Women

1
Womens health Data from the National Ambulatory
Medical Care Survey (NAMCS) and the National
Hospital Ambulatory Medical Care Survey (NHAMCS)

• Esther Hing, Ambulatory Care Statistics Branch,
  Division of Health Care Statistics

2
Outline

• Provide overview of NAMCS
• Provide overview of NHAMCS
• Emergency Departments (EDs)
• Outpatient Departments (OPDs)
• Content of NAMCS and NHAMCS (OPD and ED) Patient
  Record form (PRF)
• Examples research on womens health using NAMCS
  and NHAMCS data

3
Related NAMCS/NHAMCS sessions

• Overview of NAMCS/NHAMCS (10)
• Using Past Visits information to Enhance NAMCS
  Data (25)
• Hands on NAMCS/NHAMC Workshop (39,44)
• Prescription Drug Use (48)

4
National Ambulatory Medical Care Survey (NAMCS)

• Nationally representative survey of patient
  visits to non-federally employed physicians
  providing office-based patient care
• The NAMCS is a three-stage probability design
• 112 NHIS PSUs
• 3,000 physicians
• 25,000 visits sampled
• 1-week reporting period

5
National Hospital Ambulatory Medical Care Survey
(NHAMCS)

• Nationally representative survey of visits made
  to emergency departments (EDs) and outpatient
  departments (OPDs) of non-Federal, short-stay
  hospitals
• The NHAMCS is a four-stage probability design
• 112 NHIS PSUs
• 500 hospitals
• 400 EDs and 250 OPDs
• 37,000 ED visits and 35,000 OPD visits
• 4-week reporting period.

6
NAMCS and NHAMCS Data

• NAMCS and NHAMCS are record-based surveys
• Data abstracted from the patients medical record
  by the physician and/or his staff, hospital
  staff, or interviewer
• Estimates are in terms of visits and not persons
• Population-based surveys (NHIS) estimates persons

7

• NAMCS/NHAMCS provide information from the
  physicians perspective
• Diagnoses and services provided have high
  validity
• Data less subject to respondent recall
• Public use files released on the internet include
  input statements to assist users creating files
  in SAS, SPSS, and STATA software

8
Content of NAMCS and NHAMCS

• Data collection instrument Patient Record form
  (PRF)
• PRFs are revised every 2-3 years
• Items collected every year include demographics,
  payment source, reason for visit, diagnoses,
  services received, medications, providers seen,
  and disposition
• Service and other data items may change with each
  PRF revision

9
Content of NAMCS and NHAMCS

• Physician diagnoses
• Medications prescribed or ordered
• Mammography (PO/OPD1992, 1997-present)
• Pap test (PO/OPD1997 to present)
• Breast and pelvic exam (PO/OPD1997-2000)
• Pregnancy test (ED1995-present,
  PO/OPD1997-2000)
• STD/HIV prevention education (PO/OPD1993-2000)
• Preventive care visits (PO/OPD2001 to present)

10
(No Transcript)
11
Previous research on womens health using NAMCS
and NHAMCS data

• Preventive services practice patterns in general
  medical and gynecological examinations
• Hormone replacement therapy prescribing patterns
• Gender bias in psychotropic drug prescribing
  patterns
• Use of EDs by sexually assaulted females

12
Annual rate of hospital outpatient department
visits for preventive care by sex and patient's
age United States, 2001
13
Services ordered or provided for women aged 18-64
years during general medical examination or
gynecological examination visits United States,
1997
Source Tao, Zhang, Qian, Services Provided to
Nonpregnant Women During General Medical and
Gynecological Examinations in the United States.
Am J Prev Med.21(4) 291-297. 2001.
14
Trends in estrogen/progestin drug mention rates
at physician office visits by patients age
United States, 1995-2002
45-64 years
65 years and over1
Number of drug mentions per 100 females.
NOTE Rates based on visits made by females.
Increasing trend is significant (plt0.05).
15
Summary

• The NAMCS/NHAMCS are important tools for policy
  research on outpatient practice
• Nationally representative sampling strategies
• Data based on either physician/hospital
  self-report or medical record abstraction by
  interviewers
• NAMCS/NHAMCS and womens health
• Understand health care practice
• Examine quality of care
• Track changes in utilization