NATIONAL CENTER Series 2 

For HEALTH STATISTICS Number 8 

PROPERTY
OFTHE 

PUBLICATIONS WIANGH 

EDITORIAL LIBRARY 

VITAL and HEALTH STATISTICS 

DATA EVALUATION AND METHODS RESEARCH 

Comparisonof 

HospitalizationReporting 

in three survey procedures 

A study of alternative survey methods for COI Iection 

of hospita I ization data from household respondents. 

Washington, D.C. July 1965 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION, AND WELFARE Public Health Service 

Anthony J. Celebrezze Luther L. Terry 

Secretary Surgeon General 
This report was originally published in the series “Health Statistics 

from the U.S. National Health Survey,” which has since been replaced 

by the “Vital and Health Statistics” series. It presents findings from 

a methodological study pertaining to improved techniques in data 

collection in the Health Interview Survey. Because this material is of 

continuing importance, and is relevant to data currently being released 

from the Survey, the report is being reprinted in its present form. 

Public Health Service Publication No. 1000-Series 2-No. 8 

F . lohvthe~ n, int, d~mt of DOCI ents, U.S. Government Printing Office 
NATIONAL CENTER FOR HEALTH STATISTICS 

FORREST E. LINDER, PH. D., Director 

THEODORED, WOOLSEY,Deputy Director 

OSWALDK. SAGEN,PH. D., xfs~i$ta?ztDirector 

WALTR. SIMMONS,M.A., &ati5tical ~dvi~or 

ALICEM, WATERHOUSE,M.D., Medical Advi~or 

JAMESE. KELLY,D.D.S., Dental .4dvisor 

LOUISR. STOLCIS,M.A., Executive Oficer 

OFFICEOF HEALTH STATISTICS ANALYSIS 

IWAOM. MORXYAMA,PH. D., Chief 

DIVISIONOF VITAL STATISTICS 

ROBERTD. GROVE,PH.D., Chicj 

DIVISION OF HEALTH INTERVIEW STATISTICS 

PHILIPS. LAWRENCE,Sc. D., Cl+ 

DIVISION OF HEALTH RECORDS STATISTICS 

MONROEG. SIRICEN,PH. D., Chief 

DIVISIONOF HEALTH EXAMINATIONSTATISTICS 

ARTHURJ. MCDOWELL,Chief 

DIVISIONOF DATA PROCESSING 

SIDNEYBINDER,Chief 

COOPERATION OF THE SURVEY RESEARCH CENTER, 

THE UNIVERSITY OF MICHIGAN 

AND THE BUREAU OF THE CENSUS 

Under legislation establishing the National Health Survey, the Public 

Health Service is authorized to use, insofar as possible, the services or 

facilities of other Federal, State, or private agencies. The methodological 

study in this report was performed under a contractual arrangement with 

the Survey Research Center, Institute for Social Research,The University 

of Michigan. The Bureau of the Census also participated actively in the 

planning and conduct of the research. 

Public Health Service Publication No. 1000-Series 2-No. 8 
PREFACE


This report is the second in the U.S. National 

Health Survey’s methodological series on the subject of hospitalization reporting in the Health Interview Survey, both of which were conducted by 

the Survey Research Center of The University of 

Michigan under contract with the U. S. National 

Health Survey and in co-operation with the Bureau of the Census. These studies are part of a 

program of the National Health Survey to evaluate 

the reliability of its statistics and to develop and 

test improved methods for collection of data. 

(Prior publications in this developmental and evaluation series are listed inside the back cover of 

this report.) The statistical design and procedures 

used in the Health Interview Survey of the U. S. 

National Health Survey are described in two National Health. Survey publications. 12 

1[[, s. Nati~nal Health Survey. The StdkfiCc7~ DeS@ 0/ ‘he 

[Itdli, [Ioflscbold-intcrt,icw Survey. Health Statistics. Series A-2. 

P}IS Publication No. S84-A2. public Health Service. \Vashingcon, 

D. C., July 1958. 

2~,. S. Nati~nal [{ealth SUrVey. Concepts and De/initmns in fbe 

}ltwll/J fluz~sthold.lntcruirtu .$uruey. Health Statistics. Series A-3. 

FIIIS Publimticm No. 584-A3. Public Health Service. \Yashingtoo, 

P. C., September 1958. 

The study was a co-operative project of the 

staffs of the Bureau of the Census, the Survey 

Research Center, and the National Health Survey, 

each organization actively participating in all 

phases of the study. The sample was designed by 

Harold Nisselson of the Bureau of the Census. 

Katherine Capt and George Kearns of the Bureau 

of the Census were responsible for the preparation of interviewing manuals, training of interviewers, and general quality control of the field 

operations. An important contribution was also 

made by John Tharaldson, Edward Knowles, and 

John Campbell of the Detroit Regional Office of 

the Bureau of the Census, who helped in selecting 

the sample from the hospitals and carrying out 

the field procedures, 

Charles F. Cannell, Ph. D., and Floyd Fowler 

were the principal investigators for the Survey 

Research Center. In addition to developing a special experimental procedure and questionnaire for 

the collection of hospitalization data, they were 

also responsible for the report presented here. 

Earl Bryant of the U. S. National Health Survey staff had the responsibility of co-ordinating 

the activities of the participating organizations 

and conveying the National Health Survey viewpoint in decisions on methodology. He also 

edited the contractor’s report for the present 

publication. 
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CONTENTS 

Preface


Summary


Objectives of the Study and Description of the 

Research Design


Introduction


The Pilot Investigations


The Sample Design


Descriptionof the Procedures


The Interviewers


Assignment of Interviewers


Follow-up Techniques


Deviations From the Design


Editing, Matching, and CcxIing---------------------


Comparison of Underreporting in the Tbree Procedures


by Characteristics of the Sample Person


Comparison of Underreporting in the Three Procedures


by Characteristics of the Episodes


Follow-upto Procedures Band C--------------------

Comparison of Underreporting in tbe Three Procedures


by Characteristics of the Respondents


Accuracy of Reporting Length of Stay and Dateof


Discharge


Detailed Tables


Appendix I.


Partl: Sampling Errors


Part 2: Analysis of Interview Assignments


Appendix II. Forms and Questionnaires Used inthe 

Study --------

Procedure A Questionnaire -


Procedure B Questionnaires


Procedure C Questionnaires


Letter and Brochure


Page 

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2 

2 

4 

5 

7 

7 

8 

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8 

8 

9 

11 

12 

16 

17 

18 

32 

34 

35 

36 

41 

47 

47 
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SYMBOLS AND NOTES 

Magnitude of the sampling error precludes 

showing separate estimates (*) 

NOTE:	 Due to rounding detailed figures 

within tables may not add to totals 
COMPARISON OF


HOSPITALIZATION REPORTING


in three survey procedures 

The following reswwch report was prepared by the Survey Research Center, Institute for .%cial Research, The Universitymf Michigan. under contract with the Natianal Health Survey Division, National Center for Health Statistics. Charles F. Cannell, Ph.D. and Floyd Fow[er, of 

the Institute for !iacial Research, directed the praiect and were responsible for the analysis and ho repart presented here: Leslie f(ish, Ph. D., 

pravid~d guidance on statistical problems and was responsible for the variance anaiysis. Valuable assistance was also given by Thomas 

Bakker during the pilot investigations and by Mrs. Doris Muehl who supervised the editing and coding procedures. 

SUMMARY 

The objective of this research was to compare the effectiveness of two experimental procedures with the standard Health Interview Survey 

of the U. S. National Health Survey procedure in 

obtaining information about hospital stays. Procedure A, the control, used the standard Health 

Interview Survey (HIS) questionnaire and procedures. Procedure B was a revised interview schedule which was followed by a mail form in which 

any information about hospital stays that had been 

overlooked in the interview was to be recorded by 

the respondent. Procedure C eliminated the questions about hospitalizations from the interview; 

the requested information was to be entered on a 

self-administered form which was given to the 

respondent by the interviewer at the close of the 

interview. The follow-up forms in Procedures B 

and C were to be mailed to the Regional Office of 

the Bureau of the Census. 

The design of the study and interpretation of 

results must be judged in the context of primary 

purposes of the undertaking. Previous research 

had suggested a considerable variety of steps and 

techniques which might constitute improvements. 

The prime effort was to construct a total procedure which included a number of these potential 

improvements, and to test this procedure against 

the current standard. The key decision would be 

whether the new procedure was better than the 

old, with only secondary consideration being given 

to which of several factors were chiefly responsible for any net improvement that should appear. 

This new or consolidated procedure was the one 

designated Procedure B. During the course of 

planning the study, the possibility arose that a 

more streamlined self -administered approach 

might yield most of the benefits hoped for from 

the consolidated procedure. Accordingly, Procedure C was included in the test. 

Thus the analysis puts primary emphasis on 

over-all net effectiveness of the three procedures. 

It does not include comparative costs of the different processes. Further, it is important to note 

that the total effect from Procedure B is the product of a rather intensive interview routine followed 

by a self-administered process; while the effect 

from Procedure C is the consequence of a selfadministered process followed by a telephone and 

personal visit interview for a substantial number 

of nonrespondents. Care must therefore be taken 

in ascribing the cause for different results to any 

single feature of the procedures. 

For several reasons the study does not produce a representative measure of underreporting, 

and Procedure A does not produce a valid estimate of the level of the underreporting errors for 

estimates shown in publications of the Health Interview Survey of the National Health Survey. 

Prominent among their reasons are (1) restriction of the study to Detroit; (2) elimination of hos1 
pital episodes for deliveries, which previous 

studies have shown to be very well reported; and 

(3) the fact that NHS publications currently are 

based on a six-month-recall period. The net 

effect of these differences is an implied overstatement of underreporting by several percentage points for NHS published data. 

A stratified sample was selected from Detroit 

hospitals of residents of the Detroit area who had 

had one or more hospital stays during the year 

preceding the interviewing. Those whose onlyhospital stays were for normal deliveries were excluded from the sample. 

The following are some of the significant 

findings of this study 

The proportions of the known sample of hospital episodes which were not reported were 17 

percent for Procedure A, 9 percent for procedure 

B, and 16 percent for Procedure C. The difference 

in the reporting in experimental Procedure Band 

the control Procedure A is significant at the 0.05 

level of confidence. 

When apparent overreports were included, 

the rate of underreporting was decreased by two 

or three percentage points for each procedure. 

There was an increase in the underreporting 

rate for all three procedures as the length of time 

between the hospital discharge and the interview 

increased. There was an especially sharp increase in underreporting for all procedures when 

the discharge preceded the interview by more than 

40 weeks. However, the relationship was somewhat weaker in Procedure B for episodes which 

occurred within 40 weeks of the interview. 

one-day stays were reported very poorly, 

with the underreporting rates being almost the 

same for all three procedures. For all other 

stays, however, the reporting in Procedure B 

showed marked improvement. 

For all three procedures the degree of social 

threat or embarrassment of the diagnosis leading 

to hospitalization was negatively related to the 

rate of reporting. 

Episodes which involved surgical treatment 

were reported significantly better in all three 

procedures than those which did not. 

There was a consistent relationship in all 

three procedures between the number of chronic 

and acute conditions reported for the sample person and the reporting rate; the rate improved with 

an increase in-the number of conditions. 

In all three procedures, the reporting for persons with three or more episodes in the sample 

was considerably poorer than for persons with 

only one or two. 

For all procedures, the underreporting rate 

was higher for nonwhite than for white persons. 

In Procedures B and C the reporting for persons in low income families was significantly 

poorer than it was for those in higher income 

families. The same pattern was found in Procedure A. 

In Procedure A, episodes for persons with 

higher education were reported somewhat better 

than those for persons with lower education. This 

bias is even more apparent in Procedure C, but is 

essentially eliminated by Procedure B. 

Respondents reported their own episodes considerably better than they reported the episodes 

of others in Procedure A. This tendency is reduced in Procedure C and eliminated in Procedure B. 

A large proportion (30 percent) of the hospital episodes not reported in the direct interview 

for Procedure B was obtained in a mail-follow-up 

procedure. 

It was found that the promptness with which 

respondents replied to the follow-up was directly 

related to the quality of reporting in both Procedures B and C. 

Month of discharge was reported equally well 

in all three procedures. 

Procedure C proved to be significantly better 

than Procedure A in obtaining correct reports of 

the number of days involved in hospital episodes. 

The most outstanding finding, of course, was 

the significant improvement of reporting found in 

Procedure B. In this improvement, one clear factor was the better reporting for proxy-respondents; another was the reduction of underreporting 

for persons in the lower educational brackets. 

While it is not possible to specify the reasons 

for these improvements, several aspects of the 

procedure were designed to “motivate” respondents. As the study yielded considerable evidence 

that the level of motivation of the respondent is 

an important determinant of how well he reports, 

it is suggested that the success of Procedure B 

may be largely attributable to its effectiveness in 

encouraging and directing increased effort to report. 

OBJECTIVES OF THE STUDY 

AND DESCRIPTION OF THE 

RESEARCH DESIGN 

Introduction 

In 1959 the Survey Research Center, under 

contract with the National Health Survey, and 

working co-operatively with the National Health 

2 
Survey and the Bureau of the Census, conducted 

study which compared hospitalizations reported in 

household interviews with those recorded in hospitals.3 T’he purpose of the study was to estimate 

the magnitude of underreporting of hospital episodes in the Health Interview Survey of the National Health Survey, to investigate some of the 

patterns of underreporting, and to develop hypotheses relating to the mechanisms of underreporting. For ease of reference the 1959 study is referred to in this report as Special Study No. 8, 

which was used as the working title. 

Based largely upon the findings of Special 

Study No. 8, another study was carried out, designed to test new methods of collecting hospitalization data from household respondents. This report presents the analysis of the experimental 

study. 

Since Special Study No. 8 provided the basis 

for the development of new experimental techniques for improving the reporting of hospital 

data in the Health Interview Survey, a brief summary of the hypotheses developed from the results of Special Study No. 8 is given for background information. In addition, proposed changes 

which were the basis for the development of experimental procedures are described. 

In Special Study No. 8, respondents were 

asked to report hospitalizations which occurred 

during the 12 months preceding the Sunday night of 

the week in which the interview was conducted. 

Such a time period is confusing to the respondent 

and apparently creates problems of time reference. 

The marked underreporting of episodes 

occurring near the beginning of the 12-month period suggested that when the respondent was in 

doubt he preferred to recall the episode as having 

taken place before the beginning of the year and, 

thus, did not report it. 

The proposed solution to this problem was to 

use as a reference period that part of the calendar 

year preceding the interview and the preceding 

calendar year. The analysis then could be based 

on the 12 calendar months preceding the month in 

which the interviewing took place. 

There is a lack of positive motivation on the 

part of respondents to devote the amount of energy 

required to report hospital episodes. To recall 

3 U. S. National Health Survey. Reporting of Hospiia[ization in 

the Health interview Survey. Health Statistics. Seties D-4. Public 

Health Service Publication No. 584-D4. Public Health Service. 

Washington, D. C., hfay 1961. 

hospitalizations over a period of one year requires the respondent to exert some effort. Many 

respondents are not so motivated and are inclined 

to complete the interview as rapidly and as 

easily as possible, reporting only those events 

which are most salient at the moment. 

Proposed solutions were to: 

a.	 Ask more probe questions to stimulate 

the respondent to work harder. 

b.	 Ask questions about hospitalizations 

which research showed to be most commonly unreported-minor episodes and 

those which Wcurred several months 

prior to the interview. 

c.	 Ask about each individual separately instead of about the entire family. 

d.	Send a brochure to the household prior 

to the interview to stress the importance of the survey. 

e.	 Use the respondent as an interviewer 

to collect information from other members of the family through a self-admi&stered form. 

There is a tendency for people to conceal or 

distort their memory of episodes which are embarrassing or physically threatening. This may 

be because respondents have reservations about 

reporting certain types of problems or because 

the emotional nature of the episode has resulted 

in distortion or suppression of the memory of the 

experience. 

The assumption is that most episodes are not 

so threatening or stressful that they camot be obtained by an interviewer, but that a greater mcXivational force is required to obtain the information. A follow-up interview which was part of Special Study No. 8 supports this conclusion. 

Proposed solutions to this problem were to: 

a. Use a self-administered form where it 

might	 be easier for the respondent to 

report episodes which would not be reported readily to an interviewer. 

b.	 Include introductory statements in the 

questions to stress the importance of 

the data. 

c. Use the brochure mentioned above. 

The viewpoint taken in this research is that 

problems of memory can be understood and dealt 

with more successfully if they me considered in 

terms of motivation. For instance, a hospitalization of one day’s duration which occurred nearly a 

year ago is not actually an inaccessible memory, 

but greater effort and, therefore, a higher level 

of motivation is required for the respondent to report it. In the same way, an operation which is 

surrounded with intense emotion is not actually 

3 
repressed, but it requires a higher level of motivation for the respondent to be willing to discuss 

it. This concept is not derived solely from theory 

but conforms closely to the data from Special 

Study No. 8, especially those from the follow-up 

interviews. 

The Pilot Investigations 

Because of time and budgetary limitations, it 

was not possible to set up an elaborate experimental design to test all the variables separately. 

Instead, several small pilot investigations were 

conducted, each built upon the preceding one, and 

each one testing one or more new concepts. For 

the most part, the evaluation of these investigations was subjective, although tabulations were 

made of the major variables. The number of 

cases in each pilot study was small so that no 

statistical tests were attempted. Each pilot study 

consisted of between 25 and 50 interviews; a total 

of six investigations were carried out. 

Five interviewers were employed in the pilot 

studies, each of whom had considerable experience in pretesting questionnaires and new field 

ideas. 

The sample for the pilot investigations was 

selected from persons discharged from two 

Detroit hospitals. It was selected by a random 

process and covered hospital discharges during 

the preceding 18 months. 

l%e interviewers were told ,that someone in 

each family assigned to them had been hospitalized within the past two years. This was necessary, because it was important to use the interviewers’ experience to evaluate the various procedures. 

A questionnaire was prepared for each pilot 

investigation. Interviewers were asked to record 

verbatim the responses given to each question, 

and to note anything that might be relevant to the 

problem of reporting hospital stays. In addition, 

interviewers were asked to explore, on their own 

initiative, new questions which they thought might 

be useful in eliciting unreported hospital episodes. 

Such exploration was undertaken only after the 

! specified sequence of questions was asked. 

After each pilot investigation, a meeting was 

held with all interviewers. Interviewers’ ideas as 

to how to improve the questionnaire were discussed, and each interviewer’s experience with 

each question was reviewed in detail. 

Following the discussions the interviews were 

analyzed, searching for ways to improve the reporting of hospitalizations. The following is a 

summary of findings of the pilot investigations. 

‘l%e frame of reference of the respondent in 

reporting hospitalizations. -In the first pilot 

studv two frames of reference were observed. If 

left hee to report hospitalizations for themselves 

and their families, some respondents first talked 

about the more serious episodes for all family 

members and then the minor episodes for all family members. Other respondents tended to report 

systematically for each member of the family in 

turn, regardless of whether the episodes were 

major or minor. In later pilot studies the problem 

was to discover which frame of reference seemed 

to predominate and to make use of it in the questionnaire design, the assumption being that the 

closer the questioning conforms to the respondent’s way of attacking the problem, the better the 

reporting. 

In subsequent pilot investigations, lmth 

approaches were used independently. 

The conclusion reached was that for small 

families or families with a small number of episodes, the first method was satisfactory. For 

large families, particularly where several members had been hospitalized, a systematic questioning about each family member produced more 

complete reports. The second approach was used 

in the final questionnaire. 

Use of additional questions. -Interviewers 

tried various additional questions or probes to 

obtain more complete re@rting of episodes. In 

the first test, interviewers were asked to use 

whatever follow-up questions seemed most appropriate to obtain more complete reporting. Additional episodes were obtained by the use of these 

questions and several were standardized for the 

successive pilot investigations. Three types of 

follow-up questions were tried. The first, general 

probes, of the type, tIDid you have any other hospital stays?” The second, questions about possible 

types of hospitalization; for operations, for observations, to have a baby, etc. The third type focused 

on minor episodes and those occurring several 

months prior to the interview. 

Most families have only one or two episodes 

to report. Thus respondents tended to become 

irritated at being asked a series of questions, 

since they felt they had reported all of their episodes in response to the original question. Rapport tended to suffer, and respondents developed 

a fixed response—they answered “no” without 

really considering the question. A lengthy series 

of probes, therefore, defeated its own purpose, 

and it was concluded that only a few probes 

4 
should be used, Since the major problem of underreporting was for minor episodes, and those 

removed in time from the interview, it was decided to focus the probes on these issues. 

It was found that telling the respondent the 

reason for asking the questions helped to counteract negative reactions. The probes, therefore, 

were introduced wi$h the statement “We find that 

people tend to forget . . . etc. ” With these changes 

the respondents appeared to tolerate the additional 

probes, and these changes resulted in picking up 

episodes previously unreported. 

The reference period for reporting. —For 

reasons described in the review of hypotheses in 

the previous section, respondents were asked 

about episodes occurring at any time during the 

calendar year 1959 and that part of 1960 prior to 

the interview. (Tl_ie pilot study interviewing was 

done in the fall of 1960, so respondents were reporting for 22 or 23 months.) The analysis period 

was the 12 calendar months preceding the month 

of the interview. 

Accuracy of reporting admission and discharge dates .—Various methods of’obtaining dates 

of admission and discharge were tried in successive pilot studies. The ;bjective was to find the 

most accurate method of obtaining the discharge 

date, which was basic to the analysis. 

‘l%e discharge date can be obtained either by 

asking for the month of discharge in the interview 

or by” calculating the month of discharge by use 

of the admission date and the length of hospitalization. In the first pilot studies respondents were 

asked the month and day of admission, the length 

of stay, and the month and day of discharge. A 

comparison of these reports with hospital records revealed that respondents were fairly accurate on the month of admission or discharge, 

but inaccurate as to the ~ of admission. The report of the month of admission was slightly more 

accurate than. the month of discharge. Of the two 

methods, it was found that the reported discharge 

month was considerably more accurate than the 

computed discharge date using the date of admission and the length of stay. It was found also 

that handing the respondent a calendar before 

asking about dates improved reporting accuracy. 

Procedures to motivate the respondent.— 

Special Study No. 8 plus many other related studies provide evidence that special attempts needed 

to be taken to motivate the respondent to report 

accurately. Several techniques were attempted in 

the pilot studies. 

Introductions to the National Health Survey, 

which were designed to stress the importance of 

accurate data for health planning and to educate 

the respondent in some of the uses made of the information, were used by interviewers. These 

statements were later incorporated into a brochure and mailed to each household prior to the 

interview. 

In addition to the general introduction, special phrases were used to preface the hospital 

questions. The objective of these questions was 

to provide the respondent with some added simulation to report episodes. 

Special ‘probl;ms .—During the pilot studies, 

some of the questions were reworded. Two changes 

are sufficiently interesting to be reported here. 

The word ‘hospitalization” was confusing to some 

respondents. Some failed to understand the word, 

and for others the implication was of a “serious 

or long stay in the hospital.” Hence the final questionnaire used the awkward but meaningful phrase 

“hospital stay. ” The word “patient” also gave 

trouble, again because respondents tended to associate the word with severe illness. The word was 

therefore dropped. 

As a result of these pilot studies, techniques 

gradually evolved which appeared to increase the 

probability of obtaining a higher proportion of reports of hospitalizations than did the standard National Health Survey household interview. These 

techniques were then used in this experimental 

study. The design of this study is described below. 

The Sample Design 

Since the major interest in this study was in a 

comparison of procedures for collecting hospitalization data, rather than in population estimates as 

such, it was decided to conduct the study in a 

single, compact area. The efficiencies which resulted saved considerable money. 

A sample of 20 general or short-stay hospitals was chosen from those listed for the 

Detroit urbanized area by the American Hospital 

Association and the American Osteopathic Hospital Association. The hospitals were selected 

with probability proportional to the number of 

discharges they had during 1960 (exclusive of discharges for deliveries and for deaths). Sixteen of 

the twenty hospitals agreed to participate in the 

study. Replacements were selected for three of 

the four. Two of these replacements agreed to 

co-operate, making a total of 18 sample hospitals. 

The second-stage-sample selection was of 

persons discharged from the hospitals between 

May 1, 1960 and March 31, 1961. The sampling 

fraction for each hospital was such that the product of the first-stage-sampling ratio (of selecting 

5 
hospitals) and the second-stage ratio was constant. The sample persons were selected systematically after a random start from a list of discharges routinely maintained by the hospitals. 

To maintain the desired constant sampling 

fraction for each sample person, a subsample of 

persons with multiple discharges was taken, proportional to the number of discharges they had 

during the sampling time interval. Restrictions 

were put on the sample design to exclude the 

following 

Persons who lived outside the D@xoit urbanized area. 

Persons whose only episode during the year


was for a normal delivery. This restriction


was placed since it was found in Special Study


No. 8 that 97 percent of the deliveries were


reported, and it was desired to weight the


sample “toward the less readily reported epi­


sodes.


Hospital episodes with stay of less than over-


night. This conforms with the specifications 

of the National Health Survey. 

Persons who died in the hospital. 

Persons who were found to have moved outside the Detroit urbanized area. If the sample 

person no longer lived at the address given 

on the hospital record and could not be located, it was assumed that he had moved out 

of the area. 

After the person was chosen for the sample, 

abstracts of all his episodes terminating between 

May 1, 1960 and the date of interview were obtained. (The interviews were conducted during the 

five-week period beginning May 1, 1961.) Since 

the sample was of persons, discharged during the 

period, May 1960-March 1961, abstracts showing 

discharge dates during April, May, and June were 

for persons readmitted to the hospital and discharged during this period. Special Study No. 8 

showed that discharges which had occurred near 

the date of interview were reported more accurately than those which had occurred earlier. 

Thus, by design, the sample consisted of relatively few discharges near the date of interview. 

A Latin Square design was used consisting of 

four orthogonal, completely randomized Latin 

Squares which generated the interviewing assignments. These assignments consisted of approximately 18 interviews per week per interviewer.* 

*The design was worked out by Harold Nisselsonof the Bureau


of Census. 

The design used as two major sources of 

variance the week of the interview and tie region 

of tie city. These were randomized, with the 

effects of their interactions assumed to be balanced or negligible. 

The city was divided into five geographic regions, and as has been mentioned the interviewing 

was conducted in five weeks. Twenty interviewers 

were divided randomly into two groups. One group 

used the control procedure (Procedure A) and one 

experimental procedure (Procedure C), while the 

other group used the two experimental procedures 

(Procedures B and C). (These procedures are described in the following section.) This division in 

assignments was necessary because of the particular procedures to be tested. ‘llms, the Procedure C interviews were taken by 20 interviewers; Procedures A and B interviews were taken 

by different groups of 10 interviewers. Each interviewer was assigned twice as many A or B interviews as C interviews. The following table, 

one of the four Latin Squares, will illustrate the 

design. 

Region Region Region Region Region 

I II III Iv v 

A, C inter- Week Week Week Week Week 

viewer #1 5 2 4 1 3 

A,C intsr- Week Week Week Week Week 

view= #2 2 1 3 4 5 I I I 

A,C intsr- Week Week Week Week Week 

viewsr #3 1 3 5 I 2 I 4 I 

A.c f.ntsr- Week Week Week Week Week 

viewsr #4 t 4 , 5 I 2 I 3 I 1

A, C inter- Week Week Week Week Week 

viewsr #5 3 4 1 5 2 

It may be seen that there were five possible 

patterns of interviewing assignments. Taking interviewer No. 1, for Week 5 all of her interviews 

fell into Region I of the city. ‘TWOthirds of these 

interviews were Procedure A and one third, Procedure C. Since there were 20 interviewers, three 

other interviewers were working in the same region during Week 5, one other A,C interviewer 

and two other B,C interviewers. 

The patterns were such that no interviewer 

worked in any region for more than one week; and 

no two interviewers worked together in the same 

region more than once. 

Region of the city was selected as a major 

source of variance for three reasons. First, 

since a given hospital tends to serve persons in 

6 
its immediate area, control on region, to some 

extent, controlled the variance between hospitals. 

Second, there was some evidence in Special Study 

No. 8 that socioeconomic status is related to the 

rate with which hospitalizations are reported. 

Controlling the region of the city, to some extent, 

made it possible to isolate the variance attributable to this relationship. In addition, restricting 

the sample to five regions seemed to give optimum 

spread without substantially increasing travel 

costs per interview. 

Description of the Procedures 

As was described in the section on the research design, three procedures were used in 

this study; one control procedure and two experimental procedures. The questionnaires and forms 

used can be found in Appendix II. 

Procedure A—the control interview.—The 

survey procedure referred to as “Procedure A“ 

in this report was essentially the standard procedure used in 1961 by the Health Interview Survey of the National Health Survey, except that 

some minor changes were made in anticipation of 

the 1962NHS questionnaire. 

Prior to the interview, a letter was sent to 

each Procedure A household informing the family 

that a Bureau of Census interviewer would visit 

their home in a week or two. This letter and 

questionnaires used in the study are shown in 

Appendix II. 

In the interview the hospital questions were 

asked about each family member separately, 

rather than abut the family group as a whole as 

has been the procedure used in the National 

Health Survey in the past. 

Procedure B—an experimental interview and 

follow-up self-administered questionnaire. -Procedure B consisted of a direct interview and a 

mail follow-up questionnaire. The direct interview questionnaire was developed as a result of 

the pilot investigations described earlier. ‘Ihe 

questions are identical to those used in Procedure A except for marked differences in the hospitalization section. These differences are as 

follows: 

Hospital questions were expanded to include 

additional probe questions. 

The reference period was 1960 and that part 

of 1961 prior to the interview rather than the 12 

months prior to the week of interview as used in 

Procedure A. 

Respondents were asked to report month and 

year of discharge rather than month and year of 

admission. 

Special explanatory statements were included 

in the section. 

This procedure was also different from Procedure A in that a special brochure was enclosed 

with the letter which is ordinarily sent to the 

households prior to the interviews. The brochure 

is reproduced in Appendix II. 

Following the interview the questionnaires 

were edited in the Census Regional office. As soon 

as the editing was completed, a self-administered 

form was mailed to the family. This form contained the family composition as reported to the 

interviewer and a record of the hospitalizations 

as reported in the interview. Respondents were 

asked to answer a few questions designed to elicit 

additional hospitalizations and return it to the 

Bureau of the Census office. If the form was not 

received within one week after the date of the 

first mailing, a follow-up form was mailed, containing the same questions but a different letter 

from the Census Regional supervisor. If neither 

form was returned, an attempt was made to obtain 

the information by telephone. If telephoning was 

not possible, a personal visit was made and the 

data collected by interview. 

Procedure C—the experimental self-administered questionnaire. —In this procedure the interview questionnaire was identical to that used 

in Procedure A except that no questions on hospitalizations were included. Instead of being questioned almut hospitalizations, a form to be filled 

out by the family was left with the respondent. 

Nonresponses were followed up using the same 

techniques as for Procedure B. 

rhe Interviewers 

T%enty interviewers were employed for this 

study. Most of them had had a limited amount of 

interviewing experience, largely on the Decennial 

Census. The decision to use new interviewers 

was based on several considerations. The existing 

Census staff in the Detroit area was fully occupied. In addition, it was felt that new interviewers 

would be less likely to perceive that the rate of 

hospitalizations in the sample was abnormally 

high. Of greatest importance, however, was the 

need for training interviewers in new techniques 

without having them recognize that the techniques 

were different from the usual National Health 

Survey interview procedures. It was felt to be 

very important to keep the interviewers from 

knowing that this was a study of hospitalizations, 

since they might probe with greater zeal. Specif ­

ically, it was feared, the knowledge that there was 

7 
at least one hospitalization for each family would 

have motivated them to probe until a hospitalization was reported. 

Interviewers were trained by the Bureau of 

the Census using, in general, their usual training 

procedures. The interviewers were divided randomly into two groups; one for Procedures A and 

C, and the other for Procedures B and C. The 

training for the two groups was made as comparable as possible. 

Since it was expected that interviewers 

would improve their skill with experience, the 

week of interviewing was used as one of the controls in the research design. 

Assignment of Interviewers 

Interviewers were given assignments to be 

completed within the week. They were given the 

family name and address from the hospital records. In cases where the family name was found 

to be different from that assigned, no interview 

was taken at that address. The usual quality controls used by the Bureau of the Census on National Health Survey data were used also on this 

study. Questionnaires were edited for missing information and inconsistencies. Where necessary 

the missing information was obtained by telephone 

or a personal visit. 

Follow-up Techniques 

Procedures B and C included self-administered questionnaires: the Procedure C interviewer leaving the questionnaire at the household 

at the completion of the interview, and the Procedure B, self-administered questiomaire, being’ 

mailed to respondents. The Procedure B interviewers were presumably unaware that the followup was being conducted, at least until the third 

week when one interviewer was employed to follow up nonresponses. 

All self-administered forms were edited 

upon reaching the office. Maximum use of the 

telephone was made to obtain missing data. When 

respondents had no telephone, personal visits 

were made. 

Nonresponse was followed up by first, a 

mail inquiry to those who had not responded within a week of initial contact, and second, personal 

visits or telephone calls to those not responding 

to the mail inquiry. 

Deviations From the Design 

The study, as it was carried out, deviated 

from the design in three ways. First, if a sample 

family was found to have moved to another region 

of the city, the interviewer to whom the assignment was originally made was instructed to follow 

that family and conduct the interview. Second, in 

some cases, if the family was not found at home 

or if the assignment could not be completed during the week in which it was assigned, the family 

was interviewed during the following week. Third, 

two interviewers were unable to complete the 

study assignments. One was dropped during the 

fourth week, and another did not interview during 

the fifth week. In each case, the incomplete interviews were reassigned to another interviewer 

who was working in the same region and who was 

using the same procedures. 

Editing, Matching, and Coding 

The editing and coding was carried out by a 

trained group of coders on the Survey Research 

Center staff. Three distinct tasks were involved 

in the editing: the matching of persons, the reediting of episodes, and the matching of episodes. 

To determine whether or not the person 

whose hospitalizations were sampled was included 

in the household, age, race, sex, and name were 

used as criteria. In general, this was not a complex task, as it was usually clear whether or not 

the sample person was in the household. 

Because the interviewing took place over the 

period of a month, some of the episodes fell outside of the reference year. The reference year 

differed for the procedures. For Procedure A the 

year was the 365 days preceding the Sunday night 

of the interviewing week. For Procedures Band C 

the year was the 12 months preceding the month 

in which the interviewing took place, To be in the 

sample the hospital discharge had to be within the 

reference year. Other episodes were excluded 

from the sample for other reasons. (For instance, 

a woman who was hospitalized twice, once for a 

deliver y and once for an episode which proved to 

be outside of the reference year, was excluded 

from the sample, since her only episode during 

the reference year was for a delivery.) All hospital discharges were edited to ascertain that they 

truly were within the scope of the study. 

In matching episodes, it was occasionally 

difficult to determine whether or not the some8 
�

time-vague and inaccurate reports found in the 

interview actually referred to the episode for 

which there was a hospital discharge record. The 

length of stay, month, diagnosis, name of hospital 

and, in the case where surgery was performed, 

the type of operation, were all used as criteria 

for matching. When three of these characteriqics 

were reported with reasonable accuracy and the 

other two were not toc inconsistent, the episodes 

were considered to be matched. 

If there was a major inconsistency, especially 

if the hospital seemed to have been reported incorrectly, the decisions were made by the supervisors. For ever y interview, the editing and 

matching was checked independently by one of the 

researchers or the coding supervisor. Disagreement was resolved by consensus. Although the 

process was of necessity somewhat arbitrary, 85 

percent of the cases included only one episode 

for a person, and in these cases it was usually 

clear whether or not the episode had been reported. 

The coding was unusually accurate. In checking about 15 percent of the coding, it was found 

that the reliability was 0.99, when calculated in 

terms of the percent of variables which were 

coded correctly. l%is small percentage of error 

was further reduced by intensive consistency 

checks of the cards. 

COMPARISON OF 

UNDERREPORTING IN THE THREE 

PROCEDURES BY tHARACTERlSTiCS 

OF THE SAMPLE PERSON 

The primary purpose of this study was t~ 

compare two experimental procedures with a control procedure, i.e., the one used by the National 

Health Survey, to determine whether either or 

both show a significan~ improvement in the level 

at which hospitalizations are reported and to investigate ways in which underreporting rates for 

the procedures differ in relation to the characteristics of persons who are hospitalized. 

To gain added confidence that results obtained were not due to differences between samples rather than differences between procedures, 

demographic characteristics of the three samples 

were compared. Those differences found were 

well within chance fluctuation, as would be expected from any probability sampling design 

carefully carried out. 

The rates of underreporting of hospital episodes in’ the three procedures are compared in 

table A. The difference between the net underreporting rate of 6 percent for Procedure B and 

a rate of 14 percent for both Procedures A and C 

is statistically significant. (Standard errors of 

estimates may be found in Appendix I.) The reporting rate* for Procedure B includes the episodes reported in the mail follow-up. The results 

of the follow-up procedures are discussed in the 

following section. 

When the overreports are excluded, the underreporting rate is 17 percent for Procedure A, 

9 percent for Procedure B, and 16 percent for 

Procedure C. Considering only the direct interview for Procedure B, the underreporting rate 

was 12 percent. 

Table l“”shows that Procedure B produced a 

sizable reduction in underreporting compared 

with Procedures A and C for both males and females. ‘The underreporting rate was lower for 

males than for females (4 percent and 7 percent, 

respectively). Similarly, table 2 indicates Procedure B was superior to Procedure A for all 

age groups. ‘Ihe largest difference is for the 

group 55 years or older where there was a net 

underreporting rate of zero in Procedure B. However, differences for all age groups are significantly lower in Procedure B than in Procedure A. 

The underreporting for white and nonwhite sample 

persons is compared in table 3. For all procedures the rate of underreporting for nonwhite was 

about twice that for white persons. While Procedure B showed a substantial reduction in underreporting for both groups, the same two to one 

ratio is found in all procedures. 

Table 4 shows the comparisons of underreporting by family income. Procedure B showed 

a significant improvement in reporting episodes 

for both low and high income groups (those above 

and below $7,000). Within Procedures B and C 

persons with family incomes above $7,000 were 

significantly lower in underreporting than those 

in lower income groups. The pattern is observed 

also within Procedure A, Here, as in table 5, it 

can be observed that while Procedure B showed 

“This rate takes into consideration the episodes reported in the 

interviews thst could not be matched with hospital record$, these 

unmatched reports are referred to as “overrepons.” Experience in 

Special Smdy No. 8 suggests rhat a number of the episodes were 

classified as overreporra in error due to failure to locate the recprds in the hospitrrls. 

*Tables designated by arabic numerals sre shown in the section following the text. 

9 
------- ------- ----

--

-----

Table A. Percent of hospital episodes underreported in.$he survey, by survey procedure 

Hospital discharges 

Survey procedure Number not 

matched Percent 

Total with inter- underview report reported 

A-------- -------- -- 521 90 17 

Number of episodes 

reported in the Percent* 

survey not corre- underreported 

spondingly matched (including 

(overreports) overreports) 

17


B 558 48 9 16 

----”-------.--- 546 87 16 12 

*This percentage istheratiooftokl umeported episodes plus overrepotied episodes bbtil hospital discharges. 

14


6


14


episodes 

persons 

improvement, the patterns of underreporting remained consistent between the groups. 

The relationship between education of the 

sample person and reporting rates can be seen 

in table 5. Combining the groups, as shown in 

table B, the underreporting ratesinProcedures A 

and B for persons who had not graduated from 

high school were about the sameas the rates for 

those with higher education. For Procedure C, 

however, hospital episodes were reported better 

for those with at least a high school education, 

than for those in thelowereducationalgroup. This 

relationship possibly reflects a greater easeof 

handling self-administered forms bypersons with 

higher education. 

Table 6 shows the level ofunderreporting by 

the relationship of the sample person to therespondent. In Procedure A, respondents reported 

better for themselves than they did for others. 

This seems to be true for Procedure Crespondents also, but the picture is not clear. 

In Procedure Cthedata are confused bythe 

fact that anumber ofpeople didnotsignthefollow-up forms; and often the interviewers did not 

record the name of the person with whom they 

talked when they had to follow-up via telephone or 

personal visit. This group, probably the least cooperative and the least willing to report, is most 

prone to underreport; their underreporting rate 

being about 50 percent higher than thenexthighest 

rate. For those cases in which the respondent 

could be identified, respondents reported best for 

themselves. 

In contrast, the relationship observedin Procedure A is eliminated by Procedure B. Persons 

Table B. Percent of hospital 

underreported in the survey for 

17 years of age and over, by survey 

procedure and education of the ssmple 

person, including and excluding overreports 

Survey procedure 

and education of 

sample person-17+ 

years 

Procedure A 

Less than high 

school graduate-­

High school graduate or more -----

Procedure B 

Less than high 

school graduate-­

High school graduate or more 

Procedure C 

Less than high 

school graduate-­

High school graduate or more -----

Percent underreported 

Inc lud- Excluding ing over - over -

reports reports -1-


14 19


13 16


5 10


6 8


16 15


10 12


.


10


c 
�

reported just as well for others as they did for 

themselves. Indeed, this is one of the obvious 

ways in which Procedure B was an improvement 

over Procedures A and C, and offers one answer 

to the question of what was accomplished with 

Procedure B, which enabled the underreporting to 

be reduced so drastically. 

In conclusion, it is worth noting that the overall reporting in Procedure B was significantly 

better than in Procedures A and C. 

COMPARISON OF 

UNDERREPORTING IN THE THREE 

PROCEDURES BY CHARACTERISTICS 

OF THE EPISODES 

Turning from characteristics of sample persons to a consideration of some characteristics 

of the episodes, table 7 shows that all three procedures resulted in better reporting for episodes 

involving longer hospitalization. 

Procedure B was superior to the other procedures in evoking reports of episodes of greater 

than one day. Procedure C showed a decrease in 

underreporting as the stays became longer, but 

the underreporting was consistently higher than 

for Procedure B. The pattern in Procedure A is 

not entirely clear, probably because of the small 

number of episodes in some categories. Procedure B did not result in improved reporting of oneday stays, but there was an obvious improvement 

in the reporting of stays longer than a day. The 

one-day stays, however, were reported as poorly 

in Procedure B as they were in Procedures A 

or C. 

The “diagnostic rating” in table 8 refers to a 

subjective scale of the degree of threat which is 

involved in a” given diagnosis.* Included in this 

are two concepts, physical threat, or the medical 

seriousness of the diagnosis, and psychological 

and social threat, especially the social acceptability of a problem. For example, having a baby is 

quite socially acceptable, and therefore would be 

easily reported, even to a stranger such as the interviewer; but a psychotic breakdown or delirium 

tremens would detract from one’s social image, 

and therefore would be less readily reported. 

This rating was devised for Special Study No. 8 and a more 

detailed description of the ratings can be found in the report of that 

study. 

As can be seen, the effects of threat were 

marked in all three procedures. The underreporting rate for all degrees of threat was lowered 

with the use of Procedure B but the pattern was 

the same as for Procedures A and C, i.e., an increase in underreporting with an increase in the 

level of threat. 

It was hoped that a self-administered form 

would make-it easier for the respondent to report 

an embarrassing episode, since writing about it 

would seem to be easier than reporting it to a 

stranger; but the pattern was not changed with the 

use of Procedure C. 

Table 9 shows a comparison of the three 

procedures for hospitalization with and without 

accompanying surgery. The differences between 

the underreporting rates for surgical and nonsurgical treatment are statistically significant for 

all three procedures. Although the reporting for 

both types of episodes was improved in Procedure B, the pattern between type of treatment remained. It is undoubtedly trite that episodes involving surgery have greater emotional impact 

on the person and his family than nonsurgical 

hospitalizations, and are therefore more readily 

recalled. Surgical episodes are also likely to involve longer hospitalizations and, longer stays 

are reported more completely as shown in table 7. 

Preceding tables have shown that underreporting of hospital episodes varies with the impact of the episodes on the respondent. Another 

variable closely related to impact is the recency 

of the event. It has been found repeatedly that 

events closer to the present are recalled more 

accurately than those farther back. Table 10 

shows a comparison of episodes by the elapsed 

time between the hospital discharge and the interview. All three procedures showed an increase 

in underreporting as the time between the hospitalization and the interview became longer. The 

differences between the underreporting rates for 

the first 30 weeks and the remaining weeks are 

statistically significant. 

Procedure B was somewhat different from 

the others in that the rate of underreporting was 

relatively flat through 40 weeks, with a rise in 

the period over 40 weeks. 

It should be recalled here that the reference 

period presented to the respondent was different 

for Procedure A than for Procedures B and C. In 

Procedure A the period was one year preceding 

the interview week. For Procedures B and C it 

was the part of 1961 wilich preceded the interview 

plus all of 1960. The hope was that this change 

would help substantially to overcome the large 

underreporting rate of episodes which terminated 

II 
near the end of the reference year. Both Procedures B and C showed an improvement in this yearend effect, but in neither procedure was the effect 

eliminated. 

Table 11 shows the underreporting of hospitalizations by the number of hospital recorded 

episodes experienced by the sample person during 

the reference year. In all procedures when the 

sample person had three or more episodes during 

the reference period, the underreporting rate was 

higher than for fewer episodes. Interestingly 

enough, there is very little difference in reporting 

rates for persons with one and two hospitalizations. Again it is noted that the pattern in Procedure B is similar to that found in Procedures A 

and C, but the rate is lower for each group. 

In conclusion, this section has presented 

convincing evidence for the importance of the 

characteristics of the episodes themselves in 

problems of reporting. All of these characteristics which would make a hospital stay less psychologically relevant —one-da y stays, nonsurgical 

stays, and time-distant stays—are reported very 

poorly. The one contradictory bit of evidence is 

that high threat episodes are reported more poorly, 

even though they should have more impact on the 

respondent. Two solutions to this latter point are 

presented. First, it may be explained by stating 

that persons remember such episodes, but do not 

want to talk about them with an interviewer. Second, one can draw upon personality theory and 

postulate that the person does not even think about 

some threatening illnesses; that he keeps them out 

of consciousness to the point that it is difficult for 

him to recall them in an interview situation. The 

latter is consistent with findings of this study in 

relation to the other types of episodes that are not 

reported. In all probability, the consistent patterns 

found with threat ratings was due to a combination 

of both of these factors. 

Procedure B shows a consistently lower rate 

of underreporting and significantly improved reporting in certain subgroups. It ‘wasnot successful 

however in eliminating some patterns of underreporting, such as episodes involving one-day 

stays, and those episodes 40 weeks or more prior 

to the interview. 

FOLLOW-UP 

TO PROCEDURES B AND C 

Both Procedures B and C included self-administered forms for the reporting of hospitalizations. Procedure C relied entirely on the self-administered form for information on hospitalization. In Procedure B, however, all households 

where interviews had been completed were mailed 

a questionnaire for the purpose of eliciting hospitalizations which were not reported in the interviews. A brief description of both procedures 

is given in the first section of this report. The 

questionnaires used are shown in Appendix II. 

Follow-up to the self-administered procedure 

for nonresponse included one mail inquiry to all 

sample households not responding within a week 

of initial contact. Further follow-up to those not 

responding to the mail inquiry was made by telephone where possible and by personal visits when 

a telephone contact could not be made. 

The reason for using a follow-up questionnaire in Procedure B was the finding from Special 

Study No. 8 that a personal follow-up interview 

was successful in obtaining episodes not originally 

reported. It was felt that a mail follow-up might 

achieve the same results and be financially feasible in the National Health Survey. 

Table C shows that for Procedure B, 96 percent of the episodes finally obtained were reported 

during the interview. The follow-up procedures 

produced an additional 21 episodes. This resulted 

in a reduction of 3 percentage points in the underreporting rate, from 9 percent to 6percent including overreports, or 12 percent to 9 percent, excluding overreports (table D). 

Along most dimensions the 21 episodes which 

were reported in the follow-up for Procedure B 

were evenly distributed. There were, however, 

several groups for which the foIlow-up procedure 

was particularly effective in reducing the underreporting. The most obvious of these is that 11 of 

the 21 episodes were reported by parents for 

children under 17 years of age. This reduced the 

underreporting rate for children from 13 percent 

without the follow-up to 6percent when the followup episodes were added (table E). Note also in 

table E that self-respondents reported no better in 

the direct interview part of Procedure B than they 

did in the other procedures. However, the Procedure B interview was especially effective in 

eliciting hospital episodes from respondents 

answering for other adults. 

The second largest reduction in the underreporting rate was for nonwhite sample persons. 

The rate for white persons was only slightly 

affected, but the nonwhite underreporting rate was 

reduced from 21 percent to 10 percent when the 

follow-up reports were added. 

Two income groups show marked improvement as a result of the follow-up report. The underreporting rate for persons with an annual in12 
---------------------------

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

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

------

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

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

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

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

Table C. Number and percent distribution of hospital episodes reported in Procedure B,


by manner in which hospitalization report was obta’ined, including and excluding over-


reports


Manner in which hospitalization report Including overreports Excluding overreports


was obtained
 Number Percent Number Percent


I


Total 526 100 510 100 

I 

Household interview 505 96 490 96 

First mail form 10 2 10 2 

Second mail form---------------------- 1 3 1


Telephone or personal follow-ups : 1 7 1


Table.D. Cumulative number and percent of underreporting of hospital episodes in l%o­


cedure B, by manner in which hospitalization report was obtained, including and ex­


cluding ove”rreports


Including overreports Excluding overreports


Manner in which hospitalization Cumulative Cumulative Cumulative Cumulative


report was obtained interview percent interview percent


reports under - under -
 reported* reports 

reported*


Household interview 505 9 490 12


First mail form--------------------- 515 8 500 10


Second mail form 518 503 10


Telephone or personal follow-ups---- 526 : 510 9


*Thecumulative percentage of558hospital epkodesfromhosphalr ecordswhichhad notbeenreported after
 eachrespective


stepwm completed.


Table E. Comparison of underreporting of hospital episodes for proced~e B, with and


without follow-up, with Procedures A and C, by type of respondent


Type of respondent


Self----------------------------


Proxy for adult


Proxy for child


Procedure A Procedure B Procedure C


Percent


Percent underreported Percent


‘nderrepOrtedl==

10 6 9 9


21 6 8 16


15 6 13 12


13

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

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

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

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

come of less than $2,000 was reduced from 25 

percent to 11 percent by the addition of the follow-up reports; the underreporting rate for persons in the $7,000-10,000 category dropped from 

8 percent to 3 percent. 

A consideration of the follow-up reports in 

terms of diagnostic rating reveals no differences 

between high and low threat episodes. For all 

three categories, alxmt one third of the episodes 

not reported in the interview were reported in the 

follow-up. 

It was thought that the follow-up might help 

pick up the very short stays which tend to be forgotten. In fact, the opposite was true. Of the 32 

five or more stays not reported in the interview, 

11 were reported in the follow-up; but only 2 of 

14 unreported one-day stays were obtained in the 

follow-up. It can be concluded from this that respondents generally did not consult records to 

fill out the follow-up questiomaire, that the kinds 

of episodes which were reported in the follow-up 

were important episodes which were not likely to 

be forgotten. Actually since the numbers are 

small, no definite conclusions are made. But at 

least it seems safe to state that the short, easily 

forgotten stays, which the respondent is not likely 

to remember on the spur of the moment, were not 

well reported in the follow-up in ProcedureB. 

In regard to the interval between the hospital 

discharge and the interview, an interesting phenomenon occurred. No hospital episodes within 10 

weeks of the interview were reported in the follow-up. And, although there were 46 underreports 

after the interview among episodes which occurred 

31 weeks or more before the interview, only 10 

were reported in the follow-up. The greatest improvement in reporting, therefore, pertained to 

episodes which occurred 10 to 30 weeks prior to 

the interview. For these, the underreporting rate 

was reduced from 8 percent to 3 percent when the 

follow-up reports were added. 

These data indicate that the follow-up questionnaire of Procedure B is capable of reducing 

substantially the number of hospital episodes not 

reported in household interviews. In general, the 

follow-up was most effective among groups in 

which the underreporting rate was still high after 

the interview. The exception was among hardcore-like episodes with one-day duration,’ ‘threatening” diagnoses, and episodes which occurred 

more than 30 weeks prior to the interview. 

This suggests that the follow-up would have 

produced more striking effects than it did had it 

been used in connection with less successful 

Procedure A. 

For the self-administered form in Procedure 

C, table F shows the percent distribution of returns. Three fourths of the questionnaires left 

with the respondent by the interviewer were returned without follow-up. As shown in table G, 

had no follow-up been made, over one third of the 

episodes would not have been reported. 

Tables H and 1, show underreporting rates by 

the manner in which the hospitalization report was 

obtained. Underreporting rates by the person who 

filled out the follow-up forms for Mb Procedures 

B and C are shown in table 12. It is felt that these 

tables relate more to the characteristics of respondents than they do to the follow-up procedures. 

Tables H and I indicate that the persons who 

mailed in the first or second forms were much 

more inclined to report hospitalizations than those 

who had to be contacted a third time, either by 

telephone or by a personal visit. The implications 

of these tables seem to be apparent. Persons who 

Table F. Number and percent distribution of hospital episodes reported i,n Procedure C, 

by manner in which hospitalization report was obtained, including and excluding over -

reports 

Manner in which hospital- Including overreports Excluding overreports


i.zation report was obtained Number Percent Number Percent 

Total 471 100 459 100 

Fir”st mail form 349 74 343 75 

Second mail form 65 14 64 14 

Telephone or personal 

follow-up 57 12 52 11 

14 
---------------------

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

-----

-----------

-------

------

------

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

-------

------

---------

Table G. Cumulativenumber and percent of underreporting of hospital episodes in Pro­


cedure C, by manner in which hospitalizationreport was obtained, including and ex­


eluding overreports


Including overreports Excluding overreports


Manner in which hospitalization Cumulative


report was obtained Cumulative percent
 interview under-
 reports reported =!=
 I 

i


First mail form 349 36 343 37


Second mail form 414 24 407 25


Telephone or personal follow-uP 471 14 459 16


Table H. Number and percent of underreporting for procedure B, by the manner in which


hospitalizationreport was obtained, including and excluding overreports


Including overreports Excluding overreports


Manner in which hos-


pitalizationwas Percent
 Interview Hospital Percent Interview Hospital obtained under-
 under-
 reports records reported reports records reported


Total 526 558 6 510 558 9


First mail form 371 388 4 361 388 

Second mail form 68 72 6 66 72 : 

Telephone or personal follow-up 85 95 11 81 95 

Unknown 2 3 (*) 2 3 (:; 

Table I. Number and percent of underreportingof hospital episodes in Procedure C, by


the manner in which hospitalization report was obtained, including and excluding


overreports


Including overreports Excluding overreports


Manner in which hos­


pitalizationreport Interview Hospital Percent Interview Hospital Percent


was obtained under- under-
 reports records reported reports records reported


Total----------- 471 546 14 4!59 546 16


First mail form 349 394 11 343 394 13 

Second mail form 65 75 13 64 75 15 

Telephone or personal follow-up 57 77 26 52 77 32 

15

were prone to co-operate with the study would do 

so both by reporting hospitalizations thoroughly 

and by returning the mail form promptly. Those 

who had to be contacted repeatedly seemed to be 

less interested and unwilling to be helpful. 

In a similar vein, table 12 shows that it makes 

considerable difference whether or not the sample person or the person who was originally interviewed completed the self-administered form. 

One obvious hypothesis is that a respondent who 

was interested in a study would sit down and fill 

out the form herself, while a less interested respondent might give it to someone else to complete. Another relevant point would seem to be 

that the original interview respondent would be 

more familiar with the reasons for which the study 

was being conducted through contact with the interviewer than, for instance, her husband, and 

therefore might do a more thorough job of filling 

out the form. 

An added by-product of the follow-up to Procedure B was the use of the data to correct information obtained in the interview. Thirty-six of 

490 interview reports (7 percent) were corrected 

in some significant way by the use of information 

obtained in the follow-up. Most of these corrections related to reported length of stay, month of 

discharge, or diagnosis. 

COMPARISON OF 

UNDERREPORTING IN THE THREE 

PROCEDURES BY CHARACTERISTICS 

OF THE RESPONDENTS 

‘l%is study was not designed to permit a very 

satisfactory analysis of the reasons why one procedure performed better than another in obtaining 

hospitalizations. Except for the mail follow-up to 

Procedure B, this was an “all or none” design; 

that is, if one procedure was significantly better 

than the other, this procedure would need to be 

adopted in its entirety since the factors leading to 

improvement could not be isolated. However, certain tendencies in the data do support hypotheses 

as to the reasons for the outcome of the various 

procedures. In this section the focus is on the 

characteristics of respondents to see whether significantly different patterns of reporting are obtained by the three procedures. It should be remembered that about 40 percent of the respondents were reporting for themselves and the remainder for some other family member. 

Table 13 shows the reporting rates by survey 

procedure and sex of the respondent. For all procedures the underreporting rates were lower for 

female respondents than for males. However, except for Procedure C, the differences are not 

statistically significant. For both men and women 

respondents, Procedure B shows a considerably 

lower rate of underreporting than Procedures A 

and C. 

Another point of interest is that a higher proportion of respmdents in Procedure C were male; 

28 percent for Procedure C compared with 19 

percent for Procedure A and 17 percent for Procedure B. For 73 episodes the sex of the respondent was unknown. However, there is no indication 

that these were predominantly female. It can be 

hypothesized that filling in a questionnaire is part 

of the role of the male family head. If this hypothesis is true, a sizable number of persons filling 

in the mail form on Proceduke C were different 

from the respondents in the interview part of 

Procedure C. Thus, if the interviewer did anything 

to instruct the interview respondent or motivate 

him to fill out the mail form, the effort was either 

wasted or at best transmitted indirectly to the 

person who actually filled out the form. This 

could account for the higher underreporting rate 

for male respondents in Procedure C. 

Table 14 shows that in Procedure A, older 

respondents tend to be poorer reporters of hospital episodes than younger respondents. This is 

consistent with previous findings in Special Study 

No. 8. The relationship with age disappears in 

Procedures B and C. The reason for this difference is not apparent. 

The relationship between the education of the 

respondent and the underreporting of hospital episodes can be seen in table 15. There is a clear 

pattern in Procedure A—thehigher the educational 

level, the better the reporting. This pattern does 

not show up in Procedures B and C. In fact, one 

of the impressive differences between Procedures 

A and B was the significantly better reporting of 

hospitalizations among the lower educational 

groups in Procedure B, in which there were essentially no differences in underreporting attributable 

to the educational level. 

The findings for Procedure C are not clear 

because of the large group for which the respondent could not be ascertained. Disregarding this, 

the education of the respondent has only a slight 

effect on reporting of hospitalizations. 

In the interviews, respondents were asked to 

report chronic and acute conditions experienced 

by members of the family. Table 16 shows the 

relationship between the number of these condi -

16 
tions reported for the sample person and the rate 

of underreporting of hospital episodes. It seems 

clear for all three procedures, that the underreporting rate decreased as the number of conditions reported for the sample person increased. 

This relationship is also evident, but to a lesser 

degree, when underreported episodes are distributed by the number of conditions reported for 

the respondent. 

There are several factors which might explain this relationship. (1) A respondent who 

tends to be particularly conscious of health conditions of himself and his family may be more 

likely to recall illnesses as well as hospitalizations; (2) the sample person may be considered 

to be “ailing” and the reporting is a reflection of 

this perception; (3) that persons for whom several conditions were reported tended to have had 

recent (and, hence, better reported) hospitalizations; and (4) that reporting Imth hospitalizations 

and illnesses is an index of how hard the respondent tries to give information. If this is so, 

then reporting can be considered as an indication 

of the level of motivation of the respondent to 

report. 

Except for the mail follow-up of Procedure B 

where a reduction in the underreporting rate of 3 

percentage points was obtained, it is not clear how 

much difference each change in procedure made 

in reporting of episodes. From the patterns reported above, it may be that asking about each 

family membex individually and asking additional 

probes were useful to stimulate memory and improved reporting, particularly among proxy respondents. Also it may be that these factors 

assisted older persons in recalling episodes more 

readily. 

Reduction in underreporting for episodes of 

short duration and for those some time prior to 

the interview may be attributable to the added 

probes, one of which specifically asked for short 

stays and distant episodes. 

ACCURACY OF REPORTING 

LENGTH OF STAY AND DATE 

OF DISCHARGE 

‘Ihe preceding analysis has included only one 

type of reporting accuracy, the completeness with 

which persons report hospitalizations. There is 

another aspect of reporting which is also important in evaluating field procedures. namely, 

~he accuracy with w-hich d~tails of hospitalizations are reported. One aspect of this question 

would be the accuracy of reported diagnoses but 

unfortunately there are very few cases in any 

given diagnostic category, thus the data are not 

very meaningful. Another consideration is the accuracy with which the month of discharge and 

length of stay were reported. 

It was expected that a self:administered 

form, such as was used in Procedure C, would 

provide an opportunity for persons to refer to 

records, consult other members of the family, 

and generally give more time and thought to their 

responses. While Procedure C did not substantially increase the percentage of hospitalizations 

reported, tables 17 and 18 show that the information that was obtained ahout hospital episodes 

tended to be more accurate than the information 

in either Procedures A or B. 

The tables are generally self-explanatory. 

Slightly better reports on the month of discharge 

was obtained with Procedure C, and the improvement over Procedure A is even more marked in 

the reporting of the length of stay. Slightly more 

accurate reports with Procedure B were obtained 

on the length of stay, than Procedure A, but was 

essentially no more accurate than Procedure A 

on the month of discharge. 

An interesting feature of table 17 is that 

misreporting of the month of discharge in Procedure A tended to err in the direction of understating the interval of time that had lapsed since 

the hospitalization, while in Procedure B the reverse seemed to be true. The numbers involved, 

however, are quite small. There is a consistent 

tendency in all three procedures for the length of 

stay to be exaggerated. 

With respect to accuracy of information collected, Procedure C seemed to be superior to 

both of the other procedures, supporting the hypothesis that respondents who take the time to fill 

out a self-administered form can do a better job 

than those who respond to an interview. The data 

suggest that the primary obstacle in Procedure C 

is to motivate respondents to take the time to 

complete the form. 

17 
-------------------------------

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

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

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

DETAILED TABLES 

Table 1.


2.


3.


4.


5.


6.


7.


8.


9.


10.


11.


12.


13.


14.


15.


16.


17.


18,


Percent of hospital episodes underreported, by survey procedure and sex of sample


person, including and excluding overreports--------------------------------------


Percent of hospital episodes underreported, by survey procedure and age of sample


person, including and excluding overreports--------------------------------------


Percent of hospital episodes underreported, by survey procedure and race of sam­


ple person, including and excluding overreports----------------------------------


Percent of hospital episodes underreported, by survey procedure and family in-


come, including and excluding overreports----------------------------------------


Percent of hospital episodes underreported, by survey procedure and education of


sample person, including and excluding overreports


Percent of hospital episodes underreported, by survey procedure and relationship


of sample person to respondent, including and excluding overreports--------------


Percent of hospital episodes underreported, by survey procedure and number of


days in hospital, from hospital records, excluding overreports


Percent of hospital episodes underreported, by suwey procedure and diagnostic


rating of diagnosis, from hospital records, excluding overreports----------------


Percent of hospital episodes underreported, ILYsurvey procedure and type of treat­


ment, from hospital records, excluding overreports-------------------------------


Percent of hospital episodes underreported, by survey procedure and number of


weeks between hospital discharge and interview, excluding overreports------------


Percenc of hospital episodes underreported, by survey procedure and number of


hospital recorded episodes during the reference year for the sample person, in


eluding and excluding overreports


Percenc of hospital episodes underreported, by survey procedure and relationship


of respondent for the self-administered questionnaire to the respondent for the


household interview, including and excluding overreports-------------------------


Percent of hospital episodes underreported, by survey procedure and sex of re­


spondent, including and excluding overreports


Percent of hospital episodes underreported, by survey procedure and age of re­


spondent, including and excluding overreports------------------------------------


Percent of hospital episodes underreported, by survey procedure and education of


respondent, including and excluding overreports----------------------------------


Percenc of hospital episodes underreported, by survey procedure and number of


chronic or acute conditions reported for the sample person, including and ex­


cluding overreports--------------------------------------------------------------


Number and percent distribution of reported hospital episodes, by accuracy of re-


porting month of discharge and by survey procedure, excluding overreports--------


Number and percent distribution of reported hospital episodes, by accuracy of re-


porting length of stay and by survey procedure, excluding overreports------------


1----

rage


19


19


20


20


21


22


23


24


24


25


26


27


28


28


29


30


31


31


18

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

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

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

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

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

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

--------

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

Table 1. Percent of hospital episodes underreported, by survey procedure and sex of sample person,


including and excluding overreports


. 

Including overreports Excluding overreports 

Survey procedure and sex 

of sample person Interview Hospital Percent 

reports records underreported 

Procedure A


Total------------- 448 521 14


Male 194 229 15 184 229 20


Female 254 292 13 247 292 15 

r 

Procedure B 

I t 

Total 558 6 510 558 9 

P


Male 231 240 4 223 240 7


Female------------------ 295 318 7 287 318 10


Procedure C


Total------------- 471 546 14 459 546 16 

L 

Male 220 255 14 217 255 15 

Female I 251 291 14 242 291 17 

Table 2. Percent of hospital episodes underreported, by survey procedure and age of sample person,


including and excluding overreports


Including overreports I Excluding overreports


Interview Hospital Percent I

Interview Hospital Percent


reports records underreported reports records underreported


Survey procedure and age


of sample person


Procedure A


Total-------------


0-17 yeara--------------


18-34 years-------------


35-54 years-------------


55 years or over


Procedure B


Total--J----------


0-17--------------------


18-34 years-------------


35-54 years-------------


55 years or over--------


Unknown-----------------


Procedure C


Total


O-L7 years--------------


18-34 years-------------


35-54 years-------------


55 years or over--------


448 521


138 162


100 111


111 132


99 116


526 558


151 161


114 121


149 163


112 112


0 1


471 546


136 156


103


1:; 172


101 115


14 431 521 17 

15 136 162 16 

10 98 111 12 

.16 104 132 21 

15 93 116 20 

6 510 558 9 

6 149 161 7 

6 112 121 7 

9 144 163 12 

105 112 

(*; o 1 (*; 

14 459 546 16 

13 133 156 15 

15 88 103 15 

15 141 172 18 

12 97 115 16 

19

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

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

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

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

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

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

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

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

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

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

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

---------

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

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

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

---------

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

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

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

---------

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

Table 3. Percent of hospital episodes.underreported,by surve procedure and race of sample per­


son, includingand excludingover ;ports


Includingoverreports Excludingoverreports


Survey procedureand


race of sample person Interview Hospital PercenC Interview Hospital


reports records underreported reports records


ProcedureA I I I


Total 448 521 14 431 521


Nonwhite 50 67 I ;: 49 67 

ProcedureB 

I I I 

Total 526 I 558 I 6 510 558 

I I


White 398 454 382 454


I 

White 444 481


Nonwhite
 I 4~d4~~ ; 66 77 

ProcedureC I I 1


Total 471 546 14 459 

I 1 

White-------------------I 409 464 12 399 464 

Nonwhite 62 82 24 60 82 

Table 4. Percent of hospital episodesunderreported, by survey procedureand fam


eludingand excludingoverreporta


Percent


underreported


17


16


27


9


8


14


;;


.yincome, in­


‘eports


Percent


underreported


17


16


21


12


15


36


c1 

Survey procedureand


family income


ProcedureA


Total


Under $4,000------------


$4,000-6,999


$7,000-9,999


$10,000 or over


Unknown


ProcedureB


Total


Under $4,000------------


$4,000-6,999------------


$7,000-9,999


$10,000or over


Unknown


Procedurec


Total


Under $4,000------------


$4,000-6,999


$7,000-9,999------------


$10,000or over


Unknown


Includingoverreports


F 

448 521 14 

103 11 

1% 199 17 

108 120 10 

73 85 14 

9 14 36 

m

12 15 20 

471 546 14 

115 131 12 

140 173 19 

111 122 9 

85 96 11 

20 24 17 

Excludingove


Interview Hospital


reports records


+ 

1

87 103


158 199


105 120


72 85


9 14


510 558


104 119


207 226


105 109


82 89


12 15
 --1-- 459 546
 16 

110 131 16 

138 173 20 

108 122 11 

84 96 12


19 I 24


20

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

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

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

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

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

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

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

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

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

Table 5. Percent of hospital episodes underreported, by survey procedure and education of sample


person, including and excluding overreports


Survey procedure and


education of


sample person


Procedure A


Total


O---h~rs elementary


1-3 years high school---


4 years high school-----


1 year of college or


more


Inappropriate (child


under 17)--------------


Unknown


Procedure B


Total


0-8 years elementary


school-----------------


1-3 years high school---


4 years high school------


1 year of college or
 more


Inappropriate (child


under 17)--------------


Unknown-----------------


Procedure C


Total


0-8 years elementary


school-----------------


1-3 years high school---


4 years high school-----


1 year of college or


more


Inappropriate (child


under 17)--------------


Unknown


Including overreports Excluding overreports


Interview Mospital Percent [nterview Iospital Percent


reports records underreported reports records underreported


i 448 521 14 431 521 17


88 103 15 83 103 19 

84 96 12 79 96 18 

98 108 9 94 108 13 

42 53 21 41 53 23 

135 158 133 158 

1 3 (:; 1 3 (:; 

526 558 6 510 558 9


118 128 8 113 128 12 

96 98 2 91 98 7 

112 120 7 110 120 8 

49 51 4 47 51 8 

145 155 143 155 

6 6 (*: 6 6 (*; 

471 546 14 459 546 16


99 120 17 95 120 21 

89 105 15 86 105 18 

94 108 13 93 108 14 

52 55 5 51 55 7 

133 153 130 153 

4 5 &) 4 5 (:; 

21

---------

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

---------

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

Table 6. Percent of hospital episodes underreported, by survey procedure and relationship of sa&­


ple person to respondent, including and excluding overreports


Survey procedure and


relationship of sample


person to respondent


Procedure A


Total-------------


Self-respondent


Sample person is child


of respondent----------


Sample person is


adult but not


self-respondent--------


Unknown-----------------


Procedure B


Total-------------


Self-respondent---------


Sample person is child


of respondent----------


Sample person is


adult but not


self-respondent--------


Unknown-----------------


Procedure C


Total


Self-respondent


Sample person is child


of respondent----------


Sample person is


adult but not


self-respondent--------


Unknown


Including overreports Exclud%ng overreports


Interview Hospital Percent Interview Hospital Percent


reports records underreported reports records mderreported


448 521 14 431 521 17 

209 231 10 202 231 13 

134 158 15 132 158 16 

100 126 92 126


5 6 (:; 5 6 (:;


526 558 6 510 558 9


241 257 6 231 257 10


146 155 6 144 155 7


136 144 133 144


3 2 (*; 2 2 ($


471 546 14 459 546 16


162 179 9 160 179 11


119 135 12 116 135 14


129 153 125 153 18


61 79 ;: 58 79 27


22 
-------------------------------------

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

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

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

Table 7, Percent of hospital episodes underreported, by survey procedure and number of days in


hospital, from hospital records, excluding overreports


Excluding overreports


Survey procedure and number of days in hospital


Interview Hospital Percent


reports records underreported


Procedure A


Total-----------------------------------------


1 day-----------------------.-----------------------


2-4 days--------------------------------------------

5-7 days--------------------------------------------


8-14 days-------------------------------------------


15 days or more


Procedure B


Total


1 day-----------------------------------------------


2-4 days--------------------------------------------


5-7 daya--------------------------------------------


8-14 days-------------------------------------------


15 days or more 

Procedure C 

Total-----------------------------------------

1 day-----------------------------------------------

2-4 days--------------------------------------------

5-7 days--------------------------------------------

8-14 days----:-------------------------------------­


15 days or more


431 521 17 

39 49 20 

122 154 21 

105 125 16 

111 127 13 

54 66 18 

510 558 9 

44 56 21 

169 184 8 

98 109 10 

130 136 4 

69 73 5 

459 546 16 

34 42 19 

145 178 19 

102 119 14 

107 126 15 

71 81 12 

23

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

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

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

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

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

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

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

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

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

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

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

Table 8. Percent of hospital episodes underreported, by survey procedure and diagnostic rating


from hospital records, excluding overreports


Survey procedure and diagnostic rating


Procedure A


Total


Most threatening------------------------------------


Somewhat threatening--------------------------------


Not threatening-------------------------------------


Untion ---------------------------------------------


Procedure B


Total-----------------------------------------


Most threatening------------------------------------


Somewhat threatening--------------------------------


Not threatening-------------------------------------


Unknom


Procedure C


Total


host threatening------------------------------------


Somewhat threatening--------------------------------


Not threatening-------------------------------------


Unknom ---------------------------------------------


Table 9. Percent of hospital episodes underreported,


Excluding overreports


Interview Hospital Percent


reports records underreported


431 521 17 

66 84 21 

92 111 17 

272 325 

1 1 ($ 

510 558 9 

97 110 12 

117 127 8 

292 315 

4 6 (*; 

459 16 

70 89 21 

85 102 17 

302 353 

2 2 ($ 

by survey procedure and type of treatment,


from hospital records, excluding overreports


Excluding overreports


Survey procedure and type of treatment


F==”


Procedure A


Total


Surgical


Nonsurgical


Untiow


Procedure B


Total i 

Surgical--------------------------------------------


Noflsurgical


Unknom


Procedure C


Total-----------------------------------------


Surgical--------------------------------------------


Nonsurgical


Unkno----------------------------------------------
L

313


193


4


459


286


171


2


Hospital Percent 

records I underreported 

1 k (*) 

558 9


334 I 6


218


6


24

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Table 10. Percent of hospital episodesunderreported,by survey procedureand number of weeks be­


tween hospital-dischargeand interview;excludingoverreports


Excludingoverreports


Survey P, edure and number of weeks between 

h~.r,(.taldischargeand interview Interview


reports


Pr,>cedure
A

Total


1-10 weeks


11-20 weeks


21-30 weeks


31-40 weeks


41-53 weeks


ProcedureB


Total


1-10 weeks


11-20 weeks


21-30 weeks


31-40 weeks


41-53 weeks


ProcedureC


Total


1-10 weeks


11-20 weeks


21-30 weeks


31-40 weeks


41-53 weeks


431


49


112


89


97


84


510


47


126


114


115


108


459


48


116


91


99


105


# 

Hospital Percent


records underreported


521	I 17


I


52


123 :


100 11


122 20


124 32


558	I 9


I


8


1% 3


118


126 ;


133 19


56 14


129 10


104 12


.
 122 19


135 22


25

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

------

------

------

Table 11. Percent of hospital episodes underreported, by survey procedure and number of hospital


recorded episodes during the reference year for the sample person, including and excluding wer­


reports
 ,


Including overreports Excluding overreports
 Survey procedure and


number of hospital


recorded episodes Interview Hospital Percent Interview Hospital Percent


reports records underreported reports records underreported


Procedure A


Total 448 521 14 431 521 17


1 episode--------------- 354 410 14 339 410 17


2 episodes-------------- 78 90, 13 76 90 16


3 episodes or more 16 21 24 16 21 24 

Procedure B 

Total------------- 526 558 6 510 558 9 

1 episode--------------- 364 381 4 353 381 7 

2 episodes-------------- 105 114 8 103 114 10 

3 episodes or more 57 63 10 54 63 14 

Procedure C 

Total------------- 471 546 14 459 546 16 

1 episode--------------- 350 401 13 342 401 15 

2 episodes-------------- 92 102 10 90 102 

3 episodes or more 29 43 33 27 43 :;

Table 12. Percent of hospital episodes underreported, by survey procedure and relationship of re­


spondent for the self-administered questionnaire to the respondent for the household interview,


including and excluding overreports


Survey procedure and re­


lationship of respondent Including overreports Excluding overreports


for self-administered


questionnaire to Interview Hospital Percent Interview Hospital Percent


household interview reports records underreported reports records underreported


respondent


Procedure B


Total------------- 526 558 6 510 558 9 

Self-respondents, same 

respondent as in 

interview-------------- 113 116 3 109 116 6 

Proxy-respondent, same 

respondent as in 

interview-------------- 118 122 3 115 122 6 

Sample person, not 

interview respondent--- 36 36 0 35 36 3 

Neither sample person 

nor interview 

respondent------------- 66 75 12 65 75 13 

More than one person---- 23 24 4 22 24 8 

Unknown----------------- 170 185 8 164 185 11 

Procedure C 

Total------------- 471 546 14 459 546 16 

Self-respondent; same 

respondent as in 

interview-------------- 136 152 11 134 152 12 

Proxy-respondent, same 

respondent as in 

interview-------------- 159 180 12 156 180 13 

Sample person, not 

interview respondent--- 25 26 4 25 26 4 

Neither sample person 

nor interview 

respondent------------- 64 79 19 62 79 22 

More than one person---- 23 27 15 22 27 19 

Unknown----------------- 64 82 22 60 82 27 

27 
--------------------

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I 

Table 13. Percent of hospital episodes underreported, by survey procedure and sex of respondent,


including and excluding overreports


I Including overreports 

Survey procedure and


sex of respondent Interview


reports


Procedure A
 ,


Total-------------


Male


Female


Unknown


Procedure B


Total


Male


Female------------------


Unknown


Procedure C


Total


Male


Female


Unknown


448


80


360


8


471


124


289


58


Hospital Percent


records underreported


L

415


9 (i;


558 6


94 I 9


L

462


2 (*;


546 14


152 18


321 10


73 21


Excluding overreports


Interview Hospital Percent I reports records underreported 

431 521 17


77 97 21


82!’ 94 I 13 

ILL 

120 152 21

285 321 11 

54 73 26 

Table 14. Percent of hospital episodes underreported, by survey procedure and age of respondent,


including and excluding overreports


Survey procedure and


age of respondent


Procedure A


TOtai -------------


0-17 years--------------


18-34 years-------------


35-54 years


55 years or over--------


Unknown


Procedure B


Total


0-17 years--------------


18-34 years-------------


35-54 years-------------


55 years or over--------


Unknown


Procedure C


Total


0-17 years


18-34 years-------------


35-54 years-------------


55 years or over--------


Unknown


Including overreports


Interview Hospital Percent


reports records underreported


448 _5’2J 

2 2


166 187


180 213


94 112


6 7


526 I 558


3


18? 197


238 254


101 101


3 3


T

471 546


4 5


157 177


186 218


82 89


42 57


11 

15


$


8


6


(*;


14


~


11


15


8


26


Excluding overreports


431 521 

2 2 (; 

162 i87 13 

173 213 19 

88 112 

6 7 (:; 

510 558 

3 3 (*; 

178 197 10 

233 254 8 

94 101 

2 3 (*; 

459 546 16 

4 (*) 

154 17; 13 

182 218 17 

78 89 12 

41 57 28 

28

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

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

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

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

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

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

Table 15. Percent of hospital episodes underreported, by survey procedure and education of re­


spondent, including and excluding overreports


Including overreports Excluding overreports


Survey procedure and


education of Interview Hospital Percent Interview Hospital Percent


respondent reports records underreported reports records underreported


A


Procedure A


Total------------- 448 521 14 431 521 17


O;~h::s elementary 

105 129 19 97 129 25 

1-3 years high school--- 127 154 18 122 154 21 

4 years high school----- 153 170 10 149 170 12 

1 year college or more-- 54 59 54 59 

Unknown 9 9 (*; 9 9 (*; 

Procedure B


Total 526 558 6 510 558 ,9 

0-8 years elementary 

school----------------- 153 159 4 145 159 9 

1-3 years high school--- 124 134 7 122 134 9 

4 yearn high school----- 165 175 6 161 175 8 

1 year college or more-- 83 89 81 89 

Unknown 1 1 (*; 1 1 (*; 

Procedure C


To’cal 471 546 14 459 546 16


0-8 years elementary 

school----------------- 88 98 10 84 98 

1-3 years high school--- 109 125 13 104 125 

4 years high school----- 145 168 14 145 168 

1 year college or more-- 63 11 63 

Unknown 64 ii 21 61 ;: 

Inappropriate----------- 2 3 (*) 2 3 

29

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

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

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

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

Table 16. Percent of hospital episodes underreported, by survey procedure and number of chronic or 

acute conditions reported for the sample person, including and excluding overreports 

Survey procedure and Including overreports


number of chronic or


acute conditions re- Interview Hospital Percent


ported for sample reports records underreported


person


Excluding overreports


Interview Hospital Percent


reports records underreported


Procedure A


Total


None


1 or 2 conditions-------


3 conditions or more----


Procedure B


Total


None


1 or 2 conditions-------


3 conditions or more----


Procedure C


Total-------------


None--------------------


1 or 2 conditions-------


3 conditions or more----


448 521 14


98 129 24


205 236 13


145 156 7


526 558 6 

112 126 11 

276 293 6 

138 139 1 

471 546 14


112 148 24


222 253 12


137 145 6


T

431 521’


97 129


199 236


135 156


-4-

112
 126


270 293


128 139


459 546
 -1-
 111 148


216 253


132 145


17


25


16


13


11


8


8


25


15


9


30

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

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

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

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

-----------

----------

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

Table 17. Number and percent distributionof reportedhospital episodes,by accuracyof reporting


month of dischargeand by survey procedure,excludingoverreports


-

Excludingoverreports


Accuracy of reportingmonth ProcedureA ProcedureB I ProcedureC
 of discharge


I


Number IPercent Number Percent


I 

Reported to have occurredafter month of


9


Total - 431 100 510 100 459 100 , 

Reported to have occurredbefore actual 

month of discharge” 41 9 76 15 35 8 

discharge 59 14 46 T 37 8 

Reportedin actual month of discharge---- 331 77 386 76 380 83 

Unknown 0 0 2 0 7 1 

*Themonthofadmission
 wasasked forin Pmcedurs A. The month of discharge was then computed for this table. 

Table 18. Number	and percent distributionof reportedhospital episodes,by accuracyof reporting


length of stay and by survey procedure,excludingoverreports


b


Excluding overreports


Accuracy of reporting length Procedure A Procedure B Procedure C 

of stay 

Number Percent Number Percent Number Percent


Total------------------------------ 431 100 510 100 459 100 

More than actual days reported 138 32 152 30 138 30 

Fewer than actual days reported 110 26 115 23 61 13 

Exact number of days reported 181 42 241 47 259 57 

Unknown---------------------------------- 2 0 2 0 1 0 

31

APPENDIX I


PART 1: SAMPLING ERRORS


l%e standard errors for the estimates in this report were calculated by use of the following equatiom 

(The standard error is the square root of S:). 

m’ + ~’o’ s:= W (“;, x, - ‘RoY: x) ., 

where: u:i 

2 

‘JYixi are defined similarIy. = xi and

m= number of interviews for a given procedure. 

Yi =	 number of episodes ~ reported for sample persons in households interviewed by 

the i* interviewer. 

xi= total number of hospital episodes, base”d 

on hospital records, for all sample persons in households interviewed by the i

th 

interviewer. 

x= z Xi = total number of hospital episode% 

based on hospital records, for all sample 

persons in a survey procedure. 

R .	 z ‘i.. hospitalization underrePorting rate. 

z xi 

As may be seen, this formula treats the interviewers for a procedure as clusters. From the underreporting rates for the 10 clusters for Procedure A or Procedure B and 20 for Procedure C, the variance of estimates of underreporting may be generated, either for 

the total sam~e for subgroups within the sample. 

The estimate. To “the variance follows the standard 

procedure for cluster sampling. (e.g., W.G. CocbraW 

32 

Sampling Techniques, New York Wiley, 1953, p. 119.) 

This model was used on the advice of Dr. Leslie Kish, 

as a practical, useful approximation that fitted well 

enough, though not completely. the actual desire which 

was ;o”mewh& more complicated. Dr. Kish su&wised 

the computations and the construction and use of the 

tables of the sampling errors. 

For purposes OF comparing Procedures A and B, 

since the interviewers were different and yet randomly 

assigned to procedures, it was pessible to assume that 

the repcwt rates in the two procedures were independ. 

ent. In comparing Procedures A and C, however, since 

half of the interviewers in Procedure C were also the 

interviewers for procedure A, it was necessary to 

compute the covariance between Procedures A and C 

for estimating the variance of differences. 

Table I shows standard errors for selected characteristics of the sample as well as standard errors of 

differences between percentages for Procedures A and 

B, and between Procedures B and C. The Procedure B 

estimates include the results of the mail follow-up 

form. 

In general, and as demonstrated in table I, the 

standard error of one statistic is different from that of 

another statistic, even when the two come from the 

same survey. Since it was not feasible to compute 

standard errors for each of the many statistics in the 

report, ratios of the standard errors shown in table I 

to the standard errors of binomial variates, assuming 

simple random sampling, were computed. The ratios 

ranged from a low of about 0.7 to a high of about 2.2. 

The median value was 1.4. Rough estimates of standard 

errors of percentages shown in this report, which should 

be sufficiently accurate for most purposes, may be ob2 tained by the equation o R � 1.4 PQ/n, where P is the 

proportion of hospital episodes underreported, Q is the 

proportion reported, and n is the number of episodes in 

the sample. 

If a more conservative estimate of the variance is 

desired, use the upper limit of the ratio instead of the 

median as the constant multiplier. 
------------------

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

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

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

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

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

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

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

---------

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

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

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

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

Table 1. Standarderrors of underreportingpercentages shown in this report and standard errors


of differencesbetween ProceduresA and B and between Procedures A and C, for selected charac­


teriaticsof the sample


Standard errors of underreporting Standard errors of


Characteristicof sample percentages X 10-2 differences X 10-2


Procedure A ~ocedure B Procedure C O(A-B) ~(A-C)


Total


Income


Under $7,000-----------------


$7,00W


Type of respondent


Self


Proxy


Race


White


Nonwhite


&


Under 17---------------------


18-54------------------------


55+--------------------------


—
Sex


Male-------------------------


Female


Threat rating


Most threatening


Somewhat threatening


Not threatening


Time intervalbetween


dischargeand interview


Under 30 weeks


31-53 weeks


Type of treatment


Surgical---------------------


Nonsurgical


2.0 1.5 1.7 2.5 1.0 

3.0 1.3 2.2 3.3 4.1


2.1 1.5 2.3 2.5 2.9


1.9 1.4 2.5 2.4 2.5


3.0 2.0 2.3 3.6 2.6


2.0 1.6 1.9 2.5 2.0


7.4 4.3 5.7 8.6 7.9


4.0 1.9 3.4 4.4 5.2


2.1 2.1 2.0 3.0 2.9


4.6 1.9 4.2 5.0 4.5


2.8 1.4 3.4 3.1 4.5


2.4 2.5 1.9 3.5 1.8


4.3 4.1 5.2 5.9 9.4


5.5 2.0 4.1 5.9 7.5


2.3 1.7 2.5 2.9 3.3


1.4 0.9


3.5 2.9 ::; H


2.0 1.4 1.7 2.4 2.3


3.6 2.5 2.8 4.4 3.4


33

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

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

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

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

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

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

----------

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

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

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

PART 2: ANALYSIS OF INTERVIEW ASSIGNMENTS 

The initial samplewas composedof600,598,and editdeletions. The deletions
 shouldnotbe considered


597 personsforProceduresA, B,andC, respectively. partofthesampleastheywouldnothavebeenincluded


However,thedatashowninthisreportisbasedon 462 in theinitial
 sample iftheycouldhavebeendetected.


personsforProcedureA, 456forProcedureB,and465 The major reasonfornonrespmse was thatthe


for ProcedureC. The difference betweenthetwosets assigned familycouldnotbe located. Follow-up
offsm­


offigures isduetononresponse anddeletions from‘the ilieswho had moved outsideof theDetroit
urbanized


sample.Table H shows theresultsof theinterview areawas notattempted.


assignments, andlists thereasonsfornonresponse
 and


Table II. Df.sposkLonof intervf.ew assf.gnments,
by survey procedure


Survey procedure
 Df,apositi,on of f.nterview
assignment


A B c 

Number of interviewsassigned 600 598 597 

Number of interviewscompleted 516 492 500 

Number of interviewsnot completed 84 106 97 

Refusal 9 8 

Not at home------------------------------------ 1; 22 32 

Fami.lynot located 59 71 53 

Other 2 4 4 

Number deleted during editing 54 36 35 

Sample person not listed in interview 32 28 26 

No hospitalizationsfor sample person 

during referenceyear 20 7 6 

Other 2 1 3 

Total number of persons includedin the 

analysis--------------”--- 462 456 465 

34 
APPENDIX II 

FORMS AND QUESTIONNAIRES USED IN THE STUDY 

B.d.et B.m.. N.. 68+sLN7: . ....-— —... —- Ammvd Exoices Iune 30. 1%1 

,ORM NN5-$ -14-1 U.S. DEPARTMENT OF COMMERCE 1. ~rid No. 22 No. of 

1.s4-., I SU” EAU 0S THE CENSUS dkchmrges 

CASE ABSTRACT FORM 

o. N.me ofho.pit.l b. Lmcation 

a. Name of ptient g. Hospiml No. ofpmcienc . PATIENT 

b. Ad&e=. (Bnt.rh . . .. N . . ..tr..!Nopt. No. oroth.r d..erfpflon; h. Diachx.ge@&a.th, d.,, P.., d.m.J 

ettr (o, o.untyJ8s@ t.) 

A.M. 

P.M. 

e. Telefione No. d. Age �. sex f. Rsce i. Admission @l.?mth. d.?, y..,, tImI.> 

O Male I_J White 

o	 Female O Nonwhite A.bf. 

P.M. 

o. Nun= of neatest rel. tive b. Relntionsbip , NEAREsT 

RELATIVE 

c. Telephone No. d. Address (E.t.r ho... No.: .tt.. t; �at. No. o,.th.r d... flptlon; .Itr @r.O..lr); St.t.J, 

OR, Ifsamcas 4b, .h.ek her.: ~.~ 

. Discharge diagnosis (LI. tln .ame .Zd.t.. .w.onrnc.rd)d) LEAVE 

BLANK 

—------- . . . ..— — 

——. —.-— 

. 

. ‘Operations 

. _—— —----- ..- --— 

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

. Rcmsrka 

35 
. 

PROCEDURE A QUESTIONNAIRE 

The items below showtbe exact contentrmd wording of the basic questionnaire used intherrationwide 

household suweyof tbe U. S. National Health Suney. Theactual questionnaire isdesigned for a household as 

a unit and includes additional spaces for reports on more than one person, condition, accident orhospitalization. Such repetitive spaces are omitted in tbis illustration. 

he Nacional Health Sutveyis authorized by PubKc Law6520f the8~h Cmgress (70 StaG4S% 42 U. S.C. 305). Allinformation wbich 

ouldpermiti drndficationo f&eindividualw illhehelds trictlyc onfidentiaI, wiNbe used only by rsons engagedin and for the purosesofrhe survey, and wilInot bedisclosed orreleased to others forrmyotherpurpses (22FR1 r S7). 

?2~~,JHS-S-14-A U.S. DEPARTWNTOF COMMERCE 

sURCAU OF THE CEN,US 

1. Questionnaire 

ACTING A5C0LLECTtNQ AGENT FOR w= U.S. PUBLIC HEALTH SERVtCE of 

I 

NATIONAL HEALTH SURVEY Queationn. ims 

(o) Address or desctipic.a of location 3. lden. 

Code 3.(0)Re& 

4. Subsample 5. sample 6. g:u 7. Se:ment 8. Serisl N 

:f$d: weight 

A


(b) Maifing address if no! shown in (a) (.)~:~gof : (d) N.ua of speciml dweltfng place i Cod. 

qumrten tI

a Housing uoit \

1 

~a Other I 

Am thmre my othor Ilvlng quarws, occupld .x INSTRUCTIONS FOR Q. 9, 10 AND 11 

waccmt, in thlc b.lfdlnS (opmtm.nt. . . . . . . . . . . . . . . . . . . . . nYes D ‘0 If “YesJ ,. ~Q qaestim~ % 10 or 11 .pply definition of + housin8 

uaic to etecmme wh=thec one or mwe addfciomsl que=tmr.rmires 

should be filled. 

1, DMS anyon. �Is. Ilvlng In Y!+- bulldlng us, YOUR 

ENTRANCE to g.t to his livlng q.ortors? . . . . . . . . . . . . . a Yes ~ NO ‘lz W.* 18 ths tolcphono 11 In caso l% ovwlookod anythlru numb., fmre? what i. th, bst NM to call? sk � all units” excem. �.

rmnmem houses: 

.	 Is thw~ ony othoc Lwildlng on this Pmporty for 

paoplm to Ilvo Itr-mlther occuplod w vacant? . . . . . . . . . . . a Yes m No O No telephnne 

14. RECOROOF CALLS AT HOUSEHOLDS 

Item 1 Corn. 2 cm. 3 corn. 4 Cam. 5 COm< 

D.te 

Entire household ..-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Timt I 

. . . . . . . . . . . . . . . . . . . . . . . . ..- Cd.N> Time 

{ -

Dme . . . . . . . . . ,. . . . . . . . . . . . . . . . . Crd. NO. 

. . . . . . . . . . . . . . . . . . -. . . . . . . . Col. No. -

{ -

Date 

Cr.1. No. . . . . . . . ..- . . . . . . . . . . . . . . . . . . . 

1S.
REASON FOR NON4NTERVIEW 

rvPE I A I E I z—

U Refusal (FIU it.m 16) U Vacant. nca-sems.arml Imerview not obtnined for: 

home- U Vacant - seasonml 

.a,m$ 

repeated c+ 

nTemporsrilyabsenc 

Fit! It.m 

17 m USU.1 residence elsewhere 

I_J Armed Forces CoIs..—— — 

u Other (SP,CffY) 1 a Other @P.clfYJ because: 

I I I 

~ No one at 

6. Reason for refusal 

.~ W-UP FROCEDURE 

‘fiml call results in. Type Anon-itverview(except Refusals )uketfm follc.vringsceps: 

1. Comsctnei&htmta (caretskrs, etc. )untilyou find someo~whok”ows the funily. 

2.	 Ftndeutzbe aumdaerof ~p!einth e houaehold, tbeirmmes ands~~oximate age?; if names of all members tmt known, �acert.in 

r.l.ci onships. Record t IS mfonnatioa . . . im the regular sp.ces inmde tbe quest’orumire. 

3. Find cutifanyrne in the housing unit isnowin ah-pital asa Batieat; ifso, wMchpmsonit is. l%. icdooebydciig tbefollowing questioa 

4. IS anyono m trio h.us.hold now in the hospltol? Cl Yes a No n Donh know a N. c.ntwt made 

(a) If ‘. Yes ,,0- Who? (Emecrmmc) (Col. No.)_ 

8. Sign9ture0f fntetviewer 19. Code 

36 
-----

---------

1. (o) Wh.t I.*h. n.m. ofth. head ofth. h.us.h.ld? (Enter n.mein first column) Last name (1> 

(b) What ON the nam.s of .11 ofher persons who live here? (L&# persons who live here.) 

(c) Doony(oth.r) lcdg.r. .rroc.m.rs IIveh.re? o Yes (List) * 

(d) IS th.r. any.rn .Ise who Ilv.s hare who 

is now temporar[ IV in a hospital? n No o Yes (List) * 

(.) Away o“ b.slim..? a No a Yes (List) .-- —_-- —— -_ 

— First mame and initial (i) One visit? a No a Yes (List) c 

(s) 1. th.r. onymw .1.. .rayt”g h... now? n No o Yes (List) + 

..----4---------------- ..—---------- —----—— .--—-—--——-. 1 I @) D...fthth. w.pl. i”ihi, h... fiky~yyfm~~~$ 

.&-

u~~~~ijij- !, 

nNo(le,vc mmestionmire). ., _.. membership rules; ifn.t a hous.holdmembcr, delete) b 

t -..–..–. . . . . . . .. . . 

2.	 H.aw IJr. y.. mlat~tte th. h..d.ftha ho.seh.ld? (Enter relationship co head, for example: he.d, =ife, daughter, R.l.tio. ship 

gm.dson, m.ather+u-l.w, partner, lod~er, lodger*s wife, etc.) Head 

2. Howoldwer. youm yew I.siblrthdey? 

Age D p,:,; 

Id. Ra..(Cbeckoneboxf.res.hpetson) 

5, Sax(Check one box foreach person) n Male n Female 

If 17 yews oldorover, ash. m Under 17 years 

I_J Married a Divorced 6. AIvyounowmarrl*d, widow.d,dlvorced, sepamted .rnev.rmarrled? 

(Checkoneboxf.r .a.hperso.) nWidowed aSep.rated 

O Never married 

If 17 years old or over, ask D U.der 17 years 7, (a) Whotw.m youdolngmo.t of thepa.t 12mo.th--- n working 

(For fem.1.s> werkl”g, k.eplng ho.se, ordolng somethlngel.e? n Keeping house 

If.%om6tbingel se’’checked, and person is 45 years old orover, ask n sc.metbing else 

———----——--——---

(b) A,. y.. r.tl,.d? u Yes a No 

NOTE: Determine whi.h.dtdtsare..thome and recor~ this i.formation. Begifming fochim.elf orherself, each adult person whew st home. with questi.nfl youaretoint.cview ~ Under 17 y..,. 

nAt home n~fam 

1 ... .... 

(Formalcs~ working, ordolng something else? 

&	 Waroyou sick IItany Nmo LAST WEEK OR THE WEEK BEFORE? (Th.tis, 1he2-we.k perlodwhlch.nd*d I_J Ye. O No 

last Sunday)? 

(o) what W:.the mott.r? I 

(b) Anything �I..? 

9.	 Last w..kort hew.. kf.redidid y.ut.ke a”ymedl.in. orem.tm.”t fot..y .o”ditl.” (besides. . . which n Yes a No 

youtoldmcabout)? 

(.) Fo, what c..dlN.n.? I t 

(b) Anything �is.? 

10. 

(e) 

Las* 

What 

w..korthe 

Wem thy? 

w..kbefdldld y.. hmv. ..y.ccldentor I.[urles? h--YR-l (b) AnythlnS .1s.? 

11. Dldyouevar have an(anyoth*r) a.cldant orlnlury that w.sstlll btherlnsyou l..tweek ortheweekb.fom? 4 (a) In what way dld N both.r you? 

(b) Anything .1s.? 

12. AT THE PRESENT TIME do o.h.ve..y .llm.”t. orc..dltloth tthovol. stsd.d for. Io.g*tme? 

(a) 

(l f’’No”) 

Wat arc 

Ev.ntho.ghth.y 

tlwy? 

Ir..’tb.th.r youoll the time? =--4 (b) A.ythlng else? 

13. N.s .“nyo”. In th. family - y.., yovr -., .tc. - had ~.y of these c.ndivi.ns OURING THE PAST 12 MONTHS? n Y=. n No 

(Red Card A, condition by conditi.m record any conditions me.cio.ed in the column for che person) 

1 I 14. Do.s.nyon. lnth. family have .ny.fthes. co.dlti.n.? 

(Read G.rd B,comNtionh yconditio”; record .nyco”ditio.s mentioned inthecoI”mn for the person) 

15, (o) Hav. yo. b..nlna h..pNat .yttimeDUR IN GTHE THE PAST 12 MONTHS? a Yes n No -—___— ________ If “YCS,” 

(b) HOW many Nm.s w.re you M th. hospital ovemdght or longer? N.a...f times 

Id.	 Ubaby under one year list.dns a household member, ash QHo.pit.l 011.me (.) Wosfh. baby bo’m Inaho.pl+ol .roth.m.? (Che.L proper boxes for -—--- —— —-- >— __ 

If ’’bospit.l’tinq. 16.nd 1 .rmoreir. q. 15.sk: both mother.nd child. ) 

(b) Wasthi. hosplt.lizatio” I.c!.ded l.thenwnb.ryo. I.st gove me? } 

G Yes. ~ ?;0 

17. (.) Ourln~th. pLIst 12mo"ths h.. anyo.ein th. famllybe.n op.tient lnon.r.i.g h.m. .r... it.rium? ~ Ye* a No If “Yes. * ask: .- ———--——---—- (b) Who was thi.? 

(.) How mmy times were y.. t“ . nursing hem. or sa.ltor!.m? i%.of times 

n Responded for .seIf-entirely 

R (for F.r persons 17years old.rover, show whorespo.ded for(.rwas present d.ringthe aski.gof)q.8-l7. Col._ResP.; this person: 

q.	 8. 17) Ifpe:so. responded for self, $howwh=the, .ntirelyorp.r~ly. F.rp=soo. u.d=r 17.howwbOf.,p.nded D Ptesent and r.p.reed for !hem. n Presem -did mot r.p.rc 

a Ncx present (or child) 

37 
-----

-- --

“1 

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

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

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

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

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

— . .--. .--.--, ..... ........ .... ..... .---------- Ask foc me. tnt effects of old xnwries: i.: 6 Y=*r. Old Col (d-1) or c~.~-z) Impmnnents .nd injuries 

;s)tfdoctor cslked to: An impairment, or over �nd th.c”inclmdes the words: ,nd for: 

What dld!he&ciorsa ltWbS? 

.-dldha@+*Nomc 1 ICOI 

= 

8 Symp(Om, -—.. ‘ lAaR “Co.ditionl* 

Abscesses 

Aches 

Blcedin 

lnflmnrn~tiGn 

Neur+l$i. 

Neuritis 

for all illnesses .~~ fi.kifthe ctwryin Col. (d-1) Asko.ly if: A.k for ,nyem ,sk O~ly

“em.? L. rst “’Diseaseo) Blood Cf Ot Pains 

[b) If d.acror not t.lked to: c.rne from cf.esti.” 11 or 14: I‘“’ ““”” ]Ft%h “T-+J=” Boils Sores 

C.ncer soreness Record ori@n.1 encty mud what WOS !h. .0.S0 Of . . . ? Can you Cysr Tmnor .sh.[d - 2) - (d-5) as 1- se* well Whet kind of... IS N? Growth ulcers required.” 

Ask for *1I injuries during I 

f;f,[~~ee:)ls . . injury, al.. :Wj “ykan allergy or stroke Infection Weakness 

Dasc 2 weeks: ordinary fhat pOti of *h. body Is off.ct.d? 

n*wspop*r Show deail for: Wbd?, art of th. body W.S hurt? print with HOW d-g +h. .hv Ear or �ye - (one w both) Wlmt EI.d of in[uty was N? ~la.~.,, (strok.) aff..t you? H-ad - (Skull, s..lp f.c=) hylhlng .1s.? Back - (Upper, rniddie, lower) 

(Also, fill Table A for �ll Arm - (Shculdeq “ .c, elbow, Injtuiea)	 lower, wrist, T anti one 

or ~oth) 

‘“’ “%L%%’L’% k%i 

(d- 1) I (d-4) 

, x I

l--la x -J Yet 

_J No	 I 

— 

Qw . Wh.n dld Hew To Interviewer ‘Wh~t did they say at th. hospital the c.ndltlo. w.. .-’ 

clot) Y& #:r many did thy glv. N a m.dical nam? 

NO. nights How lll~ny :::dyou ki;:k:eny was this 

Pltal? :“*,N*YOU ‘of cbcae (If “thy” {,&tt ..y, .skh n~ht. ~;ka~ls. nights %% 

(Month, 

yes;) 

haspltal? wcce m 

:y P*.C 

were I*SC the hos-

(g)? week or 

What dld *h. last doctor you i.alk.d to soy N was? 

the week f :s:’ 0“ (Entry roust show “Cause,mS C<Kind,;* sod *’P.11 of nxmtbw? he f.are? Sundsy Body,, in s.rne detail .s required in Table I) 

sight? 

‘-- 1 

b) (c) (d) (e) (x) (n (u) 

f’ M.:_ u or n Y.. — D Ye, 

Yc_ Nights Night. = No ~;ne n No 

Me:_ not” j-J Yes . a Yes 

v,. = N:.h,. n No ~pme a No 

1. (o) I h.v. em. qu..tl.”. about he.lgh insur.nc.. W. d.nqt want t. 1“.1.d. !...rance *hat pays ONLY for . ..id.nt’. Ig Yes n No but wm are Intgmsted III all other kind..,.Oo you, ycwv--hav. insurance that pays all or port of the hllf ’ wh.” you 

go to tic hospital? Name of plan(s) 

If “Yes,” 

(b) What Is the nom. of th~ plan (or plans)? Any oth., pl.n.? 

(c) Who Is cover.d by *hi. plan (...h .1..)? (Check “Yes,” in 18(a) for each person covered) 

9. (.) Ex.1.dl.n In.u=... th.f POY. 0NL% f.r .ccld.nt., d. You, your -lmv. fn..mnce that pay. .!1 or P.* n Yes n No of thw suxgwn’s bill for an opamtion? . 

If “Yes,” Name of plan(s) 

(b) Wh.t 1. th. nam. of tb. plan (or p!...)? Any oth.r PI...? 

(.) % 1. eov.r.d by thl. PI.. (...h plan)? (Check “Yes,’} in 19(.) for e.ch persom cmv.red) 

D. (0) Da yb, your---, �tc. hw. l.swunc. that pays my port of decta.” bill’ for home .41s and n Yes u No off Ic* VISI*.7 . [f “Yes,~’ D Ye. I_J No 

(b) Do.. N poY for home calls and office vlslts for mostkinds of .I.kn.s.? Name of plan(s) If “Yes,” 

(.) What i. th. nom. of th. plo”? 

(d) Who IS .ovorod by thl. plan? 

If 17 years oldor.aver, .SIC O Under 17 y..1! 

L (o) What IS th. high.st grad. YOUatt.nd.d I. school? Elem: 12345678 

(Circle bighem grade �ttended or check 4tNorte~$) High: 1234 

Icollege: 12345+ 

n None 

(b) Dld YOOfl.lsh ih. . -grad. (Y..,)? a Yes ON. 

38 
-- ----

-----

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

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

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

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

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

---

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

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

Tabl I - ILLNES$ES, IMPAIRMENTS AND INJURIES. 

LAST WEEK How .6-16 [f 17 ye.rs Dld you first notice . . . r. Abouf If 1 or Ask after completing last 

OR THE many tars old ,ld or over (did N h.pp.n) durln the ln#*r- haw more days condition for each prson WEEK 12E- days, ,fc ,sk: past 3 months OR b. ‘!om m Col. 

FORE did lnclud. that wm.? Vi=w=r: z;: (n) .nd 

. . . ..”s. you Ing .W many LAST du,lng Cd (e) P1.cis. If “1:’ If ‘Yes= 

to cut down *h. ;y past is check- Ie”k “* *“2” or in Col. 

>. ye”, “S”al so,,”,. ,y’ did ~~EwKEgK Check one Old ,.. StOlt CON- =d *=k: thlt ea,d ‘[31S in (q~ 

. . ko.p and read Col.(p}~h,=h; actlvitlas far deys au from BEFORE, d.d.g th. P..* ~l~f&E mgths, 

How eo.h ‘ 

as much as . md chool mw many B3efore lhtc- 2w=kX Or day? sun. ,s? w.& 10YS did ,g baf.,. thcf wm.? (k) is “ k.p+ ...yO” ~an:.f ,tat.m.lw. Is this 

chec~ grk$ Then *.11 b.=.us. (~ncer d,ys? ~:~ ,.. keep ‘-. ;m, (lf dwj% past or the day. mm which of my x on vou from 2 weeks, .=k x ccudi- or most w.” “ st.hm.nt dft~ he fo, ,far,? “.*? tion of th. ;alrllg fit’ ye” each 1= For Which week, is an day? k..?, h Narls C.ondk emale. IV k.t w-k or Cwd A w..k te=yh: f 

No ,dd) cd. th~ wmek ?r is m or the fo;.m. ~~~ed) 

~t cOun*- (.)> k+fore? imp.ic- w.ek (Show 

(0. I“g wok rnem; b.fars? Grds C- .kotlt? 

t. nm.nd the ocher. F, .S 

Cet. house? wiac, apw­

(W STOP puce) 

1 

(e) ! (P) (q) (r) 

i 1 

_Days 

~ !&e } --L 

Tabh Ii - HOSPITALIZATION DURING PAST 12 MONTHS 

W.r. any op.r.N.ns p.rf.nn.d on T. Sntetview.r 

you during this stoy .: th. h.s- plt.l? Wh.t is the name and add,... of the hospitol ye. w.,. In? Carry !hi. condition tkough Table 

if it does not ap ear there 

I, 

~ N “yes,)} (Enter name, city and State; if city not know., enter COu.cy) I or more .ig& in CA. (f), ]. 

m (a) What was th. nom. of A. 

.p*mtlan? condfcion is on Cd A, or is .:. 

impairment — --- —-----— .5 

: 

(b) Any oth.r op.mthms? WIN yc.. nood to fill Toblo 1? 4 

(i) (i) (xx) 

~ Yes ~ NO 

–––––––--–-–--–---–---––-––-––– ~ Ye, a No 1 

~ Yes ~ tio 

.---————-.———--- ———————————— ~ Yes n No 2 

22,1fMnlemd17 yearsoldorovet, ‘ask a Fem. or und. 17 y- 1 

n Yes m No (a) Old you � v.r S.W. In th* Armed Forcas of the United St.?..? If “Y..,” ask 

(b) Ate YOUnew In the Armed Pore.s, not .ountlns the reserves? (If “Yes,” delere this person from questionnaire) + n Yes m No 

(c) Was any of your s.tvi=e during a war or was h p...tlmlm. only? a w,, m Pe:c.. 

If “war)”.Sk -=-------.----------- time only 

(d) D.ring whl.h war did you sow.? ~WWI1 n Korean 

n ocher If “’Pe.ce-tirnel’ only, ask 

(.) Was anyd your ..wIc. b.tw..n Jun. 27, 1950 and January 31, 1955? n Yes = No 

n Under& ~oars 23, Ask foc all petso.s 17 years old or over: n Yes 

(.) old Y.. work o~ any Nm. last w..k or th. wa.k b. for.? 

If “No:” ask 23(h) and (c). n Yes n No 

(b) Eve” the.gh you did net wc+k last week or the w..k before do you have . iob or b.xl..sx? -4 

(.) W.r. you Iooklnm for work or on Ioyoff from a lob? n Yes m No 

If ~tYes}l in Que.tiqn 23(a), (h), or (c), d- N.me of employer: 

24, (o) For whom dld you wadt? ------------------.--

Industv 

(b) What kind of b.sln.ss or Industw w.. fhls? = ------------------

(.) Wh.t kind of work w.!. ym doln~? Occupamon: 

n PriVate-p.id n Gov’t 

(d) Class of w.tk.r (fill from information above; or, if not clear, ash) m Own n Non-paid 

Ank only for Pcmons 20 years old or ovec = Under 20 years 

(.) Have you been 0--, ..r doing fhl. kind of wwrk hr the past thr.. Y...’? a Yes m No 

25.	 Which of thesa {ncom. qmups rapres*nts your total family Income for th* past 12 months, that is, your’s, your- --’s .*c? GIDUP No. 

(Show Card H). l..l.d. income fmm all .o.rc.s, such a. w.g.s, salaries, rent. from property, pensions, help fmm 

rwlatlv*s, etc. ~ 

39€
Table A. (Accidmts and hr@ics) 

f.irn&No. 1. Wh*. dld th* accld*nt happm? ~ $ ;~;i~s~~h* OcGld~t. *at wr~ ~ th* WY was h@? ~ot kind Ot IniWY W= I!? 

Table 1 part(s) of bcdy Kind of injury(s) 

n ‘e” 

:=, ❑ (ff l,do.r 1%1 As. enter= 

Month #k O! 

eek before 

10 to q. S) 

, (0) Was 0 car, t?uek bus or othmr III*M V911!Ch iWOIVOd In th occldsnt in my WOy? a Yes n No 

*) WOs mm-o thnn 0.* mayof whl.1. I.vdwd? O Yea (more than one) o No 

(c) Wos N (clth,r om) MOVi.S d fho Nmc? a Yes O No 

, (a) Wlwm dld th. aeeldan? hnomn . . at hem w SO13U othor pfO.O? 

1.0 At hm (bide Lwsae) 2. U At be-e (adjacent~emises) n Same ocher P1.ce 

2S %ame other pfxe,lt ●sfu 

(b) What ktnd of PIO.O was N? 

3. ~ SCceet ●nd hi~way (includes romdway) & U SchooI (inchwfes school premises) 

4. n Farm 7. R Phce of rectcstfrn sod spats, ●xcept st school 

5. U Industrial pfsce (includes pemfses) 8. n aber (SP*Citi th. Pt.- whom . ..ld..t h.PP.m.#J 

Wem yOL!at work ●t yOUr 10b or kuslmss wfwn dho aceldoni hnwwmd? 

1.0 Yes 2. n No 3, D ~lle in Amwd Se-ices 4. U under 17 sc d== of ●ccident 

Tablo A . (Accidents and Inlurlcs) 

LhncNo. ,. ~Q” did *hQ ~c=ld.”t ~pp”, Z At tfw tlnm of thm aceldant, what pwt C4 the body was hurt? What kind .3 Infury was N? 

Anything. IS.? Tible 1 Pm(s) cd body Kind cd injury(s) 

n ‘e” ‘ 

~ppencd “’de”’ ❑ (If 1%00, 1%, a,soenwrmc+ltb>

ISt 

eek or Month 

cek before 

;0 to q. S) 

(a) Was a car, truck, bus or otlmr motw v.hlcls Involved In tfm ..cldmt In IMY wq? n Ye. n No 

(b) W.. more then ea. motor vohlcle Involv.d? u Yes (more thin one) n No 

(c) Was N (olthw as) moving or the HIM? n Yes n No 

(a) Wlwm did the ncetd.nt happ.n - -at hmn nr serm oth.r pt..e? 

1. D At ham (inside house) 2. a At bonm (adjacent Pemiaes) m Some ether place 

SS ‘“same other place,,) .mc: 

(b) what kind of PI... was N? 

3. m Sweet and higbw.y (incl~des roadway) 6 n School (i.chdes school premi.es) 

4. a Farm 7. U Place of recreation and sports, except m school 

5. U Snducttial PI... (inchvdcs premises) 8. D @her (SP.clfY the PI... wh.r. . ..M..C h.j?p.n.dj 

, W.ra yw at wwk at your @b w busln.ss wh.n tho accident happmd? 

L a Yes 2.0 No 3. a wlile in Armed Semites 4. m UOd.1 17.1 ticm of accidrnt 

FOOTNOTES AND COMMENTS 

40 
-- ---------------------

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

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

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

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

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

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

PROCEDURE B QUESTIONNAIRES 

a.	 The household interview questionnaire. —This questionnaire was identical to that for Procedure A 

except for the section on hospitalization. 

j. Tht PHS neads to find o.* obout how much people u.. hospitals in ord.r to +. health facllitl.s and program. n Yes m No 

(.) H.v. Ye., yo.,s.lf, b... 1. a ho.pttal at any Nme during 1960 or 1961? ?%. of times 

(N “YCS”) 

(b) How many Nm.. W*W You In the hospital c.v.rnlght or I..g.r? f-l ye* .— , ;,O 

>------ (e) Did you h.v. any other ovamlght hospital stays during 1960 w 1961 besides... whh.h you told m. obo.t? 

(d) How many tint.. was this? (Do not change answer in Question 15(b)) Y.. of times 

L A,k ONLY AFTER Qu.sN.. 15 hos b..” recorded f., ..ch related m.mb., of household: n Yes 17 NO 

(a) Slnc. N IS Imptian$ to g.t an acc.mte picfur. of h..pit.l stays, lust t.t ,m. check. -

Can you think of any (oth.r) ov.might stoys In 1960 or 1961 for yourself or any member of your fomily 

(Ilvlng in this ho.s.held) � ven though they wer. short or happened some time ago? No. of times (b) (If “Yes”) How many Nmc. was this? (Do not change answers i. Question 15) 

Table If 

Give c.lend.r 

co respondent: 

What month and 

Mltr 

hosplt.l? 

(month, p.,) 

!0 : — n Stillin hospital 

‘r: — 

,9: _ m Stilli. ho.piral 

,: — 

10SPfTALIZATfON DURING PAST 12 MONTHS 

Whnt did fh.y ,.~ at if!. hospital th. condition W.. -. 

did thy sin. it Q m.dlcal name? 

(If “they” didn’t say, ask): 

What did the last docfor YOU talked to say N was? 

\E”try must show “G.5e”, “Kind”, ..d 

‘Part of Bcdy” i. ..me d.tniI .s required i n 

Table 1) 

k) 

Col. QUC*. ffewmany 

i ‘“” ci.n ntgh~n 

~ ‘f No. ;;y a per­

,; so” hespitol? 

d 

. (.) (b) (c) 

-

1 Nighrs 

2 Nights 

3 Nights 

War. any opemttons p.rfomwd on 

you during this stay at the ho.. 

pltaf? 

If “Yes,” 

(.) Wh.t was th. nam. of th. 

op.mil.n? 

(b) Any oth.r op.mtlons? 

m 

--J Yen n No 

--J Yes u No 

What Is th. nom. ond address of the hospital y.. w.r. in? 

(Enter name, city and scam; if cicy nor k..--+ .nter c.xwy) 

(s) 

To Interviewer 

c3rry this condition through Table 1, 

if it doe. not appear the:. 

ond 

still i“ hospital i“ Cof. (d) 

co”dici.” is o~C.rd A, 

or is an imp. irrncm 

Will YOU ne,d to fill T.bl. 17 

~ Yes f_J No 

41 
b.	 The mail follow-up questionnaire. -TWO different forms were used, depending on whether 

or not hospital episcdes were reported in the interview. The covering letter which was 

on the front of the questionnaire, was similar for both forms. 

Questiomaire for households reporting hospitalizations 

FORM NHS-S-14-B-2 Bud,%., Bum?.. No. 6S-6109 

la-zl-.ll APPmvsI Swims September1, 1961 

u.s.
DEPARTh4ENT OF COMMERCE 

BUREAU OF THE CENSUS 

REGIONAL OFFICE 

673 FEDERAL BUILDING 

DETROIT 2S, MICHIGAN 

TEL. WO. B.OS~O 

EXT. 210 

. In connection with the National Health Survey which the Bureau of the Census 

conducts for the U.S. Public Health Service, one of our interviewers called at your home recently. 

Your cooperation in answering these health questions was a definite public service. 

In order to be sure the information collected is as complete as possible, it is 

necessary that the Census Bureau check on its work. For sbis reason we are requesting that you 

answer the quessions on the inside of this form about hospitaI stays you and your family may have 

had during 1960 and 1961. MaiJing the form to your home will give an opportunity for all family 

members to take part in answering the questims. 

PIease mail the form back to us within five days. A self-addressed enveIope 

which requires no postage has been provided fot your convenience. 

The information wi 11 be given confidential treatment by the Bureau of she Census 

and the [J. S. PubIic Health Service. Nothing wiU be pblished except statistical summaries. 

Thank you. 

A Sincerely yours, 

(/ John E. Tharsldson 

Regional FMd Director 

CONFIDENTIAL - This information is collccced for che U.S. Public Health S.xvice under .uch.rity of 

Public f-aw 652 of che 84~h Congress (70 Scac 48% 42 U.S. C. 305). All infonnacioo wbic,b would permit 

idcmifimuiom of the i“dividud will be held strictly confidential, will be used cmly by persons e.gaged in 

a“d for the pwposes of the survey and will not be .3kclosed or released co others for any other purp.ases 

(22 FR 1687). 

USC OMI.+OC 141 53-P61 

42 
--

--

--

JLEASE FILL OUT SECTIONS A AND B ON PAGE 2 AND SECTION O ON .PAGE 4 [N ALL CASES. FILL SECTION C 

~PAGE 3, AS REQUIRED. 

S.. N.. A Section B 

.	 Thw Informotlon from the Not ion.! He. Ith Survey interview 4. The information from the National Health Survey interview at your ,h. . ..ho!d Indicated that the following persons were at your household indicated th.~ the following per. . . . were 

not {n the hospital during 1960 or 1961 .- in the h.spit.l during 1960 or 1961 

Name Relationship Name Relationship 

-. 

! 

-. 

, Can you think of any time any on. of the. psr.o”s shcrw. in 5. Pleas. look at the blue sheet which contains I. fc+m.ti.” f,.. 

S.ct!on A w.. In the h.spit. ! ovemlght or longer during the earlier i.t.rvlew .b.avt each of the h..pltol stays for the 

1960 or 1961 persons shown in Section B. 

Check “YcsSV or “No” to each pat! 

o. For an ormr. Non? C.. ye. Ihl”k of any OTHER Nme my on. of the person. 

shown i. Sectlcm B w.. i. tb. bespit.1 .v.night or 

n Yes a No longer during 1960 or 1961 

b. To have o boby or because of a miscarriage? 

(Also count trips t. hospital for false labor) 

n Yes a No Check “Yes” or ‘“No” to each pan 

. . For tc.atrncnt of a. Illness? 

m Yes m No 

d, Because of an oecidant or Iniury? a. For . short stay? 

n Yes m No n Yes D No 

. . Fci tases or observation? 

n Yes n No 

f. For any c.th.r re..m .v.. if nothing b. For . minor ailment? 

was	 s.dcusly wrong? n Yes m No 

n Yes a No 

Be sure to count stnys in the hospitnl even if the M has 

not yet been, paid or was p.id by ..meon= else. 

c. For any other re.so” @ roll? 

Al*og*th.r how m.ny tfmes w.re these p.,.ons in the m Yes u No hospital ov.rnlght or longer dwing 1960 and 1961-

No. of times in hospital or m None 

If you have checked “Y..” to any Part of qm.~o. 5* t~ough you bsve checked “Yes” co any part of qn.sti.” 2a duagh 5., complete o.. column of %.tio..C for each time each rsca f, complete one colwm of Seccion C for . ..h time each ers.n show” in Seccio” B was in tbe hospttal during 1960 or 19r 1, hewn in Section A was in the baspital during 1960 or 191?1. &sides the h~pital stays show” cm the enclosed sheet. 

FORM NHS+ 14.9.2 13.21-61) PAGE 2 

43 
SECTION C 

IF TNE RE ARE MORE THAN 2 HOSPITAL STAYS TO BE REPORTED, CONTINUE ON TNE BACK OF THIS FORf4 IF 

TNE RE ARE MORE TNAN 4 NOSPITAL STAYS, USE AN EXTRA SNEET OF PAPER TO DESCRIBE TNE ADDITIONAL 

STAYS. 

Ilospital Slay # 1 llospit*I Stay * 2 

0.	 Writ. tinth. name of th. P..... Name of person in hospitab Name .1 per..” i“ hospital: 

who ..s in the hoxpitol — 

b. How many nights w.. this p.r.on 

i. th. fmsplt.1 during fhls No. of “i.shts in hospital N.. of nights in hospital 

h.spiml SI.y? 

. . Wh.. did this p.rso. LEAVE u 1961 cl 1961 

th. hospital? c] 1960 (month left hospiml) u 1960 (month left hospi!.1) 

Check 1960 or 1961 and .1s. 

enter the mcm[h. u Still i~hospic.1 u Still i“ &iml 

d. What w.’ ih. .. . ...10. this ~] For test. or observ.ti.” ~ For tests or observ.ti.a” 

S1.Y	 in *h. hospi~al? n Ty~;;;c ;=ba+w;;h:,kiagc ~ T~&u~t.fj;~ylyb~,&c~jsc.rci.ge 

Ch..k . . many ma. . . . .s 

opply for this SI.ay i. th. ~ For treatment of . . ilk.. I_] For ue.unent of . . illness 

hospital. 

If Ih. ,..S.” for th. ho.pif.l 

stay we, a“ III”*** 0, .“ 

tni.ry, .1s. show th. 111”.ss 

or iniury in *h. box pmvld.d 

f., that P.w+s.. 

. .	 W... any op.mti.ns pmf.nn.d 

. . this p.m.. during ghis slay 

at *h. h.spiml? 

f.	 Who) .//.s th. nom. and add,.,. 

of th. hospital this p.rson w.. 

1. during this ~atflculcw stay? 

Show city and state; th. stm.t 

add,... i’ not ..c.ss. V. 

‘m ‘m 

~ Fot,t~..tnxm of . . accident or - For. t~..trn.m of an accident or 

‘m 

“m 

‘m 

Name of hospit.1 

Ciry 

St.t, 

‘c 

‘7!!!!5 

‘r


N.rne of hospic.1


City


state 

S. C*IC..C i. co. fin..d c.. *h. bock of this form 

PAGE , USC OMM-DC 14158-P81 
..?-..,...,.- -- .!s> , ,“” * - .-s” 

—.,..... . . ...” 

Hospit.1 Stay # 3 Hospital Stay � 4 

.,	 Writ. in ih. nom. of the FNWS.n Nanx of person in hos~it.k Name of person in hospital: 

who W.S in th. hospital _ 

b.	 HOW many .Ights was this P.:san 

in the hospital during this No. of nights in hospital No. of nights in hospital 

hospital stay? 

c. Wh.n dld this pctio. LEAVE ~ 1961 U 1961 

thm hospwal? 

Check 1960 or 1961 and .1s. 

enter the month. 

d.	 Whet was tiha reason for thla 

.*.Y i. th. ho.pital? 

Ch..k .s may ,.o.e”. .s 

apply far this stay I. th. 

h.spitol. 

If th. reason for *h. hoaplwl 

‘toy w., ml HI..,. 0,.” 

I“IWT, .Isoshowth. ill”.,s 

. . tni.ry 1. *h. boxpiuvld.d 

for *hot PVT.,.. 

. .	 W.m any .p.rollc.n, p,rfmm.d 

. . thi. p.,... d.ring this stay 

at th. hespit.l? 

f. Wh.twas 8heo.m. .nd.ddm., 

of	 *h. hO,ph.1 this p.,... was 

in during this patiic.1.r .t.y? 

Sh.weity.nd Stilt.; th. stmti 

odd,... i. no! n.c . . ..ry. 

U 1960 (m””’h & f’”’pi”l) U 196o (m..ch left hospital) 

0, 

U Still i. hospit.1 m Still i. hospital 

I_J For tests or .bsew.ti.n U For tests or .bsetvati.an 

n T. h.,. a baby or fot a rnisc.rci.ge a T;~tafj;~yl~$h:r~iscarriag. 

(Count false labor here) 

“m ‘r 

For.tr~.mne”t of .“ accident m a For, t~e.troe”c of .“ .c.ide”t or 

‘i ‘e 1 ~ ~t;;h;amas.aa;{o have an 

‘m “P 

- ~=, 

‘m ‘i 

Name of hospital Name of hospital 

City Ciry 

scat.? state 

SECTION D Household 

I.meolpecson(s) who filled this form: Serial N.. 

late fonnfillcd: 

-3RM Nlis-,.14. B.2 ,,-2, -.,1 e.=. 4 .-. “,COMM-.JC ,4,..--61 . 

45 
I 

Questionnaire for households notrepxting hospitalizations 

(Section C is not shown since it was the same as the Section C of the al.mve questionnaire.) 

I SECTION A I 

1.	 We have Iistedtbc following as members of you fsmily living here--

N.me Relationship 

I 

t I I I 

PLEASE ANSWER THE QVESTIONS SN SECTION B AND CONTINUE WITH SECTION C 

SECTION B 

2. Hav. anyof*h. p*rs-s I!stodin Soctlrn Ab..nln ahosplt.l overnight orlono.r.*..ytIm* 

Check ‘*Yes’’ or’’Nto*achpan:an: 

a. Foranop.m;Ion? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

b.	 Tohavma bbyorhcaus* ofamiscardago? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(Also, counc trips to che fmspitml for false labor) 

c. Fertmatient ofonilfncss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

d. B..ouse ofmne.cldent orsnlnluW? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

c. Fori*sts or6robsewotion? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

f. Foranyo&er r.ms-noven ifthemwos nothing s*rlouslywmng?. . . . . . . . . . . . . . . . . . . . 

d. fi.s19600r 1961--

I-J Yes I_J No 

n Ye. a No 

n Yes (_J No 

I-J Yes I_J No 

I-J Yes n No 

m Ye. a No 

Besucet.ac.mmcstqs inthehospital even ifthebillfms not yecb-sen paid orwaspaid bysome.ne else. I 3. AItog.th.r, kwmnytIme. w.m9h.se por-.sln .bspltol overnight orlo.g.r d.rlngl96Oandl96l? 

No. of times inhospit.1 or n None 

IF YoUHAVE CHECKED’”YES”TO ANY PART OF QUESTION 2, COhITLETE SECTION CANDTHEN FILL SECT1OND ON 

THE BACK OF THfS FORbf. 

IF YOU HAVE CSECKED “NO” TO ALL PARTS OF QUSSTION 2, FILL SECTION D ON THE BACK OF THIS FORN, I 

FORM N1.ls.S-, em., ,4-,..,, PAG6, 7. 

46 
PROCEDURE C QUESTIONNAIRES 

a.	 The household interview questionnaire, —This ques. b. The self-administered questionnaire. —This questionnaire was identical to the one shown for Proce- tiomaire was identical to the mail form in Procedure A except the questions on hospitalization (ques- dure B for households not reporting hospitalizations


tions 15, 16, and 17 and table II) were omitted. The in the interview.


questions on hospitalization were asked in a self-


administered questionnaire.


LETTER AND BROCHURE 

These were mailed to households before the interview. The letter was sent to all households 

to be interviewed. The brochure was sent to only Procedure B households. 

FORM NH$-S-I 4-2 U. S. DEPARTMENT OF COMMERCE 

(2-27-61) BUR~U OF THE CENSUS 

Regions
1 Office 

6’73Federal Building 

Detroit 26, Michigan 

Tel.WO 3-9330


Ext. 216


Dear Friend: 

The Bureeu of the Censushss been askedby the Public 

Health Serviceto act as ite agentto carryout a surveyto obtain 

informationaboutillnesses,diseasesand injuriesamongresidentsof


this area. The surveyis one part of the Natioml HealthSurveyProgram


whichCongressrecentlyauthorized
beceueeof the need for up-to-date


stetietics on the healthof our people. Physicians,
researchworkers,


and othergroupsin healthfieldsere much in’tereeted
 in the knowledge


whichwillbe gainedfromthie survey.


Everymonthseveralthousandaddressesare chosento give a
 cross-section
 of the wholeUnitedStates,and the peopleat thosead­


dressesare interviewed
to obtainthe necessaryinformation.Thismonth 

the addressof your dwellingplaceis one of thosechosen,andyou will 

be visited by a Census Bureauinterviewerwithinthe next week or two.


The interviewer
will askyou a numberof questionsaboutthe healthof


the membersof your family,particularly
aboutthe illnessand injuries


you hsvehad in recentweeks. Your cooperation
in helpingcompletea


questionnaire
 willbe verymuch appreciated.


The informs
tionyou givewill of coursebe held in confidence. 

We have the assuranceof the PublicHealthServicethatthe information will be seenonlyby authorizedpersonnelof the two agenciesand that


nothing will be published except statistical summariesin which no individuals oan be identified. 

Sincerelyyours,


A 

U
 John E. Tharaldson 

Regional Field Director 

47 
G1 

($ 

.-

: 

.-

3 

E! 

2 

I 

48 * U.S. GOVERNMENT PRINTING OFFICE : 1965 0-775-583 
REPORTS FROM THE NATIONAL CENTER FOR HEALTH STATISTICS 

Public Health Service Publication No. 1000 

Series 1. Programs and collection procedures 

tie. 1. Origin, Program, and Operation of the U.S. National Health Survey. 35 cents.


No. 2. HeaI th Survey Procedure: Concepts, Questionnaire Development, and Definitions in the Health Interview Survey. 45 cents.


No. 3. Developrwent and Maintenance of a National Inventory of Hospitals and Institutions. 25 cents.


No. 4. Plan and Initial Program of the Health Examination Survey.


Series 2. Data evaluation and methods research 

No. 1. Comparison of Two-Vision Testing Devices. 30 cents.


NO. 2. Measurement of Personal Health Expendi~res. 45 cents.


No. 3. The One-Hour Glucose Tolerance Test. 30 cents.


No. 4. Comparison of TWO Methods of Constructing Abridged Life Tables. 15 cents.


No. 5. An Index of Health: Mathematical Models.


No. 6. Reporting of Hospitalization in the Health Interview Survey.


No. i’. Health Interview Respnses Compared With Medical Records.


No. 8. Comparison of Hospitalization Reporting in Three Survey Procedures.


No. 9. Cooperation in Health Examination Surveys.


No. 10. Hospital Utilization in the Last Year of Life.


Series 3. Analytical studies 

No. 1. The Change in Mortslity Trend in the United Stnt@s. 35 cents.


No. 2. Recent Mortality Tra.ds in Chile. 30 cents.


Series 4.	 Documents and committee reports 

No reports to date. 

Series 10. Data From the Health Interview Survey 

No. 1. Acute Conditions, Incidence and Associated Disability, United States, July 1961-June 1962. 40 cents.


No. 2. Family Income in Relation to Selected Health Characteristics, United States. 40 cents.


No. 3. Length of Convalescence After Surgery, United States, July 1960-June 1961. 35 cents.


No. 4. Disability Days, United States, July 1961 -Jutie 1962. 40 cents.


No. 5. Current Estimates From tbe Health Interview Survey, United States, July 1962.June 1963. 35 cents.


No. 6. Impairments Due to Injury, by Class and Type of Accident, United States, July 1959rJune 1961. 25 cents.


No. 7. Disability Among Persons in the Labor Force, by Employment Status, United States, July 1961-June 1962. 40 cents.


No. 8. Types of Injuries, Incidence and Associated Disability, United States, July 1957-June 1961. 35 cents.


No. 9. Medical Care, Health Status, and Family Income, United States. 55 cents.


No. 10. Acute Conditiona, Incidence and Associated Disability, United States, July 1962-June 1963. 45 cents.


No. 11. Health Insurance Coverage, United States, July 1962-June 1963. 35 cents.


No. 12. Bed Disability Among the Chronically Limited, Llnit&l Sta~a, July 1957-June 1961. 45 cents.


No. 13. Current Estimates From tbe Health Interview Survey, United States, July 1963-June 1964. 40 cents.


No. 14: Illness, Disability, and Hospitalization Among Veterans, United States, July 1957-June 1961. 35 cents.


No. 15. Acute Conditions, Incidence and Associated Disability, United S@tes, July 1963-June 1964. 40 cents.


No. 16. Health Insurance, Type of Insuring Organization and Multiple Coverage, United Ststee, July 1962-June 1963. 35 cents.


No. 17. Chronic Conditions and Activity Limitations, United States, July 1961-June 1963. 35 ten*.


Series __. ___ .


No. 1. Cycle I of the Health “Examination Survey: Sample and Response, Unitsd SLSGSS, 1960-1962. 30 cents.


No. 2. Glucose ToIerance of .4dults, United States, 1960-1962. 25 cents.


No. 3. Binocular Visual Acuity of Adults, United States, 1960-1962. 25 cents.


No. 4. Blood Pressure of Adults, by Age and Sex, United States, 1960-1962. 35 cents.


No. 5. Blood Pressure of .Adults, by Race and Re~ion, United States, 1960-1962. 25 cents.


No. 6. Heart Disease in Adults, United States, 1960-1962. 35 cents.


No. 7. Selected Dental Findings in Adults, United States, 1960-1962. 30 cents.


No. 8. Weight, Height, and Selected Body Dimensions of Adults, United States, 1960-1962.


No. 9. Findings on the Serologic Test for Syphilis in .4dults, United States, 1960-1962.


11. Drk -. Fmm the Health Examination Survev 

Series 12.	 Data From the Health Records Survey 

No reports to date. 

Series 20.	 Data on mortality 

No reperts to date. 

Series 21. Data on natality, marriage, and rii vorce 

No. 1. Natality Statistics Analysis, United States, 1962. 45 cents.


No. 2. Demographic Characteristics of Persons Married Between January 1955 and June 1958, United States. 35 cent+.


Scri es 22.	 Data from the program of sample surveys related b vital records. 

No reports to date. 

1