National Center for Health Statistics

Carol DeFrances, Ph.D., Brian Ward, Ph.D., and Manisha Sengupta, Ph.D. 

Division of Health Care Statistics

2021 FCSM Research and Policy Conference 

November 2, 2021

COVID-19 Pandemic Impact on the National Health Care Surveys 
National Health Care Surveys Spectrum of Care

National Ambulatory 

Medical Care Survey 

(NAMCS)

1973-ongoing

National Hospital 

Ambulatory Medical 

Care Survey (NHAMCS)

1992-ongoing

National Hospital 

Discharge Survey 

(NHDS) 

1965-2010

National Hospital Care Survey (NHCS) 

2011-ongoing

National Study of Long-Term 

Care Providers (NSLTCP)

2012-2018

Ambulatory and Hospital Care Long-Term Care

• Physician offices

• Community health 

centers

• Emergency dept.

• Outpatient dept.

• Ambulatory surgery 

locations

• Inpatient dept. • Residential care • Adult day services

• Nursing homes • Home health

• Hospice care

Plus...

• Inpatient rehab facilities

• LTC hospitals

National Post-Acute and LongTerm Care Study (NPALS)

2020-ongoing

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National Electronic 

Health Records 

Survey (NEHRS)

2008-2021
National Ambulatory Medical Care Survey (NAMCS)

 Purpose: Designed to meet the need for objective, reliable information about the 

provision and use of ambulatory medical care services in the United States. 

Sample: Physicians classified by the AMA and AOA as providing office-based care; 

not federally employed and not in the specialties of anesthesiology, radiology, or 

pathology. Community Health Centers from listing maintained by HRSA.

 Mode: In-person induction interviews and on-site medical record abstraction for a 

sample of patient visits; conducted by U.S. Bureau of the Census Field 

Representatives (FRs).

 Questionnaire: Computerized induction questionnaire obtains data about 

characteristics of the physician and practice. Standardized form used for record 

abstraction.

 Data collection: Covers January–December annually, public and restricted use files.

 Sample size: 3,000 office-based physicians, 104 community health centers. 

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NAMCS Challenges and Changes During COVID-19

 Challenges:

• Ensure safety of U.S. Census FRs and physician office staff.

• Add COVID-19 questions in timely manner. 

 Changes:

• Delayed fielding from March 2020 to mid-May 2020; delayed an 

additional 4 weeks in “hot spots” (i.e., until July 2020).

• Moved to primarily CATI administration of Physician Induction Interview.

• Dropped abstraction of patients visits for physicians, but not health 

centers.

• Fielding for COVID-19 questions on the Physician Induction Interview 

started for physicians sampled in the second half of 2020.

• Release preliminary COVID-19 related data in October 2021. 4
Coming Soon...

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National Electronic Health Records Survey (NEHRS)

 Purpose: Assess EHR adoption and capabilities, burden associated with EHRs, and 

progress physicians have made towards meeting the policy goals of the HITECH Act 

and the Promoting Interoperability programs.

 Sponsor: Office of the National Coordinator for Health Information Technology

 Sample: Physicians classified by the AMA and AOA as providing office-based care; 

not federally employed and not in the specialties of anesthesiology, radiology, or 

pathology. 

 Mode: Multi-mode: web survey, mail survey and CATI (if needed).

 Questionnaire: 30-45 minute questionnaire; similar content/questions across 

mode.

 Data collection: Conducted annually 2008-2015, 2017-2020; restricted use files (all 

years); public use files (2018-2019).

 Sample size: 10,302 physicians for national/state estimates; 2,000 for national 

estimates only. 6
NEHR Challenges and Changes Due to COVID-19

 Challenges:

• Add telemedicine questions in a timely manner.

• No telework allowed for off-site contractor staff.

 Changes:

• Delayed fielding until September 2020 to March 2021.

• Allow some telework for off-site contractor staff so data collection could 

continue.

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National Hospital Ambulatory Medical Care Survey 

(NHAMCS)

 Purpose: Originally designed to collect data on the utilization and provision of 

ambulatory care services in hospital emergency department (ED) and outpatient 

departments (OPD) and ambulatory surgery locations (ASL); since 2018 ED only.

 Sample: Includes visits to EDs of non-institutional, general and short-stay (<30 

days) hospitals. Excludes visits to Federal, military, prisons, or Veterans 

Administration facilities.

 Mode: In-person induction interviews and on-site medical record abstraction for a 

sample of ED visits; conducted by U.S. Bureau of the Census FRs.

 Questionnaire: : Computerized induction questionnaire obtains data about 

characteristics of the hospital and ED. Standardized form used for record 

abstraction.

 Data collection: Covers January–December annually, public and restricted use files.

 Sample size: ~410 hundred hospitals. 8
NHAMCS Challenges and Changes Due to COVID-19

 Challenges:

• Ensure safety of U.S. Bureau of the Census FRs and hospital staff.

• Add COVID-19 related questions in timely manner.

 Changes:

• Delayed fielding for one week to June 2020; delayed an additional 4 weeks 

in “hot spots” (i.e., until July 2020).

• Switched to administration of Hospital Induction Interview to CATI.

• Switched from in-person abstraction to remote abstraction.

• Added new COVID-19 questions for the 2021 data collection on Hospital

Induction Interview.

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National Hospital Care Survey (NHCS)

 Purpose: Provide reliable and timely health care utilization data for hospital-based 

settings.

 Sample: Non-federal, non-institutional hospitals with 6+ staffed inpatient beds.

 Mode: Administrative claims data and electronic health record (EHR) data 

transmitted electronically to NCHS or its data collection agent.

 Questionnaire: Annual Hospital Interview collects facility information needed for 

statistical weighting.

 Data collection: January-December annually, restricted use files.

 Sample size: 608 hospitals; all inpatient and ED encounters (i.e., entire calendar 

year) requested.

 Unique feature: Personally identifiable information is collected, which allows data 

linkage across hospital settings and to external data sources such as the NDI, CMS, 

and HUD data.

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NHCS Challenges and Changes Due to COVID-19

 Challenges:

• Concerned about increased burden on hospitals during COVID-19, even 

with all electronic data collection. 

• Add COVID-19 questions in timely manner. 

 Changes:

• Fielding delayed for 2 months.

• Added COVID-19 questions to the 2020 Annual Hospital Interview; fielded 

starting in June 2021.

• Released preliminary data by week on COVID-19 for ~55 hospitals in more 

“real time” starting in February 2021; data now available for 37 hospitals 

through May 2021.

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Preliminary NHCS data available by week

https://www.cdc.gov/nchs/covid19/nhcs.htm

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Example of NHCS preliminary data

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National Post-Acute and Long-term Care Survey (NPALS)

 Purpose: Monitors trends in the supply, provision, and use of the major sectors of 

paid, regulated long-term care services.

 Sample: Adult day services center (ADSC) licensed by the state or certified to 

participate in Medicaid; Residential care communities (RCC) licensed or certified by 

the state, with 4 or more beds, providing two meals a day and around-the clock onsite supervision and help with activities of daily living.

 Mode: CMS administrative data purchased for hospice agencies, nursing homes, 

home health agencies, inpatient rehabilitation hospitals and long-term care 

hospitals. Primary multi-mode data collection (web, mail, telephone follow-up) for 

ADSC and RCC.

 Questionnaire: Provider questionnaire (provider and services user characteristics 

aggregated a the provider level). Services user questionnaire in alternate years.

 Data collection: Every two years, public use files only in 2018 (NSLTCP) and 

restricted use files.

 Sample size: ADSCs= ~5,550; RCCs=~11,600. 14
NPALS Challenges and Changes

 Challenges:

• Add COVID-19 and telemedicine questions in a timely manner.

• No telework allowed for off-contractor staff.

 Changes:

• Delayed fielding for 2 months.

• Removed some existing questions to prioritize COVID-19 questions.

• Revised some questions to adapt to COVID-19 conditions (closures, 

changes in mode of service provision) 

• Allowed some telework for off-site contractor staff so preparations for data 

collections could continue.

• Released preliminary data related to COVID-19 for RCCs and ADSCs in 

August 2021. 15
Preliminary NPALS data

https://www.cdc.gov/nchs/covid19/npals.htm

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Example of preliminary data for RCCs

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Example of preliminary data for ADSCs

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Summary: COVID-19 Challenges

 Ensure safety of U.S. Census field representatives and hospital and 

physician office staff (NAMCS and NHAMCS).

 Minimize burden on already overburdened providers due to COVID-19 

(NAMCS, NHAMCS, and NHCS).

 Secure timely OMB approval for COVID-19 and/or related telemedicine 

questions that were added to all 5 surveys (NAMCS, NHAMCS, NHCS, 

NEHRS, and NPALS).

 No telework allowed for off-site contractor staff (NEHRS and NPALS).

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Summary: Changes Due to COVID-19

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 Delayed start of data collection (NAMCS, NHAMCS, NHCS, NEHRS, and 

NPALS).

 Moved to primarily CATI administration of Physician and Hospital Induction 

Interviews (NAMCS and NHAMCS).

 Dropped medical record abstraction of patient visits for physicians, but not 

for community health centers (NAMCS).

 Switched from in-person abstraction to remote abstraction (NHAMCS).

 Allowed some telework such that preparations for data collections could 

continue (NEHRS and NPALS).

 Released preliminary data on COVID-19 for selected hospitals (NHCS) and 

preliminary selected national estimates on COVID-19 related questions 

(NAMCS physicians and NPALS).
Lessons Learned 

 Prepare for disruptions to data collections and adapt as best you can.

 Add topical questions where possible to gather relevant information on 

future current crises.

 Develop novel data dissemination methods to provide information in a 

timely manner.

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Thank you!

Contact information:

Carol DeFrances

csd0@cdc.gov

Brian Ward

ijz8@cdc.gov

Manisha Sengupta

hku2@cdc.gov

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