Mental Health Data from the NAMCS and NHAMCS Susan M. Schappert, M.A. Ambulatory and Hospital Care Statistics Branch Division of Health Care Statistics - PowerPoint PPT Presentation

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Mental Health Data from the NAMCS and NHAMCS Susan M. Schappert, M.A. Ambulatory and Hospital Care Statistics Branch Division of Health Care Statistics

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National Hospital Ambulatory Medical Care Survey (NHAMCS) ... psychiatry, neurology, ophthalmology, otolaryngology, and an 'other' category ... – PowerPoint PPT presentation

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Title: Mental Health Data from the NAMCS and NHAMCS Susan M. Schappert, M.A. Ambulatory and Hospital Care Statistics Branch Division of Health Care Statistics


1
Mental Health Data from the NAMCS and
NHAMCSSusan M. Schappert, M.A.Ambulatory and
Hospital Care Statistics BranchDivision of
Health Care Statistics
2
Topics To Be Covered
  • Survey Overview
  • Data Collected
  • Published Mental Health Research Using Data from
    NAMCS and NHAMCS
  • User Considerations
  • How to Get the Data

3
An Overview of NAMCS and NHAMCS
4
NAMCS and NHAMCS
  • National Ambulatory Medical Care Survey (NAMCS)
  • Visits to office-based physicians
  • National Hospital Ambulatory Medical Care Survey
    (NHAMCS)
  • Visits to hospital emergency and outpatient
    departments (EDs and OPDs)

5
History of NAMCS
  • Planning began in 1967
  • Inaugurated in 1973
  • Fielded 1973-1981, 1985, 1989-present
  • Database covering more than 30 years

6
History of NHAMCS
  • Planning began in 1976
  • Inaugurated December 1991
  • Fielded annually
  • 17th year of operation

7
NAMCS Sample Design
  • Three stage design
  • 112 primary sampling units (counties/groups of
    counties)
  • Physician practices within PSUs
  • Patient visits within practices
  • About 3,000 physicians are selected
  • Each physician is randomly assigned to a
    1-week reporting period
  • Data obtained for 25,000-30,000 patient visits
  • Sample data must be weighted to produce national
    estimates

8
Scope of the NAMCS
  • Basic unit of sampling is the physician-patient
    visit
  • In scope visits
  • Must occur in physicians office
  • Must be for medical purposes
  • Administrative visits not sampled
  • House calls, emails, phone calls not sampled

9
Scope of the NAMCS
  • Physicians must be
  • Classified by AMA or AOA as primarily engaged in
    office-based patient care
  • nonfederally employed
  • not in anesthesiology, radiology, or pathology
  • 59 percent response rate in 2006

10
Physicians Sampled in the NAMCS
  • Physicians are typically stratified into 15
    specialty groups
  • general and family practice, internal medicine,
    pediatrics, ob-gyn, general surgery, orthopedic
    surgery, cardiovascular diseases, dermatology,
    urology, psychiatry, neurology, ophthalmology,
    otolaryngology, and an other category
  • 2006 included an additional sample of
    oncologists, and a sample of community health
    centers
  • 29,392 Patient Record Forms completed by about
    1,400 physicians in 2006
  • 570 primary care physicians (general and family
    practice, internal medicine, pediatrics, and
    ob-gyn) responded in 2006 with data on about
    14,400 visits (nearly half of total visit
    records)
  • 80 psychiatrists reported on nearly 1,400 visits
    (4.7 of total)

11
In-Scope NAMCS Locations
  • Freestanding clinic/urgicenter
  • Federally qualified health center
  • Neighborhood and mental health centers
  • Non-federal government clinic
  • Family planning clinic
  • Health maintenance organization
  • Faculty practice plan
  • Private solo or group practice

12
Out-of-Scope NAMCS Locations
  • Hospital EDs and OPDs
  • Ambulatory surgicenter
  • Institutional setting (schools, prisons)
  • Industrial outpatient facility
  • Federal Government operated clinic
  • Laser vision surgery

13
NHAMCS Sample Design
  • Multistage probability design
  • First stage sample of 112 PSUs
  • Hospitals within PSUs
  • Clinics within OPDs, ESA (emergency service area)
    within EDs
  • Patient visits within clinics, ESAs
  • 4-week reporting period
  • 486 hospitals sampled in 2006 35,849 ED visits
    and 35,105 OPD visits

14
Scope of the NHAMCS
  • Basic unit of sampling is patient visit
  • Emergency and outpatient departments of
    noninstitutional general and short-stay hospitals
  • Not Federal, military, or Veterans Administration
    facilities
  • Located in 50 states and D.C.

15
Sampled OPD Clinics
  • 6 clinic types are defined and used for sampling
    general medicine, surgery, pediatrics, ob-gyn,
    substance abuse, and other
  • Other includes anxiety, behavioral medicine,
    eating disorders, psychiatry (adult, child,
    pediatric, geriatric), mental health, mental
    hygiene, psychopharmacology, and sleep disorders
  • Not included partial hospitalization programs,
    day hospital programs, psychology, methadone
    maintenance

16
Data Collected in the NAMCS and NHAMCS
17
Data Collection
  • U.S. Census Bureau is our field agent
  • Induction interview to train medical office or
    hospital staff on data collection procedures and
    to obtain data on practice or facility
    characteristics
  • Physicians office/hospital staff is responsible
    for completion of Patient Record forms Census
    abstracts as a last resort. In 2006, more than
    one-third of NHAMCS forms and about one-half of
    NAMCS forms were completed by Census abstraction.

18
Data Collection
  • Patient Record Forms (PRFs)
  • Nearly identical for NAMCS and OPD
  • Some differences for ED
  • Redesigned once every 2 years
  • Copies at our website www.cdc.gov/nhcs/namcs.htm

19
Data Items
  • Patient characteristics
  • Age, sex, race, ethnicity
  • Visit characteristics
  • Source of payment, continuity of care, reason for
    visit, diagnosis, treatment
  • Provider characteristics
  • Physician specialty, hospital ownership, region
    and urban-rural status, use of electronic medical
    records, and much more
  • Drug characteristics added in 1980

20
Mental Health Items Collected inNAMCS and
NHAMCS-OPD
  • Patients reason for visit (all survey years)
  • Physicians diagnosis (all survey years)
  • Does patient now have depression? (1991-92,
    1995-96, 2005-06)
  • Cause of injury (1995-2004), verbatim text added
    (1997-2004)
  • Diagnostic/screening services ordered or provided
  • Mental status exam (1979-81, 1991-92, 1995-96)
  • Depression screening (2005-06)
  • Medication therapy (1980-2006)
  • Non-medication therapy ordered or provided
  • Psychotherapy/therapeutic listening (1973-1981)
  • Psychotherapy (1985-92, 1995-2006)
  • Psycho-pharmacotherapy (1997-2000)
  • Alcohol abuse counseling (1991-92)
  • Drug abuse counseling (1991-92)
  • Stress management counseling (1991-92, 1997-2000,
    2005-06)
  • Mental health counseling (1995-2000)
  • Mental health/stress management counseling
    (2001-04)
  • Other mental health counseling (2005-06)

21
Mental Health Items Collected inNHAMCS-ED
  • Patients reason for visit (all survey years),
    verbatim text added 2005-06
  • Physicians diagnosis (all survey years)
  • Does patient now have depression? (1995-96)
  • Cause of injury (1995-2006), verbatim text added
    (1997-2006)
  • Intentional injury? (1997-2006)
  • Violence-related injury? (1995-96)
  • Alcohol- or drug-related visit? (1992-96)
  • Alcohol-related visit? (2001-04)
  • Adverse drug event (2001-02)
  • Patient oriented x 3 (2003-06)
  • Medication therapy (all survey years)

22
Multiple Response Fields
  • Up to 3 reasons for visit, causes of injury,
    physician diagnoses can be reported for each
    visit (no cause of injury on NAMCS and OPD
    starting in 2005)
  • Up to 8 medications and each medication can have
    up to 3 therapeutic classes and up to 5
    ingredients
  • Multiple procedure codes for NAMCS and OPD

23
Coding Systems Used
  • Reason for Visit Classification (NCHS)
  • ICD-9-CM for diagnoses, causes of injury, and
    procedures
  • Drug Classification System (NCHS)
  • Multum Lexicon starting with 2006 data
    (previously used National Drug Code Directory)

24
Drug Data in NAMCS/ NHAMCS
  • Respondents may list up to 8 medications
    (including Rx, or prescription, and OTC, or
    over-the-counter, medications, immunizations,
    allergy shots, anesthetics, and dietary
    supplements) that were ordered, supplied,
    administered, or continued during the visit.
  • Each entry is called a drug mention. Visits
    with one or more drug mentions are called drug
    visits.
  • Respondents are asked to report trade names or
    generic names only (not dosage, administration,
    or regimen). Cannot link drugs with diagnosis.

25
  • NAMCS or NHAMCS drug data can be analyzed
  • at the visit level (for example, the number of
    visits at which a particular drug was prescribed)
  • or at the medication level (for example, the
    number of mentions of a particular drug at
    ambulatory care visits

26
Published Mental Health Research Using Data from
NAMCS and NHAMCS
27
Hot Topics
  • See the NAMCS/NHAMCS website for a complete list
    of publications (including journal articles) by
    NCHS and others that use our data (about 100
    focus on mental health) updated monthly
  • Mental health research using NAMCS/NHAMCS data
    includes
  • visits for specific diagnoses (depression, ADHD
    attention deficit/hyperactivity disorder, and
    sleep disorders have been most commonly
    published, but there are also studies on visits
    for anxiety disorders, bipolar disorder, autism,
    schizophrenia)
  • pharmacotherapy (antidepressants, antipsychotics,
    hypnotics, stimulants, psychotropics in general)
  • mental health care by physicians other than
    psychiatrists
  • racial/ethnic/gender disparities in mental health
    care
  • other topics such as self-harm (ED visits),
    insurance issues, substance abuse

28
Additional Mental Health Data from NAMCS and
NHAMCS
  • Many annual NCHS summary reports (for example,
    Health US) include mental health related data,
    such as trends in prescribing antidepressants
  • Annual NAMCS and NHAMCS summary reports can
    include various mental health-related statistics
    (for example, statistics on visits to
    psychiatrists within tables by physician
    specialty)
  • Some NCHS reports have focused specifically on
    visits to psychiatrists, alcohol/drug related
    visits, etc.

29
User Considerations
30
A few things to keep in mind
  • NAMCS/NHAMCS sample visits, not patients
  • No estimates of incidence or prevalence
  • No state-level estimates
  • We do not sample by setting or by non-physician
    providers with one exception
  • Note that, from 2006, NAMCS includes a stratum of
    CHCs (community health centers), and
    non-physician providers are sampled within CHCs
  • May capture different types of care for solo vs.
    group practice physicians
  • May not have much data in a single year for less
    common conditions or events

31
NAMCS vs. NHAMCS
  • Consider what types of settings are best for a
    particular analysis
  • Persons of color are more likely to visit OPDs
    and EDs than physician offices
  • Persons in some age groups make
    disproportionately larger shares of visits to EDs
    than offices and OPDs

32
Ways to Improve Reliability of Estimates
  • Combine NAMCS, ED, and OPD data to produce
    ambulatory care visit estimates
  • Combine multiple years of data
  • Aggregate categories of interest into broader
    groups.

33
Caveat on Counseling Services
  • Diagnostic services are reflected accurately on
    medical records, but counseling services may not
    be
  • NAMCS (and OPD) data may underestimate the amount
    of health habit counseling that occurs if it is
    not documented in the medical record
  • These findings were published by in the following
    article Gilchrist VJ, Stange KC, Flocke SA,
    McCord G, Bourguet CC. A Comparison of the
    National Ambulatory Medical Care Survey (NAMCS)
    Measurement Approach With Direct Observation of
    Outpatient Visits. Medical Care 42(3), March
    2004, 276-280.

34
How To Get the Data
35
http//www.cdc.gov/nchs/namcs.htm
36
Public Use Micro-data Files
  • Downloadable files
  • NAMCS, 1973-2006
  • NHAMCS, 1992-2006
  • CD-ROMs
  • NAMCS, 1990-2005
  • NHAMCS, 1992-2005

37
Enhanced Public Use Files
  • SAS input statements, label statements, and
    format statements (1993-2006)
  • SPSS and Stata code for 2002-2006
  • Masked sample design variables
  • Allow use of SUDAAN, Stata, etc.
  • Available for 1993-2006

38
NCHS Research Data Center
39
Advantages of the NCHSResearch Data Center
  • Users gain access to information not available on
    public use files
  • Patient ZIP code-linked income, education,
    poverty status, percent foreign born, percent not
    speaking English well, urban-rural classification
  • Provider physician sex, age, and board
    certification, teaching hospital
  • Geographic FIPS (Federal Information Processing
    Standard) state and county codes
  • Special files and data supplements
  • For a complete list of variables, contact the
    Ambulatory and Hospital Care Statistics Branch

40
Research Data Center cont.
  • Can merge with contextual variables (e.g., Area
    Resource File, National Health Interview Survey,
    National Hospital Discharge Survey Census)
  • Health status level
  • Health Maintenance Organization (HMO) penetration
  • Physician and specialist supply
  • Medicaid reimbursement
  • Air quality
  • Percent in poverty

41
Research Data Center Procedures
  • Submit a proposal
  • May not use data to identify patients or
    providers or geographic location of providers
  • May not remove data files
  • Fees vary based on whether use is onsite or
    remote and whether project requires file
    construction by NCHS staff

42
Research Data Center
  • E-mail rdca_at_cdc.gov
  • Website www.cdc.gov/nchs/rd/rdc.htm
  • Call (301) 458-4277

43
Additional Information
  • Call the Ambulatory and Hospital Care Statistics
    Branch at (301) 458-4600
  • Visit our website at www.cdc.gov/nhcs/namcs.htm
  • Join the ACLIST. Its a moderated newsgroup for
    persons interested in NAMCS/NHAMCS. It currently
    consists of about 2,600 subscribers.
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