Women’s health: Data from the Women’s health: Data from the National Ambulatory Medical Care National Ambulatory Medical Care Survey (NAMCS) and the National Survey (NAMCS) and the National Hospital Ambulatory Medical Care Hospital Ambulatory Medical Care

Survey (NHAMCS)Survey (NHAMCS)

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

Care Statistics Care Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

OutlineOutline Provide overview of NAMCSProvide overview of NAMCS Provide overview of NHAMCSProvide overview of NHAMCS

Emergency Departments (EDs)Emergency Departments (EDs) Outpatient Departments (OPDs)Outpatient Departments (OPDs)

Content of NAMCS and NHAMCS (OPD Content of NAMCS and NHAMCS (OPD and ED) Patient Record form (PRF)and ED) Patient Record form (PRF)

Examples research on women’s health Examples research on women’s health using NAMCS and NHAMCS data using NAMCS and NHAMCS data

Related NAMCS/NHAMCS Related NAMCS/NHAMCS sessionssessions

Overview of NAMCS/NHAMCS (10)Overview of NAMCS/NHAMCS (10) Using Past Visits information to Enhance Using Past Visits information to Enhance

NAMCS Data (25)NAMCS Data (25) Hands on NAMCS/NHAMC Workshop Hands on NAMCS/NHAMC Workshop

(39,44)(39,44) Prescription Drug Use (48)Prescription Drug Use (48)

National Ambulatory Medical Care National Ambulatory Medical Care Survey (NAMCS)Survey (NAMCS)

Nationally representative survey of patient visits Nationally representative survey of patient visits to non-federally employed physicians providing to non-federally employed physicians providing office-based patient careoffice-based patient care

The NAMCS is a three-stage probability designThe NAMCS is a three-stage probability design 112 NHIS PSUs112 NHIS PSUs 3,000 physicians3,000 physicians 25,000 visits sampled 25,000 visits sampled 1-week reporting period1-week reporting period

National Hospital Ambulatory Medical Care National Hospital Ambulatory Medical Care Survey (NHAMCS)Survey (NHAMCS)

Nationally representative survey of visits made Nationally representative survey of visits made to emergency departments (EDs) and outpatient to emergency departments (EDs) and outpatient departments (OPDs) of non-Federal, short-stay departments (OPDs) of non-Federal, short-stay hospitalshospitals

The NHAMCS is a four-stage probability design The NHAMCS is a four-stage probability design 112 NHIS PSUs112 NHIS PSUs 500 hospitals500 hospitals 400 EDs and 250 OPDs400 EDs and 250 OPDs 37,000 ED visits and 35,000 OPD visits37,000 ED visits and 35,000 OPD visits 4-week reporting period.4-week reporting period.

NAMCS and NHAMCSNAMCS and NHAMCS DataData

NAMCS and NHAMCS are record-based NAMCS and NHAMCS are record-based surveys surveys

Data abstracted from the patient’s medical Data abstracted from the patient’s medical record by the physician and/or his staff, record by the physician and/or his staff, hospital staff, or interviewerhospital staff, or interviewer

Estimates are in terms of visits and not Estimates are in terms of visits and not personspersons

Population-based surveys (NHIS) Population-based surveys (NHIS) estimates persons estimates persons

NAMCS/NHAMCS provide information NAMCS/NHAMCS provide information from the physician’s perspectivefrom the physician’s perspective Diagnoses and services provided have high Diagnoses and services provided have high

validityvalidity Data less subject to respondent recall Data less subject to respondent recall

Public use files released on the internet Public use files released on the internet include input statements to assist users include input statements to assist users creating files in SAS, SPSS, and STATA creating files in SAS, SPSS, and STATA softwaresoftware

Content of NAMCS and NHAMCSContent of NAMCS and NHAMCS

Data collection instrument: Patient Record form Data collection instrument: Patient Record form (PRF)(PRF)

PRFs are revised every 2-3 yearsPRFs are revised every 2-3 years Items collected every year include Items collected every year include

demographics, payment source, reason for visit, demographics, payment source, reason for visit, diagnoses, services received, medications, diagnoses, services received, medications, providers seen, and dispositionproviders seen, and disposition

Service and other data items may change with Service and other data items may change with each PRF revisioneach PRF revision

Content of NAMCS and NHAMCSContent of NAMCS and NHAMCS

Physician diagnoses Physician diagnoses Medications prescribed or orderedMedications prescribed or ordered Mammography (PO/OPD:1992, 1997-present)Mammography (PO/OPD:1992, 1997-present) Pap test (PO/OPD:1997 to present)Pap test (PO/OPD:1997 to present) Breast and pelvic exam (PO/OPD:1997-2000) Breast and pelvic exam (PO/OPD:1997-2000) Pregnancy test (ED:1995-present, Pregnancy test (ED:1995-present,

PO/OPD:1997-2000)PO/OPD:1997-2000) STD/HIV prevention education (PO/OPD:1993-STD/HIV prevention education (PO/OPD:1993-

2000)2000) Preventive care visits (PO/OPD:2001 to present)Preventive care visits (PO/OPD:2001 to present)

Previous research on women’s health Previous research on women’s health

using NAMCS and NHAMCS datausing NAMCS and NHAMCS data

Preventive services practice patterns in Preventive services practice patterns in general medical and gynecological general medical and gynecological examinationsexaminations

Hormone replacement therapy prescribing Hormone replacement therapy prescribing patterns patterns

Gender bias in psychotropic drug Gender bias in psychotropic drug prescribing patternsprescribing patterns

Use of EDs by sexually assaulted females Use of EDs by sexually assaulted females

Annual rate of hospital outpatient department visits for Annual rate of hospital outpatient department visits for preventive care by sex and patient's age: United States, 2001preventive care by sex and patient's age: United States, 2001

2.6

6.4

0.9 0.81.8

3.3

56.6 6.5

4.73.9 3.7

1.6

6.7

2.2

All ages Under 15 15-24 25-44 45-64 65 and over

Patient's age in years

0

2

4

6

8

10

12

14

Num

ber

of

visi

ts p

er 1

00 p

ers

ons

Male Female, non-pregnant Female, pregnant

Services ordered or provided for women aged 18-64 years Services ordered or provided for women aged 18-64 years during general medical examination or gynecological during general medical examination or gynecological

examination visits: United States, 1997examination visits: United States, 1997

0 20 40 60 80 100

Mammography

Pap test

Pelvic exam

Breast exam

Percent of visits

Gynecologist General practice Hospital outpatient department

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.

Trends in estrogen/progestin drug mention rates at Trends in estrogen/progestin drug mention rates at physician office visits by patient’s age: United States, physician office visits by patient’s age: United States, 1995-2002 1995-2002

0

5

10

15

20

25

30

35

40

45

50

55

60

1995 1996 1997 1998 1999 2000 2001 2002

65 years and over1

45-64 years

Num

ber

of d

rug

men

tions

per

100

fem

ales

.

Increasing trend is significant (p<0.05).NOTE: Rates based on visits made by females.

SummarySummary

The NAMCS/NHAMCS are important tools for The NAMCS/NHAMCS are important tools for policy research on outpatient practicepolicy research on outpatient practice Nationally representative sampling strategiesNationally representative sampling strategies Data based on either physician/hospital self-report or Data based on either physician/hospital self-report or

medical record abstraction by interviewersmedical record abstraction by interviewers

NAMCS/NHAMCS and women’s health NAMCS/NHAMCS and women’s health Understand health care practiceUnderstand health care practice Examine quality of careExamine quality of care Track changes in utilizationTrack changes in utilization