Vital and


Health Statistics ~


Plan and Operation 

of the National 

Hospital Ambulatory 

Medical Survey 

Series 1:


Programs and Collection Procedures


No, 34


This report describes the methods used in the 1992 National Ambulatory 

Medical Care Survey, This survey is based on data obtained from the national 

probability sample of visits to hospital emergency and outpatient departments, 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


Public Health Service


Centers for Disease Control and Prevention


National Center for Health Statistics


Hyattsville, Ma@and


July 1994


DHHS Publication No, (PHS) 94-1310

. L-- -_~-- -.... --..-. -. a-is.-_ _- ---~-..-i _.-_--- - . _- - 

-.--_ 

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

reproduced or copied without permission; citation as to source, however, is 

appreciated 

Suggested cltatlon 

f&Caig LF, McLemore T Plan and operation of the National Hospital 

Ambulatory fv4edica.l Care Survey National Center for Health Statistics Vital 

Health Stat l(34) 1994 

Ltbrary of Congress Cataloging-in-PubllcaQlon Data 

McCaig, Linda F 

Plan and operation of the National Hospital Ambulatory Medical Care 

Survey/ [by Linda F McCaig and Thomas McLemore] 

p. cm - (vial and health statistics. Series 1, Programs and collection 

procedures; no 34) (DHHS publication; no (PHS) 94-1310) 

“July 1994 ” 

includes bibliographical references. 

ISBN O-8406-0493-9 

1 National Hospital Ambulatory Medical Care Survey (U S ) 

2 Hospitals-Outpatient services-Research-united States. 3. Medical care 

surveys-4Jnited States I McLemore, Thomas II National Center for Health 

Statistics (U S ) Ill Series IV Series: DHHS publication; no (PHS) 94-1310 

FtA409U44 no 34 

[F!A974] 

362 1‘0723 s-dc20 

[362 1’1’072073] 

94-12448 

CIP 

For sale by the U S Government Printing Office 

Superintendent of Documents 

Mail Stop: SSOP 

Washington, DC 20402-9328 
National Center for Health Statistics 

Manning Feinleib, M.D., Dr.P.H., 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 

Peter L. Hurley, Associate Director for Wal and Health 

Statistics Systems 

Robert A. Israel, 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 

OfFiceof Vital and Health Statistics Systems 

Peter L. Hurley, Associate Director 

Division of Health Care Statistics 

W. Edward Bacon, Ph.D., Director 

Thomas McLemore, Deputy Director 

Catharine W. Burt, Ed.D., Chie$ Ambulatory Care Statistics 

Branch 

Manoochehr K. Nozary, Chiej Technical Services Branch 

Caaperation of the U.S. Bureau of the Cema.s 

Under the legislation e-.stabliibingthe National Health .%rveyj tbe Public Health 

Serviee is authorked to use, insai%ras possiile, the serviee-sor facilities of other 

Federal, State, or private agencies. 

-Iwaceordancewitb specifications estebliabed by tbe National_CenteLforlieakh 

Statistics, the U.S. Bureau of tbe CeOSW under a conlractnal armrrgemen$ pardcipated 

in plamdng tie survey end colkcting tbe data. 
.

Contents


Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1


Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Sample design . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Primary sampIing units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...3


Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Outpatient clinics and emergencyservice areas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4


Visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...5


Data collection procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . 6


Field training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
 ,.
 Hospital induction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6


Outpatient clinic and emergency service area induction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7


Data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7


Field quality control ,., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7


Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...8


Data processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Medicrd anddrugcoding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4... . . . . . . . . . . . . . . . . . . . . . . . . . 9


Edits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...9


Quality control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Imputations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...9


Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...10


Inflation by reciprocals ofprobabilities of selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...10


Adjustment for nonresponse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10


Ratio adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10


Reliability ofestimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...11


E&imation ofstandard errors.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...11


Standard error approximations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <................11


Standard error applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11


Nonsampling error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...13


Data dissemination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14


I 1993–94NationalHospitalAmbulatoryMedicalCare Survey . . . . . . . , . . . . . . . . . . . , , , , . , . . . . . . . . . . . , .,. . . . . . . . . . . . . . 15


References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . ...16


I Appendixes 

I.


11.


III.


n?


v


VI.


VII,


VIII.


Legislative authorization . . . . . ..-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 18 

Definitions ofcertain terms used inthe survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 

Data collection forms usedinthe 1992 National HospitalAmbulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . 23 

Definitions ofterms relating tothe Patient Record forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 

Introductory letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...71 

Endorsement letters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 

Thank you letters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, ,,,,., . . . . . . . . . . . 75 

Patient Record forms used inthe 1993-94 National HospitalAmbulatory Medical Care Sumey . . . . . . . . . . . . . . . ...77 

... 

Ill 
---

Text tables 

A. Number of hospitals in the National Hospital Ambulatory Medical Care Survey universe and sample . . . . . . . . . . . . ...4 

B. Coefficients for use in the approximate standard error equations for the National Hospital Ambulatory Medical Care 

Survey, by type of service areru United States, 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 

c. Estimates of the civilian noninstitutionrdized population, by selected demographic characteristics: United States, 

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 

“ 

. . . 

— 

0.0 

z 

* 

Symbols 

Data not available 

Categoty not applicable 

Quantity zero 

Quantity more than zero but leas than 

0.05 

Quantity more than zero but less than 

500where numbers are rounded to 

thousands 

Figure does not meet standard of 

reliabilityor precision 

iv 
I 

I 

! 

I 

I 

Plan and Operation of the 

National Hospital 

Ambulatory Medical Care 

Survey 

by Linda F. McCaig, M.P.H. and Thomas McLemore, 

M.S.P.H., Division of Health Care Statistics 

Introduction 

In December 1991, the National Center for Health Statistics (NCHS) inaugurated the National Hospital Ambulatory 

Medicrd Care Survey (NHAMCS) to gather and disseminate 

information about the health care provided by hospital emergency and outpatient departments to the population of the 

United States. The purpose of this report is to describe the 

background and development of the NHAMCS and to provide 

the survey design and methodologies of the 1992 NHAMCS. 

NCHS has authority under Section 306(b) (1) (F) of the 

Public Health Service Act (42 USC 242k) to collect data 

concerning the public’s use of health care and services (see 

appendix I). Ambulatory care is the predominant method for 

the provision of health care services in the United States. In 

1991 there were approximately 1.43 billion ambulatory visits 

in the United States (l). Ambulatory care is provided in a wide 

variety of settings. The largest proportion of the ambulatory 

care occurs in physicians’ offices. Since 1973, NCHS has 

collected data on patient visits to physicians’ offices through 

the National Ambulatory Medical Care Survey (NAMCS); 

however, visits to hospital emergency (ED) and outpatient 

departments (OPD), which represent the second largest segment 

of the ambulatory medical system, are not covered in the 

NOTE This report describes the development and methods used in the 1992 

National Hospital Ambulatory Medical Care Survey (NHAMCS). The design 

and execution of a large survey such as the NHAMCS cordd not have been 

accomplished without the participation of a large number of people. Many 

members of the staff of the National Center for Health Statistics (NCHS), in 

particular, James Def.ozier (former Chief of the Ambulatory Care Statistics 

Branch, DHES) and Iris Shirnizu (Office of Research and Methodology), and 

many othera outside of NCHS, participated in the development of the 

NHAMCS. Private contractors, the National Opirion Research Center, and 

Westat, conducted feasibili~ studies and pilot tests of methods. The Bureau of 

the Census conducted the data collection for the 1992 study. Lastly, we are 

indebted to the sampled hospitals and their staflk as without their support and 

cooperation the NHAMC!Scould not have been successfully completed. 

NAMCS (2). These health care settings accounted for an 

estimated 164 million visits in 1991. Furthermore, hospital 

ambulatory patients are known to diiTer from office patients in 

their demographic characteristics and are thought to difter in 

medical aspects as well (3). The omission of hospitrd ambulatory care from the ambulatory medicrd care database, therefore, has left.a significant gap in coverage and limits the utility 

of the current NAMCS data. The NHAMCS is meant to fill 

this data gap and to respond to the increasing demand for more 

complete ambulatory medical care data. 

This need for ambulatory care data has been accentuated 

by increasing efforts at cost containment, the rapidly aging 

population, the growing number of persons without health 

insurance, and the introduction of new medical technologies. 

As a result of these societal changes, there has been considerable diversification in the organization, financing, and delivery 

of ambulatory medical care. 

In an attempt to address these and other issues, NCHS ‘ 

developed a plan to restructure its surveys of health care 

providers. Under this plan, the NAMCS, the National Hospital 

Discharge Survey (NHDS), the National Nursing Home Survey (NNHS), and the National Master Facility Inventory 

(NMFI) have been modified and expanded into an integrated 

National Health Care Survey (NHCS). One of the stated 

objectives of the NHCS is to expand coverage into health care 

providers and settings not previously surveyed. Included in 

these settings are hospital emergency and outpatient departments, ambulatory surgery centers, home health agencies, and 

hospices. At the request of NCHS, this plan to develop the 

NHCS was evaluated by a panel of experts convened by the 

National Academy of Sciences and the Institute of Medicine. 

The iinal report from the evaluation, Toward a National 

Health Care Survey: A Data System for the 21st Century 

supported the original NCHS plan that included the development of a survey of hospital ambulatory medical care (4). 

. 
Background 

The development of the NHAMCS actually began more 

than 15 years ago with the first of three major research 

projects to explore the expansion of the NAMCS into the 

hospital ambulatory care setting. In 1976, a study was conducted under contract with the National Opinion Research 

Center (NORC) to assess the feasibility of collecting data from 

hospital outpatient departments by applying then current 

NAMCS Patient Record forms and data collection methodologies: these methods included a l-week reporting period using 

a prospective method of data collection where visits were 

sampled as they occurred and Patient Record forms were 

completed by the physicians and hospital staff near the time of 

the visit (5). This project demonstrated the feasibility of 

collecting data from these hospital settings and provided 

experience in hospital data collection, the use of endorsements, hospital induction procedures, and what to expect in 

terms of cooperation from hospitals and clinics. Results from 

this study included recommendations for changes in the Patient 

Record form and in hospital protocols. Numerous topics for 

additional study and testing were also recommended. 

In 1984, a field test was conducted under contract with 

NORC to test several alternative data collection methodolo­

~gies in the hospital ambulatory care setting (6). This study 

tested two methods of data collection, a retrospective approach 

in which data were abstracted from medical records and a 

prospective approach in which data were provided at or near 

the time of the encounter, and two lengths of data collection (2 

and 4 weeks) in hospital emergency and outpatient departments. Data collected using these procedures were then compared with office-based data collected in the NAMCS Results 

included a variety of survey design recommendations, including use of a multistage probability design, maintenance of 

both the prospective and retrospective methods of data collection, use of personal inductions of hospitals and clinics, and 

changes in the Patient Record form. 

In 1989, a pilot study was conducted under contract with 

Westat to develop the national sample design, including the 

determination of the optimum number and allocation of the 

sampling units at each stage of sampling, the stratification 

variables, and the estimation and variance procedures (7). 

Methodological issues also addressed in this study included 

the specification of visit sampling procedures, the development of data validation and other quality control methods, and 

the evrduation of hospital and clinic sampling frames. Recommendations included the use of two of the four panels of the 

National Health Interview Survey (NHIS) sample of primary 

sampling units (PSUS) for the sampling framq use of a 

four-stage design with a nonrotating sample of hospitalq 

stratification of hospitals by various indicators and the clinics 

by specialty are% and use of a 4-week data collection period. 

2 
Sample design


The 1992 NHAMCS included a national probability sample 

of visits to the emergency and outpatient departments of 

noninstitutional general and short-stay hospitals, exclusive of 

Federal, military, and Veterans Administration hospitals, located 

in the 50 States and the District of Columbia. The NHAMCS 

was designed to provide estimates based on the following 

priority of survey objectives: United States, region, emergency 

and outpatient departments, and type of ownership. The 

NHAMCS used a four-stage probability design with samples 

of PSUS, hospitals within PSUS, clinics within hospitals, and 

patient visits within clinics. A description of each stage of 

sampling is described in the following text. 

‘i Primary sampling units 1 

I The first-stage sample consisted of 112 PSUS, which 

1 comprised a probability subsample of the PSUS used in the 

1985–94 NHIS. The NHAMCS PSU sample included with 

certainty the 26 NHLS PSUS with the largest populations. In 

addition, the NHAMCS sample included one-half of the next 

I 26 largest PSUS and 1 PSU from each of the 73 PSU strata 

I formed from the remaining PSUS for the NHIS sample. 

Procedures for selecting the NHIS PSU sample are summa1 rized below. 

The NHIS PSU sample was selected from approximately 

1,900 geographically defined PSUS that covered the 50 States 

and the District of Columbia. A PSU consists of a county, a 

group of counties, county equivalents (such as parishes and 

independent cities), towns, townships, minor civil divisions 

(for some PSUS in New England), or a metropolitan statistical 

I	 area (MSA). MSAS were defied by the U.S. Office of 

Management and Budget on the basis of the 1980 Census. The 

I	 1,900 PSUS were stratified by socioeconomic and demographic variables and then selected with a probability proportional to their size. Stratification was done within four 

geographical regions by MSA or non-MSA status. Based on 

data tkom the 1980 Census of Population, a computer program 

was used to minimize the between-PSU variance for the 

stratification variables. Because the PSUS were selected with a 

probability proportional to size, the largest PSUS in the United 

States were selected with certainty. F@-two PSUS were so 

selected and referred to as self-representing PSUS. The remaining PSUS, the non-self-representing PSUS, were combined into 

73 strata and 2 PSUS were selected without replacement and 

with probabilityproportionalto the projected 1985population 

within each stratum. A detailed description of the 1985–94 

NHIS PSU sample design is presented in a Vital and Health 

Statistics Series 2 report (8). 

Hospitals 

The sampling frame for the 1992 NHAMCS was compiled tlom the hospitals listed on the April 1991 SMG 

Hospital Market Database. Hospitals with an average length of 

stay for all patients of less than 30 days (short stay) or 

hospitals whose specialty was general (medical or surgical) or 

children’s general were eligible for the NHAMCS. Excluded 

were Federal hospitals, hospital units of institutions, and 

hospitals with less than six beds staffed for patient use. The 

SMG Hospital Market Database contained 6,249 hospitals that 

met this eligibility criteria. Of the eligible hospitals, 5,582 

(89 percent) had emergency departments (ED) and 5,654 

(90 percent) had outpatient departments (OPD). Hospitals 

were defined to have an ED if the hospital iile indicated the 

presence of such a unit or if the me indicated a non-zero 

number of visits to such a unit. A similar rule was used to 

define the presence of an OPD. Hospitals were classified into 

four classes: those with only an ED, those with an ED and an 

OPD, those with only an OPD, and those with neither an ED 

nor an OPD. Hospitals in the last class were considered as a 

separate stratum and a small sample (50 hospitals) was 

selected from this stratum to allow for estimation to the total 

universe of “eligible hospitals and the opening and closing of 

EDs and OPDS in the sample hospitals. 

All hospitals in non-certainty PSUS with five or fewer 

hospitals were selected with certainty. There were 149 hospitals in 55 PSUS in this category. In non-certainty PSUS with 

more than five hospitals, hospitals were stratified by hospital 

class; type of ownership (not-for-profit, non-Federal Government, and for-profit> and hospital size. Hospital size was 

measured by the combined volume of ED and OPD visits. 

From the stratified hospital list, five hospitals were selected in 

each PSU with probability proportional to the number of ED 

and OPD patient visits. A total of 161 hospitals was selected 

from this group. In the certainty PSUS, hospitals were stratified by region, hospital class, ownership, and size. From the 

stratified hospital list, 240 hospitals were selected based on 

probability proportional to the hospital size. A sample of 50 

hospitals was selected from the 427 hospitals that had neither 

an ED nor an OPD. 

The hospital selections were made so that each hospital 

would be chosen only once to avoid multiple inclusion of very 

3 
large hospitals. As shown in table ~ a iixed panel of 600 

hospitals was selected for the NHAMCS sampl% 550 hospitals 

had an ED and/or an OPD and 50 hospitals had neither an ED 

nor an OPD. 

To preclude hospitals participating during the same time 

period each year, the sample of 600 hospitals was randomly 

divided into 16 subsets of approximately equal size. Then each 

of the subsets was assigned to 1 of the 16 4-week reporting 

periods beginning December 2, 1991. Therefore, the entire 

sample does not participate in a given year and each hospital is 

inducted approximately once every 15 months. 

The first three reporting periods were originally intended 

to be used as a pretest to allow field staff adequate time to 

familiarize themselves with the forms and procedures. After 

reviewing the data from these reporting periods, NCHS determined that the data were of sufficient quality to be retained. 

Hence, the 1992 NHAMCS included data collected from. 

December 2, 1991, through December 27, 1992, and consisted 

of a sample of 524 hospitals. Subsequent annual samples will 

consist of 13 reporting periods in the calendar year. Of the 524 

hospitals in the 1992 NHAMCS, 474 were in scope or eligible 

to participate in the survey. The hospital response rate for the 

NHAMCS during this period was 93 percent. 

Outpatient clinics and emergency service 

areas 

Within each hospitrd, either all outpatient clinics and 

emergency service areas or a sample of such units were 

selected. Clinics were in scope if ambulatory medical care was 

provided under the supervision of a physician and under the 

auspices of the hospital. Clinics were required to be “organized” in the sense that services were offered at established 

locations and schedules. Clinics where only ancillary services 

were provided or other settings in which physician services 

were not typically provided were out of scope. In addition, 

freestanding clinics were out of scope since they are included 

in the NAkfCS; and ambulatory surgery centers, whether in 

hospitals or freestanding, were out of scope since they are to 

be included in the National Survey of Ambulatory Surgery that 

will be fielded in 1994. A list of in scope and out of scope 

clinics is provided in appendix II. The OPD clinic definition 

excluded the “hospital as landlord” arrangement in which the 

hospital only rented space to a physician group and was not 

otherwise involved in the delivery of services. These physicians are considered office-based and are currently included in 

the NAMCS. Emergency services provided under the “hospital 

Table A. Number of hospitale in the National Hospital Ambulatory 

Medical Care Survey universe and sample 

Hospital CkS Universe Sanrplel 

Total. . . . . . . . . . . . . . . . . . . . . . . . 6,249 60il 

Emergency only . . . . . . . . . . . . . . . 166 

Emergency and outpatient. . . . . . . . . 5,414 5s: 

Outpatient only . . . . . . . . . . . . . . . . 240 15 

Neither . . . . . . . . . . . . . . . . . . . . . 427 50 

he 1992 NHAMCS ssmpleconsistedof 524 hosp”tisthetwere surveyedfrom 

December 2, 1991, throughtDecember27,1992. 

as landlord” arrangement, however, were eligible for the 

study. An emergency department was in scope if it was staffed 

24 hours a day. If an in scope emergency department had an 

emergency service area that was open less than 24 hours a day, 

then it was included under the emergency department. If a 

hospital had an emergency department that was staffed less 

than 24 hours a day, then it was considered an outpatient 

clinic. 

Hospitals may define the term “separate clinic” differently, for example, by physical location within the hospital, by 

staff providing the services, by specialty or subspecialty, by 

schedules, or by patients’ source of payment. Because of these 

differences, “separate clinics” in the NHAMCS were defined 

as the smallest administrative units for which the hospital kept I 

patient volume statistics. 

During the visit by a field representative to induct a 

hospital into the survey, a list of all emergency service areas 

and outpatient clinics was obtained from the sample hospital. 

Each outpatient department clinic’s function, specialty, and 

expected, number of visits during the assigned reporting period 

were also collected. If there were five or fewer clinic sampling 

units, then all were included in the sample. Approximately 

20 percent of the hospitals had outpatient departments with 

more than five clinics. Generally, these hospitals had fewer 

than 20 clinics but several had more than 100 clinics, If a 

sample hospital had more than five cli@c sampling units, then 

five units were randomly selected as follows. The individual 

clinics were listed first by five clinic categories: general 

medicine, surgery, pediatrics, obstetrics/gynecology, and other, 

During data processing, substance abuse clinics were removed 

from the “other” category and placed ,in a separate stratum, A 

listing of specific clinic types and their classification is 

presented in appendix II. Within each category, clinics were 

listed in order of clinic size-from smallest to largest. Clinic 

size was defied as the expected number of patient visits 

during the assigned 4-week reporting period. Within each 

clinic group, if a clinic expected fewer than 30 visits, it was 

grouped with one or more other clinics to form a sampling 

unit. Over 90 percent of the clinics were large enough to form 

their own sampling unit. After grouping the clinics into 

sampling units, five of these sampling units were selected 

based on probability proportional to the size of the sampling 

unit. If clinic sampling was required, the sampling was 

completed by Census headquarters staff in Washington, DC. 

The 1992 NHAMCS included 854 clinics horn 314 outpatient 

departments. 

The emergency department was treated as a separate 

stratum and all emergency service areas were selected with 

certainty. In the rare instance that a sample hospital had more 

than five emergency service areas, a sample of five emergency 

service areas was selected with probability proportional to the 

expected number of visits to each emergency service area, 

Only one hospital in the 1992 NHAMCS reported having 

more than five emergency service areas and required sampling. The 1992 NHAMCS included 462 emergency service 

areas from 437 emergency departments. 

4 
Visits 

Within emergency service areas or outpatient department 

clinics, patient visits were systematically selected over a 

randomly assigned 4-week reporting period. A visit was 

defined as a direct, personal exchange between a patient and a 

physician, or a staff member acting under a physician’s 

direction, for the purpose of seeking care and rendering health 

services, Visits solely for administrative purposes, such as 

payment of a bill, and visits in which no medical care was 

provided, such as visits to deliver a specimen, were out of 

scope. 

The target numbers of Patient Record forms to be completed for EDs and OPDS were 50 and 150, respectively. In 

clinics with volumes higher than these desired figures, visits 

were sampled by a systematic procedure that selected every 

nth visit after a random start. Vvsit sampling rates were 

determined from the expected number of patients to be seen 

during the reporting period and the desired number of completed 

Patient Record forms.. The Sampling Record (IWL$MCS101/S) was used by the field representative to summarize inferrnation necessary for clinic and visit sampling and a random 

start chart was provided on a preprinted label that was 

attached to the front of the form (see appendix III). This basic 

procedure was adapted, as necessary, to the recordkeeping 

systems of the particular hospitals. Dufig the 1992 NHAMCS, 

Patient Record forms were completed for 36,271 ED visits and 

35,114 OPD visits. 

Original specilititions for visit sampling called for a 

maximum sampling rate of 1 in 20 visits or a maximum of 500 

visits, whichever yielded the smaller sample size. Field experience in the early part of the 1992 study indicated the 

potential for heavy respondent burden for clinics with high 

volume. Therefore, the maximum number of sampled visits 

was reduced to 200 and the sampling rates were increased 

accordingly. 

5 
Data collection procedures


The Bureau of the Census served as the data collection 

agent for the 1992 NHAMCS. Data collection and Patient 

Record forms used in the 1992 NHAMCS are shown in 

appendix III. Detitions of terms relating to the Patient 

Record forms are provided in appendix W. 

Field training “ 

Census Headquarters stti were responsible for overseeing the data collection process and training the Census Regional 

Office staff. Regional Office staff were responsible for training 

the field representatives and monitoring hospital data collection activities. Field representatives inducted the hospitals and 

trained the hospital staff on visit sampling procedures and 

completion of the Patient Record forms. However, if hospital 

stti were unable to complete the forms, some field representatives had been trained to abstract the data. In selecting field 

representatives for the NHAMCS, every effort was made to 

choose experienced staff who had also worked on the NAMCS 

or the NHDS. These field representatives were most familiar 

with working with medical professionals and had an understanding of medical terminology and procedures. 

Census Headquarters staff were responsible for writing 

the field manual, which contained the following 

the purposes of the survey


interviewing techniques


a description of the NHAMCS induction questionnaire and


related forms


the procedures for inducting hospitals, conducting hospital


visits, sampling clinics, determining the random start and


take every numbers, instructing hospital staff, supervising


patient visit sampling, editing completed forms, and retriev­


ing missing data.


NHAMCS field representative training included both selfstudy and classroom training. The self-study took approximately 4 hours to complete and was used to introduce the field 

representatives to WCS concepts and give a general 

overview of the NHAMCS forms and procedures. Classroom 

training was conducted in each of the 12 Census Regional 

Offices for 1% to 2 days. The training covered the following 

topics inducting hospitals, clinic sampling procedures, determination of the random start and take every numbers, instructing hospital stti, supervising patient visit sampling, editing 

completed forms, and retrieving missing data. While the 

classroom training provided a more detailed explanation and 

6 

illustration of the forms and procedures, its major focus was 

on gaining hospital cooperation and selling the survey, The 

training utilized many interactive techniques such as role 

plays, practice interviews, and discussion groups. In many 

sessions, a NAMCS field representative also attended to point 

out obstacles in dealing with medical staff and suggestions for 

overcoming them. 

Hospital induction 

Approximately 3 months prior to the hospital’s assigned 

reporting period, NCHS sent a personally signed introductory 

letter from the Director of NCHS to the hospital administrator 

or chief executive officer of each sampled hospital. The names 

of the hospital officials were obtained from the American 

Hospital Association (AIM) Guide to Health Care. The letter, 

which is shown in appendix V, described past ambulatory 

medical care surveys and the purpose of the present survey. In 

addition to the introductory letter, NCHS also enclosed endorsement letters from the ~ the Emergency Nurses Association, and the &uerican College of Emergency Physicians to 

emphasize the importance of the study to the medical community. These letters are shown in appendix VI. 

Approximately a week after the mailing of the introductory letter, the Census field representative called the hospital 

administrator to arrange for an appointment to further explain 

the study and to verify hospital eligibility for the survey, 

Earlier studies indicated that the 3-month lead time was 

necessary to obtain a meeting with the admim’strator, gain 

hospital approval, collect the required information about the 

hospital’s ambulatory care services, develop the sampling 

plan, and train participating hospital staff (6,7). 

During the initial meeting with the administrator, the field 

representative explained the purpose of the survey, described 

the data collection methods and lengjh of data collection, and 

obtained both general descriptive information about the or~ 

nization of the emergency and outpatient departments and 

specific information needed to sample clinics within the 

hospitals. Inmost hospitals, the hospital administrator appointed 

another person to act as liaison or hospital coordinator to assist 

the field representative. 

Information obtained by the field representative about the 

sample hospital was recorded on the NHAMCS-101 (see 

appendix III). The NHAMCS-101 contains several sections: 

. the telephone screener 

. the induction interview 
. the emergency department description 

. the outpatient department description 

� thenoninterview information 

. the disposition and summa~ 

This Ii-page questionnaire was administered to screen sample 

hospitals, ve’iify the hospital sampling frame information, 

induct the sample hospitals, and obtain emergency and outpatient department data. The field representative also completed 

an Ambulatory Unit Record (NHAMCS-101KJ) for each clinic 

and emergency service area in the hospital, regardless of 

whether it was selected to participate or not, to collect 

information on the location, director, types of services provided, hours of operation, etc. If an ambulatory unit was 

eligible for the study, but was not selected to participate, only 

the first section was complete~ if the unit was selected, all 

sections were completed. 

Outpatient clinic and emergency service 

area induction 

After the initial visit and the development of the sampling 

plan, the field representative contacted the hospital coordinator 

to arrange for induction of the sample emergency service areas 

and outpatient clinics and for instruction of the hospital stti. 

At these visits, the field representative described the purpose 

and use of the survey data and explained the data collection 

process, including the visit sampling procedures and instructions for completing the Patient Record forms. 

Previous studies found that many clinics keep their own 

appointment logs, w~ch can be used as the sampling frame 

for visits (6,’7).If suitable logs were available, they were used 

to sample visits. In cases where such a log was not available, 

the field representative supplied the clinic with a NHAMCS103 Patient Vkit Log (see appendix III) that could be used to 

record patient names. In order to assure patient confidentiality, 

the NHAMCS-103 Patient Visit Log was not collected by the 

field representative at the end of the reporting period but was 

retained by the hospital. The field representative used the 

NHAMCS-124 Sampling and Information Booklet to determine the random starts and take every numbers for the clinics 

and emergency service areas (see appendix III). 

Data collection 

The actual visit sampling and data collection for the 

NHAMCS was primarily the responsibility of hospital staff, 

This procedure was chosen for several reasons. First, the lack 

of a standard form or record coversheet in hospitals and the 

individuality of the hospital recordkeeping made field representative training difiicult. Second, for confidentiality reasons, 

numerous hospitals did not want the field representatives to 

review patient logs or see actual medical records. Third, 

hospital stafls were better qualilied to abstract data since they 

were familiar with the medical terms and coding, knew the 

recordkeeping systems, and could complete the forms at or 

near the time of the visit when the information was the most 

complete and easiest to retrieve. 

Patient visit data were recorded for each sample visit 

using either a prospective or retrospective data collection 

method, In the prospective approach, the hospital staff sampled 

patient visits and then completed the Patient Record forms 

(hugely through observation) during or shortly after the sample 

visits. In the retrospective approach, hospital staff sampled 

visits after the patients were seen and then completed the 

Patient Record forms through medical record abstraction. 

Hospital staff responsible for completing these forms were 

instructed how to complete each item by the field representatives. Separate instruction booklets for emergency service 

areas and outpatient department clinics were prepared and 

provided to guide hospital stti in this task. These booklets 

provided an ovewiew of the survey, sampling instructions, 

instructions for completing the Patient Record forms, and 

definitions. 

A brief, one-page Patient Record form consisting of two 

sections was completed for each sample visit. To account for 

the differences in emergency and outpatient care, dfierent 

Patient Record forms were developed for each of these 

settings. The top section of both forms, which contain the 

patient’s name and patient record number, was separated from 

the bottom section by a perforation running across the page. 

The top section of the form remained attached to the bottom 

until the entire form was completed. To ensure confidentiality, 

before collecting the completed Patient Record forms, the top 

section was detached and given to the hospital stall The field 

representatives instructed hospital stti to keep this portion for 

a period of 4 weeks, in case it was necessary to clarify 

recorded information or retrieve missing data. 

The bottom section of the Patient Record form consisted 

of either 18 (for the outpatient department clinics) or 19 (for 

the emergency service areas) items about the patient’s demographic characteristics and specific information about the visit, 

including the patient’s reason for visit and physician’s diagnoses. These Patient Record forms were patterned after the 

NAMCS and can be completed in 2 to 3 minutes. The OPD 

Patient Record form most closely resembles the NAMCS 

form, while the ED Patient Record form has been designed to 

reflect the type of care provided in that setting. Copies of the 

1992 NHAMCS Patient Record forms are shown in appendix 

III. Terms and definitions relating to the Patient Record forms 

are shown in appendix IV 

Each sample utit received a supply of the Patient Record 

forms that were uniquely assigned to that unit. The Patient 

Record forms were contained in the NHAMCS folio, a soft 

cover folder. The forms and folioes were color-coded, yellow 

for emergency service areas in emergency departments and 

blue for outpatient department clinics to aid in field operations. 

Field quality control 

The field representative visited the sampled emergency 

service areas and clinics each week during the data collection 

period and maintained telephone contact with the hospital staff 

involved in the data collection effort. These visits were 

documented on the NHAMCS-101/U. An essential part of this 

7 
documented on the NHAMCS-101KJ. h essential part of this 

effort focussed on the completeness of the patient sampling 

frame, adherence to the sampling procedures, and assurance 

that a Patient Record form was completely filled out for every 

sample patient visit. The field representative reviewed the log 

or other records used for visit sampling to determine if any 

cases were missing and also edited completed forms for 

missing data. Attempts were made to retrieve both missing 

cases and missing data on spec~c cases, either by consulting 

with the appropriate hospital stti or by reviewing the pertinent medical records. A record of this retrieval effort was also 

made on the NHAMCS-131 Edit Checklist. 

On the iinal visit, the field representative collected the 

remaining Patient Record forms and obtained or verified the 

total count of visits occurring during the reporting period by 

reviewing the log used for sample selection or by obtaining 

counts directly from hospital stti. Because this information 

was critical to the estimation process, extensive effort was 

made to ensure the accuracy of this number. 

Additionally, during the first three reporting periods, a 

short Debriefing Form, NHAMCS-133, was administered to 

the hospital stafE involved in data collection. Stall were 

instructed to return these forms in a pre-addressed envelope 

that was provided. Several problems and suggestions provided 

on this form were used to revise materials and procedures for 

the remainder of the 1992 NHAMCS. 

At the end of the hospital’s reporting period, the field 

representative sent the administrator a personalized “Thank 

you” letter. A “Thank you” letter was developed during the 

survey year for distribution to other participating hospital staff. 

These letters are shown in appendix VII. 

Confidentiality 

Assurance of confidentiality was provided to all hospitals 

according to Section 308 (d) of the Public Health Service Act 

(42 USC 242m). Strict procedures were utilized to prevent 

disclosure of NHAMCS data. All information that could 

identi& the hospital or their facilities was confidential and was 

seen only by persons engaged in the NHAMCS and was not 

disclosed or released to others for any other purpose. Names 

or other identifying information for individual patients were 

not removed from the hospitals or individual facilities. 
Data processing


Medical and drug coding 

Data from the 1992 NHAMCS were coded by trained 

medical coding personnel from the Division of Data Processing at the NCHS computer facility in Research Triangle Park 

North Carolina, Information contained in item 10 of the OPD 

and item 11 of the ED Patient Record forms (“Patient’s 

complaint(s), symptom(s), or other reason(s) for this visit”) 

were coded according to A Reason for Viiit Classification for 

Ambulatory Care (RVC) (9). The physician’s diagnoses (item 

11 of the OPD and item 12 of the ED Patient Record forms) 

were coded according to the International Classification of 

Diseases, 9th Revisio~ Clinical Modification (ICD-9-CM) 

(10). Item 10 of the ED Patient Record form (“cause of 

injury”) was coded according to the ICD-9-CM Supplemental Classification of External Causes of Injury and Poisoning 

(E-codes). A maximum of three entries was coded from each 

of these items. 

The NHAMCS medication data (item 16 of the OPD and 

item 17 of the ED Patient Record forms) were coded and 

classified according to a scheme developed at NCHS based on 

the American Society of Hospital Pharmacists’ Drug Product 

Information File, which is maintained by the American Druggist Blue Book Data Center. A maximum of five drug entries 

was coded for this item. A description of the drug coding 

scheme has been published (11). 

Edits 

In addition to followups for missing and inconsistent data 

made by the field staff, numerous clerical edits were performed on data received for central data processing. Detailed 

editing instructions were provided to manually review the 

Patient Records forms and to reclassify or recode “other” 

entries, Computer edits for code ranges and inconsistencies 

were also performed. 

Quality control 

All medical and drug coding and keying operations were 

subject to quality control procedures. Quality control for the 

niedical and drug coding operation, as well as straight-key 

items, involved a two-way 10-percent independent vefication 

procedure. As an additional quality control, all Patient Record 

forms with differences between coders or with illegible enties 

for the reason for visit, diagnosis, E-code, and medication 

items were reviewed and adjudicated at NCHS. The average 

keying error rate for nonmedical items was 0.5 percent. For 

items that required medical coding, discrepancy rates averaged 

less than 5 percent. 

Imputations 

Item nonresponse was quite low, 3 percent or less, for all 

data items with the following exceptions: race (8 percent), 

ethnicity (15 percent), whether the patient had been seen 

previously for the same condition, item 12 on the OPD form 

(7 percent), and whether the visit was alcohol-or drug-related, 

item 14 on the ED form (8 percent). Incomplete data items 

were imputed using a “hot deck” procedure by assigning a 

value from a randomly selected Patient Record form with 

similar characteristics. For item 13 (urgency) on the ED 

Patient Record form, the sorting used was ED size by the 

3-digit ICD-9-CM code for principal diagnosis. For other ED 

variables-item 4 (date of birth), item 5 (sex), item 6 (race), 

item 7 (ethnicity), item 14 (problem alcohol- or drug-related), 

item 18 (disposition), and item 19 (providers)-the sort used 

was ED size by urgency by the 3-digit ICD-9-CM code for 

principal diagnosis. ED size was determined from the entry on 

the NHAMCS-1OUU. For the OPD, imputation procedures 

were performed for the following variables: item 4 (date of 

birth), item 5 (sex), item 6 (race), item 7 (ethnicity), item 9 

(referral), item 12 (patient seen before), item 17 (disposition), 

and item 18 (providers). The sorting used was OPD size by 

clinic type by the 3-digit ICD-9-CM code for principal 

diagnosis. OPD size was determined from the entry on the 

NHAMCS-1OW.J, and clinic type used the following categories: general medicine, surgery, pediatrics, obstetrics/ 

gynecology, substance abuse, and other. Records with imputed 

variables were flagged on the public-use data tape. 

9 
Estimation “procedures


The probability sample design of the NHAMCS allowed 

the sample data to be weighted to produce national estimates 

for the United States. Unweighed data are not used for 

analysis as unweighed data ignore the disproportionate sampling used in the NHAM(X. 

Statistics from the NHAMCS were derived by a multistage estimation procedure that produces essentially unbiased 

national estimates. Separate national estimates were produced 

for visits to hospital emergency and outpatient departments. 

The weight included three basic components: inflation by 

reciprocals of the probabilities of selection, adjustment for 

nonresponse, and ratio adjustment to fixed totals. Each component is briefly described in the following text. 

Inflation by reciprocals of probabilities of 

selection 

Because the survey utilized a four-stage sample design, 

four probabilities of selection existed: the probability of 

selecting the PS~ the probability of selecting the hospital 

within the PS~ the probability of selecting the emergency 

service area or outpatient clinic within the hospital; and the 

probability of selecting the visit within the particular emergency service area or clinic. The overall probability of including a hospital in the sample was the product of the probability 

of the PSU being selected multiplied by the probability of the 

hospital being selected. The probability of selecting the hospital was 1.0 for hospitals in noncertainty PSUS with fewer than 

five hospitals and was the hospital size divided by a sampling 

interval for all other hospitals. The sampling intervals for 

PSUS with more than five hospitals was the cumulative sum of 

the hospital sizes (the total of ED and OPD visits) in each PSU 

divided by five. The sampling intervrd for the certainty PSUS 

was the cumulative sum of all of the hospitals in these PSUS 

divided by 240. 

The probability of selecting a clinic within a hospital was 

1.0 for clinics in hospitals with five or fewer clinics and was 

the clinic size divided by the sampling interval for clinics in 

hospitals with more than five clinics. The sampling interval 

was defied to be the cumulative sum of sizes for the clinics 

(the expected number of visits during the reporting period) in 

the hospital divided by five. 

The probability of selecting a visit was defined as the 

actual number of visits during the hospital’s assigned reporting period divided by the number of Patient Record forms 

completed. Estimates were adjusted to account for the extended 

data collection period for the 1992 survey, which included 14 

4-week reporting periods from December 2, 1991, through 

December 27, 1992. Subsequent survey years will include 13 

4-week reporting periods that will be inflated to derive annual 

estimates. 

Adjustment for nonresponse 

Estimates from NHAMCS data were adjusted to account 

for sample units that were in scope but did not participate in 

the study. These adjustments were calculated to minimize the 

impact of nonresponse on final estimates by imputing to 

nonresponding units the characteristics of similar responding 

units. Aa nonresponse may occur at each stage of sampling, 

severiil adjustments were required, For these adjustments~ 

hospitals were judged similar if they had the same ownership 

and were in the same PSU or region and MSA status. Clinics 

were judged similar if they were of the same clinic type and 

were in the same PSU. Wits were judged similar if they 

occurred in the same clinic. 

Ratio adjustment 

NHAMCS estimates were adjusted within 12 strata defined 

by region and ownership. Separate poststratification adjustments were made for emergency and outpatient department 

estimates, For ED estimates, the ratio adjustment for each 

stratum was a multiplication factor that had as its numerator 

the number of ED visits in the universe in the stratum and as 

its denominator the estimated number of ED visits in that 

stratum. For OPD estimates, the ratio adjustment for each 

stratum was a multiplication factor that had as its numerator 

the number of hospitals with an OPD in the universe in the 

stratum and as its denominator the estimated number of 

hospitals with OPDS in that stratum. The data for the numerator and denominator of both adjustments were based on figures 

from the SMG Hospital Market Database. 

10

I 

Reliability of estimates


Because statistics from the NHAMCS are based on a 

sample, they may differ somewhat from the figures that would 

be obtained if a complete census were taken using the same 

forms, definitions, instructions, and procedures. However, the 

probability design of NHAMCS permitted the calculation of 

sampling errors. The standard error is primarily a measure of 

sampling variability that occurs by chance because only a 

sample rather than the entire population is surveyed. The 

standard error, as calculated for the NHAMCS, also reflected 

part of the variation that arises in the measurement process, 

but does not include estimates of any systematic biases that 

may be in the data, The relative standard error (WE) of an 

estimate is obtained by dividing the standard error by the 

estimate itself and is expressed as a percent of the estimate. 

Generally, an asterisk (*) is used to indicate any estimate with 

more than a 30-percent relative standard error. 

In repeated samples using the same forms and procedures, 

the chances are about 68 of 100 that an estimate from the 

sample would differ from a complete census by less than the 

standard error, The chances are about 95 of 100 that the 

difference would be less than twice the standard error and 

about 99 of 100 that it would be less than 2Y2 times as large. 

Estimation of standard errors 

Estimates of sampling variability for the 1992 NHAMCS 

data presented in NCHS publications are computed using a 

first-order Taylor Series approximation of the deviation of 

estimates from their expected values. The SUDAAN software 

is used to compute the standard errors. A description of this 

software and the approach it uses has been published (12). 

Standard error approximations 

The SUDAAN procedure can be used to compute directly 

the standard errors and relative standard errors for NHAMCS 

estimates. However, this procedure is not practical or feasible 

for all users of the data. Therefore, a generalized procedure for 

approximating the relative standard errors for the NHAMCS 

estimates was developed. 

Relative standard errors were computed for estimates in 

the Advance Data reports on emergency and outpatient departments (13,14). Regression techniques were then used to 

produce equations from which a standard error for any estimate may be approximated.These regressionequations, representedby parametersa and b, are shownin tableB. Separate 

Table B. Coefficients for use in the approximate standard error 

equations for the National Hospital Ambulatory Medical Care 

Survey, by type of service arez United States, 1992 

visits Drug mentions 

Type of service area a b a b 

Emergency department. . . . . 0.00158 5,040.5 0.00235 5,142.9 

Outpatient department . . . . . 0.00912 7,516.5 0.01395 5,519.1 

equations are presented for estimates of visits and drug 

mentions. Rules explaining the use of these equations are 

presented in the following section. 

To derive error estimates that would be applicable to a 

wide varie~ of statistics and could be prepared at moderate 

cost, several approximations were required, As a result, standard errors computed using this procedure should be interpreted as approximate rather than exact for any specific 

estimate. The coefficient of determination (#) for the ED and 

OPD visit equations are .62 and .43, respectively, and for the 

ED and OPD drug mention equations are .82 and .57, respectively. Particular attention should be exercised when the 

estimate of interest is small or when this procedure is used for 

estimates based on the American Indian/Eskimo/Aleut or 

Asian/Pacific Islander race categories. Further, because of the 

small number of cases in each category, these estimates do not 

apply to estimates of ambulatory surgical procedures. 

Standard error applications 

Estimates of standard errors for aggregate 

estimates 

The approximate standard errors for estimates of the 

number of visits (drug mentions) with a particular characteristic may be computed using the following formula, where x is 

the aggregate estimate of interest and a and b are the 

appropriate parameters from table B. 

SE(X)=&mii---

The approximate relative standard error for the estimated 

number of visits (drug mentions) with a particular characteristic may be computed as follows: 

RSE(X)= ra +~ 

11 
Estimates of rates where the denominator is 

assumed to have negligible error 

The approximate relative standard error for a rate in 

which the denominator is the total U&ted States population or 

one or more of the age-sex-race groups of the total population 

is equivalent to the relative standard error of the numerator 

that can be obtained using the relative standard error formula 

above and appropriate parameters from table B. The standard 

error is then given by: 

SE@ = r RSE(rj 

The population figures used in computing annual rates are 

based on the July 1, 1992, estimates of the civilian, noninstitutionalized population of the United States and are shown in 

table C. 

Estimates of standard errors of percentages where 

both the numerator and denominator are estimated 

from the same sample 

Approximate relative standard errors (in percent) for 

estimates of percentages maybe computed using the appropriate relative standard errors for the aggregate statistics as 

follows. Obtain the relative standard error of the numerator 

and denominator of the percent. Square each of the relative 

standard errors, subtract the resulting value for the denominator from the resulting value for the numerator, extract the 

square root, and multiply by 100. 

RSE(p) =RSE (X/y) = 100tiRSE2(x)
+RSE2(y)

Alternatively, approximate relative standard errors (in 

percent) for estimates of percentages maybe computed using 

the following fonnuia, where p is the percentage of interest 

and y is the denominator of the percentage using the appropriate parameter from table B. 

rb (1-p) RSE(p)= 100 ~


For standard errors, the appropriate formula is: 

bp (1-p) SE@)= ~
 r 

The approximation of the absolute or relative standard 

error is vrdid if the relative standard error of the denominator 

is less than 0.05 (15) or if the relative standard errors of the 

numerator and denominator are both less than 0.10 (16). 

Estimates of rates (r = x/y) where numerator is not a 

subclass of denominator 

The standard error for a rate maybe approximated by: 

RSE(~)=RSE (x/y)=
1CNRSE2 (x)+RSE2(y)


SE(~)= ~RSE(~)


This approximation is valid if the relative standard error 

of the denominator is less than 0.05 (15) or if the relative 

standard errors of the numerator and denominator are both less 

than 0.10 (16). 

Estimates of differences between two statistics 

The standard error of the dblerence between two statistics 

is approximated by 

SE(X1-
 XJ={SE2(Xl) + SE2(xJ 

where SE(XI) and SE(XJ are computed using the appropriate 

directions. 

This formulation represents the standard error for the 

dMerence between separate and uncorrelated characteristics, 

although it is only a rough approximation in most other cases, 

In analysis of the NHAMCS data, the determination of 

statistical inference is generally based on the t-test. The 

Bonferroni inequality is used to establish the critical value for 

statistically signillcant differences (0.05 level of significance) 

TableC. Estimates of the civilian noninstitutionalized population, by selected demographic characteristics: United States, 1992 

,4// Less than 15-24 25-44 45-64 65-74 75 years 

Characteristic ages 15 years yeara years years years and ovet 

Race and sex 

Ali races . . . . . . . . . . . . . . 251,443,459 56,442,611 34,364,602 S1,32S,380 48,501,115 18,469,880 12,321,871 

Male . . . . . . . . . . . . . . . 122,1s7,479 28,S91,742 i7,097,767 39,899,851 23,305,965 8,275,207 4,617,147 

Female . . . . . . . . . . . . . 129,260,980 27,550,889 17,286,635 41 ,32S,729 25,195,150 10,194,873 7,704,724 

White . . . . . . . . . . . . . . . 209,464,504 44;985,523 27,479,768 67,716,634 41,743,164 16,365,982 1$;$,:: 

Male . . . . . . . . . . . . . . . 102,413,873 23,046,144 13,776,312 33,733,182 20,299,022 7,375,023 

Female . . . . . . . . . . . . . 107,050,631 21,939,379 13,703,476 33,983,452 21,444,162 9,010,959 6:969,203 

Black . . . . . . . . . . . . . . . . 

Male . . . . . . . . . . . . . . . 

31,461,180 

14,722,067 

S,954,786 

4,555,607 

5,100,047 

2,450,005 

9,795,332 

4,424,866 

4,969,293 

2,227,63’I 

1,643,776 

711,472 

977,844 

352,806 

Female . . . . . . . . . . . . . 16,739,083 4,399,179 2,650,042 5,370,466 2,761,662 932,306 625,436 

Other . . . . . . . . . . . . . . . . 10,522,775 2,502,302 1,804,767 3,816,414 1,766,638 440,120 180,634 

Male . . . . . . . . . . . . . . . 

Female . . . . . . . . . . . . . 

5,051,519 

5,471,256 

1,289,991 

1,212,311 

571,450 

933,317 

1,641,603 

1,974,s11 

779,312 

969,326 

188,712 

251,408 

60,451 

110,063 

Geographicregion: 

Northeast . . . . . . . . . . . . . 50,000,327 ,.. . . . . . . . . . .,, ,,, Midwest . . . . . . . . . . . . . . 61,472,367 . . . . . . . . . . . . .,, ,,. south. . . . . . . . . . . . . . . . 84,419,002 . . . . . . . . . . . . ,.. ,,. West . . . . . . . . . . . . . . . . 55,558,743 . . . . . . . . . . . . ,., *., 

12 
when more than one test is performed simultaneously. Terms 

:: relating to diiTerences such as “greater than” and “less than” 

* indicate that the differences are statistically significant. Terms 

;J such as “similar” or “no difference” mean that no statistical ,!

,! significance exists between the estimates being compared. A 

lack of comment regarding the difference between any two ~ 

t estimates does not mean that the dtierence was tested and 

, found to be not significant. 

~ Notwunpling error 

J 

1 Estimates based on the 1992 NHAMC!S are subject to 

nonsampling as well as sampling errors. Nonsampling errors 

* include reporting and processing errors, as well as biases due 

to nonresponse or incomplete response. Although the magnitude 

of the nonsampling errors cannot be computed, these errors 

are kept to a minimum by procedures built into the operation 

of the survey. To eliminate ambiguities and encourage uniform 

reporting, careful attention was given to the phrasing of 

questions, terms, and definitions. Also, extensive pretesting of 

most data items and survey procedures was performed. The 

steps taken to reduce bias in the data are discussed in the 

sections on field procedures and data collection. Quality 

control procedures and consistency and edit checks discussed 

in the data processing section reduced errors in data coding 

and processing. Because survey results are subject to sampling 

and nonsampling errors, the total error will be larger than the 

error due to sampling variability alone. 

13

Data dissemination


I


Analysis of the NCHS ambulatory medical care data will 

be of two general types: descriptive analyses of the content of 

hospital ambulatory medical care and comparative analyses of 

the content of ambulatory medical care provided in the 

hospital and office settings. The initial Advance Data reports 

summarizing the NHAMCS emergency and outpatient department data have been published (13,14). Descriptive, analytical, and methodological reports will be published in Vital and 

Health Statistics, Series 1,2, and 13. Brief reports on topics of 

special interest will be published in Advance Data From Wal 

and Health Statistics. Information may also be presented in 

journal articles and in papers presented at professional meetings. As resources permit, special tabulations and analyses will 

be provided to data requesters inside and outside the Federal 

Government. 

t 

n, 

For each data year, a public-use data tape and data tape I 

documentation will be prepared for distribution through the ! 

National Technical Information Service (NTIS). The publicuse data tape for the 1992 NHAMCS is scheduled for release 1, 

in the summer of 1994. There are also plans to release 

NHAMCS data on diskette and CD-ROM using the Statistical 

Export and Tabulation System (SETS) database software, The 

Catalog of Publications, Catalog of Electronic Data Products, 

and Catalog of Public-Use Data Tapes may be obtained from 

the Data Dissemination Branch, National Center for Health 

Statistics, 6525 Belcrest Road, Room 1064, Hyattsville, Maryland 20782, (301) 436-8500. 

14

1993-94 National Hospital 

Ambulatory Medical Care 

Survey 

A number of refinements were made to the 1992 NHAMCS 

procedures for the 1993-94 survey. These included 

. revising the Patient Record forms (appendix VIII) 

. adjusting the sampfig procedures so that the maximum 

. target sample size for the outpatient department was 200, 

rather than 500 

. creating a “Thank you” letter for participating hospital 

staff 

. developing a semiautomated process for sampling that 

utilizes a Lotus 123 spreadsheet to input clinics, list them, 

total the visits, select an initial interval for sampling, and 

choose random number starts. 

In addition, several of the data collection forms were 

revised, eliminated, or combined. Due to the burdensome and 

unnecessary task of completing the Ambulatory Unit Record 

PCS-101KJ) for each unit, procedures for the 1993-94 

NHAMCS were revised so that NHAMCS 101IU’S were 

completed only for units that were selected rather than on all 

units. Because much of the information on the NHAMCS101/S is collected elsewhere, the Sampling Record was eliminated for the 1993 NHAMCS. 

Methods for field representative training were revised and 

in November 1992 a refresher training was held at four 

regional sites, combining staff from three regional offices into 

one site and integrating parts of the training with the NAMCS 

field representatives. To aid this training, booklets were prepared to address definitions of clinics and of common medical 

ierms. 

15

References


1.	 Adams PF, Benson V. Current estimates from the National 

Health Interview Survey, 1991. National Center for Health 

Statistics. Wtal Health Stat 10(184). 1992. 

2. Tenney JB, White KL, Wfiamson JW. National Ambulatory 

Medical	 Care Survey Background and methodology. Nationrd 

Center for Health Statistics. Vhl Health Stat 2(61). 1974. 

3.	 Loft JD, Sheatsley PB, Frankel MR. Comparison report on the 

hospital ambulatory medical care evaluation study. Contract No. 

282-82-2111. Chicago, Illinoix National Opinion Research Center. 1985. 

4.	 Institute of Medicine. Toward a national health care survey A 

data system for the 21st century. Washingtorx NationslAcademy 

Press. 1992. 

5.	 Extension of the National Ambulatory Medical Care Survey to 

hospital outpatient clinic visits. Contract No. 230-76-0065. 

Chicago, Illinois National Opinion Research Center. 1977. 

6.	 Methodological report on the hospital ambulatory medical care 

evaluation study. Contract No. 282-82-2111. Chicago, Blinoi* 

National Opinion Research Center. 1984. 

7.	 Final report-Survey of hospital emergency and outpatient 

departments. Contract No. 200-88-7017. Rockville, Maryland 

Westat. 1990. 

8.	 Massey JT, Moore TF, Parsons ~ Tadros W. Design and 

estimation for the National Health Interview Survey, 1985-94. 

National Center for Health Statistics. Vitrd Health Stat 2(110). 

1989. 

9.	 Schneider D, Appleton ~ McLemore T. A reason for visit 

classification for ambulatory care. National Center for Health 

Statistics. Vitrd and Health Stat 2(78). 1979. 

10.	 Public Health Service and Health Care Financing Administration. International classification of diseases, 9th revision, clinical 

modification. Washington Public Health Service. 1991. 

11.	 Koch H, Campbell WH. The collection and processing of drug 

information: National Ambulatory Medical Care Survey, United 

States, 1980. National Center for Health Statistics, Vital Health 

Stat 2(90). 1982. 

12. Shah BY Barnwell BG, Hunt PN, La Wnge LM. SUDAAN 

user’s	 manual, release 5.50. Research Triangle Park, North 

Carolina Research Triangle Institute. 1991. 

13.	 McCaig LF. National Hospital Ambulatory Medical Care Survey 1992 emergency department summary. Advance data from 

vital and health statistics, no 245. Hyattsville, Maryland: National 

Center for Health Statistics. 1994. 

14.	 McCaig LF. National Hospital Ambulatory Medical Care Survey 1992 outpatient department summary. Advance data from 

vital and health statistics, no 248. Hyattsville, Maryland National 

Center for Health Statistics. 1994. 

15.	 Hansen MH, Hurwitz WN, Madow WG. Sample survey methods and theory VOI1. New York John Wiley and Sons. 1953. 

16.	 Cochran WG. Sampling techniques. New York John Wiley and 

Sons. 1953. 

16 
Appendixes


I. Legislative authorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18


Il. Definitions of certain terms used in the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19


m.	 D’ata collection foims used in the 1992 National Hospital Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . 23


NHAMCS-101 questionnaire . . . . . . . . . . . . . ...0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23


NHAMCS-lO1/S sampling record , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . 34


NHAMCS-1OVU ambulatory unit record . . . . . . , . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37


NHAMCS-103 patient visit log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46


NHAMCS-124 sampling andinformation booklet , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . . 47


NHAMCS-131 edit checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60


NHAMCS-133debriefing form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64


Emergency department Patient Record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .’. . . . . . 66


Outpatient department Patient Record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67


IV. Definitions ofterms relating tothe Patient Record forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68


Y Introductory letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71


VI. Endorsement letters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72


VII. ‘f’hankyouletters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75


VIII. Patient Record forms used inthe 1993-94 National HospitalAmbulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . 77


1


17

Appendix I 

Legislative authorization 

PublicHealth Serviee Act 

Section 306 (a) & (b) 

NATIONAL CENTER FOR HEALTH STATISTICS 

Sec. 306. [242k] (a) There is established in the Department of Health and Human Services the 

National Center for Health Statistics (hereinafter in this section referred to as the “Center”) which shall be 

under the direction of a Director who shall be appointed by the Secretary and supervised by the Assistant 

Secretary for Health (or such officer of the Department as may be designated by the Secretary as the 

principal adviser to him for health programs). 

(b) In carrying out section 304(a), the Secretary, acting through the Center -

(1) shall collect statistics on­

(A) the extent and nature of illness and disability of the population of the United States (or 

any groupings of people included in the population), including life expectancy, the 

incidence of various acute and chronic illnesses, and infant and maternal morbidity and 

mortality, 

(B) the impact of illness and disability of the population on the economy of the United States 

and on other aspects of the well-being of its population (or of such groupings), 

(C) environmental, social, and other health hazards, 

(D) determinants of health, 

(E) health resources, including physicians, dentists, nurses, and other health professionals by 

specialty and type of practice and supply of services by hospitals, extended care facilities,


home health agencies, and other health institutions,


(F) utilization of health care, including utilization of (i) ambulatory health services by


specialties and type of practice of health professionals providing such service, and (ii)


services of hospitals, extended care facilities, home health agencies, and other institutions,


(G) health care costs and financing, including the trends in health care prices and costs, the


sources of payments for health care services, and Federal, State, and local governmental


expenditures for health care services, and


(H) family formation, growth, and dissolution;


(2) shall undertake and support (by grant or contract) research, demonstrations, and 

evaluations respecting new or improved methods for obtaining current data on the matters 

referred	 to in a paragraph (l); 

(3) may undertake and support (by grant or contract) epidemiologic research, 

demonstrations, and evaluations on the matters referred to in paragraph (l); and ....” 

(4) may collect, furnish, tabulate, and analyze statistics, and prepare studies, on matters 

referred to in paragraph (1) upon request of public and nonprofit entities under arrangements 

under which the entities will pay the cost of the service provided. 

Amounts appropriated to the Secretary from payments made under arrangements made under paragraph (4) 

shall be available to the Secretary for obligation until expended. 

18

Appendix II 

Definitions of certain terms 

used in the survey 

Patient—An individual seeking personal health services 

not currently admitted to any health care institution on the 

premises. A person under a physician’s care for health reasons. 

Patients are defied as in scope or out of scope as follows: 

.	 In scope—A patient seen by hospital staff in an in scope 

emergency service area or clinic except as excluded below. 

.	 Out of scope-Patients seen by a physician in their private 

office, nursing home, or other extended care institution or 

in the patient’s home. Patients who contact and receive 

advice from hospital staff via telephone. Patients who 

come to the hospital only to leave a specimen, to pick up 

insurance forms, to pickup medication, or to pay a bill. 

Viiit-A visit is a direct, personal exchange between an 

ambulatory patient and a physician or other health care 

provider working under the physician’s supervision, for the 

purpose of seeking care and receiving personal health services. 

Drug mention—The entry of a pharmaceutical agent 

ordered or provided by any route of administration for prevention, diagnosis, or treatment. Generic as well as brand name 

drugs are included, as are nonprescription as well as prescription drugs. Along with all new drugs, the hospital staff also 

records continued medication if the patient was specifically 

instructed during the visit to continue the medication. 

Hospital—AU hospitals with an average length of stay for 

all patients of less than 30 days (short stay) or hospital whose 

specialty is general (medical or surgical) or children’s general 

are eligible for the National Hospital Ambulatory Medical 

Care Survey, except Federal hospitals and hospital units of 

institutions and hospitals with less than six beds staffed for 

patient use. 

Ownershi~Hospitals are designated according to the 

primary owner of the hospital based on the SMG Hospital 

Market Database. 

� Voluntary nonproj%—Hospitals operated by a church or 

another nonprofit organization, 

� Government non-Federal—Hospitals operated by State or 

local governments. 

� ProprietapHospitals operated by individuals, partnerships, or corporations for profit. 

Urbanicity-Hospitals are classified by their location in a 

metropolitan or nonmetropolitan area. 

. Metropolitan-Metropolitan Statistical Area (MSAS) as 

defined. by the U.S. Office of Management and Budge& 

The definition of an individual MSA involves two 

considerations: first, a city or cities of specified population 

that constitute the central city and identify the county in 

which it is located as the central county; second, economic 

and social relationships with “contiguous” counties that 

are metropolitan in character so that the periphery of the 

specific metropolitan area may be determined. MSAS may 

cross State lines. In New England, MSAS consist of cities 

and towns rather than counties. 

. Nonmetropolitan-Other than metropolitan. 

Emergency department-Hospital facitity for the provision of unscheduled outpatient sewices to patients whose 

conditions require immediate care and that is staffed 24 hours 

a day. Emergency departments that are open less than 24 hours 

a day are included as part of the hospital’s outpatient department. 

Emergency service area—Area within the emergency 

department where emergency services are provided. This 

includes services provided under the “hospital as landlord” 

arrangement in which the hospital rents space to a physician 

group. 

Outpatient department-Hospital facility where nonurgent ambulatory medical care is provided under the supervision of a physician. 

Clinic—Administrative unit within an organized outpatient department that provides ambulatory medical care under 

the supervision of a physician. This excludes the “hospital as 

landlord” arrangement in which the hospital only rents space 

to a physician group and is not otherwise involved in the 

delivery of services. Clinics are grouped into the following six 

specialty groups for purposes of systematic sampling and 

nonresponse adjustment: general medicine, surgery, pediatrics, 

obstetrics/gynecology, substance abuse, and other. Clinics are 

defined as in scope or out of scope as follows 

� In scope-General medicine 

AIDS 

Allergy 

Ambulatory care 

Anti-coagulation 

Anesthesia/pain 

Apnea 

Arthritis 

Asthma 

Brain tumor (and other tumor) 

-Cardiology . . . 

Cerebral palsy (adult) 

19 
Chest


Coagulant


Cystic fibrosis (adult)


Cytomegalovirus


Dermatology


Diabetes


Diabetic counseling


Digestive diseases


Down’s syndrome (adult)


Endocrinology


Epilepsy


Family practice


Gastroenterology


General medicine


Genetics (adult)


Geriatric


Head (nonsurgical)


Head and neck (nonsurgical)


Hematology


Hemophilia (adult)


Homeless


Huntington’s disease/chores


Hyperlipidemia


Hypertension


Immunology


Infectious diseases


Internal medicine


Lead poisoning (adult)


?Akemirdbone marrow aspiration


Lipid


Liver


Lupus (systemic lupus erythematosus)


Medical screening


Melanoma


Metabolic


Movement and memory disorders


Multiple sclerosis


Musdar dystrophy 

Myelomeningocele 

Nephrology 

Neurocutsneous


Oncology


Outreach program (generrd medicine)


Pacemaker


Pentamidine


Peripheral vascular disease


Pheresis/plasma pheresis


Pigmented lesion


Ptiary care


Pulmonary


Renal


Rheumatology


Seizure


Senior care


Sexually transmitted diseases (STD)


Sickle cell (adult)


Spina btida (adult)


Thyroid


Tuberculosis


Urgent care


Walk-in andlor screening


Weight management


24-hour observation


.	 In scope-surgery 

Amputee (surgery and rehabilitation) 

Ano-rectal


Arthroscopy


Back care


Breast


Breast care


Bronchoscopy


Burn


Cardiothoracic


Cast/brace


Chief resident followup (surgery)


chronicwound 

Cleft palate


Club foot


Colon and rectal surgery


Cryosurgery


Cystoscopy


Elective surgery


Endoscopy


ENT (ear, nose, and throat)


Eye


Fine needle aspiration


Fracture


General surgery


Genitourinary


Genitourinary surgery


Hand surgery


Head and neck surgery


Knee


Lithotripsy


Myelo- (and other myelo)


Necrologic surgery


Oncologic surgery


Ophthalmologic surgery


Ophthalmology


Orthopedic


Orthopedic surgery


Ostomy


Otokuyngology


Otolaryngologic surgery


Otolog


Otorhinolaryngology


Pediatric ear, nose, and throat


Pediatric orthopedic surgery


Pediatric otolaryngology


Pediatric surgery


Pediatric urology


Plastic surgery


Post-operative


Proctology


Puhnonary/thoracic surgery


20 
Scoliosis (adult) 

Sigmoidoscopy


Spine


Sports medicine


Suture


Transplant surgery


Trauma


Urodynamics


Urologic surgery


Urology


Vascular surgery


Vkmal fields


�	 In scope-Pediatrics 

Adolescent/young adult 

Adolescent medicine 

Airway (pediatric) 

Allergy (pediatric) 

Behavior and development (child) 

Birth defect 

Cardiology (pMlatric)


Cerebral palsy (child)


Child seirurd assault


Clotting (pediatric)


Congenital heart


Continuity (pediatric)


Craniofacial


Craniomalfonnation


Critical care (pediatric)


Cystic fibrosis


Dermatology (pediatric)


Developmental disability


Developmental evaluation


Diagnostic (pediatric)


Down’s syndrome (child)


Endocrinology @ediatric)


Gastroenterology (pediatric)


Genetics


Hematology (pediatric)


Hemoglobinopathy (pediatric)


Hemophilia (child)


High risk (pediatric)


Infant apnea


Infectious diseases (pediatric)


Lead poisoning (child)


Learning disorder


Neonatology


Nephrology (pediatric)


Newborn


Oncology (pediatric)


Ophthalmology (pediatric)


Pediatrics


Perinatal


Phenylketonuria


Pulmonary (pediatric)


Regional development


Rheumatic heart


Rheumatology/arthritis (pediatric)


Scoliosis (child)


Seizure (pediatric)


Sickle cell (child)


Spins biilda


Teenage


Teen-tot


Well child care


�	 In scope-Obstetrics/gynecology 

Adolescent gynecology 

Birth control 

Colposcopy


Dysplasia


Family planning


Gynecology


Gynecologic oncology


In vitro fertilization


Infertility


Maternity


Maternal health


Obstetrics


Obstetrics-high risk


Obstetriepost-partum


Obstetrics-prenatal


Pregnancy+ounseling


Pregnancy verification


Prenatal


Preteen gynecology


Reproductive


Reproductive endocrinology


Well woman


Women’s care


�	 In scope--Substance abuse 

Alcohol abuse 

Alcohol detoxification 

Alcohol Wdk-iIl 

Chemical dependency (excluding methadone 

maintenance) 

Drug abuse (excluding methadone maintenance) 

Dmg detoxification 

Substance abuse 

Women’s alcohol program 

. In scope-Other 

Adolescent psychiatry 

Adult psychiatry 

Anxiety 

Biofeedback 

Child psychiatry 

Eating disorder 

General preventive medicine 

Mental health 

Mental hygiene 

Myasthenia gravis 

Neurology 

Neurophysiology 

Pain management 

Partial hospitalization program (psychiatric) 

21

Pediatric neurology 

Preventive medicine 

Psychopharmacology 

Sleep disorder 

Social evaluation 

Toxicolow 

�	 Out of scope-Other 

Abortion/pregnancy termination 

Ambulatory surgery centers 

Blood bank 

Cardiac catheterization 

Chemotherapy


Dental/dental oncology/dental surgery


Employee health service


Hemodialysis


Kidney (renal) dialysis


Methadone maintenance


Occupational safety and health


Occupational therapy


Oral surgery


Pharmacy


Physical medicine/therapy


Podiatry


Radiation therapy/radiation diagnosis/radiation oncology


Radiology/diagnostic x-ray (imaging)


Reading and language


Rehabilitation


Region-Hospitals are classified by location in one of the 

four geographic regions of the United States that correspond to 

those used by the U.S. Bureau of the Census. 

Region States included 

Northeast	 Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York 

New Jersey, and Pennsylvania 

Midwest	 Michigan, Ohio, Illinois, Indiana, Wisconsin, 

Minnesota, Iowa, Missouri, North Dakota, South 

Dakota, Nebraska, and Kansas 

south	 Delaware, Maryland, District of Columbia, Virginia, West V@inia, North Carolina, South 

Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, and Texas 

West	 Montana, Idaho, Wyoming, Colorado, New 

Mexico, Arizona, Utah, Nevada, Washington, 

Oregon, California, Hawaii, and Alaska 
~

Appendix III 

Data collection forms used 

in the 1992 National Hospital 

Ambulatory Medical Care 

Survey 

OMB No. 0920-0278 Approval Expires 2/28/92 

NOTICE - Infwnmtlon contained m this form which would permit identification of any individual m establishment hw been collocted with a gU.3rante8that it will 

beheld In strict .mnfidwme, will be wed only for DUrWXeSstated for this study, and will not be disclosed or released to others without the consent of the individual 

or the ostabli$hmerd in accordance with section 3cf8(d) of the public He.qth Swvic. Act (42 uSC 242m). Public reporting burden for this phase of lhe survey !s 

estimated to average 147 minutes per rqmnse. If you have any comments regarding lhe burden estimate or,e.nyother aspect of this survev, including suggestions 

fm WIJueingthis burdm, send them to the PHS Report. Clerjm..e of ficer; Aff,T Pw HHH Building, ffm. 72 1.S; 200 Independence Ave.. S.W., Wadd”gton, 

DC 20201, and to the Office of Mmaganent and BudQeCpapww.nk Reduction Project (0920.0278); Wa$hi”gto”, DC 20503. 

1.Label pmNHAfblCS-101 

U.S. DEPARTMENTOF COMMERCE 

BUilfAUOFTHECENSUS 

ACTINGASCOLLECTINGAGESTFORTHE 

NATIONAL CENTERFORHEALTH STATISTICS CENTERSFOROISE.43ECONTIIOL 

NATIONAL HOSPITAL 

AMBULATORY MEDICAL CARE 

SURVEY 

1992 PANEL 

Zil. Hospital contact information b, Hospital contact information 3. Fisld representative in formaticm 

Name Name Telephone screener / Code 

I 

Title Title HospitalInduction ~Code 

! 

Telephone “umber (Area codeand number) Telephone numbw (Area codeandnumber) Clinicinduction ~ Code 

I I I 

Section I - TELEPHONE SCREENER 

4. Record of telephone calls 

call Date Time Results 

, 1 

2 

5 

6 

j. Final outcome of hospital screening 

I � Appointment 

Day I Dste I Time .,m.l Place 

I I I p.m. 

2 � Noninterview - Complete sections V and W, beginning on gage 8. 

During your ;nitial call to the hospital, attempt to apeak to the contact person (as provided in item 2al. If the contact 

person is not available at this time, determine when he/she can be reached and call again at the designated time. l! after 

several attempts, you are still unable to talk to the contact or have determined the contact ia no Iongar an appropriate 

respondent, begin the inter’!de w with a representative of the contact person or tre w contact, as appropriate. Record all 

new contact information in item 2b. 

Part A. INTRODUCTION 

Good (mmrslnglafternoonl. . .. My name is. (Your name). I am calling for the Centers for Oiseaae Control concerning 

their study of hospital outpatient and emergency dapartment$, YOU should have received a letter from Dr. Manning 

Feinleib, tha director of the National Center for Health Statistics, describing the study. (Pause) You’ve probably aIso 

receiveds iatter from the Census arsreau. Wa are acting SEfield agent for the study. 

6 6.	

1 

SD~1Ask item 7a 

~a. I’d be very happy to send you anothsr copy of the ~ 

letter. Let me Just verif y that 1am sending it to the 1� Yes - Read STATEMENT be/ow 

right mailing sddress. Is (Read address from item 1) 

the correct address? 

~ 

! 2D No - Ask item 7b 

! 

Did you receive tha Iatter[s)? 

I I � Yes — SKIP to Part B, Verification of 

E/igibi/ity, page 2 

I 2DN0 

b. What is your correct msillng address? I Number and street 

I t

/city State ZIP Code I I 

I STATEMENT 

Although you have not received the Iettsr, I“d like to brlafly explain the study to You at this time and 

msswar any questions about it.. 

23 
Section I - TELEPHONE SCREENER – Continued 

Part B. VERIFICATION OF ELIGIBILITY 

Tha National Center for Health Statistics of the Canters for Disease Control is conducting an annual study 

of hospital-basad ambulatory cara. They hava contracted with the Buraau of tha Census to collect data for 

tha study. [am calling to arranga an appointment to discussyour participation. I 

Bafore discussing the details, I would fike to verify our besicinformationabout (Name of hospital) tobe sura 

we havecorrectlyincludedyour hospitalin thestudy.First,concerninghospitalcontrol: I 

8.	 IS this hospital vokrntary non-profit, govamment, \ I •l Voluntary non-profit 

or proprietary? I 20 Government 

I 30 Promietaw 

g!.	 Does this hospital provide amergency sarvicas ~ I � Yes — SK/Pto item 10 that are kteffad 24 HOURS each day either hare 

et the hospital or elsewhere? I

I 

213N0 

I b, Does thishospiteloperateany emergencysarvica ~ I •l Yes araaathatareNOT eteffed24 HOURS aachday? I 20 No 

10.	 Doss this hospital operata an organized outpatient ~ ; � yes 

department either at the hospital or elsewhere? ~ 

20No 

/ 

I I � The hospitalmeetseligibilityrequirements(Yesin any of items9a OR 9b OR 10) — Go to Part 

C, Studv DescriLrtion 

I 20	 The hospitaldoes not meet eligibilityrequirements(No in allthree items 9a AND 9b AND 10) — 

SKIP to CLOSING STATEMENTbalow 

Part C. STUDY DESCRIPTION 

Thank you. Our information setkmscorract. Now I would fike to provide you with further information 

on the study. 

�	 This studyis an extension of the 

NAMCS 

�	 No currentsourceof nationaldata 

on hospitalambulatorycare 

�	 Endorsedby the AmericanHospital 

Association,tha AmericanCollege 

of EmergencyPhysicians,and the 

EmergencyNurses Association 

� Nationwidesampleof 500 hospitals 

� Four weekdatacollectionperiod 

�	 Brief1 pagaforms completedfor a 

sampleof patientvisits 

The hospitalstudy willbean extensionof the National 

AmbulatoryMedicalCareSurvey, or NAMCS, which collects 

dataon visitsto physiciansin office-basedpractice.NAMCS 

dataareusedby healthserviceplanners,researchers.and 

educators.Hospitalsprovidea significantportionof the nation’s 

ambulatorycare.Yet, thereis no sourceof nationaldataon this 

significantareaof healthcare. Extendingthe coverageof 

NAMCS to includehospitaloutpatientcareis consideredan 

importantpriorityfor the National Centar for Health Statistics 

and is andorsed by suchorganizationsas the AmaricanHospital 

Association,AmericanCollegeof EmergencyPhysicians,and 

the EmergencyNursesAssociation. 

The study is beingconducted in approximately 500 

hospitalsnationwide.Brief,one pageforms, similarto 

thoseused in the studv of office-basedmacticeswillbe 

completedfor a small&leof patient-visitsto emergency 

and outpatientdepartmentsover a four week pariod. 

As one of the hospitals thet has been selected for the study, your contribution will be of great 

value in producing retiable national data on ambulatory care. 

11.	 I would liketo arrangeto meet with you so that I can bettar prasent the details of the study. ISthera 

a convenient tima within the next week or so that I could meetwith you or your rapresantative? 

I Thank you . . . . for your cooperation. I am looking forward to our meeting. Record day, date, tima, and 

place of appointment in item 5, page 1; and termhrate telephone call. 

CLOSING STATEMENT 

Thank you . . . .. but it saams that our information was incorract. Sinca (Name of hospital) does not 

have emergency services or outpatient ciinics, h should not have been chosen for our study. Thank 

you vary much for your cooperation. Terminate telephone call and complete sections Vand VI beginning 

on page 8. 

NOTES 

I FORM NHAMCS-1OI [4.lf 

24 
Section II – INDUCTION INTERVIEW 

Part A. INTRODUCTION 

I would like to begin with a briaf raviaw of the background for thie etudy. 

�	 Data are already available on Dataareavailablaon patientvisitsto physician’aoffices 

patient visite to office-baeed throughthe NationalAmbulatory MedicalCare Survey, or 

physicians from NAMCS NAMCS, sponsoredby the NationalCenterfor Health 

Statisticsof the Centarsfor DiseaseControl.Thesa datahava 

beenusedextensivelyby healthserviceplannersand 

� NAMCS is sponsored by the researchers. 

NCHS 

�	 NAMCS data used extensively 

by health service planners and 

researchers	 Patientvisitsto hospitalemergencyand outpatient 

departmentsaccount for about 150 millionpatientvisits 

annually.However, there is no nationaldata collation on �	 150 milfion annual ED/OPD the characteristicsand heelthproblemsof personssaenin

patient visits these settings. 

�	 Currantly no national data 

collection concerning hospital 

ambulatory care 

NCHS is conductingan annualstudy to provide national 

� Buraau of tha Ceneus is data irrformationon hospitalambulatorycare.Tha Bureauof the 

collating agent Cansusisresponsiblefor datacollection.The study has been 

endorsedby the AmericenHospitalAssociation,the 

AmericanCollegeof EmergencyPhysicians,and the 

�	 Endorsements by the AHA, EmergencyNursesAssociation,Theirendorsementswere 

ACEP, and ENA includadwith our letterand copiasarein tha manual. 

�	 Study is authorized by Titla 42, 

U.S. Code Saction 242k 

Now I would liketo providean overviewof the study protocol 

� Participation is voluntary	 and answerany questionsyou might have. Beforewe 

proceedwith the details,Iam raquiredto adviseyou that this 

study isauthorizedby Tkle 42, UnitadStatesCode, Section 

� All information held in strict 242k. Participationin the study isvoluntaryand thereareno 

confidence	 penaltiesfor rafusing.All informationcollected,includingthe 

nameof your hospital,willbe heldin strictconfidence. 

Patientnemesand identifiersobtainedduring datacollection 

� Collects no patient namae or willbe removedfrom the dataforms and left with the 

identifiers hospital.Datafrom the study willbe usedonly in statistical 

summaries. 

NOTES 

FORM NHAMCS-101 (4.16.91) E3w 

25 
Section 11— INDUCTION INTERVIEW — Continued 

Part B. SURVEY DESCRIPTION 

�	 Covers ambulatory care 

fa:~nie: on and off hospital 

�	 Covers care provided by or 

under the supervision of a 

physician 

�	 Excludas off:ca-based 

physicians 

�	 Excludes visits to laboratory 

and radiology services 

�	 Excludes organized ambulatory 

surgery centers 

�	 Four week data collection 

~eriod beginning 

) 

“ Sample of approximately 50 ED 

and 150 OPD visits 

“ Form takas onIy a few minutes 

to complete 

�	 Forms to be completed by 

hospital staff at their 

convenience 

VOTES 

Page4 

The study coversambulatorycarefacilitiesthat are operated 

by the hospitsl,here or elsewhere in the area, in which cara is 

providedby a physicianor under the supervisionof a 

physician.Ingeneral,we aretryingto includecareby 

hospital-basedphysiciansand excludevisitsto offica-based 

physicians,which arecoveredunder the presentNAMCS. 

Visitsto laboratoryand radiologyserviceswillnot be 

included.Also, organizedambulatorysurgerycenterswillnot 

be included,as NCHS isdevelopinga separatesurveyfor 

studyingthesefacilities. 

Essentially,the datacollectiontaskisquitesimpla.Ovar a 

four weak period, baginningMonday, ( ), we 

would liketo collectsome basicinformationon a randomly 

selectadsampleof patientvisits,about 50 in tha Emargancy 

Departmentand about 150 in outpatientclinics. 

* SHOW pa tient record forms. 

Thesearethe datacollectionforms. We havetriedto make 

the itemsself-explanatoryand generallythe form shouldtake 

only a few minutesto complete.We willshow your staff how 

to salectthe sampleof patientsandfillout tha forms. Tha 

forms canbe complatedat thetime of the patient’svisit,at 

the end of the day or shift, or in soma combinationof these 

times,whicheveris most convenientfor your stsff. 

FORM NHAMCS-101 (4.15911 

26 
Section II — INDUCTION INTERVIEW — Continued 

Part C. SURVEY IMPLEMENTATION 

As I msntioned earlisr, I would like to dlscuaa the plan for conducting the study. Your hospital has 

been assigned to a 4-week data collection pariod beginning on Monday, ( ). Thara are 

savaral steps to be compiated to prepare for this. 

First, I would like to discuss the steps naaded to obtain approval for the study. We will ba glad to help 

in any way we can. 

Sacond, I wili naed to construct the sampiing pian for your hospitel. For this I wiii need some basic 

information on your (emargancy dapartmant/(and) ,youroutpatient department). 

It may teke me a few days to develop the sampling plan. I wili return to discuss the study with the 

(emergency ’department staff/(and) ciinic staff) end show tham tha procedures. Befora I return, I will” 

tail to determine how you wish ma to procead in contacting these staff. 

2. First, could we discuss the steps naaded to obtain approvei for the study? 

Record the approval process in the space provided below. – 

I � Respondent — Go to Check kern B be/ow 

2 •l Someone eise — Specify balow q 

If different respondent(s), arrange to obtain data 

today if possible. Otherwise arrange an 

appointment with designated person(s). Briefly 

explain the study to the new respondent(s). Then 

proceed with Section ///, Emergency Depatimant 

Description or Section IV, Outpatient Depaflment 

Description, as appropriate. Thank current 

respondent for hislher time and cooperation. 

Name 

Title 

Department 

Neme 

Title 

Department 

13. Now, I would like to make arrangamenta to 

obtain the information needed for sampiing. I will 

need to determina how your (amargancy 

department/ (and) outpatient department) (is/are) 

organized and obtain an astimate of the numbar 

of patient visits expected during tha 4-weak 

paricd. Would you prafer I get this information 

from you or someone else? 

t 

1 

I 

I 

I 

I 

I 

I 

I 

I 

I 

1 

I 

I 

f 

I 

I 

I 

] 

I � The hospital provides emergency services that sre staffed 24 hours esch day. (Yes in item 9a) — Go to 

Section Ill, Emergency Department Description, on page 6. 

2 � The hospitsl DOES NOT provide emargency sarvicas that are staffed 24 hours each day. (No in item item 9a) 

–	 SKIP to Section IV, Outpatient Department Description, on page 7. 

. FORMNHAMC2.101(4-16.91) rage o 

27 
Section Ill – EMERGENCY DEPARTMENT DESCRIPTION 

To develop the sampling plan, I would like to learn how your emergency department is organizad. I have a 

set of spaclfic quastions to ask you about this. 

I 

14. Doastheemergency dapertmentoparate I

I I � Only at hospital - SK/P to jtern 16 

any facilities elsewhare in the community 

I or only at the hosp-til? 20 Hospital and elsewhere - Ask item 75

15. Do the facilities located outside of the hospital~ae ~ (Markbox 7foremer9enc;esANDnOneIr’Ier9ende.S’). 

true emergency patients, that is, petients with [ 1� Emergencies conditions thet threaten Iifa or function end 

require immediate attention; or do they see only ~ 20 Nonemergencies only 

nonemergancy patiants? I 

\ 

16. Does tha emergency department here at the I 

hospital see both emergency and walk-in I I � Both — SKIPto item 78 

nonemergency patienta? 2D Emergency only - Ask hem 77 

I 

17. Where are walk-in nonemergency ~ Duringthe day 

patiants seen?	 I 

[ After hours 

I 

1 

18. Are patient visit statiatice kept for the emergency ~ t � Department aa a whole department as a whola or for Individual patient


service areas? i 20 Individual service ereaa


1% ISthere one patient registration or arrivei 1•l One log 

log kept for the department or are separate 20 Multiple logs

logs kept for different sections? For 3 � Other — Specffy ~ example, are diffarent logs kept for walk-in 1 and ambulance petients? 

I 

Reviaw information thoroughly and ask respondent to clarify any points needed. Then complete Section A, 

Ambulatory Unit Information of the NHAMCS- 10 l/U, Ambulatory Unit Record, for the emergancy serwbe area. If 

more than one aarvice area, complete a separate NHAMCS- 10 I/U, Section A, for each area. 

Describe the sample units for the ED. Include emergency service areas that are not staffad or available 24 

hours aach day, since they are part of an ED that is staffed or availabla 24 hours each da y. 

�	 To finish the sampling plan i will naad a few more detaile, including an estimate of the number of 

patient visits (for the ED/eech section of the ED) during the four weeks of the study — that is from 

Monday, ( ) to Sunday, ( ). 

NOTES 

Page 6 FORM NHAMCS101 (418.91) 

28 
Section IV – OUTPATIENT DEPARTMENT DESCRIPTION [ 

In order to develop the ssmpling plsn, I will need some detaile about the organization of your outpatient 

services and each of your outpatient ctinics. Sinca we will includa only certein typae’of outpatient 

sarvices in the study, I first would iike to explain the scope of the study. 

Explain scope. The study excludes nonph ysician clinics, ancillary services, ambulatory surgery centers,


facilities not opereted by or for the hospital (office-besedphysicians). II


If the hospital does not heve an Emergency Department that is staffad or available 24 hours each day, but does


have emergency service areas, include them as part of the Outpatient Department. II


Now, I would like to ask a few general questions about your outpatient services. II 

Zo.	 Could you tell ma how many clinics ere in tha ; 

outpatient department hers at the hospital? I UC1..mber 

21.	 Doesthe hospitel oparate outpatient clinics at any \ lCl Yes- Go to item 22 other locations off tha pramisas? For exemple, I walk-in clinics or drug traetment clinics? 2 � No — SKIP to item 23

i 

22. How many clinics ara thara at other Iocetions? ~ 

j, CU1..mber 

I Zait. Doss the hospitel oparata an organized I •l Yes ambulatory surgery center?’ 

/ 20No 

b.Does thehoepitel opsrate any clinics which are ~ lCi Yes- Specify below ~ under the supervision of someone other than a I 20No physician? (a.g., therapists, nurse midwife)? 

t 

I .“ I I I

1’ I 

Now, I would like to get a few details on each outpatient clinic. I wiil need the name and type of the 

clinic and an estimate of the expected number of patient visits for the study period Monday, 

(. ) to Sunday, ( ). 

Complete a separate Section A of the NHAMCS- 10 I/U, Ambulatory Unit Record for each clinic beginning with 

OPD(S) at hospital. Remind respondent of exclusions and clarify eligibility as needed. Remember to include 

those emergency aervica areaa that are not part of a 24-hour Emergency Department. 

)TES 

8 NHAMCS.101 [4.16.911 Page 

29 
Section —-----.. V — NONINTERVIEW 

I


[. Where did nonresponse occur? I I � Hospital - Ask item 25


I 2D Clinic(s) 1 3D Emergency service area(s) } 

SKIP to item 27


I


! 

;. What is the reaaon the hospital did not participate ~ I � Hospital closed — SK/P to section W, page 10


in this study? I 20 Hospital not eligible - Ask item 26


I 3D Hospital refused — SKIP to item 30


40 Other — Specify ~


I


I


I SKIP to section Vl, page 10


I
 ;. Describe the condition or reaaon the hospital is I � Federal hospital
 ineligible for the study. 20 No emergency service


areas AND no outpatient SKIP to department section VI,
 1 SD Other — Specify ~ page 10


I


I


1


I } 

[ 

?.	 List tha ambulatory unit(s) (clinic(s) /emergency ~ Line Clinic/Emergency service :nm#&g ED opo I No. service area(s)) that did not participate. I area name 

Indicate the sampling unit number in the space II � �


provided and mark (X) the appropriate box for OPD or I


ED. If more than 3 ambulatory units, contact your ~


supervisor immediately. ,2 •1 •1


I


13 � •1
 1


o 

3. What is the reason the (clinic/emergency service ~ Clinic/Emergency Clinic!Emergerrcy Clinic/Emergency 

service area on service area on service aree on
 area) did not participate? I Iina 1 line 2 Iina 3


Mark (X) appropriate box(es). I


a,	 Clinic/Emergency service area not open during I


reporting period — SKIP to section W, page 10 after :


completing for each unit marked ‘ I In 10 In


b. :tir&c//E:;~y service area not eligible – I


I 20 20 20


C.	 Clinic/Emergency service area director refused – I


SKIP to item 30 I 30 30 30


d. Other – Specify reason then SKIP to I
 section W, page 10 after completing for 40 40 40


each unit marked. ~ Spacify ~ Specify ~ Specify ~


I


!’ 

I


!9. What is the reason or condition the (clinic/emergency ~ Clinic!Emergency Clinic/Emergency Clinic/Emergency


service area) was not eligible? I serwce araa on service area on service area on


line 1 line 2 line 3


Mark (X) appropriate box(es). t 

& Clinic/Emergency service not under the I


auspices of hospital I 10 In 10


b. Ancillary service facility (such aa laboratory and ~ 

radiology services) I 20 20 2CI 

C. Cara not provided by or under the direct supervision ~ 

of physician(s) 1 30 30 30


d.	 Other – Specify reason or condition then go to ~


sect;on W, page 10 after completing for each 40 40 40


unit msrked. I


I Specify ~ Specify ~ Specify ~ 

I


1


/ 

NOTES 

3ge 8 FORM NHAMCS-101 14-1E91v 

30 
------

------ --------

--

---

-----

-------

----

-----

---

Hospital ------------ -- ----

---------

---------

-- -- ----- --

----- ----- ---- -- ---- -----

------ ---- ------- --- --

------ ---

Section V – NONINTERVIEW – Continued 

la. At what point in the interview did ;he I Clinic/EmergencyClinic/EmergencyClinic/Emergency 

refusal/breakoff occur? Hospitsl service araa on service araa on service area on 

line 1 Iina 2 line 3 ; Mark (X) appropriate box(aa). 

(1) During the telephone screening i ,D 

-——— ————— —— -—-— ——_.———— ~l––– _ _—— — —————— -—-- ———.

(2) 

(4) Duflngthe c~nic/emergency 

——-——-— 

service 

_——————_—————————— 

areainductionl 40 

—-40 —— --——-— 40 40 

–-–--–––––––-–––– -–––-–+––––––– – ———— —— —-—— —-— ———— —. 

(5) After theclinic/emergency service areainduction, ~ ;D 

but prior to assigned reporting period I --——— ------—-——-— 50 

— ——— 

50 50 

—--- --—————— . 

During	 the hospital induction I 20 t ---––-––-––––-–––––– A––-–––– – ---— —— —-— ——— —-————. (s)~fi~rzhe hoapital induction, butpriortothe \ ~a 

clinic/emergency service area inductions I t 

——- -. 

(6) During aaaigned reporting period I aU a17 1 alZ I 60 

1 b. Bywhom? Clinic/EmergencyClinic/EmergencyClinic/Emergeric\ 

I Hospital service area on service area on aewice area dn 

line 1 line 2 line3 

Mark [X) appropriate box(es). L 

I (1) Hospital Administrator 10 In 10 10 

————— ——-———-————-—— ————;–––– –-– ————— —— - -— --— -, 

(2) c~niclemergency service area director -––-l 20 20 ——————20 

--–---–––––-–-–––––– —--—- --———

(3) Approval	 Board or official I 30 30 30 30 

-——- --————---——---- -,------- —--- --——— —-—- ,,--- —--

“(4) Other hospital official – Specify ~ I 40 40 40 40 

Specify~ , Specify~ Specify ~ 

!
I II
 I I

1I 

I I


I


I I I 1 

C.	 Whatreason waagiven? lfmorethan lunit, please specify thelinenumbarof theclinic/emergency 

sarvice area {from item 2 Z) before recording responses. 

d. Date refuaal/breakoff (a) reported I 

Enter date(s) in appropriate box(esl. I Month Day Year 

(1) -— _____________ ___.~mmm (2)Clinic/Emergency service area on line 1 ;---m---m----m-----”--­ -— --— —--- -

(3) Ckic/Emergency service ares on line 2 —----— -———————--——— ———— T--m---m----m

(4) C~nidEmergency service area on line 3 :---m---m----i 

I f?. Waaconversion attempted? Clinic/EmergencyClinic/EmergencyCliniclEmergenc ! Hospital service area on sewicasreson service erea on 

Iin,a1 line2 line3 

I If Yes, ask item 30f. I I I 

Yes 

/f/VO, SK/Ptosection V/, page 70aftercomp/eting \ 

I 1� Yea I I •l Yes CIYes I 113

foreach unitmarked. I 20No 20No I 20No 20 No 

I 

f. What was the result? I Clinic/EmergencyClinic/EmergencyCliniclEmergenc\ 

I	 Hospital service area on service area on aarvice area on 

line 1 line2 line 3 I 1 

(1) Hospital administrator refused I la In In In 

——— —-----— —----— ____, ——— —— —- —— —-- --— —--- . I 

20 20 20
 (2) Clinic/Emergancy sewicearea director refused j -—- -— ——--—. ——-— —— —-- --— 1 ——- 1 1
 ! 

(3) Approval board or official refused I 30 30 30 30 

- —-------- __— _ ---— -—— 1 —-- 1 -——- 1 

(4) Hospital administrator —-——-——- agreed to aee FR I I I -——- -— -- - I-----’_–_ –– _____ —— -- -——— -

(5) ~&IjE~:::~# sarvice area diractor I 50 50 50 

Oga9 FORM NHAMCa.101 (4.15eli 
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Seotion VI – DISPOSITION AND SUMMARY 

1 

31. FINAL DISPOSITION I I � &lleli:ible units completed patient record 

/ 2 � ::r:seligible units completed patient record


/ 3 � Hospital refused


I


1 40 Hospitsl closed


I 5U Hospital ineligible


32. AMBULATORY UNIT SUMMARY 

OPD or ED Su Number Completed Number of As:~:ed 

Line Clinic/Emergency service area name [b) number of Pvs fo;:s? completed 

No. forms numbers 

(a} OPD ED (c) (d) YES NO (f) {g) 

. 

NOTES 

Page10 FORM NHAMC3-TO114.lb 

32 
NOTES 

FORM NHAMCS.101 (4-1 S.91) “. ~. WI— PU~UIC ,,m.t 1991/548-0S0/40053 Page 11 

33 
co 

A 

1. Hospital name k Hospital number 

NHAMCS-101/S U.S. DEPARTMEN:XCFC$M;: CHECK ITEM A FORM

131!311 ACTING AS COLLECTING AGENT FORTHE 

NATIONAL CENTER FOR HEALTH STATISTICS 

CENTERS FOR OISEASE CONTROL 

I � The hospital HAS emergency service ereas. — Begin with Emergency 

Department Sampling Sumnlary Form on page 2. Refer to page 1 of the 

EMERGENCY AND OUTPATIENT 

NHAMCS- 124, Sampling and Information Booklet, for instructions on 

completing this form. 

DEPARTMENT SAMPLING RECORD 2 � The hospital DOES NOT have emergency service areas. — Complete the 

NATIONAL iiosplTAL AmbUlatOry Outpatient Department Sampling Summary Form on page 3. Refer to 

MEDICAL CARE SURVEY page 3 of the NHAMCS- 124} Sampling and Information Booklet for 

instructions, 

r 

IRANDOM START LABEL 
.

----

---

—..—- ———..—. 

. Il.-. Page _ of pages 

2. RO code 3. FR code 

EMERGENCY DEPARTMENT SAMPLING SUMMARY FORM 

I

4. Hospital name 5. Hospital number 

Expected Name of emergency service area number of visits Take every Start number 

(d) (e) 

— ___ ———-—---. — ,.. - ..—. —. .-.. —--- .. ... ..—.. 

—---t---

2 

.-..———— — . . . .. .. . - . ...-..—— .-.. .. ... . .-. . . .... ..- .—. .- —.—-— — .--—.- ——— . .----

1 3 t
 !,___ ..— —.—.- .—-— ——_— ---— ——. — I _—_——


4 

—.--— —.. ——.—-_.-_————— —-

5


. . .,,.--..———. -.-- .—-—. ——— -----’--+-–- —— -. —-—


6 ‘--”””’-------~-
 ... . — ..-——.——-—-— -— —— — 

.

7

.. --. ..-.-— — -..---———— ‘-----–____r- -— 

8 “–~ -. . ..-— —— —-..—. ...-— —— . ...--- ——---- . .-———

! 9 

i.. _ ..- -— —


: 

,.——


10 ““-


TOTAL VISITS ~ I 

CHECI( ITEM B 

. . ...- .. ——— — —- ——— ‘“”-” ““”-- --’–~–”–”--—-

I 

I I El Yes — Go to next page and complete Outpatient Department Sampling Summary Fcrrm, 

refer to page 3 of the Sampling and information Booklet for instructions. 

Does this hospital have an outpatient department?	 / 

I 2 ~ No— Contact the hospital administrator and arrange to meet with the director(s) of 

the emergency service area(s). 

I 

- . .. Al.:.s :,!! s .3 I 911 Page 2 ~ ‘“ 
.. .

.

——------

-------- --

.

----

---

1. Page _ of pages 

2. RO code 3. FR CO&? 

OUTPATIENT DEPARTMENT SAMPLING SUMMARY FORM I 

4. Hospital name 5. Hospital number 

TO BE COMPLETED BY CENSUS HEADQUARTERS ONLY ., Expected Proba- Take Start 

———

No, of SU No. bility every No. SU No. Estimated No. of visits visits TOTA1 Co/. (e) Foreach clinic in SU 

., (d] (cl (f) (g) [h) [i) (j) (k) 

.,--

1 ..-—.—.- —+— +_ + _“_ + —— -- ..-..-...—.— — —-—.-— .. .-— —— 

2 

..-. ..——--— ——- .——.— —-.-—- .--- ——- —+— +_ +_ +_ 

3 -.——-—...... —— 

.. .—-. +_ —- 4 1- I —+— + +_ .-— — ...-—— —— 

5 

—- ...--—— 

6 

. ..-.———-——-—-- . ..... -——.. ——-. — —.. ... . .. ..- .— ---t== 

7 

. .—. .—— —— _ ..— ——. .— - —— .--.-— TOTAL SU VISITS ~ 

B 

+ .—— —— NOTES 

!3 

—— — _--— 

— 

Ic 7

TOTAL VISITS ~ 

Contact hospital administrator and arrange to meet with the director(s) of each service area and/orclinic selected for the study. ~ 

W.4 w.Ah4cs ]!21 s [3.1 91) rage 
., 

OMB No. 0920-0278: ADDrOVd . . ExrIires 2/28/92

3fiM NHAMCS-IOIAI U.S. DEPARTMENT OF COMMERCE 

!-16.91) BUREAU OF THE CENSUS Section A — AMBULATORY UNiT INFORMATION ACTING AS COLLECTING AGENT FOR THE 

NA;gJy:&;;::;:: a. ED or OPD b. Emergency service 

CENTERS FOR DISEASE CONTROL Mark (X) one areas/clinics 

� ED � lOPD of ‘


AMBULATORY UNIT RECORD I


G. Hospital name


SURVEY OF HOSPITAL EMERGENCY I
 AND OUTPATIENT DEPARTMENTS


NATIONAL HOSPITAL AMBULATORY d. Hospital number ,, 

MEDICAL CARE SURVEY 

I


COMPLETE THIS RECORD FOR EACH AMBULATORY UNIT 

Enter the name of the emergency service area/clinic. If no name, identify it by location, service type, or some 

other unique identifier. 

I


1. What is the name of the (emergency service Name 

area/clinic)? I


I


2. Where is the (emergency service area/cIinicl i I � Onsite at hospital located? I 2 � Elsewhere — Specify ~ 

I


I Address (Number and street)


I


I City/State \ ZIP Code 

i“ I
 -.
 I I


3. What is the name, title, and telephone j Name


number of the director of the (emergency I


service area/clinic)? 

I Title


I


1


~Telephone (Area code and number) 

1


I


4.	 How many patient visits are expected 

during the 4-week reporting period Monday, / 

., 

through Sunday, ? i

1’ Expected number of visits 

5. Is this estimate based on a recent period, same I


month last year, monthly average over last year I I � Recent Period 

or some other basis? I 2 � Same month last year 

3 � Monthly average over last year 

/ 4 � Other basis — Specify ~ 

I


I


~mergency service area 

� OPD clinic – SKIP to itern 9, page 2


I
 6.	 What is the function of this service area, that is, 

what types of patients are seen or services /

provided? . . 1. 

I


I


7. Isa separate arrival log kept for this service area? I lCIYes — SKIP to instruction 1, page 2


I 20No 

8. Where is the arrival log for these patiants kept and : 

how is it organizad? I


I


I


37 
Section A – AMBULATORY UNIT INFORMATION – Continued 

Instruction 1 

‘If there are more emergency service areas, complete a separate SectionAoftheNHAMCS-101 /U, 

Ambulatory Unit Record for each additional area, if you have not already done so. 

‘If there are outpatient department clinics, complete Section IV – Outpatient Department 

Description on page7oftheNHAMCS-101 before beginning the first clinic’s Ambulatory Unit 

Record. Complete Section A of the NHAMCS-101 /U, Ambulatory Unit Record for each clinic. 

‘If you have completed a SectionAoftheNHAMCS-101 /U, Ambulatory Unit Record for each 

emergency service area and each outpatient department clinic, read STATEMENT A below. 

1. What type of clinic is this, that is, what I 

physician specialties are seen in this clinic or / I � General medicine 

what type of services are provided? I

I	 20 Surgery 

3 •l Pediatrics 

4 El Obstetrics and/or Gynecology 

i 

1 5 � Other — Specify ~ 

I 

hlsfrucfion 2 

“If there are more OPD clinics, complete a separate SectionAoftheNHAMCS-101 /U, Ambulatory Unit 

Record for each additional clinic; if you have not already done so. 

“ Complete SectionAoftheNHAMCS-101 /U, Ambulatory Unit Record for each emergency service area, 

if you have not already done so. Remember to complete Section Ill — Emergency Department 

Description on page 6 of the NHAMCS-101 before beginning theNHAMCS-101 /U, Ambulatory Unit 

record for the first emergency service area. 

“If you have completed a SectionAoftheNHAMCS-101 /U, Ambulatory Unit Record for each emergency 

service area and each clinic, read STATEMENT A below. 

STATEMENT A 

Thetis all the information I need for now. Thank you for your assistance. Now I need to do the 

sampling. It wiII take a few (days/hours) to complete the sampling plan. Then I will call to discuss 

arrangements for contacting and training the hospital staff. Complete the AWAMCS-101 (S), Sampling 

Record for this hospital. 

NOTES 

Page 2 FORM NHAMCS.1 0$/U (4.1 6-91 

38 
INSTRUCTIONS FOR COMPLETING THE AMBULATORY UNIT RECORD 

(SectionA should akeady be completed) 

1. Prepare Sections B–L of this form for each 

emergency service area/clinic selected in this 

hospital for the study. 

2. Complete Section B before meeting with the unit 

administrator or other designated respondent. 

Transcribe the information provided in part A of the 

NHAMCS-101 /S to items 1, 2, and 3. 

In item 4, enter the total number of visits expected 

for the entire ED or OPD, as appropriate. 

Record the 4-week reporting period for the unit in 

item 5. 

If the unit is part of an outpatient department 

sampling unit, enter the number of clinics in the 

sampling unit in item 6. If the unit is part of the 

emergency department, enter the number of 

service areas in the emergency department. 

3. Complete Sections C and D with the designated 

respondent	 for the unit. 

, 

4.	 Section E is completed only when a new Take 

Every or Random Start number must be 

calculated (as determined in item D-3). For item 

E-1, refer to the tables on pages 6 and 7 of the 

NHAMCS-I 24. Use the revised estimate of visits 

for the clinic reported in item D-2 and the original 

total visits for the department in item B-4 to determine the new Take Every number, Record the 

new number in the blank provided. 

In item E-2, you must determine a new Random 

Start for sampling patient visits using the newly 

calculated Take Every number in E-1. Refer to the 

table affixed to the front of the NHAMCS-I 01 /S 

and find the next available (i.e., unused) unit row. 

The new Random Start is located in the cell where 

this row and new Take Every column intersect. 

Record this number in the blank provided in 

item E-2. 

5.	 Enter the name, title, shift and telephone number 

of each hospital staff member involved with the 

data collection activities for the unit in Section F. 

6. In Section G, record the range of Patient Record 

Form (PRF) numbers assigned to the unit in the 

boxes provided. If multiple ranges, or individual 

numbers not within a range are assigned, record 

these numbers in the notes section located below 

Section G. 

IRM NHAMCS-101/U M-1 6.91 I 

7. Record the date and time of each training session 

(i.e., instructions for sampling and completing 

PRFs) conducted with the hospital staff in 

Section H. [n column (d), enter your name as 

instructor, and enter the names of the hospital 

staff receiving training in the multiple cells 

provided in column (e). 

8. After completing Section H, explain the procedures 

for sampling patient visits and completing PRFs to 

the hospital staff. Refer them to the ED or OPD 

Instruction Manual, as appropriate. 

9.	 During the unit’s reporting period, you will make 

weekly Quality Control visits to the clinic to 

monitor the progress of the study and to collect 

any PRFs already completed. Provide a record of 

each of these visits in Section 1. 

10. Item 1 of Section J asks for the number of visits in 

the emergency service area or clinic during the 

reporting period. It is extremely important that an 

accurate entry be made for this item. To ensure 

the accuracy of this entry, refer to the ambulatory 

unit’s patient log, appointment book, registration 

list, records, etc., to accurately determine the 

number of visits. It is best to complete this each 

week during your quality control visit. 

In item 2, record the number of PRFs completed 

during the unit’s reporting period. This number 

should be equal to the number of PRFs transmitted 

to the regional office. 

The remainder of the items in Section J should be 

completed when the reporting period is over and all 

PRFs are collected. 

11.	 Complete Section K only for those units reporting 

during the first three reporting periods. 

A NHAMCS-I 31, Debriefing Form, is completed by 

all hospital staff members involved in the data 

collection activities. List the name and title of each 

staff member, and indicate their role in the study 

and the date of debriefing. 

12.	 Should any new hospital staff members become 

involved with the study (or any other notable 

changes in staff occur), provide an updated report 

of the hospital staff information in Section’L. 

Page 3 

39 
Section B – INFORMATION FROM SAMPLING RECORD 

Transcribe information from part A, page2or3oftheNHAMCS-101 (S) to items 1 –4 and 6. 

. Random Start number 2. Take Every number 3. Estimated number of ~ 4. Total estimated number of 

visits in this unit I visits for the entire ED/OPD 

during field period I during the reporting period. 

i 

From I To 6. Number of clinics ~ 

i. PERIOD I

I in this SU I 

Section C – EMERGENCY SERVICES/OUTPATIENT CLINIC INFORMATION AND LOGS 

1. What are the usuaI operating hours of this unit? 

Mark (X) ONLY one 

Day(s) Time 

Open 24 hours Not open Hours)vary 

(a) (b] (c) [d) 

Monday a.m. 1 TO 

p.m. ~ 

a.m. 

p.m. 10 20 30 

Tuesday a.m. I To 

p.m. I 

a.m. 

p.m. 10 20 30 

Wednesday ;: ; TO 

,. I 

a.m. 

p.m. 10 2CI 30 

Thursday a.m. I TO 

p.m. I a.m. 

p.m. In 2CI 30 

Friday a.m. ~ To 

p.m. I 

a.m. 

p.m. In 20 30 

— . . . . . a.m. I To a.m. Saturday - p.m.1 p.m. 10 20 30 

6 a.m. 1 TO a.m. Sunday p.m. I p.m. 10 20 30 

2.	 How many separate shifts are therein this unit? [ Number of separate shifts 

I 

3a. How many separate patient registration logs are ~ Number of logs 

maintained in this unit? I 

I 

b. How (Hare) the log(s) organized? I llJOne log for all patients 

1 20 Computer log supplemented by handwritten entries 

30 Separate logs for different type of cases 

! -@Other - Specify ~ 

Section D — VERIFICATION OF ESTIMATED VISITS 

I Verify with ED/ciinic director I 

1.	 According to our information, about (Number from / 

B-3) patient visits are expected during the survey I 1•l Yes — SKIP to section f-, page 5 

period. Do you agrae with this estimate? I

I 20No 

I 

Z. About how many visits do you expect during the / Revised estimate 

reporting period, to ?! 

Determine if new Take Every and Random Start must / 

be calculated for this clinic. Revised estimate 

. 3a. Divide the revised estimate by the original ; 

+,= 0(’=”’” 

estimate from B-3. ~ Original estimate 

b. Isthe result of (a) between 0.7 and 1.3? i I H Yes — SKIP to saction F, page 5 

i 20 No . 

Paga 4 FOFIM NHAMcS-1OW [4-lbW 

40 
Section E – CALCULATE NEW SAMPLING INTERVAL AND RANDOM START FOR THIS CLINIC 

I


~ i	 ~a[cuiate new sampiing Take Every, using the tables on “~ 

page 6 or 7 of the NHAMCS-1 24. (Use the revised 

estimate of visits from D-2 and the original total visits \ 

from B-4). I New Take Every 

2.	 Calculate a new random start, using the next I


available row on the label affixed to the front of I 

New Random Start I


the NHAMCS-1 01/S. I


Section F – DATA COORDINATOR AND KEY HOSPITAL STAFF 

Enter the name, title, shifts, and te/ephone number of the data coordinator and key hospital staff 

involved in the data collection. 

Line Title shift Telephone number 

Name No. (e) 

(a) (b) (c) (d) Area code Numbar Ext. 

1


2


3


l–r .1


5


6


7


8


Section G – PATlENT RECORD FORM INFORMATION 

This AU assigned patient record forms ~to~ 

NOTES 

FORM NHAMCS-1OILI (4-16-91) rag[ 

41 
Section H – TRAINING 

Enter dates and times of training sessions, the names of the instructo~ and the names of the hospital staff members trained. 

.ine Date Time Instructor Trainee(s) Vo. 

(a) (b) (c) (d) (e) 

1 2 3 

1	 a.m. 4 5 6 p.m. 

1 2 3 

2	 a.m. 4 5 6 p.m. 

1 2 3 

3 a.m. 4 5 6 p.m. 

1 2 3 

4 a.m. 4 5 6 p.m. 

1 I I I I I J , Begin instruction on patient visit sampling and completing Patient Record Forms. Refer to the ED or OPD 

Instruction Manual, as appropriate. 

Section 1– QC VISITS 

Wew4date~@im-efiQC-vkits and the contact(s) at the visit? 

.ine 

No. Dete Time Contact(s) 

(a) (b) (c) (d) 

I 2 

1 a.m. 4 p.m. 

I 2 

2	 a.m. 

p.m. 

I 2 

3 a.m.

.. .. p.m. 

4 a.m. 3 4 p.m. 

5 a.m. 3 4 p.m. 

9

6 a.m. 3 4 p.m. 

I I 

‘age 6 FORM NHAMCS-1 01/U (4.1 6.91) 

42 
Section J – AU DATA 

I 

. What was the total number of patient visits to this NUMBER OF VISITS 

(emergency service area/clinic) 1 Week 1 Week 2 Week 3 Week 4 TOTAL 

I from I 

(Refer to patient Iog$’registration /is;, etc. Ask if 

necessary. DO NOT LEAVE TOTAL BLANK. BE AS I 

COMPLETE AND ACCURATE AS POSSIBLE.) 1 

How many patient visit forms were filled out for 

‘” this AU (emergency service area/c\inic)? 

I 

I Week 1 

NU MBER OF FO RMS 

Week 2 Week 3 .Week 4 TOTAL 

I 

I 

/ 

1. Were patient record forms filled out during or within I ID During or within an hour after the visit an hour after the visit, more than 1 hour after the I .20 More than 1 hour after the visit visit, or both? 

I 30 Both 

1. Describe methods for completing forms. If possible attach a blank form if used as data source. 

5.	 Did this ambulatory unit use the NHAMCS-I 03, 

Patient Log, or their own log? 10 NHAMCS-I 03 — SKIP to section K, page 8 

20 Own log 

B. Describe the ambulatory unit’s patient log. 

., 

NOTES 

: 

1 .—––-! 

I FORM NHAMCS-101 Al (4-1 6.91) rage I 

43 

I 
COMPLETE FOR FIRST THREE REPORTING PERIODS ONLY 

Section K – DEBRIEFING 

Indicate who participated in the debriefing and what their role was in the study. 

Date Participant Participant title 

(a) (b) (c) 

NOTES 

age 8 

Role in study 

(d) 

I � Sampled patients 

20 Filled out forms 

3 � Supervised data collection 

I, � Sampled patients 

20 Filled out forms 

3 � Supervised data collection 

I � Sampled patients 

20 Filled out forms 

3 � Supervised data collection 

I � Sampled patients 

2 � Filled out forms 

30 Supervised data collection 

I � Sampled patients 

2 � Filled out forms 

3 � Supervised data collection 

I � Sampled patients 

2 � Filled out forms 

3 � Supervised data collation 

I � Sampled patients 

2 � Filled out forms 

3 H Supervised data collection 

1 � Sampled patients 

2 � Filled out forms 

3 � Supervised data collection 

FORM NHAMCS-101/lJ (4.16-911 

44 
Section L – UPDATED CONTACT OR APPROVAL INFORMATION 

Contact name Shift 

Title 

/ Area Code Number Extension 

Telephone I 

I I 

Comments 

Contact name Shift 

Title 

[ Area Code Number Extension 

Telephone I 

2 I 

Comments 

Contact name Shift 

Title 

~ Area Code Number Extension 

Telephone I 

3 

Comments ‘ 

Contact name Shift 

Title 

! Area Code Number Extension 

,, Telephone I 

4 I 

* I Comments 

1 

-, FORM NHAMCS-101/U (4-16.911 Page: 

45 
kfB No. 0902-0278 ApprovalExpires2/28/92 Sheet— of_ sheets 

‘ORM

4-15-91) BUREAUOFTHE CENSUS 

ACTING AS COLLECTINGAGENT FORTME I 

NATIONAL CENTERFOR 

HEALTH STATISTICS z. Sampfing Taka Every 3. Random Start Number 

NHAMCS-103 U.S. DEPARTMENTOFCOMMERCE 1.Clinic/Service Area Name 

CENTERS FOROISSASE CONTROL

PATlENT VISIT LOG NOTE - Hospitslisto retainlog after completionof study.This log 

is for optionaluse Puta check mark (K) in column(f) “Sample” next NATIONAL HOSPITAL AMBULATORY toaach patlant selactedforthe sampleof vmts. Burdenassomated MEDICAL CARE SURVEY with this form is smallandis countadaa part ofthe burden 

~associatedwith completionof the patientracordform. J 

Sample Patient Mark (/) L# Date of Patient name recordl Remarks foo~ti~m;: viait identification 

number am13yi’Of 

(a) (b) (c) (d) (e) (fl 

.-
UNITED STATES DEPARTMENT OF COMMERCE 

Bureau of the Census 

NHAMCS-124 

1, 

I 

I NATIONAL HOSPITAL AMBULATORY MEDICAL CARE SURVEY 

I 

SAMPLING AND INFORMATION BOOKLET 

47 
EMERGENCY DEPARTMENT SAMPLING INSTRUCTIONS 

Collect all NHAMCS-l Ol(U)s, Ambulatory Unit Records, completed forthe emergency service 

areas within the Emergency Department (ED). Then turn to page 2 of the NHAMCS-101 (S), 

Sampling Record, and begin completing the Emergency Department Sampling Summary Form 

using the instructions provided below. (Remember to complete the heading items 1-5 at the top 

right-hand side of the page). 

(1) (b) Name of emergency service area 

Enter the name of each emergency service area for which an Ambulatory Unit Record 

was completed in column (b) of the ED summary form. If there are more than 10 

emergency service areas, continue listing these areas using a Supplemental Emergency 

Department Sampling Form. Indicate the page number of this form and the total number 

of Summary Form pages in the space provided at the top right-hand corner of the 

Summary Form. (For example, if there were three Summary Forms completed and this 

is the first form filled, record as - Page + of _3_ pages.) All eligible emergency 

service areas in the ED are included in the sample. However, if the hospital does not 

have an Emergency Department which provides services 24 hours each day, but 

does staff emergency service areas that operate less than 24 hours each day, 

include these emergency service areas with the Outpatient Department and list them 

on the Outpatient Department Sampling Summary Form. 

(2) (c) Expected number of visits 

In column (c), transcribe the expected number of visits for each emergency service area 

from Section A, item 4, of theNHAMCS-101 (U), Ambulatory Unit Record. After recording 

the expected number of visits for all areas, sum the total of visits for the entire department 

and enter the total in the box provided at the bottom of column (c). 

(3) (d) Take every 

Enter the Take Every (TE) number for each service area in column (d). To determine the 

TE for each area, refer to page 6 of this booklet. MAKE SURE YOU REFER TO PAGE 

6- THIS IS THE PAGE CONTAINING THE EMERGENCY DEPARTMENT TAKE EVERY 

NUMBERS. Locate the number of total visits for the entire ED in the range of numbers 

running down the left-hand side of the page. (If you can not find the number of total 

visits in any of these ranges (i.e., this number exceeds all ranges), call the regional office 

supervisor immediately. After locating the number of total ED visits in one of the ranges, 

proceed to find the number of visits expected for the individual emergency service area 

in the row of ranges running across the top of the page. Move your finger across the row 

containing the number of-visits for the entire ED until it intersects the column containing 

the number of visits for the individual service area. The number located in the cell where 

this column and row intersect is the Take Every number. Enter this number in column 

(d) and repeat the process for each service area listed. 

1 

48 
EMERGENCY DEPARTMENT SAMPLING INSTRUCTIONS (CONTINUED) 

(4) (e) Start number 

Once a Take Every number has been determined for each service area, select the 

random start numbers. Refer to the label affixed to the front of the NHAMCS-101 (S), 

Sampling Record. A table has been generated on this label consisting of a row or 

heading of TE numbers and a column or left margin of ten numbered rows. Random 

numbers (between 1 and the TE number) were generated in the table’s cells. To 

determine the random start for the first service area listed, locate the area’s TE (as 

provided in column (d)) in the table heading. Starting with row number 1, move your 

finger across the row until it intersects the column headed by the TE number. The 

number located in this cell is the Random Start number. Circle the number and enter it 

in column (e) next to the first service area listed. Proceed to select the random start for 

the next service area listed, this time using the TE determined for this area and row 

number 2. Continue the process until a random start has been selected for all areas in 

the ED. Should you have more than 10 service areas within the department, contact your 

regional office supervisor and provide him or her with the TE numbers of all remaining 

service areas. The supervisor will determine the random stacts for all remaining units. 

(5)	 Once you have completed the Emergency Department Sampling Form(s), complete 

CHECK ITEM B at the bottom of page 1 of the NHAMCS-101 (S), Sampling Record. 

49 
OUTPATIENT DEPARTMENT SAMPLING INSTRUCTIONS


Collect all completed NHAMCS-l 01(U)s, Ambulatory Unit Records, for all clinics in the Outpatient 

Department (OPD). Then turn to page 3 of the NHAMCS-101 (S), Sampling Record, and begin 

completing the Outpatient Department Sampling Summary Form using the instructions provided 

below. (Remember to complete the heading items 1 -5 at the top right-hand side of the page). 

sEcmori i ORGANIZING NtiAMc2s-101 WE, AMBULATORY UNIT REcORDS 

m Divide me NHKMCSIT117U)Smto the five specialty groups listed below. Refer to item 9 

on page 2 of the NHAMCS-101(U), Ambulatory Unit Record, to determine in which of the 

five specialty groups each clinic belongs. 

Sr3ecialtv Gr0LI13 

(1) General Medicine 

(2) Surgical 

(3) Pediatrics 

(4) Obstetrics/Gynecology 

(5) -Other 

Code 

GM 

s 

PED 

OB/GYN 

OT 

(2)	 Within each specialty group, order the NHAMCS-1OI (U)s, Ambulatory Unit Records, by 

clinic size (i.e., expected number of visits) from smallest to largest. (The number of 

patient visits can be found in item 4 on the cover page of the NHAMCS-1OI (U), 

Ambulatory Unit Record). 

(3) (b) Name of clinic 

Beginning with the clinics in the General Medicine group and continuing in the order 

listed in instruction (1) above, list the name of each clinic in column (b). Remember, the 

clinics should be listed from smallest to largest within each specialty group. If any of the 

specialty groups are not represented in the hospital OPD, continue with the next specialty 

group represented. If there are more than 10 clinics, use Supplemental Outpatient 

Department Sampling Summary Forms. Indicate the page number of this form and the 

total pages of Summary Forms completed in the space provided at the top right-hand 

corner of the Summary Form. 

(4) (c) Specialty group 

Enter the specialty group code in column (c) for each clinic listed in column (b). (The 

codes fcr each specialty are listed m Instrucxcn i:) above!. 

50 3 
.

(5) 

(6) 

t 

(7) 

* 

(8) 

OUTPATIENT DEPARTMENT SAMPLING INSTRUCTIONS (CONTINUED) 

Count the number of clinics listed in column (b). The total should equal the number of 

NHAMCS-101 (U)s completed for the Outpatient Department at this hospital. If not, 

reconcile before continuing. 

(d) Expected No. of visits 

In column (d), transcribe the expected number of visits for each clinic from Section A, 

item 4, of the NHAMCS-1OI (U), Ambulatory Unit Record. 

(e) SU No. and (9 Probability 

If 5 or fewer clinics are listed, number them sequentially from 1 to 5 (or number of 

clinics) in column (e), and in column (9enter 1. Enter the total number of visits for the 

OPD (i.e., the sum of expected visits for all clinics) in the box provided at the bottom of 

column (d). Then continue with instruction 9. 

(i) SU, No. and (j) Estimated number of visits 

If there are more than 5 clinics listed for this Outpatient Department, call your regional 

office supervisor immediately for instructions. 

(In most cases, the supervisor will instruct you to FAX the OPD Sampling 

Summary Form(s) to the regional office FAX number and to a designated FAX 

number at Census Bureau Headquarters in Washington (301-763-2703). If there 

are small clinics (Le., clinics with fewer than 30 expected visits during the 4-week 

reporting period), these clinics will be merged with one or more other clinics into 

a ...sampling .. . .. .. . unit .. .. based . . on their..sizp.apd_SpeCLa!!y...g rupup. Mo? sarn.p!ing Units.w[ll 

consist of only one clinic. From the total list of sampling units, no more than 5 

will be selected for the sample. Headquarters will determine the Take Every 

pattern and random start number for each of the clinics within the SUS chosen for 

the sample. This information will be returned to you by FAX or telephone, 

whichever is most convenient, no later than 3 days after you send the Summary 

Forms. In most cases this will not take more than 24 hours.) 

Skip to instruction 11. 

4 51 
OUTPATIENT DEPARTMENT SAMPLING INSTRUCTIONS (CONTINUED) 

SECTION II SELECTING PATlENT VISITS 

(9) (9) Take every number 

The Take Every (l%) number for each clinic is entered in column (g). To determine the 

TE for each clinic, refer to page 7 of this bcoklet. MAKE SURE Y~Ll REFER TO PAGE 

7- THIS IS THE PAGE CONTAINING THE OUTPATIENT DEPARTMENT TAKE EVERY 

NUMBERS. Locate the number of visits for the individual clinic in the row of number 

ranges running across the top of the table on page 7. After locating the number of visits 

for the individual clinic in one of these ranges, find the number of visits expected for the 

entire OPD in the column of ranges running down the left-hand side of the page. (If you 

can not find the number of visits in any of the ranges (i.e.: this number exceeds all 

ranges), call the regional office supervisor immediately.) Move your finger across the row 

containing the number of visits for the entire OPD area until it intersects the column 

containing the number of individual clinic visits. The number located in the cell where this 

column and row intersect is the Take Every number. Enter this number in column (g) and 

repeat the process for each clinic listed, 

(10) (h) Start No. 

Once a Take Every number has been determined for each clinic, select the Random Start 

numbers. Refer to the label affixed to the front of the NHAMCS-101 (S), Sampling Record. 

A table was generated on this label consisting of a row or heading of TE numbers and 

a column or left margin of ten numbered rows. Random numbers between 1 and the TE 

number were generated in the table’s cells. To determine the Random Start for the first 

clinic listed, locate the clinic’s TE (as provided in column (g)) in the table heading. Using 

the first row (or next available row if others were previously used), move your finger 

across this row until it intersects the column headed by your TE number. The number 

in this cell is the Random Start number. Circle the number and enter it in column (h) next 

to the first clinic listed. Proceed to select the random start for the next clinic listed, this 

time using the TE determined for this clinic and the next available (i.e., unused) row. 

Continue the process until a random start has been selected for all areas in the OPD. 

Should you run out of available rows, contact your regional office supervisor and provide 

him or her with the TE numbers of all remaining units. The supervisor will determine the 

remaining Random Starts. 

(11)	 Once the Summary Form(s) has been completed for the Outpatient Department, arrange 

to meet with each ambulatory unit director and/or other official(s) at the selected clinics 

and emergency service areas, if any. 

5 

52 
------ ------- ------ ------ ------ ------- ------ ------

----- ---- ---------- --------- --------- --------- --------- ---

EMERGENCY DEPARTMENT 

Table of Take Every Numbers 

EMERGENCY DEPARTMENT (ED) TAKE EVERY CHART 

Visifs Visits to the individual service arep 

to the -----$ 

Total 160 90 120 150 180 210 240 270 300 450 600 over 

ED 

59 89 119 149 179 209 239 269 299 449 599 999 999 

4 --------

1 

I 

1

, 99 :1 1 NA NA NA NA NA NA NA NA NA NA NA 

99 149 :1 

1 

2 2 2 NA NA NA NA NA NA NA NA NA 

150 199 :1 2 3 3 3 3 NA NA NA NA NA NA NA 

200 249 :1 2 3 4 .4 4 4 4 NA NA NA NA NA 

250 299 :1I 2 3 4 5 5- 5 5 5 NA NA NA NA 

300 349 :1 2 3 4 5 6 6 6 6 6 NA NA NA 

350 399 :1 2 3 4 5 6 7 7 7 7 NA NA NA 

4 

400 449 :1 2 3 4 5 6 7 8 8 8 NA NA NA 

450 499 :1 2 3 4 5 6 7 8 9 9 9 NA NA 

500 749 :1 

I 

2 3 4 5 6 7 8 9 10 10 10 NA 

750 999 :1 2 3 4 5. 6 7 8 9 10 15 15 15 

1,000 9,s99 :1 2 3 4 5 6 7 8 9 10 15 20 20 

10,OOO12,499 :1 2 3 4 5 6 7 8 9 10 15 20 25 

12,500 14,999 :1 2 3 4 5 6 7 8 9 10 15 20 30 

15,000 17,199 1 2 3 4 5 6 7 8 9 10 15 20 35 

53 
------ ------ ------ ------ ------ ------

------ --- ------- -------- -------- -------- -------- -------- -------- --

1

2

3

4

5

6

7

� 

OUTPATIENT DEPARTMENT 

Tabie of Take E%ry (’hrnbers 

OUTPATIENT DEPARTMENT (OPD) TAKE EVERY CHART 

Visits .Yisits.to the individual clinic


to the -. -.. . ----.- . . . . . . -,


Total 16090 120 150 180 210 240 270 300 450 600 over 

OPD 59 89 119 149 179 209 239 269 299 449 599 999 999 

I Take Ewy I 

1

299 I 1 1 1 1 Ii ! 1 I NA NA NA NA 

300 449	 I 1 2 2 2 2 2 ~ 2 2 NA NA NA 

450 599 # 

4 1 2 3 3 3 3 3 3 3 3 NA NA 

600 749 I 1 2 3 4 4 4 4 4 4 4 4 NA 

750 899 ,

1 

1 1 2 3 4 5 s 5 5 5 5 5 NA 

900 1,049 :1 2 3 4 5 6 6 6 6 6 6 NA 

1,050 1,199 

t

I 

1 

1 2 3 4 5 6 7 7 7 7 7 NA 

1,200 1,349 1 

1 1 2 3 4 5 6 7 8 8 8 8 8 NA 

1,350 1,499 1 

, 1 2 3 4 5 6 7 8 9 9 9 9 NA 

1 

1,500 2,249 1 1 2 3 4 ~ 6 7 8 9 10 10 10 10 1 

2,250 2,9!39 :1 2 3 4 5 6 7 8 9 10 15 15 15 

, 

1

3,000 9,999 I 1 2 3 4 5 6 7 8 9 10 15 20 20 

8 

10,000 12,499	 1 1 2 3 4 5 6 7 8 9 10 15 20 25 & 

12,500 14,999	 1

, 1 2 3 4 5 6 7 8 9 10 15 20 30

15,000 ~7,1gg 8

I 1 2 3 4 5 6 7 8 9 10 15 20 35 

54 

1 
OUTPATIENT DEPARTMENT 

Classification of Clinics 

I GENERAL MEDICINE 

AIDS 

Allergy 

Cardiolog


Dermatology


Diabetes


Endocrinology


Family Practice


Gastroenterology


General Medicine


General Preventive Medicine


Geriatric


Hematology


Hypertension


Immunology


Infectious Diseases


Internal Medicine


Nephrology


Neurolo~


Oncology


Ophthalmology


Otolaryngology


Preventive Medicine


Pulmonary


Rheumatology


Walk-in and/or Screening


U SURGERY


Cardiothoracic


Colon and Rectal Surgery


General Surgery


Hand Surgery


Head and Neck Surgery


Necrologic Surgery


Ophthalmology Surgery


Orthopedic Surgery


Otolaryngology Surgery


Pediatric Surgery


Plastic Surgery


Puknonary~l%oracic Surgery


Urological Surgery


Vascular Surgery


111 PEI)IATRICS 

Adolescent Medicine 

Neonatology 

Pediatric Allergy 

Pediatric Cardiology 

Pediatric Dermatology 

Pediatric Endocrinology 

Pediatric Gastroenterolo~ 

Pediatric Hematolo~ 

Pediatric Infectious Diseases 

Pediatric Nephrology 

Pediatric Neurolow


Pediatric Oncology


Pediatric Ophthalmology


Pediatric Pulmonary


Pediatric Rheumatology/Arthritis


Pediatrics


Well Child Care


IV OBSTETIUCS/G~ECOLOGY


Abortion


Breast


Family Planning


Gynecology


Gynecologic Colposcopy


Gynecologic Oncology


Obstetrics


Obstetrics - Post Partum


Obstetrics - Prenatal


Reproductive Endocrinology


V OTHER


Adolescent Psychiatry


Adult Psychiatry


Alcohol Abuse


Child Psychiatry


Drug Abuse (excluding Methadone


Maintenance)


8 

55 
(1) Briefly state the purpose of the M-I.AhfCS. 

(2) Explain the ambulato~ unit staff members involvement with the study. They will: 

e List all eligible patient visits during the specified 4-week period. 

= Sample only certain visits using the take every and random start numbers. 

=	 Complete a brief l-page form for each of the sampled visits, Each form should take 

a couple of minutes to complete, and at most, the unit should only have to complete 

5 forms each day. 

(3) Complete Sections C through G of the Ambulatory Unit Record. 

(4) Ask the director to designate staff to assist with the data collection activities. 

Make sure all hours and shifts are covered. 

Person completing forms should be knowledgeable about medical care and services and 

should have access to the medical records or patient visits. 

Person performing listing and sampling should have access to arrival log(s). 

Assign one member of the staff as “data coordinator” to oversee patient visit sampling and 

completion of Patient Record forms. 

(5) Arrange to meet with each designated staff member. 

a 

56 
AMBULATORY UNIT INSTRUCTION CHECKLIST 

(1) Verify patient list kept by ambulatory unit is usable for sampling. That is, all patient visits 

are listed and can be easily counted or numbered, (If not, provide a NHAMCS-103 

Optional Patient Log). 

(2) Who to List/Who not to List on Patient Log 

List every eligible ambulatory patient visit to this unit during the 4-week reporting period. 

Include patients doctor does not see but who receive care from a physician assistant, nurse, 

nurse practitioner, etc. 

Exclude persons who visit for administrative reasons, such as to complete an insurance form 

or pay a bill. 

Exclude patients who do not seek care or services, for example, they come to pick up a 

prescription or leave a specimen. 

Exclude visits by persons currently admitted as inpatients to the sample hospital. (Nursing 

home patients should be included, however). 

Exclude telephone contacts with patients. . 

(3) Explain sampling system. 

Define the Random Start number and explain how it is used only once at the beginning of 

the reporting period to start patient visit sampling. 

Discuss the Take Every Pattern and demonstrate an example of its use. Emphasize the 

importance of sampling continuously from the patient list - never starting over at the 

beginning of a new day or shift. 

Show staff Section I of the appropriate department instruction booklet. Take Every and 

Random Start numbers are provided in C.2. 

(4) Go over Patient Record Form items, paying careful attention to -

Emergencv Deua~ent Patient Record Form 

lTkM 9- Indicate whether the visit is a first visit or follow-up for an injury or illness. 

ITEM.10 -If the major reason for this visit was an injury, as indicated in boxes 1 and 2 of 

item 9, describe in detail the events and that preceded the injury, for example, the place and 

cause of this injury, . 

ITEM 11- To be recorded in patient’s own words. If the patient is unable to respond, 

record the reason as stated by the person accompanying the patient. 

ITEM 12a - Diagnosis can be tentative, provisional or definitive. However, exclude “Rule 

Out” diagnoses. Should relate to the response recorded in item lOa. 

10


57 
AMBULATORY UNIT INSTRUCTION CHECKLIST (CONTINUED)


(5) 

(6) 

ITEM 12b,c - Enter any other diagnoses, including those not necessarily associated with this 

visit. 

ITEM 17- Record all medications administered during the visit as well as all new or 

continued medications provided or ordered, using the same brand name or generic name 

entered on any prescription or the medical record. Include immunizations, allergy shots, etc. 

Outpatient Deuattment Patient Record Form 

ITEM 9- Indicate whether this visit was due to the advice or direction of a physician other 

than the one being visited. 

ITEM 10- To be recorded in patient’s own words. If the patient is unable to respond, 

record the reason as stated by the person accompanying the patient. 

ITEM lla - Diagnosis can be tentative, provisional or definitive. However, exclude “Rule 

Out” diagnoses, Should relate to the response recorded in item 10a. 

ITEM llb,c - Enter any other diagnoses, including those not necessarily associated with this 

visit. 

ITEM 12- Indicate whether the patient has been seen in this clinic previously. Be sure to 

answer the subquestion underneath for each “Yes” response. 

ITEM 13- Record up to two ambulatory (outpatient) surgical procedures. For the visit on 

line a, check whether it was performed at this visit or scheduled to be done later. Also 

check the type of anesthesia that was used or is planned for use. Include minor procedures 

(e.g. wound care) as well as more complex procedures (e.g. lens extractions, vasectomies). 

Procedures that were performed should be listed before procedures that were scheduled. 

If reporting two that were performed. or two that were scheduled, list the more complex 

procedure first. If no procedures were scheduled or performed, the staff should enter 

“NONE” on line a. 

ITEM 16- Record all new or continued medications, using the same brand name or generic 

name entered on any prescription or medical record. Include immunizations, allergy shots, 

etc. Fill 17a for each medication listed. 

Instruct the hospital staff to refer to the item-by-item instructions in the Instruction Booklet 

if they are unsure of how to complete any item on the Patient Record form. 

Remind the staff to tear off the top portion of the form containing the patient’s name and 

identification number, before they are collected. 

Explain that the staff should never borrow Patient Record forms from another participating 

ambulatory unit. Should they start running low, they should call you immediately. 

Explain that vou will return at least once a week to collect completed forms, review the data 

collection ac~ivities. and assist in any other way needed. 

?1


58 
(1) 

(2) 

(3) 

(4) 

(5) 

(6) 

QUALITY CONTROL VISIT CHECKLIST 

Verify patient visit log is complete, that is, all eligible patient visits are listed and all blocks 

of time the ambulatory unit is open are amounted for on the log. 

Ensure ambulatory unit is correctly sampling patient visits: 

u Are ineligible visits being excluded from the list or the count of visits? 

R	 Was the random start used to begin the sample selection? Was it used only at the 

beginning of the reporting period? 

Cir Is the correct Take Every pattern being followed? 

u Is the sample being selected continuously, i.e. from shift to shift and/or day to day? 

Review completed Patient Record Forms paying careful attention to ensure: 

= patient Record Forms are completed for all patient visits selected from the patient log 

w All items on the patient Record Forms have entries 

e N entries are legible 

Check supply of Patient Record Forms to ensure there is an adequate supply remaining to 

complete the reporting period. 

If applicable, examine pad of Patient Visit Logs to ensure the unit has an adequate supply. 

Answer any questions or resolve any problems the staff might be experiencing. 

12 59 
pllHAMCS-l 31 U.S. DEPARTMENT OF COMMERCE a. Hospital No. b. Hospital name BUREAU OFTHECENSUS 

c. Field Rep. code d. Assigned ~FROM ~TO 

EDIT CHECKLIST reporting I I 

period ~ I 

NATIONAL HOSPITAL AMBUIJiTORY e. No.of clinics in OPD f. No. of emergency service areas in ED

MEDICAL CARE SURVEY 

INSTRUCTIONS 

Fill this form as you edit each completed case. As you complete each task listed below, place an “X” or enter a 

“Yes” or “No” response, as appropriate, in the Field Representative Checklist column. (The “Office Checklist” 

column is for the RO editor’s use.) 

All editing marks on the Patient Record Forms (entering missing data, explanations, etc.) must be entered in GREEN 

PEN OR PENCIL. 

Also, make notes of any errors or problems you discover during the weekly quality control visits immediately after 

you find them. DO NOT TRUST THIS INFORMATION TO MEMORY. 

1. Check that all applicable questions are answered in each applicable Field Representative Office Ctiecklist 

section	 of the NHAMCS-101 questionnaire. Checklist 

(a) (b) 

a. Section I – TELEPHONE SCREENER 

b. Section II – INDUCTION INTERVIEW 

c. Section Ill — EMERGENCY DEPARTMENT DESCRIPTION 

d. Section IV – OUTPATIENT DEPARTMENT DESCRIPTION 

e. Section V — NONINTERVIEW 

f. Section VI - DISPOSITION AND SUMMARY 

(1)	 Are all sampled ambulatory units listed? 

(2) Are columns (b)–(g) completed for each unit? 

2.	 Check that all applicable items are completed in the NHAMCS-101/S, 

Sampling Record 

amPage2— EMERGENCY DEPARTMENT SAMPLING SUMMARY FORM 

(1) Are columns (c)–(e) filled for all service areas listed? 

(2) Is the total visits box completed? 

b. Page 3 – OUTPATIENT DEPARTMENT SAMPLING SUMMARY FORM 

(1) Are columns (c)–(h) completed for each clinic listed? 

(2) If applicable, are columns (i)–(k) completed? 

c.	 Are all additional Sampling Summary forms attached to 

the NHAMCS-I 01 /S? 

, 

I 

, 

I 

i 

60 

i 
.’,.= ”,. $..- —.- . . ..7 ,’.,C.U,’ --.—.— . . . . . . . . .— -—. —--. -.--, . . . ..- =..’--. -.7... -..:- —. — .... 

3. Check that all applicable items are completed in each applicable Field Representative Office Checklist 

section	 of the NHAMCS-I 01 /U, Ambulatory Unit Record. Checklist 

(a) “= I
 (b)

a. Section A – AMBULATORY UNIT INFORMATION I I


b. Section B - INFORMATION FROM SAMPLING RECORD 

t 

c.	 Section C - EMERGENCY SERVICES/OUTPATIENT


INFORMATION AND LOGS I I


d. Section D – VERIFICATION OF ESTIMATED VISITS 

e.	 Section E – CALCULATE NEW SAMPLING INTERVAL AND RANDOM 

START FOR THIS CLINIC 

i\ f. Section F – DATA COORDINATOR AND KEY HOSPITAL STAFF 

l\ ,
 i.


g. Section G – PATlENT RECORD FORM INFORMATION 

h. Section H – TRAINING 

1. Section I – QC VISITS 1“ I


j.	 Section J - AU DATA (Make any necessary effort to ensure you receive 

accurate entries for items 7 and 2.) 

k. Section K – DEBRIEFING 

1. Section L – UPDATED CONTACT OR APPROVAL INFORMATION 

4. Were the Patient Lists kept by the ambulatory units complete? That is, 

were all days and blocks of time when the unit operated accounted for? 

(For each unit, compare the days and hours of operation to those 

provided in Section C of the NHAMCS- 70 I/l.) for that unit.) 

MISSING INFORMATION CHART 

Ambulatory unit name Not reported Reason 

Will staff Number of provide
 (b) information? patients seen
 I


(a) DAYS I HOURS (c) (d) (e)


1


!. 

I


I


I


! 

I


I


I


I


I


I


4


I


1


I


I


I


I


I
 I I I I I


‘age 2 FORM NHAMCS-1 S1 (6-7-91) 

61 
. . .. ——v-——=._ _._m . ~--.= ._. . . . . . . . . . . . . . .. _ ___, _,_ ..-— 

E%.	 Check for missing Patient ReccIn5 Forms (e.g., if ycw collect Patient Record Forms 000001 –000023 and 

000027–000054, contact the ambulatory unit to find out what happened to records 000024–000026. 

YOU should also contact the unit if the Patient List kept by the unit indicates additional forms should have 

been filled.) 

Refer to Section G of the NHAMCS-I 01 AI to make sure the PRFs collected are the same as originally 

assigned to this clinic or service area. 

(If Patient Record Forms are missing, record the 6-digit PRFnumber and indicate the unit they were missing from. 

If the PRFs completed for this unit are not the same as those originally assigned, record below and make special 

notes of this situation in the “NOTES” section of the correspondingNHAMCS-101 questionnaire.) 

MISSING PATlENT RECORD FORMS 

I 

Ambulatory unit name 6-digit PRF numbers 

, 

b.	 Check that all items are answered on each Patient Record Form (items 3– 18 on the OPD form and items 3– 19 

on the ED form). 

(If any items are missing, list below and indicate the ambulatory unit to which they balong. Indicate in the 

“Comments’r column whether the item was retriaved, and if not, why the item was not retrieved.) 

Patient 

Ambulatory unit name record Item Comments 

number numbers 

FORM NHAMCS-131 (S-7-91 1 Page: 

62 
6. Were any of the ambulatory units contacted for any reason during the edit process? 

n YES – Enter comments below ~ 

� NO 

FIELD REPRESENTATIVE’S COMMENTS OFFICE EDITOR’S COMMENTS 

\, 

. 

r 

L


Page4 FORM NHAMC3-131 (6-7-91)


S3 

I

UMU ---- -,- No. ---- A-. -..., c-:.- narmla? UYLU-L-, n97n. “. “~p,”.., =ap,,rj. “&,&”,”, 

NOTICE - Information contained on thk form y~ch would PEI@t identificationof arw individualor establishmenthas been collected with a guarantee 

that it will be used only for puqosas atatd for this studv, and WI!]not be djsclosador raleasedto othem without the consantof the individualor the 

mtabliahmentin accordancew!th aectlon3QfMd)of tha PubhcHaalthService Ati.(42 USC 242m). ~blic reporting burden for this phasa of the suwey is 

estimated to average J 5 mlnutea Par rasponse. If YOUhave my commantaregardqg the burdenestlmete or any other aspectof this suwey, including 

suggestion.sfor reducingth!sburden.aendtham to the PI-ISRwonaClearanceOffIce,. Attn: p~. HHH Suildirrg, Rm. 721-B 200 Independence Ave., 

SW, Washington, DC 20201. andto the Offica of ManagementandBudgaCpaperworkReductionProject(0920-0278); Washington, DC 20503. 

~R#HAMCS-133 A. Hospital name B. Hospital number 

U.S. DEPARTMENTOF COMMERCE ency service area name WREAU OF TNECENSUS ACTING AS COLLECTING AGENT FOiI THE 

NATIONAL CENTERFORHEALTHSTATISTICS 

CSNTERS FOR DISEASE CONTFIOL 

D. Staff membar name 

NATIONAL HOSPITAL 

AMBULATORY MEDICAL CARE Position/Title 

SURVEY 

DEBRIEFING FORMS Study responsibilities 

~ IMPORTANT — To find out how well ssmpling and data collection procedures worked, we are asking each 

p-anticipatingstaff membar to complete this form. HospJtsladministrators are asked to 

complete question 6 only. Thank you again for your participation on this important study. 

I


1.VISIT SAMPLING I \ Cl Ye5e XCxy Tz


a. Were there any problems determining I z@ No 

which	 patient visit to sample? I


I


I


b. Did you miss any patient visits (i.e., were 

eligible patient visits excluded from the / lCi Yes - Specifq ~ 

patient log)? I

I 20 No 

i


c. Were any ineligible visits included I
 on the log? I lUYe5 + ‘%Sctq ~


I


I 20No 

I


I
 d. How could these problams have I


been avoided? I


1


I


2. DATA COLLECTION METHOD I


I I a At time of visit 

� . When was PATIENT RECORD FORM / 20 After visit recording done? I

I so Both “ 

I


b. Which data items did you record?” ; I D None I


I 20 All


1


I


I


I


c.	 What procedures might improve the method I


of data collection that you used? I


I


I


PLEASE CONTINUE ON REVERSE 

84 
---------------------

---

). DATA COMPLETENESS / 

� . Was completeness of the data affected by - ~ 3111Yes 

(1)completeness of the medical record? ~ 20No 

4--------------------------------

I I •l Yes 

(2]inaccessibiiity ofttie medical record? ! 20No 

———— -—— ——— —-- ———— ———— _______ I _— - ___ ___ ___ ____ ____ -—— I€

I€

(3)staff too busy to completa certain items? f 

b. Which data items were most affected by ~€

these problems? I€

I€

I€

c.What procedures might correct these I€

problems? I€

I€

I€

II. BURDEN I 

i€

a. What specific inconveniences or burdens I€

to the staff did you observe? I€

I€

b. How might these staff burdens be reduced? ~ 

c. Could substantially more forms have been 

completed without greatly increasing the 

burden? 

d. Would you prefer a shorter time period, say z€

weeks instead of 4, with the same number of€

Patient Record Forms?€

5. GENERAL COMMENTS 

a. How would you describe the amount of effort 

the study required for the hospital staff? 

b. How do you evaluate the value of 

the data to the health profession? 

c. Would you participate again one€

year from now?€

d. Other reaction to forms and procedures 

I€

1€

I


~ 

/€

I€

I€

I 

I 

I€

I€

\ 

1€

I€

I 

I€

I 

I€

I€

t€

I 

I 

I 

I€

I€

I€

I€

I€

InYes 

20No 

I � None 

I •l Yes 

20No 

I •l Yes 

20No 

I � Large 

20 Moderate 

30 Small 

I � Very valuable 

2D Somewhat valuable 

30 Liile value 

40 No value 

I � Yes 

2DN0., ,. 

COMMENTS - Use this space for any additional comments. 

FORM NNAMCS-131 {9-3-911 

65 
Department of Health and Human Services OMB No, 0920-0278 

Public Health Service, Centers for Disease Control Expires: 2/28/92 

National Center for Health Statistics CDC 64,53 

NOTICE - Information contained on this form which would permit identification of any individual or establishment has been collected with a guarantee that it will be held in 

Strkt confidenc~,will be usedonly for purposesstated for this Study, and will not be disclosedCIrreleasedto others without the ~on~entof the i~ividual w the e~tablishme~ 

in accordancewith section308(d) of the Public Health Service Act (42 USC 242m). Public reporting burden for this phaseof the survey is eedmated to average3 minutes per 

response. If you have any comments regarding the burden estimate or any other aspect of this survey, including suggestionsfor reducingthis burden, sendthemto the PHS 

Reports ClearanceOfficer; Atos: PRA HHH Building, Rm. 721-B; 200 IndependenceAve., S.W., Washington, OC 20201, and to the Office of Management and Budget;Paper. 

work ReductionProject (0920 .027BI; Washington,DC 20503. 

*

NATIONAL HOSPITAL AMBULATORY 1. PATIENT NAME 

MEDICAL CARE SURVEY 

EMERGENCY DEPARTMENT 

PATlENT RECORD 2. PATlENT RECORD NO. 

I . ...—_ .—— ———. —————__.—_ .— —.—— .—— —— —— —— ——... 

L DATE OF VISIT 5. SEX 6. RACE 7. ETHNICITY 8. EXPECTED SOURCE(S) OF PAYMENT 

(Check all that apply) 

9, MAJOR REASON 

FOR THIS VISIT 

(Check one) , � ~ema,e ; ~ ::: 1 � Hispanic I � Medicare 50 f#p~{d&her 1 0 Injury, firasvisit 

3 � Asian/Pacific 2 n Medicaid 2 � Injury, follow-tip 

L DATE OF BIRTH 2 � Male 

Islander 

4 � American , � Not 

6 a Patientpaid 3 � Illness,firstvkft 

I I Indian/ Hispanic 3 � j%%ment 7 � No charge 4 � Illness,follow.up 

Month Day Year	 Eskimo/ 4 � &*me~rcial 8 � Other s D Other reason Aleut 

O. CAUSE OF INJURY 11. PATIENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER 12. PHYSICIAN’S DIAGNOSES 

(Complete ifs%jury is marked REASON(S) FOR THIS VISIT (In patient’s own words)


in 9. Describe cause and


place o~injury.) a. Principaldiagnosis/


problem associated a. Most important: with item 1la, 

b. Other: b. Othefi 

c. Other: c. othec 

13. URGENCY OF THIS VISIT 15. Diagnostic/SCREENING SERVICES 16. PROCEDURES (Check allprouided on this uklt) 

(Check only one) (Check all ordered orprouided.) 

I a None 6 n Wound care � Urgent/Ernergem I u No”, 7 D Cheatx-ray 

! Q Non.urgent 2 � Blood pressurecheck e � Extremity x-ray z � Endotracheal 7 � Eye/ENT care 

incubation 

8 � Orthopedic care 3 U Urinalysis IO � CT scan/MRl 30 CPR 9 � Bladdercatheter 14. IS PROBLEM ALCOHOL- 4 � HIV serology 11 � otm~iag”mti. 4 � IV fluids to � Lumbar nunctura 4’ 5 .f_J Othwblaod-test E~NGtubef 

� Neither e � EKG 12 ~ Other(.peci/y) gastricIavage 

! � Almh&related 7 � Mental statwexam II O Other(s) (Specify) 

I H Orugrelated 

I � Both 

OR DRUG-RELATED? 

17. MEDICATION 18. DISPOSITION THIS VISIT 19. PROVIDERS SEEN 

(Record all new or continued medicatwn ordered, administered, or provided (Check all that apply) THIS VISIT 

at this uisit. Uae the same brand name or generic name entered on any RX (Check all that apply) or medical record. Include immunisatwns and desensitizing agfnts.) 1 � Returnto EI)PRN 

� None 2 � Return to ED - appointment 1 � Res.ktent/intern 

3 � Return to referringphysician 2 � Staff physician 

1. 4 D Refer to other physician/clinic 3 � Other physicien 

5 � Admit to hospital 4 � Physicianassktant 

2. 

6 � Transfer to other facitity 5 a Nurse practitioner 

7 � 00A/died in ED 

3. 

a � Left AMA a � Registerednurse 

9 � No follow-up planned 7 � l-~~ed practical 

4. 

10 � Other (Specify) 8 � Nurse’saide 

5. 

66 
Departmentof Healthand HumanServices OMB No. 0820-0278 

Public Health Service,Canterafor DiseaseControl Exphes: 2/28/92 

Natibnal Canterfor Health Statistics CDC 64.54 

NOTICE - information contained on this form which would permit identification of any individual or establishment has been collected with a guarantee that it will be bald in 

strict confidence, will be used only for PUITSOSSSstated for this study, and will not be disclosed or released to others without the consent of the individual or the establishment 

in aceardance with section 308(d) of the Public Haalth Sarvice Act (42 USC 242m). Public reporting burden for this phase of the survey is estimated to average 3 minutes per 

rasponse. If you have any immmenta regarding the burden estimate or any other aspect of this suway, including suggestions for reducing this burden, send them to the PHS 

Raparts Clearance Officer; Attn: PRA HHH Building, Rm. 721-B; 200 Independence Ave., S.W., Washington, DC 20201, and to the Office of Management and Budget; Paperwork Reduction Project (09200278); Washington, DC 20503. 

tiATIONAL HospITAL AmbUlatOry 1. PATlENT NAME 

MEDICAL CARE SURVEY 

OUTPATIENT DEPARTMENT 

PATlENT RECORD 2. PATlENT RECORD NO. 

1 J .—-— .—— ——— —.-— —— ——— .— ——. . ..—. — ——— . 

L DATE OF VISIT 5, SEX 6. RACE 7. ETHNICITY 8. EXPECTED SOURCE(S) OF PAYMENT 9. WAS PATI ENT 

1 � White (Check all that apply) REFERRED FOR 

THIS VISIT BY 

Month

I 

Oay 

I 

Year I � Female 2 � Black I O Hispanic I � Medicare 5 � HMO/other ANOTHER 

t.	 DATE OF BIRTH 3 � Asian/Pacific z � Medicaid prepaid PHYSICIAN? 

[slander ZaN#t 3 � other 6 a Patient paid 

2 � Male 4 � ~g;$an IsPanic government 7 � Na drarge 1 � Yes 

I I EckimO/ 4 � Private/ a � Other ZONO 

Month Day Year Aleut Commercial 

10.	 PATlENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER 11. PHYSICIAN’S DIAGNOSES 12. HAS PATIENT BEEN SEEN 

REASON(S) FOR THIS VISIT (in patierrt~s own words) IN THIS CLINIC BEFORE? 

a.	 Principal diagnosis/ 

problem associated 

a. Mo* impartanti with item 10a. 10Y= 20N0 

t 

b. Othac b. Other: If yes, for the condition in 

item 1 la? 

c. Other: c. Other: IDYa3 2DN0 

13. AMBULATORY SURGICAL 14. DIAGNOSTIC/SCREENING SERVICES 15. THERAPEUTIC SERVICES 

PROCEDURE(S) (Check all ordered orprorrided.) (Check all ordered orprorrided. Exclude medication) 

(Record any outpatient diagnostic 

or thempeutic procedure. For the 1 � None II � Pap test I � None 

firet, check appropriate boxes.) 2 � Bkmd pressure 12 � Strep throat test COUNSELINGIEDUCATION: 

3 � Urinalysis 13 � HIV serology Znoiet a 0 Smokingcersatim 

40 EKG -rsating 14 0 Cholesterol measure 3 0 Exercise 9 � Family/social 

a, 5 � EKG - exercise 15 � Other lab test 4 Q Cholesterol raduqtion 10 � Growth/developmant 

1 � scheduled 3 � Local anesthesia e � Mammogram te � Hearing test 6 � Waight reduction I I � Family planning 

2 � Performed 4 � Regional anesthesia 7 � Ch=t x-ray 17 � Visual acuity a � Drug abuse 12 � Other counseling 

6 � Ganaral anesthesia a � Other radiology le � Mental status exam 7 � Almhol abuse 

OTHER THERAPW !g � Other (Specify) 9 a Alkrgy tasting 13 � Psychotherapy 16 � Physiotherapy 

b. IO O Spirmnmrf 14 � CorrectiveIemss 17 � Other therapy (Specify) 

15 0 Hadring aid 

16.	 MEDICATION 17. DISPOSITION THIS VISIT 18. PROVIDERS SEEN 

(Record all new or continued medication ordered, administered, or provided (Check all that apply) THIS VISIT 

on this uiait. Uae the same brand name or generic name oreany Rx or 1 � Return to clinic PRN 

(Check all that apply) 

medical record. Include immuniaatiorss and desensitizing agents.) 

� Nom NEW MEDICATION? 2 � Rmum to clinic - appointment 1 � Resident/Intern 

3 � Telaphone follow-up planned 2 � Staff physicisn 

1, taYea2aNo 4 � Return to referring physician 3 � Other physician 

5 � Refer tO other physician/clinic 4 � Physician a&.istant 

z 1DYa52aN0 

a � Admit to hospital 5 � Nurse practitioner 

3. 1DY12s20N0 7 � No follow~p plsnned a a Registered nuraa 

8 � Other (Spacify) 7 � Lio3nsad practical nurse 

4. 1nYe52nNo a � Nurse’s aide 

a, 10 Ys32DNo 

67 
� 

� 

� 

� 

� 

Appendix IV 

Definitions of terms relating 

to the Patient Record forms 

Age—The age calculated from date of birth is the age at 

last birthday on the date of visit. 

Race—Hospital stafEwere instructed to record based on 

observation or the hospital’s usual practice or knowledge. The 

following category deilnitions were provided 

� White-A person having origins in any of the original 

peoples of Europe, North Afric% or the Middle East. 

� Black—A person having origins in any of the black racird 

groups of Mica. 

� AsianlPacific Islander—A person having origins in any of 

the oiiginal peoples of the Far East, Southeast Asia, the 

Indian Subcontinent, or the Pacific Islands. This area 

includes, for example, China, India, Japan, Korea, the 

Philippine Islands, and Samoa. 

�	 American IndianlEskimolAleut-A person having origins 

in any of the original peoples of No-fibAmerica, and who 

maintains cultural identification through tribal affiliation or 

community recognition. 

Ethnicity-Hospital staff were instructed to mark the 

appropriate categorybased on the hospital’susual practices. 

.	 HiSpanic origin—A person of Mexican, Puerto Rican, 

Cuban, Central or South American, or other Spanish 

culture or origin, regardlessof race. 

. Not Hispanic-AU other persons. 

Expected source(s) of payment—Hospital staff were 

instructed to check the source(s) that would pay for ‘this visit. 

Medicare-Charges paid in part or in full by a Medicare 

plan. Includes payments made directly to the hospital as 

well as payments reimbursed to the patient. 

Medicaid-Charges paid in part or in full by a Medicaid 

plan. Includes payments made directly to the hospital as 

well as payments reimbursed to the patient.


Other government-Charges paid in part or in fill by any


other local, State, or Federal health care programs, such as


workers compensation programs and Civilian Health and


Medical Programs of Uniformed Services (CHAMPUS).


Private commercial-Charges paid in part or in full by a


private insurance company. Includes payments made directly


to the hospital as well as payments reimbursed to the


patient.


HMOlother prepaid-Charges included under a prepay­


ment plan. Includes health maintenance organizations


(HMOs), independent practice associations (IPAs), preferred provider organizations(PPOS),etc. 

� Patientpaid-Charges paid in part or in full by the patient 

or the patient’s family that will not be reimbursed by a 

third party. Includes “co-payments” and “insurance deductibles. ” Excludes prepaid plan visits for which no 

co-payment is charged. 

� No charge—Visits for which no fee is charged. 

� Other—Any other source of payment not covered in the 

categories above. 

Major reason for this visit (ED)—Hospital staff were 

instructed to indicate whether this visit is the first visit or 

followup visit for an injury or illness. 

� Injury j%st visit-Self-explanatory. 

. Injury, followu~elf-exphmatory. 

� Illness, first v~it+elf-expkmatoiy. 

� Illness, followu-e~-explanatory.


. Otherrea.sobhdudes general health maintenance examinat­


ions, routine periodic examinations of presumably herdthy 

persons-both childrenand adults-and malingering. 

Cause of injury (ED)—Hospital staff were instructed to 

describe in detail the events and circumstances surrounding 

the injury, for example, the place and cause of injury. 

Patient referred (OPD)—Referrals are any visits that are 

made at the advice or direction of the hospital staff other than 

the ones being visited. The interest is in referrals for the 

current visit and not in referrals for any prior visit, 

Patient’s complaint(s), symptom(s), or other reason(s) for 

this visit (in patient’s own wora%)-1’he patient’s problem, 

complaint, symptom, or other reason for this visit as expressed 

by the patient. Hospital staff were instructed to record key 

words or phrases verbatim to the extent possible. “Most 

important” refers to that problem which, in their judgment, is 

most responsible for the patient’s visit. 

Physician’s diagnosis-The physician’s best assessment 

of diagnosis of the patient’s most important problem, complaint, or symptom. The term “principal” refers to the firstlisted diagnosis. The diagnosis represents the hospital staff’s 

best judgment at the time of the visit and may be tentative, 

provisional, or definitive. 

Urgency of this visit (ED)—Hospitalstaffwere instructed 

to check the category that best indicates the urgency of the 

visit. 

68 
Urgentlemergent—Patient requires immediate attention for


acute illness or injury that threatens life or function. Delay


would be harmful to the patient.


Non-urgent—Patient does not require attention immedi­


ately or within a few hours.


Alcohol- andlor drug-related (ED)—Patient’s most important complaint or presenting problem is alcohol- and/or drugrelated. 

Seen in clinic before (OPD)—’’Seen before” means provided care in that clinic at any time in the past. The second 

part of item 12 refers to the patient’s current condition. 

Ambulato~ surgery (OPD)—Any surgicrd procedure performed in the clinic or ordered to be performed elsewhere on r	 an outpatient basis, including suturing of wounds, reduction of 

fractures, application or removal of casts, incision and drainage of abscesses, application of supportive materials for * fractures and sprains, irrigations, aspirations, dilations, and 

excisions. 

Diagnostic/screening services—Hospital staff were 

instructed to mark all services and procedures that were 

ordered or provided during this visit for the purpose of 

\ screening or diagnosis. 

Blood pressure check-Self-explanatory. 

Urinalysis-#my physical, chemical or microsmpic examination of urine. 

HIVserology-The study of the human immunodeficiency 

virus (HIV) antigen-antibody reaction in vitro. 

Cholesterol measure—A blood test taken to measure the 

level of cholesterol in a patient’s blood, 

Other blood test (ED)-Self-explanatory. 

Pap test (OPD)—Papanicolaou test. 

Strep throat test (OPD.)-Rapid strep test or throat culture. 

Other lab test (OPD)4elf-explanatory. 

EKG-resting-Resting-electrocardiogram. 

EKG-exercise (OPD)—Exercise-electrocardiogram. 

Mental status exam-Any formal, clinical evaluation 

designed to assess the mental or emotional status of the 

patient. 

Mammogram (OPD)—X-ray of the breasts. 

Chest x-ray-Single or multiple x-rays of the chest for 

diagnostic or screening purposes. Excludes fluoroscope 

and studies of ribs, bony thorax, and spine. 

Extremity x-ray (ED)—X-ray of the arms, legs, hands, or 

feet. 

CT scanlMM (ED)-Computerized tomography scant 

magnetic resonance imaging. 

Other diagnostic imaging (ED)-Self-explanatory. 

Other radiology (OPD)4elf-explanatory, 

Hearing test (OPD)43elf-explanatory. 

Vkal acuity (OPD)--Self-explanatory. 

Spirometry (OPD)—Measurement of air capacity of the 

lungs, 

Allergy testing (OPD)—May include the direct introduction of antigen into the skin, allergen inhalation, or 

bronchial challenge tests. 

Procedures (ED)—Hospital staff were instructed to mark 

all procedures provided this visit. 

Endotracheal incubation-A laryngoscope inserted into 

the mouth followed by a tube into the trachea. 

CPR-Cardiopulmonary resuscitation. 

lV@ids-Administration of intravenous fluids. 

NG tube-Insertion of nasogastric tube through the nose, 

down the esophagus, and into the stomach. 

Gastric lavage—Passage of a solution through the inflow 

tube into the nose, down the esophagus, and into the 

stomach where the gastric contents are irrigated and 

returned through an outflow tube. 

Wound care—Includes cleaning, debridement, and dressing of bums repair of lacerations with skin tape or 

sutures; removal of foreign bodies; excisions; and incision 

and drainage. 

Eye/ENT care-Care provided to the eyes, ears, nose, and 

throa~ includes measurement of intraocular pressure in the 

eyes, removal of ear wax, removrd of foreign bodies, nasal 

packing, and laryngoscopy. 

�	 Orthopedic care—Treatment of orthopedic injuries or 

conditions; includes casting, wrapping, splinting, and aspiration of fluid from joints. 

�	 Bladder catheter—Any type of catheter used to catheterize the bladder, for example, Foley. 

� Lumbar puncture-Insertion of a needle into the lumbar 

spine to extract spinal fluid for laboratory examination. 

� Other(s) speci~Up to two other diagnostic and/or treatment pro~ed~es pr&ided this visit were recorded. 

MedhzztiofiHospital staff were instructed to I@ using 

brand or generic names, all medications orderq injectd administered, or provided this visit including prescription and nonprescription drugs, immunizations, and desensitizing agenta. Also 

included are drugs and medications ordered or provided prior to 

the visit that the patient was instructed to continue taking. 

Disposition (ED)—Hospital staff were instructed to mark 

all categories that apply. 

� Return to ED PRN-The patient is instructed to return to 

the ED as needed. 

�	 Return to ED-appointment-The patient is told to schedule an appointment or is given an appointment to return to 

the ED at a particular time. 

�	 Return to referringphysician—The patient was referred to 

the ED by his or her personal physician or some other 

physician and is now instructed to consult again with the 

physician who made the referral. 

�	 Refer to other physician/clinic—The patient is instructed 

to consult or seek care from another physician or clinic. 

The patient may or may not return to this physician or 

clinic at a later date. 

�	 Admit to hospital—The patient is instructed that further 

care or treatment will be provided as an inpatient in the 

hospital. 

�	 Transfer to other facilityJThe patient is transferred to a 

facility other than a facility operated under the auspices of 

this hospital. 

�	 DOA/died in the ED-If the patient is dead on arrival 

(DOA) or died in the ED, this patient is still included in 

the sample. 

69 
.	 LeftAM4-If the patient was registered to be seen but left 

prior to being seen by a health care provider or left against 

medical advice (AMA), this patient is still included in the 

sample. 

� No followupplanned+Jo return visit or telephone contact is 

scheduled or planned for the patient’s problem on this visit. 

. Other—Any other disposition of the case not included in 

the categories above. 

Disposition (OPD)—Hospital staff were instructed to 

mark all categories that apply. 

� Return to clinic PRN-The patient is instructed to return 

to the clinic as needed. 

� Return to clinic-appointment-The patient is told to schedule an appointment or is given an appointment to return to 

the clinic at a particular time. 

�	 Telephone followup planned—The patient is instructed to 

telephone the physician or other clinic staff on a particular 

day to report on his or her progress, or to call at any time 

if he or she has a problem or wishes further consultation. 

� Return to referringphysician—’l%e patient was referred to 

this clinic by his or her personal physician or some other 

physician and is now instructed to consult again with the 

physician who made the referral. 

� Refer to other physicianlclinic-The patient is instructed 

to consult or seek care horn another physician or clinic. 

The patient may or may not return to this physician or 

clinic at a later date. 

�	 Admit to hospital—’l%e patient is instructed that further 

care or treatment will be provided as an inpatient in the 

hospital. 

.	 No followupplamzed-No return visitor telephone contact 

is scheduled or planned for the patient’s problem on this 

visit. 

.	 OtheG speci~Any other disposition of the case not 

included in the categories above, 

Providers—Hospital staff were instructed to mark all 

providers seen by the patient during this visit. 

� Resident/intern-Persons graduated from medical school I 

and in training. 

� Staffphysician-Physician who is employed by the hospi- ! 

tal or the university affiliated with the hospital and is a 

member of the hospital staff. 

�	 Other physicianansulting physicians and other part- < 

time physicians who are not considered to be members of 

the hospital staff. 

� Physician assistant4rtified health care professional 

who delivers health care services under the supervision of 

a licensed physician. 

� Nursepractitioner-Registered nurse with advanced training who provides primary health care services. Supervision by a physician is required in some states. 

� Registered nurse-Self-explanatory. 

� Licensed practical nurse-Self-explanatory. 

� Nurse’s aide+elf-explanatory. 

t 

70 

/ 
Appendix V 

Introductory letter 

,V. www , ,, 

*.+ 

~“ 

‘“*2 

, 

J# DEPARTMENTOF HEALTH & HUMAN SERVICES	 Public Health Service 

Centers for Disease Control 

National Center for Health Statistics 

6525 Belcrest Road 

Hyallsville, MD 20782 

Date 

Chief Executive Offker


Title


Hospital Name


Address


City, State, Zip


Dear (Chief Exeeutive Officer):


AS part of its continuing program to provide information on the health status of the 

Ameriean people, the National Center for Health Statistics (NCHS) of the Centers for Disease 

Control (CDC) is beginning an annual study of hospital-based outpatient care. This new study 

is the National Hospital Ambulato~’ Medieal Care Survey (NHAMCS). The NHAMCS is an 

extension of the National Ambulatory Medical Care Survey (NAMCS), which collects 

ambulatory care data from physicians in ot%ce-based practices. 

The purpose of this new study is to collect information about the large portion of 

ambulatory care that is provided by hospital outpatient departments and emergeney 

departments. The data requested concern ambulatory patients, their health problems, and the 

reaoureea needed for their care. The resulting information will help the hospital industry and 

the medieal profession plan for more effective health services, determine health manpower 

needs, and improve medical education. 

‘fIre enclosed “Advaneedata” summary of the 1989 NAMCS providea an overview of the 

data that are available on office-based ambulato~ care. As the enclosed letters of endorsement 

attest, comparable data on ambulatory care provided in hospital settings are essentird to meet 

the needs of the hospital industry and the medical profession. 

The NHAMCS is authorized by Title 42, United Statea Code, Section 242k. Participation 

is voluntmy and there are no penalties for not participating. However the success of the study 

depends on the willingness of health professionrds like yourself to provide current medical 

information. AU information collected is eordldentti including the identity of your hospital. 

Patient names and personal identifiers will not be recorded. Data eolhxted will be used only to 

prepare statiatierd aummeriea. 

Within a few days a representative of the Bureau of the Census, which is acting as our 

data coketion agen~ will telephone your office to arrange a vish to discuss the details of your 

participation. We greatly appreciate your cooperation. 

Sincerely Youra, 

Manning Feirdeib, M.D., Dr. P.H, 

Director 

71 
Appendix VI 

Endorsement letters 

~~ American College of Emerge&y Physicians
 ..”-
 ‘::= F&t
 CHf!!e%x61S911 

Dallas, Tex66 75261-9911 

214/550.091 1 

214/5S0-2616 (Fax Number) 

Dear Emergency Department Directoc 

I am writing to urge your participation in the National Hospital Ambulatory Medical 

Care Survey. This survey is part of an ongoing project sponsored by the National 

Center for Health Statistics to gather data about medical care provided in outpatient 

and emergenq facilities. The information gathered is used by medical educators, , researchers, planners, and health administrators to assess health needs and resources 

and for planning and organizing health services. 

The American College of Emergenq Physicians has long recognized the need for 

national data describing emergency department visits. For this reasoq the College 

has participated in the development of the survey forms and procedures. 

I believe the data to be collected in this survey will be vital for researchers, 

planneq and detilon makers addressing emergency medicine issues. I urge you to 

complete the survey. 

72 

i 
.;.., :.:..:4 -.::... .. . 

EMERGENCY


NURSESASSOCWION 230 East Ohio


Suite 600


Chicago, Illinois60611-3297


Telephone 312/649-0297


Fax 312/649-9430


Dear Emergency Department Director:


The need and value of national data from ambulatory settings .
 is clear from educational, planning, and assessment


viewpoints. I am writing to urge your participation in the


National Hospital Ambulatory Medical Care Survey which is


part of an ongoing project to fill an informational gap in


our area of health care.


The Emergency Nurses Association and the 22,000 emergency


nurses it represents are pleased to support and encourage


this effort. The information gathered will provide


educators, researchers, planners, administrators, and


managers with an additional tool to better understand the


outpatient and emergency care areas.


Please help the National Center for Health Statistics


collect this data by completing this survey. Your


contribution will be a building block in establishing a data


base which will be vital to future efforts in this area of


health care.


Sincerely,


$zgn&.ZcEN


President


73 
American Hospital Association 

840 North LIk Shnre Drive 

Chicago, Illinois 60611 

Telephone 312.280.6000 

Cable Address AMHOSP 

April 1991 

To: Chief Executive Officers 

The National Center for Health Statistics is conducting a study to collect


data on hospital-sponsored ambulatory care. Information from hospital€

ambulatory care programs and emergency departments will complement similar


data obtained from private physicians in the National Ambulatory Medical Care


Survey (NAMCS). NAMCS data are used by medical educators, researchers,€

planners, and administrators to develop profiles of the patients treated in


ambulatory settings, their health problems and clinical needs, and the health


professionals providing services to meet these needs.


The American Hospital Association is keenly interested in these data and has


been involved in developing the forms and procedures for this study. The data


collected will fill important gaps regarding basic dimensions of hospital


ambulatory care. Little or no basic patient socio-demographic information is


available on a national basis for the ambulatory care industry. We believe


that the survey design calls for a minimal amount of record-keeping and time


on the part of your staff. All information collected will be kept


confidential and will be reported only in surmnary form. 

i am confident that the information obtained in this survey will be well worth 

the effort expended by your hospital staff. 

Thank you for your help and cooperation. 

Sincfiely 

/Peter D. Kralovec 

Director 

Hospital Data Center 

74 
! 

Appendix Vll 

Thank you letters 

. ,,”bh, ,;, 

‘J# 

*.” “ , . 

.) llEPARTMENTOF HEALTH& HUMAN SERVICES Public Health Service 

Centers for Disease Control ; 

*:, 

~/&. National Center for Health Statistics >
 +’”,,,, 6525 Belcrest Road


Hyattsville, MD 20782 

Chief Executive Officer


Title


Hospital Name


Address


City, State, ZIp


Dear (Chief Executive Officer),


We wish to thank you for your participation in the National Hospital Ambulatory Medieal Care


Survey (NHAMCS). Please convey our sincere appreciation to your hospital staff for their


invaluable help in completing the study in your hospital. Their efforts on our behalf are very


much appreciated.


This new information on ambulatory care provided by hospital outpatient and emergency


departments will be used to bridge the gap which currently exists in ambulatory care data.


Data collection for the NHAMCS will be completed in January, 1993, and the initial report from


the study will be published in late 1993. Upon its release, we will forward a copy of the report


to you so that you can see the value of your participation. Again, our sincere thanks to you and


your staff for your interest and cooperation.


Sincerely yours, 

James E. DeLozier 

Chief, Ambulatory Care 

Statistics Branch 

Division of Health Care 

Statistics 

75 
WAX’,, ~ 

-.,,> ‘ f+ 

,<-

.’ DEPARTMENT OF HEALTH& HUMAN SERVICES Public Health Service z

;

-= Centers for Disease Control -~ 

...

%,,,4,(, National Center for Health Statistics 7

6525 Be[crest Road 

Hyattsville, MD 20782 

3Lzm4 ZJL 

We wish to thank you for your participation in the National Hospital Ambulatory Medical Care 

Survey (NHAMCS). Your efforts have been invaluable in completing the study in your hospital 

and are very much appreciated. 

This new information on ambulatory care provided by hospital outpatient and emergency 

departments will be used to bridge the gap which currently exists in ambulatory care data. 

Data collection for the NHAMCS will be completed in January, 1993, and the initial report from 

the study will be published in late 1993. Upon its release, we will forward a copy of the report 

to your hospital so that you can see the value of your participation. If you would like to have an 

additional copy of the report sent to you or your office, please complete and return the form 

below. 

Again, our sincere thanks to you for your interest and cooperation. 

“ James E. DeLozier ..f 

-/ Chief, Ambulatory Care Statistics Branch 

Division of Health Care Statistics 

Please send the 1992 NHA.w2S Summary Report to 

lNAME 

Last Nanw FIm Name Ml 

TITLE OR 

DEPARTME~ 

I 

I 

I 

HOSPITAL NAME 

ADDRESS 

Streat Addms 

City side ZIP de 

MAIL TO	 Ambulatoy Care StatisticsBratteh 

Room 9S4 

6.52SBelcrcst Road 

Hyattwik, Maryland 207S2 

76 
Appendix Vlll 

Patient Record forms used 

in the 1993-94 National 

Hospital Ambulatory Medical 

Care Survey 

Department of Health end Human Services OMB No. 0920-0278 

Public Health Service, Centers for Diseaae Control Expires 6/30/94 

National Center for Health Statistics CDC64.53

NOTICE - Information cantalnad on this form which would pmnlt identification of any individual or estsbfishment hss been collected with a guarantee that it will be held 

in strict contidance, will be used only fafpurposes sta!ad for this study, and will not ba disclosed or wdeaaed to others without the consent of Iha individual m the establishment 

In accordance wllh sactlon 30S@)of the Public Health Service Act (42 USC 242m). Public reporting burden for this phase of the survay Is estimated to average 3 minutes 

per response. If you havs any commonls regarding the burden estimate or any other aspect of this survsy, including suggestions for reducing this burden, send them to 

the PHS Rep.arts Clearance Offfcefi Attm PRA HHH Building, Rm. 721+% 200 Independence Ave., S.W., Washington, DC 20201, and to Ihe Office of Management and 

Eudget Papsrwork Raduclion Project (0920.027Sfi Washington, DC 20503. 

NATiONAL HOSPITAL AMBULATORY 1. PATlENT NAME 

MEDICAL CARE SURVEY 

EMERGENCY DEPARTMENT 2. PATIENT RECORD NO. PATlENT RECORD .cla.l ““ 1 CXJOW* 1 1 

———-—.————————m————————— ———————————— 

OATE OF VISIT 5. SEX 6. RACE 7. ETHNICITY &	 EXPECTED SOURCE(S) OF 9. PLACE OF INJURY 

PAYMENT (Cfi,ck all h! UPPfY) (Check one, # visiI i.J 

-

Day 

, � ~emtie I •l Whhe , � ~~panic I H Private/ cwnmercid 5 � ~,~e~pr,.paid , � Ho&Wrc’””dJ tlonth 2 � Black origin z � Work 

Not 2 � Medicare e � Patient paid s � Schwl/Day care DATE OF BIRTH 2 � Male , � ::s:pacific 

2 � Hispanic 3 � Medicaid 7 � No charge , � S!reeWfighway 

~ 

tionti Day 

, � Ame,ica” lmdian/ 4 � Olher government 8 � Other z � Other (SpccifJ) 

Eslamo / Aleut 

1. CAUSE OF INJURY 11. PATlENT’S COMPLAINT(S), SYMPTOM(S), OR 12. PHYSICIAN’S DIAGNOSES 

(Describe ,Vtllt, that OTHER REASON(S) FOR THIS VISIT preceded i“juq, e.g., 

driver of mom? vehicle, (In pmient’s own words) a. Pdndpal diagnosis I O.D. of cocaine, fell 05 P@Sem as=c.ckted swing.) a. Mus inpxlant wlh ilem 11,s 

b. Othec b. OMec 

c. Olhec c. Other: 

3, URGENCY OF THIS VISIT 15. DIAGNOSTICISCREENING SERVICES 16.PROCEDURES (Check all ordered or provided on 

(Chtck only one) (Check all ordered or provided) this vi$b) 

I � UrgentfEmargent , � None 5 � EKG : � None 6 � Wound care 

2 � Non.urgem z � Bleed pressure 6 H Chest x.ray 2 � Endokached incubation 7 � Eye/ENT care 

3 � Urinalysis 7 � Extremity x.ray 3 � CPR 8 � Orthopedic care 4.	 IS VISIT ALCOHOLOR DRUGRELATED? ~ � HIV serology 8 � Other diagnostic imaging 4 � IV fluids 9 � Bladder catheter 

I � Naither 9 � Other (SpecifiJ 

5 � NG Iubelgas!ric Iavage m � Lumbar p.mmre 

2 � Almhot.mlated


3 � Drugrelated II Q Olher (Sp@)


~ � Both 

s � Unknown 

7. MEOICATIONS / INJECTIONS None � 1S. DISPOSITION THIS VISIT 19. PROVIDERS SEEN 

(checkd that apply) THIS VISIT 

(Checkall lhat L7pplY) 

Include	 . Rx and OTC . Meals ordered, � New reeds ~ � No follow.up planned . Immunizations suppfied, or � Continuing reads , � Resident/Intern . Allergy shots administered (with or without 2 � Return to ED PRN � Anesfhetica maw orders) 2 � Slafl physician 

s � Return to EO - apwintmsnt 

s � Other physitian 

I 4 � Return to relerring physician Physician assistant 

2 

e � Admit to hospital 

5 � Registered nurse 

L&mad practical 

3 7 � Transfer to other facility en nurse 

8 � 00Afdied in ED 7 � Nurse’s aide 

I 

5 � Refer to other physicianlcfinic 4 � Nurse practitioner 

9 � O[her (Specifi) 8 � Other (Specifi) 

5 

77 
Department of Health and Human Services OMB No. 0920-0278 

Public Health Service, Centers for Disease Control Expires: 6130194 

National Center for Health Statistics CDC 64.54 

NOTICE — Informationcontainsdon this form which would permit identificationof any individualor establishmenthas baen colbcted with a guarantee that it wilf be held 

in strict confidence, will be usedonlyfor purposesstatedforthisstudy,andwillnotbe disclosedorrelessed to otherswithoutthe consentofthe individualorthe estsbtfshment 

in acsordancswith sestion308(d) of the Public Health Servim Act (42 USC 242m). Pubficreportingburden for this phase of the suwey is estimatedto average 3 m(nutes 

per response. If you have any commente regarding the burden estimate or any other aspect of this suwey, including suggestions for reducing this burden, eend them to 

the PHS Reports Clearance Officec Attn PRA HHH Building, Rm. 721-B; 200 Independence Ave., S.W., WasNn9t0n, DC 20201, and to the Ofice of Mana9emenf and 

Budget Paperwork Reduction Project (0920-0278fi Washington, DC 20503. 

NATIONAL HOSPITAL AMBULATORY 1. PATIENT NAME 

MEDICAL CARE SURVEY 

OUTPATIENT DEPARTMENT 2. PATlENT RECORD NO. PATlENT RECORD 

1993-94 

—— _————— —. ——..— ——————..——— ———————..——.—— 

DATE OF VISIT 5. SEX 6. RACE 7. ETHNICITY 8. EXPECTED SOURCE(S) OF 9. WAS PATIENT 

PAYMENT (Check all that Oppiy) REFERRED FOR 

THIS VISIT BY 

~ I � Female ‘ � ‘tite Month Day Year 2 � Black 

, � t+$pa.ic I � Private/ commercial 5 � ~t~e~’prepaid ANOTHER origin PHYSICIAN? 

Asian/ Pacific Not 2 � Medicare 6 � Patieflt paid 

~ ~ � :nl;::;:~ 1 

4 � Other government 8 � Other 2HN0 

O. PATlENT’S COMPLAINT(S), SYMPTOM(S), OR 11. PHYSICIAN’S DIAGNOSES 12. HAS PATlENT BEEh 

OTHER REASON(S) FOR THIS VISIT SEEN IN THIS 

(In perienrh own words) a. Principaldiagnosis1 CLINIC BEFORE 

I, Most important 

pmt4emszaccistsd 

with ilem 1O.a f j_J Yes 20N0 

L 

xOther: b. Other: If yes, for the condition 

in item 11a? 

DATE OF BIRTH 2 � Male 3 � islander 2 � Hispanic 3 � Medicaid 7 � No charge 

f IJ Yes 

:. Othen c. other: ,nYes zaNo 

13. TESTS, SURGICAL AND NONSURGICAL PROCEDURES, AND THERAPIES None � 14. COUNSEfJNG/EDUCATION 

(Check ail ordered or provided) 

a. SELECTED b. ALL OTHER SERVICES 

SERVICES Include Performed Ordered I � None 

(Check all ordered . Tests � [magings , ,1-J 2D 2 � Exercise or provided) .	 Surgeries and other 3 � Cholasteror reductiorr procedures 

I � Blood pressure . other therapies 2 fn 2D 4 � Weight reduction 

(such as contact lenses, 

2 � Urinalysis psychotherapy, 3 fcl 20 5 � Smoking cessation 

or physiotherapy) 6 � Growth/ development 3 IJ Spirometry Exclude 

. Sewices in item 13a 4 ID *I-J 1 � Injury prevention 

4 � Allergy lasting	 � Counseling I education 

� Meducations 5 lo *D 8 � HIVtransmission 

5 � HIV serology (Recordone on each line 9 � Other STD lransmssion 

and check peflorrned or 6 

6 � Other blood test ordered for each.) ‘n ‘n ?0 � other 

15.€ MEDICATIONS / INJECTIONS None � 16. DISPOSITION THIS VISIT 17. PROVIDERS SEEN 

I 

r 

i 

,-

(Check all fha apply) 

Include � Rx and OTC . Meals ordered, � New reeds 

� 1mmunizations 

. Allergy shots 

� Anesthetics 

1 

2 

3 

4 

5 

supptied, or . Continuing reeds 

adminiatared I � No follow-up planned (with or without 

new orders) 

2 � Return to clinic PRN 

3 � Return to cJinic- appointment 

~ � Telephone follow-up planned 

5 � Return to referring physician 

6 � Refer to other physiciaticlinic 

7 � Admit to hospital 

8 � Other (Specify) 

THIS VISIT 

(Check al! thatapply) 

t � ResidenMnrern 

2 H Staff physician 

3 � Other physician 

, Q	 Physician assistardl 

Nurse practitioner 

5 � Registered nurse 

, � Lksed practfcaf 

7 � Nurse’s aide 

6 � Other (Specffi) 

78 ‘U.S. GovernmentPrfntlngOffice: 1994- 301.019/c41107 

.. 
Vital and Health Statistics 

series descriptions 

SERIES 1. 

>, 

SERIES 2. 

b 

SERIES 3, 

SERIES 4. 

SERIES 5. 

SERIES 6, 

SERIES 10. 

SERIES 11. 

.

4. 

SERIES 12. 

SERIES 13. 

Programs and Collection Procedures—These reports 

describe the data coll~”on programs of the National Center 

for Health Statistics. They include descriptions of the 

methode used to collect and process the data, definitions, 

and other material necessary for understanding the data. 

Data Evaluation and Methods Research-These reports 

are studies of new statistical methods and include analytical 

techniques, objective evaluations of reliability of collected 

data, and contributions to statistical theory. These studies 

also include experimental teata of new survey methods and 

comparisons of U.S. methodology with those of other 

countries. 

Analytical and Epidemiologkal Studies-These reports 

present analytical or interpretive studies based on vital and 

health statiatfcs,These reporta carry the analyses fiuther than 

the expository types of reporta in the other series, 

Documents and Committee Reports-These are final 

reporta of major comm”meesconcerned with vital and health 

statistics end documents such as recqmended model vital 

registration laws and revised birth and death certificates. 

International Vital and Health Statistics Reports-These 

reports are analytical or descriptive reporta that mmpare 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 Survey 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. 

Data From the National Health Interview Survey-These 

reports contain statistics on illness; unintentional injuries; 

disabilii use of hospital, medical, and other health services 

and a wide range of special current haalth topics covering 

many aspects of health behaviors, health status, and health 

care utilization. They are based on data collected in a 

continuing national household interview survey. 

Date From the National Health Examination Survey, the 

National Health and Nutrition Examination Surveys, and 

the Hispanic Health and Nutrition Examination Survey— 

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 conditions in the United 

States and the dietrib~”ons of the population with respect to 

physical, physiological, and psychological characteristics, 

and (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 heafth resources and the public’s 

use of health care resources including ambulatory, hospital, 

end long-term care sem”ces based on data collected directly 

from health care providers and provider records. 

SERIES 14. 

SERIES 15. 

SERIES 16. 

SERIES 20. 

SERIES21. 

SERIES 22. 

SERIES 23. 

SERIES 24. 

Data on Health Resources: Manpower and Facilities— 

Discontinued in 1990. Reporta on the numbers, geographic 

distribution,and characteristics of heafth resources are now 

included in Series 13. 

Data From Special Surveys—These reports contain 

statistics on health and health-related topics collected 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 

Statistlca-Advance Data Reports provide early relaase 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 Mortality-These reports contain statistics on 

mortelii that are not included in regular, annual, or monthly 

reports. Special analyses by cause of death, age, other 

demographic variables, and geographic and trend analyses 

are included. 

Data on Natality, Marriage, and Divorc&These repotis 

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 SurveyeDiscontinued in 1975. Reports fkom these sample surveys, 

baaed on vital records, are now published in Series 20 or 21. 

Date From the National Survey of Family Growth-These 

reports contain statistics on factors that affect birth rates, 

including contraception, infertility, cohabtiation, marriage, 

divorce, and remarriag~ adoption; use of medical care for 

family planning and infertilii and related maternal and infant 

heatth topics. These statistics are based on national surveys 

of childbearing age, 

Compilations of Data on Natallty, Mortality, Marriage, 

Divorce, and Induced Terminations of Pregnancy— 

These include advance reports of birtha, deaths, marriages, 

and divorces based on final data from the National Vital 

statistics System that were published es supplements to the 

Month& VII Statistks Report (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 baaed on final data from the National Viii statistics 

System and may be followed by detailed reporta in Series 20 

or 21. 

For answera to questions about this report or for a list of reports published 

in these series, contact 

Data Dissemination Branch


National Center for Health statistics


Centera for Disease Control and Prevention


Public Health Service


6525 Be[crest Road, Room 1064


Hyattaville, MD 20782


(301) 436-6500

DEP~TMENTOF 

HEALTH& HuMAN SERVICES BULK RATE 

POSTAGE& FEES PAID 

Public Health Service 

Centera for Disease Control and Prevention 

PHS/NCHS 

PERMIT NO. G-281 

National Center for Health Statistics 1 I 

6525 Belcrest Road 

Hyattsville, Maryland 20782 

OFFICIAL BUSINESS 

PENALTV FOR PRIVATE USE, $300 

DHHS Publication No. (PHS) 94-1310, Series 1,. No. 34 

4-1043 (7/94) 

—..