Old age

A. HOUSEHOLD COMPOSITION PAGE 1 —-----

1

.. . ..——

a. What ●m thenamesof all persona livingor stayinghors?$tarf withthanameof thapersonor 1. F& name - Mid.init.

ormof theparsonswho ownsor rantsthishome. Enterrwme in REFERENCEPERSON column. 1

Lastmm

b. What●mtherram~sof ●llothwparsons living or staying here? .%tar names in columns. If .T-, - ~nfer

m ~ , :,:Nr -

‘hrd 1

rymes ;n selumns

2fl F

2. Relationship

c. I haveIlstad(read rramas). HaveI mlssgd Yes No REFERENCE PE7Wt0

- wry bablasor smallchildren? 3. ~tat~f bhlh ,Date

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :%.,

- ●ny Iedgors,INNErdwa, or personsyou●mploywhoIIW hwa? . . . . . . . . . . . . . . . . E :

- ●nyonewhoUSUALLYliveshwabuti8nowawayfromhome

trm.alhrgor lnahoqitel?..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I_J ❑

HOSP. WORK RD Z-WK. OV

-anyono alsastaylrrg hare?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑

cl 00nNone

low. 10 Ye, ’00 ‘0”’

d. Do allof theparsonsyou havanamedusuallylivehara? U Yes (2) Number

2D Wb 2D No Number

#.~.”f

n No (APPLYHOUSEHOLDMEMBERSHIP

*. $.. ... .. . 4\ -.:4$... :*:+’; -: :

Probe /f nacessarw RULES.De/eta nonhousehold members C2

by an “X” from 1 – C2 and enter re8son.) ~K _

Doss -- usuallylivesomawhwe●lsa? p- –~b-v-pmpllnl HSICONO.

——-——

II

I I I 1

Ask for Wpersons beghrnhrg with column 2:

, Whmt 1. -- mlatiOnohip tO (rafere”~e pe~~”)?

LA

. What Is

‘–– ~R~ –1Ev– Tr,3. ic~iill

-- dataof bhth? (Enter date and age and mark sex.} 111111

, I

REFERENCE PERIODS --—— ---

LA

2-WEEK PERIOD

111111

. ------- ____________________________________ ____

Al

12-MONTH DATE

-——— —----——__——

-------- _____ ____________________ ________ ____ ___

LA IRA ~OV IINJ.ICLLTN HSICOND.

!111

1 #

13-MONTH HOSPITAL DATE

——__ ___________

h2 ASKCONDITIONLISTS1,2, ●“d 3.

LA IRA i w IINJ. I CLL7RIHslcOND.

11! 111

II 1!11

, .; :,,>,

: .’ .’.&:’ “;’”..:; ‘o%:G, ?:>- ,: .’ ; ,

1

L. DEMOGRAPHIC BACKGROUND PAGE, Continued

-~*’-! ... :

;#.:- , ,,+/:;, ,>J :-:.y - ,,,--’ ..,. ~

on Under 18 (NP)

L2 Refarto “Age’<and “Wa/Wb’’boxesin Cl. 1❑ Wa IMX marked (6a)

‘2

:B ~ti~x~yrfl((ib)

BE. Emrliw you satrf that -- hasaJobor brwhwmbutdid not worklastwaakor theweekbaform

Waa

50.

-- lookingfor work or on layofffrom ● job during those2 waaka? 1❑ Yes (6C) 2❑ NO (6b)

___________________________________________________ __e _____ ___________

b. &ryou safdthat -- didn’t have● job or buaktoeeIaatweekor thowaekbefore.

-- Iooklng for work or on l~yoff from a Job during thoso 2 weeks?

b.

1•1 Yes 2❑ No (W’)

___________________________________ _______________

__ ________________

c .Whlch, lookingfor workor on layofffrom ● job? c. 1❑ Lc4iw fad 3❑Smh (6b)

Zn Lsyoff (6b)

6a. fkrllsr yOfE said that -- w~~ lam Waak O, ~~ ~~k ~OW. ASk 6b.

__________________________________________________

b. Forwhom did -— work? Entername of company, business, organization, or other Omp/Over. 6b. Employ.r

O NEV (6#/

----- — - — _________________________________ __________

●nd

o,Forwhomd~ --wo~at __ lastfull-tlmcjoborbtwirwsslasting2 cmwacutlveweeksormore? c. ❑ AF (6.)

Entornam.sof company,business,organization, orotheremployar, ormark “NEV”or “AF’’box[nperson’s column.

---- _-- ——_____ ________________ ____________________ ___ _________________

d. What kindof businessorlrrdrrefryisthis?For exsmpfe, TV and redio manufacturing, I“dustw

ratai/ shoe store, State Labor Department, farm.

d.

----- ------- __________________ _____________ ________ ___ _________________

/f “AF”’ In 6b/c, mark “AY box in paraon’s column Without asking. a. OccupaNOn

●. What khrdof workwas -— doing? For examp/e, electrical angineer, stock clerk, typist, farmer. ❑ AF (NP)

------ _____________________ _______________________

f. What warn-- moatimportantaotlviffaaorduties●t thatjob? Foraxamp/a, types,

keeps account books, files, sells cars, operatea printing preaa, finishes concrete.

- ~. ofii&--------------

---------- ____________________ _____ __________________ ___ ________________

Complete from entries in 6b–f. If not clear, aak: Cfassof wotker

g.Waa --

An cmpfoyss of ● PRWATa COIWMIIY, busln~o w

ff.

aeIf-Smpk2y9d 1. OWN bU9hWS, pmfusfOnSI

lnP sol

Indlvldrd for WSQS9,salary,w comnl”lon . . . . . . . . . P Pracrk, or fmn? 2D F aclsE

AFEOE7fALgewmmsntcmployae?...............F Azk lmtho buslmss krcorfmra2sd7 30 e 7 cfwP

AalATEgovsmmmimmpfqss?.. . . . . . . . . . . . . . ..a Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ALOCALaowremsnf wrrployss?.. . . . . . . . . . . . . . ..L No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ai 4D L anNEV

Wmkfna WITHOUT PAY tn family kmhrass

erfm117 . . . . . . . . . . . . . . . . . . . . . . . . . . . ..WP

- NEVER WORKEOarmrsr werktiaf s 7u21-Sms

iofIkW49Cr2w99kaerm ma . . . . . . . . . . . . . ..NSV

)OTNOTES

. . . . ..- . . .

IM m,., ,wwu,mr,l ,Z., .30, Page 42

43
A. HOUSEHOLD COMPOSITION PAGE

I. What arotfwnamesof ●ll personslivingor stayinghem?Startwiththa nameof thaptmon or

oneof thepamons who ownsor rentsthishome. Entername in REFERENCEPERSON column.

. WhM●mttmrwmasof allothwpersonslivingor stayinghare? Enternames in columns. if ,,YSS,3-entw

m

mmsz in cvlumnz

. i havoIietad(read names). Hava[ missed Yes No

-arybsbiae orsmallchkimn?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ o

- ●nylodgers,bowdam,or parsonsyouemploywholivehots?. . . . . . . . . . . . . . . . ❑ ❑

- anyonowho USUALLYlivesherebutisnowawayfmm homa

travalingor in a hospital?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 0

-any0rr*a18aeteyingbefa?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ •l

L DO●ll of tho personsyou havanamedusuallylivehorn? ❑ Yes (2)

•l No(APPLYHOUSEHOLDMEMBERSHIP

Probe if nacessary: RULES.Oaletenorthoussffoldmembers

00ss -–

by sn “X” from 1-C2 sndentarreaaon.J

usually Iiweomowhomelse?

Ask for allpersona beginning with column 2:

What ia -- mfatiorwhipto (rafarance parsord?

Whet IS-- dataof birth? {Ente<drsteand aga and mark sex.)

REFERENCEPERIODS

2-WEEK PERIOD

-.--. . ---- —- . ---------- . - —----------------------

12-MONTH DATE .- —- ——-------- --- —---— ————------ ———--— —----- —----

13-MONTH HOSPITAL DATE

42 Asf(cofJD\Tl@J,Ll$T$ 9,2,●nd3.

L.DEMOGRAPHIC BACKGROUND PAGE, Contfnuftd

Mark box if under 14. If “Married’* refer to houaahofdcompositionand mark acaordingfy.

1. IS -- ~W WW, WMOWOCI, tfivorod, separated, or has -- neverbearfmwtferf?

la. Wastfretotelcomftlntt,;AMILYIncomeduringthapast12months- thatIs,yews, ~

madForoasmemba noath omd more w Iasathan $20,0007 Mu* MWSSYfrom WC, -M seomftyt

felimmsnfInmtre,unemploymentpaymorrts,public●ssietanae, and so fofth. AfsOhrofwfe hroome from

imtcrea& dividends,notInomnefmmbushes%farm,orrerrf,●nd ●nyothwmemylfIOOMSfc-=lwI.

Resdif necasaary:InoomoisImportantlywtaiyzfngtheheafthInformationweoolfeat.Feswtasnpia, this

fmformatfotthelpsustofearnwhetherpersonsinon. Irtoomsgroupuseoertaintypesof matfieaicam

eemfoeeof haveserfeinoondftfonsmoreor feesoftenthmtthoseifI●oSwr gsoupo

--------------------------------------------------

b. Of thoseinoomogroups,which latterboatmpmsontetfwtotalcombinedFAMILY inoomc

drrrhtgUN past12 months(thatla,yours, (read names, IncludingArmed Forcaamembers

livingat home))? Inohtdowages,salariaa,●nd otherktemswoJueftalkad●bout.

Read If necessary: incorrwis importantin ●tmlysingfha hdth informationweoolieot.For wzampio,

tbiainfmnmtkwthaipsuato Iaemwhethw parsonsin onaImromagroup usocartelntypesof

medioaloam ●wviccsor havocertainconditionsmom or Iasaoftwrthanthoeain●mtfwr group.

R

L3

L4

GHA

●. Mark first appmpdate box.

------------------- —-- --------------------------

b. Enterperaon number of reapondenr.

Enterpareon numberof first parent Iiated or mark box.

Enterperson number of spouee or mark box.

●. is--currently a memberof GHA?

---- ---- ---- ---- ---- ---- ---- -“--- ---- ---- ----

b. AtanytimesinceOctober1988,has--been a mamber of GHA?

1

.I Firm numa Mid. init. KAIP

:21 \

I , t , #

~----- ----------

IRA : DV ;8NJ.: CLLIR; HS:COM

II—————K

t,

----

LA IRA

----

I DV

I

I

pii.pqisp-r(

11[1

‘. o •1 Unasl14

lnhfsrfisd -sWssln HH

2nMmisd- slx41mnmin Htl

3 ❑ Wldowsd

4 ❑ mvomsd

6 •l S+srstd

1=. 1 Cl 820,0W or nwm lffmd Card II

2 ❑ LSSSthm $20,200 (ffmd C#rdJ)

-- .

b.

----------------

00UA 10DK 200 u

oiUa lIDL 21OV

02DC 12DM 22CIW

0300 ISDN 230X

040E 1400 24DY

OSOF 150 P 2SCIZ

06DG 161ZQ 2aCizz

070H 17DR

0s0 I was

OSUJ 190T

Ra. oclune+f17

1 c1 Pmssnt for SIf qwn.bm

2 ❑ Prumz for sorns q+ntbtu

3 ❑ f40f prssom

--+------------------

Wnfkominhamsfdd

L4

Psrsmnumbw of ●Poum

00 n Non+inhousehold

S.IInY**&’P) 2i_JNO(b)

t

---- ---- ---- ----

I

b. 1D h 2DN0

FsW4law WV-l (2.1.s0! PS2S u

44
❑ Old age ——. —.. . . . .. . . .

A. f.fnllscufii n ~nurwiem-s~~ PAGE 4 ... -------- “.. w ““,., r”~ , ,, Q.. . . . . . .

.—. -.. ”_._._..

m. What are the names of all persons Iivlng or stayl”g hem? s~~ with the iWmO Of th~ pOMII ~1.

8

1. Fkst name

one of the persons who owns or rentE this home. Enter name in REFERENCE PEt?SON column.

Last name

g: J. What em the names of all othw pCIrEO”S Iivlng or staying h.re? Enter names in CO)W-WS,

.— .. . .. . . . . .

/f r“,,, ~nter

oamesmcolumns 1

:.1have listed (~. Hava I mlsssd:

‘---1 ,, r

2. Relationship

Yes T

REFERENCE PERSON

—anybabies orsmallchlidre”? . . . . . . . . . . . . . . . . . . . . . . .,.,,..,,,,, ,’ ~ k

3. ~:t:i birth

— CIEEYIMO?8, fEOOtiWS, Ot ~OflE yOU OmplOy who 11”0 hare?

~Dale pear nln

— anyone Who USUALLY lives ham but is now away from home

-..

tiavelin swhahsptil ?.... . . . . . . . . . . . . . . . . . . . . . . . .

HOSP. WORK RO 2-WK, DV

–anyoneelse staying hem?.... . . . . . . . . . . . . . . . . . . . . . . . . . . .:: k~:

c1 00 DNo..

IUwa ,C ,.s ““o ‘0”’

..— ___ _____

1. Do all of the persons you have named usually iive here?

~ Zn Wb 2DN0 —

[.; Yes (,2) Number

~J NO (APPLY HL7LKEHOL9 MEMBERSHIP

,,. ~;~,~.;;i.~, ..; ,}Q$;:>,.,.; ;=y,,:.}:, ?; “~+x., ,,,.* ,,

Probe If necessa~: RULES. Deieu? ~onhousehold members C2 by an “X” f.,w. ?---C2 and enter reason. ) ~r _

Does –– usually live 8omewhom else? ~– ‘~ 6V– ~Nq ~Ct_L~l MS I COKO

———.

Ask for all persons beg{nning with column 2:

—. —... . . . .. . ...” . .._. . . . . .

What Is –– mlatlonship to (refereoce psrson)? ;::9

——— . . .. . . . ,., -_ .“__

What is –- dote of birth? (Enrer date and age and mark sex.)

LA IRA \ 0 v- ~Nj TU–L,T, R~~@rff,j

t,,

1 I 1 , ,

-... —.-— .. _____

REFERENCE PERIODS

L~ – ~~ ‘1 ~V– iiN~ TU-LTRI w~~~~fi

2-WEEK PERIOD

,,, ,,

, 1 I 1 I

Al

12-MONTH DATE LA k--–––-–––- DV 18NJ. lCLLTRl I+SlfX+4D -

1 (1,,,

, I 1 , (

13-MONTH HOSPITAL DATE

——_. _. _______

42

-—-——__ IRA IDv IINJ. ICLLTNHSICOND

ASK CONDITION LiSTS 1,2, and 3.

LA

111, ,

—

;l ,1,,

L. DEMOGRAPHIC BACKGROUND PAGE, Contimvad

L5 Ref.sv toag#. Complete a separataco)umn for each ncmdeletedperson aged 7t? a“d CWer. ~~

PERSON NUMBER

&

Read to respondent(s): In order to datmmina how health prmxfces and condltlonm are

*‘~~..: ~. .

,,,,.$,,$m’.:: .$;

related to how Iong.paople fiva, we would Ilke to refer to statistical

~“”:$$:,:;;4#;g;g;kF*ix@!@$#~

,%,..,: .,, , #’.>,,

~ ‘;’”’’!f@v’s

;<~,; : ;,;*lit <$?s< ~W% ~

records malnminad by tfm National Center for f+oaith Statistics. ,;;: ~,~-.. %6$+ $@+. ,,,.-

.,

., ,,!<,e ‘% :,,*>;.*$

#%,* ...& ,.$q%a;,~ !!

Dateof birth ~

L6 Enter date of birth from quesdo” 3 on Household Composition page.

‘6 ~

—— ._. ’_, .

la. III what Stato O, c.xE”t~ W*S -— b~m?

&

9*. S9 ❑ OK fNF’J

print the full name of the St#te w mark the .qppropriste b~~ if the

person was not bom in the United States.

state

01 n Pwno Rico 06 aCub4

02 ❑ Virgin Islands

.-.-i... -----------------

0+ n Mexico

03 ❑ Guam S8 ❑ All other

04 a Cemada co.ntrks

E

If born in U.S., ask 96; if born in foreign country, ask 9c.

----! -- ----------------

1 D Less thm 1 y, 4 ❑ 10ym, l*slthm16

b. Altogether, how many yearn hns –– Ilwd in (State of present residence)? b. 2D1w., kssthcm5 5a15”’,. cffnofe

3n5ys.,lmsthm10 9DOK

c. Altogether, how many yearn has -— lived In the UnlteEI Statern? ~ ❑ ,Om, J-&

> D Less than I ~r.

~ c. 2D1w,, !assthm5 5 ❑ 15 “m or mom

3m5yrs,,low Uam10 8UDK

\

-. ——-

.. . . . . . . . . . .--, ,.”— ,..,.m,

– .w@4$s

45
&

SUGGESTED SCRIPT TO INTRODUCE PERMISSION FORMS As I mentioned earlier, GHA isworking with Westat on this study. As part of the data collection, we would like to

obtain some additional information from your medical records at GHA. One of the purposes of thisstudy isto see how certain national health statisticswould be differentifthey were

made from medical records rather than from interviewing people in households. To do this, we need your writtenpermission. I remind you that any informationthat would identify

you or members of your family will be destroyedafterthe data collection.

Hand permission form to respondent, If additiona/ GHA members in household, fill out permission forms for them, and arrange to have them signed as well.

PERSON 1 PERSON 2 PERSON 3 PERSON 4 PERSON 5

0 ❑ Not Required O ❑ Not Required O ❑ Not Required O ❑ Not Required O ❑ Not Required

PF1 Enter status of permission PFI 1 ❑ Signed 1 ❑ Signed 1 ❑ Signed PFI 1 ❑ Signed 1 ❑ Signed

form for each person 2 ❑ Not Obtained; 2 ❑ Not Obtained; 2 ❑ Not Obtained; 2 I_J Not Obtained; 2 l_J Not Obtained;

Lefi at Household Leftat Household Left at Household Left at Household Left at Household

3 ❑ Refused 3 ❑ Refused 3 ❑ Refused 3 ❑ Refused 3 ❑ Refused

4 ❑ Other 4 ❑ Other 4 ❑ Olher 4 ❑ Other 4 ❑ Other

:

“m.
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5,

SERIES 6.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics.They include descriptionsof the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

Data Evaluation and Methoda Research—These reports

are studies of new statistical methods and include anal~”cal

techniques, objective evaluations of reliability of collected

data, and contributionsto statisticaltheory.These studiesalso

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistii. These reporta carry the anatyses furtherthan

the expository types of reports in the other series.

Documents and Committee Reports-These are final

reports of major committees concerned with vital end health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

International Vital and Health Statistics Reports-These

reports are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

Cognition and Suwey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

Date From the National Health Intewiew SuweWThese

reports contain statistics on illness; unintentional injuries;

disability;use of hospital, medical, and other health services

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuingnational household interview survey.

Data From the National Health Examination Suwey, the

National Health and Nutrition Examination Suweys, and

the Hispanic Health and Nutrition Exemhration Suwey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or condtions in the United

States and the distributionsof the population with respect to

physical,physiological,and psychologicalcharacteristics,end

(2) analyses of trends and relationships among various

measurements and between survey periods.

Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

Data From the National Health Care Survey—These

reports contain statisticson health resources and the publii’s

use of health care resources including ambulatory, hospital,

and Iongterm care services based on data collected directly

from health care providars and provider records.

SERIES 14.

SERIES 15.

SERIES 16.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

SERIES 24.

Data on Health Resources: Manpower and FacilitieaDiscontinued in 1990. Reports on the numbers, geographic

distribution,and characteristics of health resources are now

included in Series 13.

Data From Special Surveys—These reports contain

statistics on health and health-related topics collacted in

special surveys that are not part of the continuing data

systems of the National Center for Health statistics.

Compilations of Advance Data From Vital and Health

Statistic&Advance Data Reports provide early relsase of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reporta in Series 10-13.

Data on Mortali~-These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trand analyses

are included.

Data on Natality, Marriage, and Divorce-These reports

contain statistics on natalii, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

Date From the National Mortality and Natality SurveyaDiscontinued in 1975. Reports from these sample suweys,

baaed on vital records, are now publishedin Series 20 or 21.

Data From the National Survey of Family Growth—

These reports contain statistics on factora that affect birth

rates, including contraception, infertility, cohabitation,

marriage, dworce, and remarriagct adoption; use of medical

care for family planning and infertilii and related maternal

and infant health topics. These statistics are based on

national surveys of childbearing age.

Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics system that were published as supplements to tha

Monthly Vi Statistics Re@ (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final date from the National Vial Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact

Data Dissemination Branch

National Center for Health Statistics

Centers for DiseaseControl and Prevention

Public Health Service

6525 Belcrest Road, Room 1064

Hyattaville, MD 20782

(301) 436-6500

E-meik nchsquery@nchlOa. em.cdo.gOV

Internet http:/Avww.cdc.gov/nchswW/nchshome.htrn
DEPARTMENT OF

HEALTH AND HUMAN SERWCES

PublicHealth SeNice

Centers for Disease Controland Prevention

NationalCenterfor Health Statistics

6525 Belcrest Road

Hyattsville,Maryland20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

BULK RATE

POSTAGE & FEES PAID

PHS/NCHS

PERMIT NO. G-281

DHHS PublicationNo. (PHS) 96-1396, Series 2, No. 122

6-0260 (8/96)