2010 NHAMCS MICRO-DATA FILE DOCUMENTATION PAGE 1 ABSTRACT This material provides documentation for users of the public use micro-data files of the 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is a national probability sample survey of visits to hospital outpatient and emergency departments, conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. The survey is a component of the National Health Care Surveys, which measure health care utilization across a variety of health care providers. There are two micro-data files produced from NHAMCS, one for outpatient department records and one for emergency department records. Section I of this documentation, “Description of the National Hospital Ambulatory Medical Care Survey,” includes information on the scope of the survey, the sample, field activities, data collection procedures, medical coding procedures, and population estimates. Section II provides detailed descriptions of the contents of each file’s data record by location. Section III contains marginal data for selected items on each file. The appendixes contain sampling errors, instructions and definitions for completing the Patient Record forms, and lists of codes used in the survey. PAGE 2 2010 NHAMCS MICRO-DATA FILE DOCUMENTATION SUMMARY OF CHANGES FOR 2010 The 2010 NHAMCS Emergency Department (ED) and Outpatient Department (OPD) public use micro-data files contain some important changes relative to the 2009 files. These mainly reflect changes to the survey instruments (the Patient Record form and the Hospital Induction Interview form) and are described in more detail below. Emergency Departments 1. New or Modified Items a. In item 1i, Expected Source of Payment, the category “Medicaid/SCHIP” was changed to “Medicald or CHIP/SCHIP”. b. In item 7, Diagnostic/Screening Services, the category “Pregnancy test” was changed to “Pregnancy/HCG test”. c. In item 12, Visit Disposition, the category “Left before medical screening exam” was changed to “Left before triage.” The category “Left after medical screening exam” was changed to “Left after triage”. One new category was added: “Return/Transfer to nursing home.” d. In item 13a, Hospital Admission: Admitted to:, the category “Stepdown or telemetry unit” was changed to “Stepdown unit”. e. In item 13d, the question, “Date and time patient actually left the ED” was changed to “Date and time patient actually left the ED or observation unit”. However, this information is not provided on the public use file. From the Hospital Induction Interview, two new items were added and one item was modified. Also, modifications were made to item 14, which concerns the adoption of Electronic Medical Records/Electronic Health Records (EMR/EHR). (EMR/EHR modifications are identical to those made in the 2010 National Ambulatory Medical Care Survey.) f. Items 11d and 11e: “Does your hospital have hospitalists on staff? and “Do the hospitalists on staff at your hospital admit patients from your ED?” were both added in 2010. g. Item 14h, “Do ED physicians make decisions for patients in this observation or clinical decision unit?” (Answer categories were Yes, No, Not applicable) (OBSDEC on the public use file) was changed to, “What type of physicians make decisions for patients in this observation or clinical decision unit? (Answer categories are: ED Physicians, Hospitalists, Other Physicians, and Not Applicable) (OBSDECMD on the public use file) h. “Does your ED have a computerized system for patient demographic information?” was changed to “Does your ED have a computerized system for patient history & demographic information?” i. Does your ED have a computerized system for clinical notes, and, if yes, do they include medical history and follow up notes?” was changed to “Does your ED have a computerized system for clinical notes, and, if yes, 1) do they include a list of medications that the patient is taking? and 2) do they include a comprehensive list of the patient’s allergies (including allergies to medication)?” j. “Does your ED have a computerized system for orders for tests?” was changed to “Does your ED have a computerized system for lab tests? 2010 NHAMCS MICRO-DATA FILE DOCUMENTATION PAGE 3 k. “Does your ED have a computerized system for viewing lab results?” – a sub-question was added: “If yes, are results incorporated in EMR/EHR?” l. “Does your ED have a computerized system for electronic reporting to immunization registries?” was added. m. “At your ED, if orders for prescriptions or lab tests are submitted electronically, who submits them?” was added. Note that this item, on the Hospital Induction Interview Form, does NOT immediately follow the two questions about whether the ED has a computerized system for orders for prescriptions or for lab tests, but was added as a separate item following that entire section. Therefore, there was no skip pattern to link responses to this question with the previous two questions. Because of the independence of these items, inconsistencies were noted during data processing between responses to the earlier items about whether the ED had a computerized system for orders for prescriptions or lab tests and responses to the later item about who submits such orders. A decision was made in consultation with branch staff to present both versions of the “who submits them?” item – the first version is as reported and will sometimes conflict with responses to the previous two questions. The second version has been recoded to take into account both previous questions. Researchers may make their own decisions about how to use these data. n. Does your hospital have plans to apply for Medicare or Medicaid incentive payments for meaningful use of Health IT? (Yes, Uncertain, No) o. What year does your hospital expect to apply for the meaningful use payments? (2011, 2012, After 2012, Unknown) p. “Are there plans for installing a new EMR/EHR system or replacing the current system within the next 3 years?” was changed to “At your ED, are there plans for installing a new EMR/EHR system within the next 18 months?” 2. Deleted Items a. The year of visit item (VYEAR) is no longer included on the public use file. Although the NHAMCS reporting periods will often begin in the last week of December and end in the last week of the following December, they are designed to yield statistics that are representative of the actual calendar year. The survey variable YEAR continues to be on the file and all visit dates may be assumed to reflect the calendar year. If more specific information is required, it is necessary to access the data through the NCHS Research Data Center. b. Although still collected, the verbatim cause of injury item, VCAUSE, is not included on the 2010 public use file. NCHS policy now requires that no new public use data files contain verbatim text responses. In order to use VCAUSE data, it is necessary to access the data through the NCHS Research Data Center. Please visit their website www.cdc.gov/rdc for additional information. c. From the Hospital Induction Interview form, the EMR question: “Does your practice have a computerized system for viewing imaging results? – the sub-question, “If yes, are electronic images returned?” was deleted. d. From the Hospital Induction Interview, the EMR question: “Does your practice have a computerized system for public health reporting?” was deleted. PAGE 4 2010 NHAMCS MICRO-DATA FILE DOCUMENTATION Outpatient Departments 1. New or Modified Items a. In Item 1. Patient Information, sub-item g) Expected source(s) of payment for this visit, checkbox 3, “Medicaid/SCHIP”, was changed to “Medicaid or CHIP/SCHIP”. b. In item 5, Provider’s Diagnosis for this Visit, sub-item b) “Regardless of the diagnoses written in 5a, does the patient now have”, under the checkbox for cancer, there are now 6 checkboxes to specify the stage. Stage of cancer was last included on the Patient Record Form in 2008. c. In item 7, Diagnostic/Screening Services, the Pregnancy checkbox was changed to Pregnancy/HCG Test. d. In item 9, Non-Medication Treatment, a checkbox was added for radiation therapy. This question was previously asked in 2008. From the Hospital Induction Interview, modifications were made to item 14, which is concerned with the adoption of Electronic Medical Records/Electronic Health Records (EMR/EHR). These modifications are identical to those listed in the section on Emergency Departments. e. “Does your OPD have a computerized system for patient demographic information?” was changed to “Does your OPD have a computerized system for patient history & demographic information?” f. “Does your OPD have a computerized system for clinical notes, and, if yes, do they include medical history and follow up notes?” was changed to “Does your OPD have a computerized system for clinical notes, and, if yes, 1) do they include a list of medications that the patient is taking? and 2) do they include a comprehensive list of the patient’s allergies (including allergies to medication)?” g. “Does your OPD have a computerized system for orders for tests?” was changed to “Does your OPD have a computerized system for lab tests? h. “Does your OPD have a computerized system for viewing lab results?” – a sub-question was added: “If yes, are results incorporated in EMR/EHR?” i. “Does your OPD have a computerized system for electronic reporting to immunization registries?” was added. j. “At your OPD, if orders for prescriptions or lab tests are submitted electronically, who submits them?” was added. Note that this item, on the Physician Induction Interview Form, does NOT immediately follow the two questions about whether the OPD has a computerized system for orders for prescriptions or for lab tests, but was added as a separate item following that entire section. Therefore, there was no skip pattern to link responses to this question with the previous two questions.