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Scientific Data Documentation
Epidemiologic Followup Study, 1986 Health Care Facility Stay
DSN: CC37.HANES1FU.FCLTY86 NHANES EPIDEMIOLOGIC FOLLOWUP STUDY HEALTH CARE FACILITY STAY 1986 Acknowledgments The NHANES I Epidemiologic Followup Study (NHEFS), 1986 Health Care Facility Stay Public Use tape was prepared by Virginia M. Freid under the direction of Jennifer H. Madans. Assistance was provided by other members of the NHEFS data management team: Joel C. Kleinman, Fanchon F. Finucane, Christine S. Cox, Sandra T. Rothwell, Brian A. Kissel, Cynthia A. Reuben, Michael E. Mussolino, Helen E. Barbano, Madelyn A. Lane, and Jacob J. Feldman. Virginia M. Freid, Sandra T. Rothwell, and Dawn M. Scott were in charge of data set management. La-Tonya D. Curl, Patricia B. Salins and Carole J. Hunt were in charge of manuscript preparation. Special thanks are extended to Joan Cornoni-Huntley of the National Institute on Aging (NIA) who played an important role in the development and continuation of the NHEFS. The contribution of Westat, the contractor who collected the data for this longitudinal study, is also gratefully acknowledged. The NHEFS originated as a joint project between the National Center for Health Statistics (NCHS) and NIA. It has been funded primarily by NIA, with additional financial support from the following components of the National Institutes of Health (NIH) and other Public Health Service agencies: the National Cancer Institute; the National Institute of Child Health and Human Development; the National Heart, Lung, and Blood Institute; the National Institute on Alcohol Abuse and Alcoholism; the National Institute of Mental Health; the National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute of Arthritis and Musculoskeletal and Skin Diseases; the National Institute of Allergy and Infectious Diseases; and, the National Institute of Neurological and Communicative Disorders and Stroke. Use of NHEFS Data With the goal of mutual benefit, NCHS requests the cooperation of recipients of data tapes in certain actions related to their use: A. Any published material derived from the data should acknowledge the National Center for Health Statistics (NCHS) as the original source. It should also include a disclaimer which credits any analyses, interpretations, or conclusions reached to the author (recipient of thetape) and not to NCHS, which is responsible only for the initial data. B. Consumers who wish to publish a technical description of the data will make a reasonable effort to insure that the description is not inconsistent with that published by NCHS. This does not mean, however, that NCHS will review such descriptions. C. Authors should provide NCHS with a reprint of published articles which utilize the 1986 NHEFS data. Please send reprints to: NHEFS Data Management Staff Division of Analysis National Center for Health Statistics Presidential Building, Room 1080 6525 Belcrest Road Hyattsville, MD 20782 Note: New address effective May 1990. Errors in the Data Tapes and Survey Differences The NHEFS Public Use data tapes have been subjected to a great deal of careful editing. However, due to the large volume of data in the series, it is likely that a small number of errors or discrepancies remain undetected. In general, the NHEFS data management team has not attempted to resolve substantive data discrepancies that may exist 1) within the 1986 NHEFS data tapes, or 2) between the 1986 NHEFS data tapes and the data tapes of the original National Health and Nutrition Examination Survey (NHANES I) and other NHEFS followup waves. Background 1986 The NHANES I Epidemiologic Followup Study (NHEFS) is a longitudinal study which uses as its baseline those adult persons ages 25 to 74 years who were examined in the first National Health and Nutrition Survey (NHANES I). The NHEFS is comprised of a series of followup surveys, three of which have been conducted to date. The first wave of data collection, the 1982-84 NHEFS, was conducted from 1982 to 1984 and included all persons who were between 25 and 74 years at their NHANES I examination (n=14,407). This series of tape documentation describes data collected in the second wave, the 1986 NHEFS. The 1986 NHEFS was conducted for members of the NHEFS cohort who were 55-74 years at their baseline examination and not known to be deceased at the 1982-84 NHEFS (n=3,980). The third wave of data collection took place in 1987. An attempt was made to re-contact the entire non-deceased NHEFS cohort (n=11,750) at that time. A plan to re-contact the entire non-deceased NHEFS cohort in 1991 is currently under review. Methods NHANES I collected data from a national probability sample of the United States civilian non-institutionalized population between the ages of 1 and 74 years. The survey, which included a standardized medical examination and questionnaires that covered various health-related topics, took place from 1971 through 1974 and was augmented by an additional national sample in 1974-75. The NHANES I sample included 20,729 persons 25 to 74 years of age, of whom 14,407 (70 percent) completed a medical examination. The design, content and operation of NHANES I has been described elsewhere (Vital and Health Statistics, Series 1, Nos. 10a, 10b, and 14). Although NHANES I provided a wealth of information on the prevalence of health conditions and risk factors, the cross-sectional nature of the original survey limits its usefulness for studying the effects of clinical, environmental, and behavioral factors and in tracing the natural history of disease. Therefore, the NHEFS was designed to investigate the association between factors measured at baseline and the development of specific health conditions. It has been jointly sponsored by the National Center for Health Statistics (NCHS), the National Institute on Aging, and other components of the National Institutes of Health and Public Health Service. The 14,407 participants who were 25 to 74 years of age when they were examined in NHANES I (1971-75) are included in the followup study population. In the first wave, the 1982-84 NHEFS, data were collected on all 14,407 subjects (i.e., individuals examined at NHANES I) in the cohort. Tracing of subjects began in 1981 and data collection was conducted from 1982 to 1984. Approximately 93 percent (n=13,383) of the cohort was successfully traced by the end of the survey period. Detailed information on the design, content, and operation of the 1982-84 NHEFS may be found in the Plan and Operation of the NHANES I Epidemiologic Followup Study 1982-84, Vital and Health Statistics, Series 1, No. 22. The basic design of the 1982-84 NHEFS consisted of the following components: tracing subjects or their proxies to a current address; acquiring death certificates for deceased subjects; performing in-depth interviews with the subjects or with their proxies including, for surviving subjects, taking pulse, blood pressure, and weight measurements of subjects; and, obtaining hospital and nursing home records, including pathology reports and electrocardiograms. The 1986 NHEFS, the second wave of the NHEFS, collected information on changes in the health and functional status since the last contact with the older members of the NHEFS cohort. It was restricted to those subjects who were at least 55 years old at their NHANES I examination (n=5,677), which is almost 40 percent of the entire NHEFS cohort. This group includes 1,697 subjects who were deceased at the time of the 1982-84 NHEFS and 3,980 subjects who were not known to be deceased at the time of the 1982-84 NHEFS. The 1982-84 NHEFS decedents were excluded from additional data collection in the 1986 NHEFS. Tracing and data collection were undertaken for the 3,980 subjects not known to be deceased in the 1982-84 NHEFS, regardless of their tracing or interview status in that survey. The design and data collection procedures adopted in the 1986 NHEFS were very similar to the ones developed in the 1982-84 Survey: subjects (or their proxies) were traced; subject and proxy interviews were conducted; and, health care facility abstracts and death certificates were collected. For more information on the 1986 NHEFS, see the Plan and Operation: NHANES I Epidemiologic Followup Study, 1986 (a Vital and Health Statistics, Series 1, No. 25). Tracing began in November 1984 for the 1986 NHEFS. A large variety of tracing sources were used in order to locate subjects. For example, all subjects were matched against information from the National Death Index (NDI) and the enrollee files of the Health Care Financing Administration. The additional tracing sources used in the 1986 wave, though, depended on the subject's vital status in the 1982-84 NHEFS. Subjects who had been successfully traced alive in the 1982-84 NHEFS underwent one set of tracing procedures while those who had not been successfully traced in the 1982-84 NHEFS underwent another. Date and place of death were obtained for all subjects identified during tracing as deceased. These data were used to obtain a copy of the subject's death certificate from the appropriate State Vital Statistics office. A death identified by the NDI or by the other tracing methods was also verified by obtaining the death certificate from the State of death. All death certificates were coded by NCHS using the International Classification of Diseases, Ninth Revision and multiple cause-of-death codes. All subjects who could not be located through the tracing procedures were considered lost-to-followup in the 1986 NHEFS. In some cases, information about the death of a subject was obtained from a former neighbor, a relative or another tracing source. Although this information was noted in the subject's tracing record, he or she was considered lost-to-followup unless the information was verified by means of a death certificate or proxy interview. A subject's death had to be confirmed by either a death certificate or proxy interview. In addition to verifying the subject's vital status, the tracing process also was used to obtain the current address of a surviving subject as well as to identify a knowledgeable proxy respondent for a deceased subject or a surviving but incapacitated subject. Respondents (i.e., subjects or their proxies) who were identified and located through the tracing procedure were then contacted and asked to participate in a telephone interview. In a few cases, subjects who had been traced successfully could not be relocated for the interview. Only their vital status and the date when they were last traced in the 1986 Survey are available. A major difference between the 1982-84 and 1986 NHEFS waves was the manner in which the interviews were conducted. In the 1982-84 NHEFS, the two-hour subject interview usually was conducted in-person while, in the 1986 NHEFS, the interview was shortened to 30 minutes in length and was conducted primarily by telephone. In addition, since the questionnaire was not administered in-person, no physical measurements were made in the 1986 NHEFS. The 1986 NHEFS interviews were conducted over the telephone using a Computer Assisted Telephone Interviewing (CATI) system. CATI is a telephone interviewing technique that allows the interviewer to enter the answers supplied by the respondent directly into the computer. Thus, editing and coding time is reduced and keypunching from a hard copy questionnaire is eliminated. A computer program drives the questionnaire so that the correct skip patterns are followed and the appropriate questions are displayed on the computer monitor. The skip patterns are based on information gathered from previous data collection waves or on responses provided during the interview. For example, the questions on pregnancy and menstrual history in the 1986 NHEFS interview were programmed to be skipped automatically if the subject was male or if the female subject had had an interview in 1982-84. Edit and logic checks are incorporated into the data collection system itself, thus improving the quality of the data. The 1986 NHEFS included a health care facility record collection component designed to provide information on all overnight stays for subjects since their last interview. Subjects were eligible for this component if either an interview or a death certificate had been collected for them in the 1986 Survey. As of July 28, 1986, the end of the 1986 NHEFS survey, 3,767 (94.6 percent) of the 3,980 members of the 1986 NHEFS cohort had been successfully traced. Interviews were conducted for 3,608 subjects (95.8 percent of those successfully traced), 167 of which were conducted during three pretest periods in 1985 and 3,441 during a main survey period in 1986. In addition, 5,405 facility stay records were collected for 2,021 subjects. Death certificates were obtained for 616 (97.0 percent) of the 635 subjects who were known to have died since last contact. The data collected from the 1986 NHEFS are stored on four separate tapes: 1) Vital and Tracing Status tape -- contains vital status, tracing, and demographic information on all subjects 55 years or older at NHANES I, 2) Interview tape -- contains the data collected from the 1986 NHEFS subject and proxy interviews, 3) Mortality Data tape -- contains data abstracted from the death certificate for all known decedents aged 55 years or older at NHANES I for whom a death certficate was obtained, 4) Health Care Facility Stay tape -- contains information collected during the 1986 NHEFS on reports of stays in hospitals and nursing homes, as well as information abstracted from facility medical records. This tape is discussed below in the following pages. Stay Reports The 1986 NHEFS Health Care Facility Stay file contains information on all overnight health care facility stays for members of the 1986 Followup cohort. The 1986 Followup cohort consisted of the 3,980 subjects who were at least 55 years old at their NHANES I examination and were not known to be deceased at the time of the 1982-84 NHEFS. Followup cohort members who have either an interview or a death certificate on the 1986 NHEFS data files were eligible for the health care facility records component. The aim of this component was to develop a complete set of health care facility (i.e., hospital and nursing home) records for each 1986 Followup cohort member. This was accomplished by identifying all facility stays through a series of reporting mechanisms. Facilities were contacted to obtain copies of medical records. Reports and medical records were then linked and the 1986 NHEFS Health Care Facility Stay file was constructed. The procedures for obtaining reports and collecting abstracts are described in detail in the Plan and Operation: NHANES I Epidemiologic Followup Study, 1986 (Vital and Health Statistics, Series 1, No. 25). They are outlined briefly, below. The 1986 NHEFS Health Care Facility Stay file contains all information on overnight stays that are in-scope for the 1986 NHEFS period. For subjects interviewed during the 1982-84 NHEFS, the 1986 in-scope survey period is from the date of the 1982-84 interview to the date of the 1986 interview for surviving subjects and from the date of the 1982-84 interview to the date of death for deceased subjects. The 1986 in-scope survey period for subjects who were not interviewed in the 1982-84 NHEFS is from the date of NHANES I examination to the date of the 1986 interview for surviving subjects and from the date of NHANES I examination to the date of death for deceased subjects. Stays that were reported prior to the in-scope period were defined as out-of-scope for the 1986 survey. Identification of Stay Reports Reports of overnight hospital or nursing home facility stays were obtained from various sources. Most reports were elicited through a series of detailed questions in sections B and F of the interview. Generally, respondents were asked to report all overnight facility stays since 1980 if the subject was last interviewed in the 1982-84 NHEFS or since 1970 if the subject was last interviewed at NHANES I examination. In addition to interview information, data on facility stays were gathered from other reporting sources: from the death certificate, tracing sources, and other hospital abstracts. At the conclusion of the interview, authorization was obtained for permission to contact facilities. Facility Data Collection For each stay reported during the interview, the name and address of the facility, the reported dates of the stay, and the reason for the stay were recorded on the hospital and health care facility chart (HHCF). A separate log book was kept containing similar data for reports gathered from the death certificates, tracing sources, and other hospital abstracts. All reports of facility stays were compiled and entered into a computerized tracking system. All reported facilities were contacted by mail and asked to review the subject's medical records and to abstract information on exact dates of admission, discharge and diagnoses onto standard abstract forms. In addition to completing abstract forms, facilities were requested to submit photocopies of selected sections of the subject's inpatient record i.e., the "facesheet", the discharge summary, the third day EKG (for myocardial infarction diagnoses, 410 in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)) and of pathology reports (for any admission where a new malignancy was diagnosed). Matching Records As the abstracts were received, they were checked against report information in the tracking system to determine if the abstract "matched" any of the reported stays. Date of admission and diagnosis were used as matching criteria but exact matches on date or diagnosis were not required for a stay to be considered matched. Abstracts were matched to reports if the reported date of admission was within a year of the actual date of admission and if the reported reason for admission involved the same body system as at least one of the diagnoses present on the abstract. Cases that did not meet these specific criteria were reviewed by NCHS staff and matched when appropriate. Since the matching rules allowed for an admission date of up to one year before or after the reported date of admission, some stay records are present on the file with a match record status, an out-of-scope report date, but an in-scope date on the abstract. These records are identified by a Type C flag in position 199 of the file. Each record on the file represents an overnight facility stay. Therefore, one or more records will exist for some 1986 Followup cohort subjects, while other subjects will have no records on the file. The structure of the data file reflects the system used to obtain and process stay information. The record is divided into four major sections: 1) the report section, 2) the record status section, 3) the abstract section and, 4) the related stay section. An example of the record layout is provided in figure 1. The subject identification number (i.e. the sample sequence number) is in positions 1-5 on each record. This number is unique for each subject and is used when linking the Health Care Facility Stay tape to all other NHEFS and NHANES I Public Use Data Tapes. The total number of records per subject is found in positions 6-7 on the file. The first section of the record is the report section (positions 29-59 and 63-204) which contains information from the reporting source as well as stay identification numbers assigned by NCHS. Each stay entered into the report section is assigned a health care facility stay id number (positions 29-33). When used in conjunction with the sample sequence number, this number uniquely identifies each record on the file. The reported date of admission is found in positions 47-54. This date is used in conjunction with the last interview date to determine whether reported stays were in-scope for the NHEFS 1986 survey (position 199). The record status section (positions 60-62) contains a code for the result of the abstract request, i.e. match or non-match status. If a facility returned an abstract that matched a report then a record status code of MAT (match) was applied. A returned abstract that did not match a report but was in-scope for the 1986 survey period was assigned the record status code of ASF (additional stay found). A record status code of CRM (cross-referenced match) was applied to a stay that was the continuation of a stay begun prior to the 1986 NHEFS survey period. If an abstract was not returned, the appropriate non-match code was assigned. The abstract section (positions 205-379) contains the information obtained from the facility records including actual dates of admission, discharge and diagnoses. The diagnoses on the abstracts were coded using the ICD-9-CM according to the medical coding specifications detailed in the following section of this codebook. The abstract section is similar to the original 1982-84 NHEFS Health Care Facility record file released in August, 1987 while the other three sections are new additions to the NHEFS 1986 facilty tape format. (A revised file which restructures the 1982-84 Health Care Facility data into the current format has also been released.) Information will be present in one or more sections of the record depending on whether a report was obtained, and whether an abstract was received. The presence or absence of information in the first three sections results in three different record profiles. Figure 2 illustrates these three profiles. The first is the successfully matched stay record, where an abstract was received which matched a report. Abstract information is added to the report and the code of MAT was entered into the record status section. Complete information is available in the first three sections of the record for these stays. The second type occurs when an abstract was not matched to a report and, therefore, no data is contained in the abstract section. The appropriate non-match code was entered in the record status section. The third type of record is one which was generated solely by the receipt of a facility abstract. This type of record resulted when the facility returned an in-scope abstract that did not match with any report on the tracking system. When this occurred, the abstract was entered on the file, and stay identifiers were assigned in the report section of the record but no other information in the report section is present. An ASF (additional stay found) code was entered in the record status section. Due to the procedures we instituted for maximizing the collection of reports of hospital or nursing home stays, i.e., deliberately requesting out-of-scope report information, it was necessary to devise rules for removing the "correctly reported" out-of-scope reports from the final version of the file. This was only possible after the facilities returned abstract information to us. Reports of stays with a reported date of admission more than one year prior to the last interview in health care facilities which had not been contacted previously were flagged with a Type D in position 199. If an in-scope abstract was received from the facility it was added onto the file with a record status code of ASF, and the Type D report was deleted from the final version of the file. If the facility responded to the request for information but no in-scope abstracts were received from the facility, the Type D report was deleted from the file based on the presumption that the date had been correctly reported and the stay was out-of-scope. In 20 cases, the Type D reports remain on the final version of the file. This occurred when it was impossible to contact the facility or the facility did not return any information to us. These records for unconfirmed reports of out-of-scope stays can be eliminated from analyses at the analysts' discretion. A Type C flag was assigned in position 199 when a reported date of admission was within one year of the previous interview. If an in-scope abstract was returned which matched the Type C report, it was assigned a record status code of MAT (n=73). (The matching rules permitted an admission date of up to one year before or after the reported date of admission). If the facility responded but no in-scope abstracts were received the Type C reports were removed from the file again on the assumption that the correct date had been reported and the stay was truly out-of-scope. In 10 cases it was not possible to contact the facility, and the Type C reports remain on the file. These unconfirmed reports of out-of-scope stays are identified by a non-match status in positions 60-62 and a Type C flag in position 199. The final section of the record, the related stay codes (positions 380- 429), are used to identify stays which are contained within other stays. This occurred most often when nursing home residents had a brief hospital stay but then returned to the nursing home. A detailed example of the related stay section is presented below. In panel A, a chronologic history of a subject's hospital and nursing home stays is presented in order to facilitate the discussion of the related stay codes. This subject was admitted to the nursing home on March 1, 1985, and discharged to the hospital on April 1, 1985. He returned to the original nursing home on April 8 and stayed until April 22 when he required readmission to the hospital. He returned from the hospital to the nursing home on April 25, 1985 where he remained until April 30, 1985. Panel A: Chronologic profile of hospital and nursing home stays Location Admission Discharge Nursing home 03/01/85 04/01/85 Hospital 04/01/85 04/08/85 Nursing home 04/08/85 04/22/85 Hospital 04/22/85 04/25/85 Nursing home 04/25/85 04/30/85 Panel B: Final file layout Panel B illustrates how these stays are present in the final file. The three nursing home stays were collapsed into one long stay with two related hospitalizations. The related stay codes were added to demonstrate the relationship between the hospital and nursin home stays. Variable Position: 29-33 209 210-215 216-221 380-384 385-389 Variable Name: Stay Dis- First Second Number Type Admit charge Related Related 20201 N. Home 03/01/85 04/30/85 20101 20102 20101 Hosp 04/01/85 04/08/85 20201 20102 Hosp 04/22/85 04/25/85 20201 Coding Procedures and Guide to Tape Layout Medical Coding Specifications Medical coding for the NHEFS 1986 data tape was based on the International Classification of Diseases-9th Revision-Clinical Modification (ICD-9-CM). The health care facility was asked to abstract all diagnoses and procedures onto a special form. In most cases, a copy of the hospital discharge summary and/or medical records facesheet was attached to the abstract. The diagnoses and procedures listed on the discharge summary or facesheet were then compared with those provided on the abstract form. In most instances, discrepancies were resolved by coding the diagnoses or procedures as provided on the discharge summary or the facesheet. All diagnoses were coded to the highest level of specificity possible. The fourth-digit subcategory for diagnosis and procedure codes was used whenever possible. The fifth-digit subclassification of disease for diagnosis codes was also used when appropriate. A three-digit ICD code was used only if it could not be further subdivided. The following rules were used to code diagnoses and procedures. Rules Governing Medical Coding of Diagnoses All medical diagnoses listed on the health care facility abstract form or the discharge summary are coded in the order in which the diagnoses were listed. The principal diagnosis is the condition established after study to be chiefly responsible for occasioning the admission of the patient to the health care facility. The admitting diagnosis is not used as the principal diagnosis unless the admitting and discharge diagnoses are the same. Ex: Patient admitted with a diagnosis of bronchopneumonia. After workup and treatment, x-ray findings, etc., the patient was discharged with a final diagnosis of bronchopneumonia. The principal diagnosis is coded 485 for bronchopneumonia. Note that the facility was asked to select the principal diagnosis and no review of the records was made to determine if the correct diagnosis was selected. All other diagnoses or conditions existing at the time of admission or that developed subsequently during the stay are coded. Ex: Patient was admitted with a diagnosis of uncontrolled diabetes mellitus, and during the course of examination and treatment, phlebitis was discovered. The diabetes and the phlebitis are coded. Diagnoses documented as probable, possible, suspected, question of, suggestive of, compatible with, or questionable are coded and prefixed with a "P". Ex: If the diagnosis is stated possible myocardial infarction, the diagnosis code is P410.9. If a diagnosis is stated as "rule out" or "R/O", the condition is coded as if it exists and the "P" prefix is not used. If a diagnosis is stated as "ruled out", the condition is not coded. Ex: If "R/O M.I." appears on the facesheet, the code is 410.9 If "M.I. ruled out" appears, the condition is not coded. Hospital acquired infections, such as a "staph" infection, if documented on the facesheet and/or discharge summary are coded. Documentation may be in the form of a note by the infections committee, stamped notation, or a checkmark, depending on the record format. Malignant neoplasms are coded according to ICD-9-CM coding specifications which indicate primary site of origin. Injuries and poisonings are coded, where applicable, using both the nature of the injury and the external cause of injury code (E800-E999). Ex: Patient sustained comminuted fracture of the femur due to a fall down stairs. Nature of injury code is 821.00 and external cause of injury code is E880.9 "History of" conditions are not coded with the following exceptions: Old myocardial infarction (more than 8 weeks since last occurrence) Status post bypass surgery Malignant neoplasm (cancer in remission or under treatment) Old cerebrovascular accident Sterilization Normal pregnancy undelivered Manipulation of an IUD These diagnoses are coded using "V" codes and were used on a limited basis. Recurrent malignancy codes are prefixed with an "R". Symptoms (ICD-9-CM codes 7800-7999) were coded using the following guidelines: 1. When the only diagnosis listed on the abstract form, facesheet, and/or discharge summary is a symptom, the symptom is coded. Ex: The only discharge diagnosis listed is "chest pain". The code number 786.50 (chest pain, unspecified) is assigned. 2. When a symptom is listed that is unrelated to any of the diagnoses listed, the symptom is coded. Ex: The discharge diagnoses listed are acute myocardial infarction, diabetes mellitus, and hepatomegaly. The hepatomegaly is also coded. 3. When a symptom is listed and is related to a listed discharge diagnosis the symptom is not coded. Ex: The discharge diagnoses listed are diabetes mellitus, acute appendicitis, severe abdominal pain. Only the diabetes and the appendicitis are coded. The abdominal pain is not coded. Rules Governing Medical Codes for Procedures The same general rules apply to coding procedures as to coding diagnoses. Medical procedures are coded and sequenced in accordance with the principal and secondary procedures described on the health care facility abstract form or the discharge summary/facesheet. The principal procedure is the primary procedure most related to the principal diagnosis and is performed for definitive treatment as opposed to diagnostic and/or exploratory purposes. Ex: Diagnosis = uterine fibroids. Procedures = biopsy of uterus, total abdominal hysterectomy, incidenta appendectomy. The hysterectomy is coded as the principal procedure and the appendectomy and the biopsy are coded as secondary procedures. All procedures documented on the discharge summary and/or facesheet are coded if they fall into the following categories: Biopsies (if related to the principal diagnosis and procedure or if related to other listed diagnoses) Surgical procedures Cardiac catheterizations D and C (following delivery or abortion only) The following procedures are not coded: Surgical approach Operative cholangiogram Lumbar puncture CT scan Endoscopy Diagnostic D and C Diagnostic radiology Examination (under anesthesia, physical exam, etc.) Manipulations Physical therapy Application or removal of casts, splints, etc. Medical Coding Conventions Diagnostic codes--Up to ten diagnoses are coded for each hospital and nursing home stay. The format for each diagnosis code is six positions. The following conventions were used when entering diagnostic codes on the data tape: 1. ICD-9-CM diagnostic codes (including "V" codes) were entered beginning with the second position of the variable field continuing through the sixth position. There is an implied decimal point between the fourth and fifth positions of the variable field. 2. If the diagnoses code required less than five digits the remaining tape positions are blank. 3. Prefix codes "P" and "R" are coded in the first tape position. If the diagnosis code has no prefix the first position is blank. Ex. 1: _ 4 2 2 9 0 Code is 422.90 Ex. 2: _ V 7 1 1 _ Code is V71.1 Ex. 3: _ 4 3 6 _ _ Code is 436 Ex. 4: P 1 8 0 0 _ Code is P180.0 Ex. 5: R 1 7 4 9 _ Code is R174.9 4. E codes - External cause of injury codes An external cause of injury code is provided, when applicable, immediately after the medical diagnosis code which describes the nature of the injury. E codes were entered on the data tape beginning in the first position of the variable field and continuing through the fifth position. There is an implied decimal point between the fourth and fifth positions of the variable field. If an E code required less than five positions the remaining positions are blank. If an E code is not applicable (i.e. the medical diagnosis code is not a nature of injury code) or could not be coded, the variable field is blank. Ex. 1: E 9 0 6 1 Code is E906.1 Ex. 2: E 8 5 1 _ Code is E851 Procedure codes--Up to five procedures are coded for each health care facility record. Each procedure code is formatted in a field containing four positions. Procedure codes were entered beginning with the first position of the variable field continuing through the fourth position. There is an implied decimal point between the second and third positions of the variable field. If a procedure code required less than four positions the remaining positions are blank. Ex. 1: 4 2 9 2 Code is 42.92 Ex. 2: 0 3 1 _ Code is 03.1 Record Layout Tape Position Frequencies Variable Description and Codes SUBJECT INFORMATION 1-5 5405 NHANES I Sample Sequence Number 6-7 Record Count 5405 01-29 = Total number of records Note: Each record on the file represents an overnight stay in a health care facility (hospital or nursing home). This variable identifies for each subject the total number of records on the file. It will be the same for each record the subject has on the file. 8-28 5405 Blank Tape Position Frequencies Variable Description and Codes STAY IDENTIFIERS AND REPORTED INFORMATION ON FACILITY STAYS Note: The report section of the record (positions 29-59 and 63-204) contains the information on health care facility stays that was reported on the questionnaire, on a death certificate, on another hospital/nursing home abstract form, or obtained from other sources. (29-33) Health Care Facility Stay ID Number Note: When used in conjunction with the sample sequence number this number uniquely identifies each record on the tape. It is composed of three variables: Survey Period Identifier, Facility Number and Stay Number Within Facility. For example: a Stay Number of 20102 refers to a facility stay reported during the NHEFS 1986 wave (2) in the first facility reported for that subject (01) but the second admission to that facility (02). 29 Survey Period Identifier 5405 2 = NHEFS 1986 Note: This variable identifies the survey period in which the stay data were collected. A facility stay reported during the NHEFS 1986 wave will be identified with a code number "2". All records on this file are coded "2" in this field. 30-31 Facility Number 5405 01-08 = Hospital/nursing home number Note: For each NHEFS subject, a two digit number was assigned to each facility in which a stay occurred. Thus, if a subject had multiple stays at the same facility, all stays will have the same facility number. Facility numbers were assigned consecutively. However, due to tape editing, there are missing numbers in the sequence of facility numbers. 32-33 Stay Number Within Facility 5385 01-30 = Stay number 20 00 = D stay record Note: The two digit stay numbers were assigned to identify different stays in the same facility. Type D stay records were assigned a stay number of "00". A type D stay record is defined as a stay with a reported admission date more than one year prior to the date of last interview (see position 199). Stay numbers within facilities were assigned consecutively. However, due to tape editing, there are missing numbers in the sequence of stay numbers within facilities. 34-35 Facility ID Prefix 4784 01 = Hospital 528 02 = Nursing home 93 03 = Out of country, don't know, not ascertained Note: This variable identifies the type of facility to which the request for a stay record was mailed. 36-46 5405 Blank Tape Position Frequencies Variable Description and Codes (47-54) Reported Admission Date/Range The date of admission to a facility is reported by month, day and year. A range of years was coded when the respondent was unable to recall the exact year of admission. When the year of admission was reported as a range, the beginning year of the range is found in positions 51-52 and the ending year of the range is found in positions 53-54. Except for type D (position 199) records the reported date of admission is present for all source code 2 and 4 records (see position 200), and CRM and CRX records (positions 60-62). 47-48 Reported Month of Admission 2674 01-12 = Month of admission 1592 98 = Don't know 20 99 = Not ascertained 1119 Blank = Type D (position 199), record status code ASF (positions 60-62), source code 1 or 3 (position 200) and record status code (positions 60-62) not a cross-referenced stay (CRM, CRX) 49-50 Reported Day of Admission 1175 01-31 = Day of admission 3091 98 = Don't know 20 99 = Not ascertained 1119 Blank = Type D (position 199), record status code ASF (positions 60-62), source code 1 or 3 (position 200) and record status code (positions 60-62) not a cross-referenced stay (CRM, CRX) 51-52 Reported Year of Admission or Beginning Year of Range 4030 70-86 = Year of admission or beginning year of range (1970-1986) 239 98 = Don't know 17 99 = Not ascertained 1119 Blank =Type D (position 199), or record status code ASF (positions 60-62), or source code (position 200) 1 or 3 and record status code (positions 60-62) not a cross-referenced stay (CRM, CRX) 53-54 Reported Year of Admission - Ending Year of Range 322 73-86 = Ending year of range (1973-1986) 5083 Blank = No range given for reported year of admission, type D (position 199), or record status code ASF (positions 60-62), or source code (position 200) 1 or 3 and record status code (positions 60-62) not a cross-referenced stay (CRM, CRX) Tape Position Frequencies Variable Description and Codes (55-59) ID Number of Cross Referenced Facility Status Stay Note: The ID number on the 1982-84 NHEFS Facility Tape (positions 29-33) is used to reference stays in a hospital or nursing home that began during the 1982-84 NHEFS period and which continue into the 1986 survey period. This variable is coded only for records with a CRM or CRX in positions 60-62 on the 1986 file. 55 Survey Period Identifier of Cross-referenced Facility Stay 132 1 = NHEFS 1982-84 5273 Blank = Stay not cross-referenced 56-57 Facility Number of Cross-referenced Stay 132 01-06 = Stay number 5273 Blank = Stay not cross-referenced 58-59 Stay Number Within Facility of Cross-reference Stay 132 01-03 = Stay number 5273 Blank = Stay not cross-referenced RECORD STATUS Note: The record status section of the record (positions 60-62) contains information on the outcome of the request for a health care facility stay. 60-62 Record Status Code Note: See Appendix A for an explanation of the record status codes. 5405 ANO - XRD = Record status code Tape Position Frequencies Variable Description and Codes (63-198) Reported Conditions and Codes During the process of completing the Hospital and Health Care Facility Chart (HHCF) respondents described the conditions that led to their overnight facility stays. This information is included as a text field on the stay record. Space is allotted for the recording of up to four reasons for the hospital or nursing home stay (see positions 67-96, 101-130, 135-164 and 169-198). A numeric code was assigned to each text description to aid the researcher in the use of this information (see positions 63-64, 97-98, 131-132, 165-166). These variables should be used in conjunction with information in the abstract section, i.e, ICD-9-CM diagnosis codes, present on records with a record status code of MAT, ASF or CRM. Appendix B contains a complete description of these fields along with guidelines for their use. (63-96) First Reported Condition 63-64 Condition Code 4174 01-37 = Condition code (See Appendix B) 1231 Blank = Source Code equal to 2 or 3 or D stay record or Record Status Code ASF or source code equal to 1 and record status code not CRM. 65-66 5405 Blank 67-96 Condition Text 4174 Description of reason for facility stay 1231 Blank = Source Code equal to 2 or 3 or D stay record or Record Status Code ASF or source code equal to 1 and record status code not CRM. Tape Position Frequencies Variable Description and Codes (97-130) Second Reported Condition 97-98 Condition Code 1481 01-36 = Condition code (See Appendix B) 3924 Blank = Source Code equal to 2 or 3 or D stay record or Record Status Code ASF or source code equal to 1 and record status code not CRM or only one condition reported 99-100 5405 Blank 101-130 Condition Text 1481 Description of reason for facility stay 3924 Blank = Source Code equal to 2 or 3 or D stay record or Record Status Code ASF or source code equal to 1 and record status code not CRM or only one condition reported Tape Position Frequencies Variable Description and Codes (131-164) Third Reported Condition 131-132 Condition Code 402 01-35 = Condition code (See Appendix B) 5003 Blank = Source Code equal to 2 or 3 or D stay record or Record Status Code ASF or source code equal to 1 and record status code not CRM or less than three conditions reported 133-134 5405 Blank 135-164 Condition Text 402 Description of reason for facility stay 5003 Blank = Source Code equal to 2 or 3 or D stay record or Record Status Code ASF or source code equal to 1 and record status code not CRM or less than three conditions reported Tape Position Frequencies Variable Description and Codes (165-198) Fourth Reported Condition 165-166 Condition Code 117 01-35 = Condition code (See Appendix B) 5288 Blank = Source Code equal to 2 or 3 or D stay record or Record Status Code ASF or source code equal to 1 and record status code not CRM or less than four conditions reported 167-168 5405 Blank 169-198 Condition Text 117 Description of reason for facility stay 5288 Blank = Source Code equal to 2 or 3 or D stay record or Record Status Code ASF or source code equal to 1 and record status code not CRM or less than four conditions reported Tape Position Frequencies Variable Description and Codes 199 Type of Stay Flag 83 C = A reported stay with admission date up to one year prior to the date of last interview (i.e. the NHEFS 1982-84 if interviewed at that time or date of NHANES I Examination if never interviewed at NHEFS 1982-84). 20 D = A reported stay with admission date more than one year prior to date of last interview and the facility had not been contacted during the 1982-84 NHEFS. If there were multiple reported stays in the same facility that were all type D (more than one year prior to last interview) these stays were consolidated into one entry in the tracking system. If an in-scope abstract was received in response to a type D report, the abstract was never matched, but assigned a record status code of ASF (positions 60-62). The type D report was then removed from the file. The 20 type D reports remaining on the final file are all non-responses from the facility and thus were not able to be resolved. 5302 Blank = In-scope stay; a reported date of admission after the last interview date. This field is also blank for record status codes of ASF, CRM or CRX (positions 60-62). Note: This variable identifies reported facility stays as in-scope or out-of-scope for the NHEFS 1986 interview period. Reported dates of admission of don't know (989898) or not ascertained (999999) in positions 47-52 were considered in-scope. 200 Source of Report of Stay that Initiated Request for Abstract 36 1 = Information from death certificate 103 2 = Information from hospital abstract report 79 3 = Information from other source 4192 4 = Information from NHEFS 1986 interview 995 Blank = Not a requested stay. Additional stay information obtained from facility (record status code ASF positions 60-62). ASF may also be coded as source code 3. 201-204 5405 Blank ABSTRACT DATA Note: The abstract data portion of the record (positions 205-380) contains information obtained from an abstract form returned by the facility. This section of the stay record (excluding positions 207-208) will be blank when a facility did not return an abstract form for a stay (n=1496). 205-206 Abstract Number 3909 01-29 = Number of abstract 1496 Blank = Stay reported, no abstract form received Note: For each subject, a two digit number was assigned consecutively to each abstract form received. 207-208 Total Number of Abstracts Received 5405 00-29 = Total number of abstracts received Note: This number represents the total number of abstracts received for each subject. The total number is repeated on each subject record. 209 Facility Record Type 3496 1 = Hospital 413 2 = Nursing home 1496 Blank = Stay reported, no abstract form received Tape Position Frequencies Variable Description and Codes (210-215) Date of Admission 210-211 Month of Admission 3909 01-12 = Month of admission 1496 Blank = Stay reported, no abstract form received 212-213 Day of Admission 3909 01-31 = Day of admission 1496 Blank = Stay reported, no abstract form received 214-215 Year of Admission 3909 72-86 = Year of admission (1972-1986) 1496 Blank = Stay reported, no abstract form received Tape Position Frequencies Variable Description and Codes (216-221) Date of Discharge Note: When a subject had a brief break in a nursing home stay not due to a hospitalization, the nursing home stays were combined into one long stay with the latest discharge date assigned to the stay. The information contained in the report and abstract sections of the stay is from the earliest abstract. For example: subject A was in a nursing home from 10-31-85 to 12-22-85. The subject was readmitted to the same nursing home 1-3-86 and stayed until their death 3-5-86. No information is available for 12-22-85 to 1-3-86. These 2 stays would appear on the file as 1 stay from 10-31-85 to 3-5-86. Length of stay would be calculated on the entire stay (see positions 222-225). If the break in the nursing home was due to an interspersed hospitalization, the nursing homes stays were collasped as described above and a code was entered in the related stay section (see positions 380-429). 216-217 Month of Discharge 3732 01-12 = Month of discharge 177 97 = Inapplicable (still at facility on date of 1986 interview) 1496 Blank = Stay reported, no abstract form received 218-219 Day of Discharge 3732 01-31 = Day of discharge 177 97 = Inapplicable (still at facility on date of 1986 interview) 1496 Blank = Stay reported, no abstract form received 220-221 Year of Discharge 3732 72-86 = Year of discharge (1972-1986) 177 97 = Inapplicable (still at facility on date of 1986 interview) 1496 Blank = Stay reported, no abstract form received 222-225 Length of Record Stay 16 0000 = Died on day of admission 3716 0001-4218 = Total number of days in facility 177 9997 = Inapplicable (still at facility on date of 1986 interview) 1496 Blank = Stay reported, no abstract form received Note: Length of stay is calculated by subtracting the date of admission from the date of discharge. For subjects with nursing home stays, brief breaks were collapsed into one continuous nursing home stay (see positions 216-221). For subjects with information coded in the related stays section (see positions 380-429) length of stay will include time spent in other facilities. 226 Was the Patient in Cardiac Intensive Care Unit? 379 1 = Yes 2790 2 = No 413 7 = Inapplicable (facility is a nursing home) 327 9 = Not ascertained 1496 Blank = Stay reported, no abstract form received 227-229 Number of Days in Cardiac Intensive Care Unit 363 000-197 = Number of days 3530 997 = Inapplicable (position 226 = 2,7,9) 16 999 = Not ascertained 1496 Blank = Stay reported, no abstract form received Note: A length of stay of 0 days occurred when a subject was admitted to the facility and died on the day of admission. 230 Was the Patient In Other Intensive Care Unit? 31 1 = Yes 2607 2 = No 413 7 = Inapplicable (facility is a nursing home) 572 9 = Not ascertained 1496 Blank = Stay reported, no abstract form received 231-233 Number of Days in Other Intensive Care Unit 310 000-090 = Number of days 3592 997 = Inapplicable (Position 230 = 2,7,9) 7 999 = Not ascertained 1496 Blank = Stay reported, no abstract form received Note: A length of stay of 0 days occurred when a subject was admitted to the facility and died on the day of admission. 234 Patient Admitted to Nursing Home From: 121 1 = Private residence 214 2 = Acute care hospital 6 3 = Chronic disease hospital 68 4 = Other nursing home 3496 7 = Inapplicable (facility is a hospital) 4 9 = Not ascertained 1496 Blank = Stay reported, no abstract form received 235 Disposition of Hospital Patient 2556 1 = Routine discharge/discharged home 6 2 = Left against medical advice 473 3 = Discharged/transferred to another facility or organization 135 4 = Discharged/referred to organized home care ser 268 5 = Died 7 6 = Not discharged/still in hospital on the date of 1986 interview 413 7 = Inapplicable (facility is a nursing home) 51 9 = Subject discharged, disposition not ascertaine 1496 Blank = Stay reported, no abstract form received 236 Disposition of Nursing Home Patient 170 1 = Not discharged/still in a nursing home on date of 1986 interview 23 2 = Discharged to private residence/referral to organized home care services 106 3 = Died 39 4 = Discharged to private residence/no referral 75 5 = Transferred to another facility 3496 7 = Inapplicable (facility is a hospital) 1496 Blank = Stay reported, no abstract form received 237 Transferred to Another Health Care Facility 37 1 = Acute care hospital 35 2 = Other nursing home 0 3 = Chronic disease hospital 3 4 = Other 3834 7 = Inapplicable (Position 236 = 1,2,3,4 or 7) 1496 Blank = Stay reported, no abstract form received 238-239 Number of Diagnoses 3909 01-22 = Number of diagnoses 1496 Blank = Stay reported, no abstract form received Note: This variable identifies the total number of diagnoses entered on the abstract. The number of coded diagnoses may exceed the maximum number allowed on the data tape (10). Tape Position Frequencies Variable Description and Codes 240-245 Principal Diagnosis 3909 ICD-9-CM Code 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 246-250 Principal Diagnosis E Code 299 ICD-9-CM Code 5106 Blank = Stay reported, no abstract form received or principal diagnosis does not require E code Note: See medical coding specifications. 251-256 Second Diagnosis 3413 ICD-9-CM Code 496 999997 = Inapplicable (only one diagnosis coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 257-261 Second Diagnosis E Code 87 ICD-9-CM Code 496 99997 = Inapplicable (only one diagnosis coded) 4822 Blank = Stay reported, no abstract form received or second diagnosis does not require E code Note: See mdical coding specifications. 262-267 Third Diagnosis 2794 ICD-9-CM Code 1115 999997 = Inapplicable (less than three diagnoses coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 268-272 Third Diagnosis E Code 56 ICD-9-CM Code 1115 99997 = Inapplicable (less than three diagnoses coded) 4234 Blank = Stay reported, no abstract form received or third diagnosis does not require E code Note: See medical coding specifications. 273-278 Fourth Diagnosis 2109 ICD-9-CM Code 1800 999997 = Inapplicable (less than four diagnoses coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 279-283 Fourth Diagnosis E Code 44 ICD-9-CM Code 1800 99997 = Inapplicable (less than four diagnoses coded) 3561 Blank = Stay reported, no abstract form received or fourth diagnosis does not require E code Note: See medical coding specifications. 284-289 Fifth Diagnosis 1458 ICD-9-CM Code 2451 999997 = Inapplicable (less than five diagnoses coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 290-294 Fifth Diagnosis E Code 24 ICD-9-CM Code 2451 99997 = Inapplicable (less than five diagnoses coded) 2930 Blank = Stay reported, no abstract form received for fifth diagnosis does not require E code Note: See medical coding specifications. 295-300 Sixth Diagnosis 946 ICD-9-CM Code 2963 999997 =Inapplicable (less than six diagnoses coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 301-305 Sixth Diagnosis E Code 25 ICD-9-CM Code 2963 99997 = Inapplicable (less than six diagnoses coded) 2417 Blank = Stay reported, no abstract form received or sixth diagnosis does not require E code Note: See medical coding specifications. 306-311 Seventh Diagnosis 602 ICD-9-CM Code 3307 999997 = Inapplicable (less than seven diagnoses coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 312-316 Seventh Diagnosis E Code 14 ICD-9-CM Code 3307 99997 = Inapplicable (less than seven diagnoses coded) 2084 Blank = Stay reported, no abstract form received or seventh diagnosis does not require E code Note: See medical coding specifications. 317-322 Eighth Diagnosis 418 ICD-9-CM Code 3491 999997 = Inapplicable (less than eight diagnoses coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 323-327 Eighth Diagnosis E Code 13 ICD-9-CM Code 3491 99997 =Inapplicable (less than eight diagnoses coded) 1901 Blank = Stay reported, no abstract form received or eighth diagnosis does not require E code Note: See medical coding specifications. 328-333 Ninth Diagnosis 265 ICD-9-CM Code 3644 999997 = Inapplicable (less than nine diagnoses coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 334-338 Ninth Diagnosis E Code 3 ICD-9-CM Code 3644 99997 = Inapplicable (less than nine diagnoses coded) 1758 Blank = Stay reported, no abstract form received or ninth diagnosis does not require E code Note: See medical coding specifications 339-344 Tenth Diagnosis 160 ICD-9-CM Code 3749 999997 = Inapplicable (less than ten diagnoses coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 345-349 Tenth Diagnosis E Code 1 ICD-9-CM Code 3749 99997 = Inapplicable (less than ten diagnoses coded) 1655 Blank = Stay reported, no abstract form received or tenth diagnosis does not require E code Note: See medical coding specifications. 350-351 Number of Procedures 3496 00-07 = Number of procedures 413 97 = Inapplicable (facility is a nursing home) 1496 Blank = Stay reported, no abstract form received Note: This variable identifies the total number of procedures coded on the facility abstract. The number of reported procedures from a hospital may exceed the maximum number of five coded on this data tape. 352-355 First Procedure 1192 ICD-9-CM Code 2717 9997 = Inapplicable (facility is a nursing home or no procedures coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 356-359 Second Procedure 471 ICD-9-CM Code 3438 9997 =Inapplicable (facility is a nursing home or only one procedure coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 360-363 Third Procedure 129 ICD-9-CM Code 3780 9997 = Inapplicable (facility is a nursing home or less than three procedures coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 364-367 Fourth Procedure 32 ICD-9-CM Code 3877 9997 = Inapplicable (facility is a nursing home or less than four procedures coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. 368-371 Fifth Procedure 11 ICD-9-CM Code 3898 9997 = Inapplicable (facility is a nursing home or less than five procedures coded) 1496 Blank = Stay reported, no abstract form received Note: See medical coding specifications. Tape Position Frequencies Variable Description and Codes (372-373) Presence of Documents 372 Pathology Report 168 1 = Required and present 58 2 = Required and not present 3270 6 = Not required 413 7 = Inapplicable (facility is a nursing home) 1496 Blank = Stay reported, no abstract form received 373 Third Day EKG Report 128 1 = Required and present 50 2 = Required and not present 3318 6 = Not required 413 7 = Inapplcable (facility is a nursing home) 1496 Blank = Stay reported, no abstract form received 374-379 5405 Blank Tape Position Frequencies Variable Description and Codes RELATED STAY CODES Note: Residents in nursing homes are often admitted to hospitals during the course of their stays in the nursing home. The related stay section of the record cross-links nursing home stays with interspersed hospital stays. In the case of nursing home records, this set of variables identifies hospital stays that occurred during the nursing home stay. Up to 10 related stays can be listed. In the case of hospital records, this set of variables identifies the nursing home stay within which the hospital stay occurred. Only one related stay is identified for hospital records. The Related Stay is identified by its Health Care Facility Stay ID Number (positions 29-33) of the record for that stay. An example of the usage of the related stay section is found in the introduction to this codebook. (380-429) ID Number(s) of Related Stay(s) (380-384) ID of First Related Stay 380 Survey Period Identifier 283 2 = NHEFS 1986 5122 Blank = No related stays 381-382 Facility Number 283 01-06 = Hospital/nursing home number 5122 Blank = No related stays 383-384 Stay Number Within Facility 283 01-21 = Stay number 5122 Blank = No related stays Tape Position Frequencies Variable Description and Codes (385-389) ID of Second Related Stay 385 Survey Period Identifier 38 2 = NHEFS 1986 5367 Blank = No second related stay 386-387 Facility Number 38 01-06 = Hospital/nursing home number 5367 Blank = No second related stay 388-389 Stay Number Within Facility 38 01-09 = Stay number 5367 Blank = No second related stay Tape Position Frequencies Variable Description and Codes (390-394) ID of Third Related Stay 390 Survey Period Identifier 13 2 = NHEFS 1986 5392 Blank = No third related stay 391-392 Facility Number 13 01-05 = Hospital/nursing home number 5392 Blank = No third related stay 393-394 Stay Number Within Facility 13 01-08 = Stay number 5392 Blank = No third related stay Tape Position Frequencies Variable Description and Codes (395-399) ID of Fourth Related Stay 395 Survey Period Identifier 6 2 = NHEFS 1986 5399 Blank = No fourth related stay 396-397 Facility Number 6 01-03 = Hospital/nursing home number 5399 Blank = No fourth related stay 398-399 Stay Number Within Facility 6 02-06 = Stay number 5399 Blank = No fourth related stay Tape Position Frequencies Variable Description and Codes (400-404) ID of Fifth Related Stay 400 Survey Period Identifier 2 2 = NHEFS 1986 5403 Blank = No fifth related stay 401-402 Facility Number 2 03 = Hospital/nursing home number 5403 Blank = No fifth related stay 403-404 Stay Number Within Facility 2 04-08 = Stay number 5403 Blank = No fifth related stay Tape Position Frequencies Variable Description and Codes (405-409) ID of Sixth Related Stay 405 Survey Period Identifier 2 2 = NHEFS 1986 5403 Blank = No sixth related stay 406-407 Facility Number 2 03 = Hospital/nursing home number 5403 Blank = No sixth related stay 408-409 Stay Number Within Facility 2 01-10 = Stay number 5403 Blank = No sixth related stay Tape Position Frequencies Variable Description and Codes (410-414) ID of Seventh Related Stay 410 Survey Period Identifier 1 2 = NHEFS 1986 5404 Blank = No seventh related stay 411-412 Facility Number 1 03 = Hospital/nursing home number 5404 Blank = No seventh related stay 413-414 Stay Number Within Facility 1 11 = Stay number 5404 Blank = No seventh related stay Tape Position Frequencies Variable Description and Codes (415-419) ID of Eighth Related Stay 415 Survey Period Identifier 1 2 = NHEFS 1986 5404 Blank = No eighth related stay 416-417 Facility Number 1 03 = Hospital/nursing home number 5404 Blank = No eighth related stay 418-419 Stay Number Within Facility 1 12 = Stay number 5404 Blank = No eighth related stay Tape Position Frequencies Variable Description and Codes (420-424) ID of Ninth Related Stay 420 Survey Period Identifier 1 2 = NHEFS 1986 5404 Blank = No ninth related stay 421-422 Facility Number 1 03 = Hospital/nursing home number 5404 Blank = No ninth related stay 423-424 Stay Number Within Facility 1 13 = Stay number 5404 Blank = No ninth related stay Tape Position Frequencies Variable Description and Codes (425-429) ID of Tenth Related Stay 425 Survey Period Identifier 1 2 = NHEFS 1986 5404 Blank = No tenth related stay 426-427 Facility Number 1 03 = Hospital/nursing home number 5404 Blank = No tenth related stay 428-429 Stay Number Within Facility 1 01 = Stay number 5404 Blank = No tenth related stay Figure 1: Health Care Facility Record Layout _____________________________________________________________________________ Facility identifiers! ! Actual dates !Codes assigned by Reported date of ! Match ! admission and !NCHS to identify admission ! or ! discharge !stays contained Reported cause o ! reason for ! ICD-9-CM diagnoses!within other stays admission ! non-match ! Discharge status ! Source of report ! ! from hospitals and! ! ! nursing homes ! ______________________________________________________________________________ Record Related Report Section Status Section Abstract Section Stay section Figure 2: Example of Matching Process and Record Status Codes Record status code Match Report Section! Mat !Abstract Section ______________!_____!__________________ non- Non-match Report Section! match !No Abstract code received ______________!________!______________ Additional abstract No report section ! ASF ! Abstract Section found ___________________!______!____________________ APPENDIX A 1986 Appendix A: Record Status Codes Code Frequency Description ANO - 28 "Authorization Not Obtained." This code indicates that that subject or proxy refused to sign the Medical Authorization For (MAF). These stays are not requested from the reported facilities. ASF - 1063 "Additional Stay Found." This code was assigned when a received stay could not be matched to a reported stay and the received stay is in-scope. This code was also assigned to in-scope stays that were received as a result of an inquiry generated by a type report (Position 199). The type D report was deleted from the final file. CRM - 124 "Cross-Referenced Match." This code indicates a stay that was begun prior to the NHEFS 1986 survey period and continues into the 1986 survey period. For this type of stay, the abstract is brought forward from the previous wave. The discharge date and discharge status information are the only positions that are updated. The admission date is prior to the 1982-84 interviev because this is a continuing stay. Thus, it appears but is no out-of-scope for 1986. CRX - 8 "Cross-Referenced Non-Match." A code assigned by NCHS staff to close out a stay that was begun in a previous wave and was reported to have continued into the 1986 Survey period, yet no in-scope stay was received for the 1986 survey period. FNC - 90 "Facility Never Contacted." This code was assigned when the facility was not contacted for the following reasons: the respondent could not recall the name of the facility; the facility was closed; the facility could not be located; and facility located outside the United States. MAT - 2722 "Record Match." This code was assigned when a received stay matches a reported stay. This code was assigned to in-scope and type C (position 199) reports, but never to type D reports. In-scope stays that were received as the result of a type D report were assigned an ASF code. See ASF. ONR - 276 "Other Non-Response."This code is assigned to a stay when no response for the stay request has been received from the facility by the end of the study period. REF - 189 "Refused." This code is assigned after a facility refuses to send back the stay record requested. It is record, not subject specific. For example, a facility may send some records for subject but refused to send others. XNH - 212 "Subject Never at Facility." This code is used when the facility indicates that the patient was never admitted to that facility. XNS - 686 "Other - No Stay Found." This code is assigned when a facility responds it is unable to send records because an in-scope stay was not found at this facility, or when the facility returns the request form without records and provides no explanation for the failure to provide records. XRD - 7 "Record Destroyed or No Longer Available." This code is assigned if the facility attempts to locate the record and states it no longer exists, i.e., destroyed, lost. NOTE: Additional information concerning the assignment of the record status codes is found in the introduction to this codebook. APPENDIX B 1986 Numeric Codes for Reported Conditions Code for Condition Reported Condition Description 01 Arthritis 02 Gout 03 Heart attack 04 Another heart condition besides heart attack 05 Coronary bypass surgery 06 Pacemaker repair, insertion and/or replacement 07 T.I.A., small stroke 08 Stroke or CVA (cerebrovascular accident) 09 Diabetes 10 High Blood Pressure 11 Cancer and/or cancer treatment 12 Fractured hip 13 Another type of bone fracture besides a hip fracture 14 Pneumonia or flu 15 Surgery 16 Don't know 18 Tests/observation/x-rays/physical exam 19 Digestive/endocrine condition 20 Respiratory condition (other than influenza and pneumonia) 21 Infection 22 Kidney/bladder/urinary condition 23 Debility/pain 24 Male reproductive condition 25 Musculoskeletal problem or injury other than a fracture 26 Circulatory condition 27 Female reproductive condition 28 Mental illness 29 Neurologic condition 30 Nutritional condition or dehydration 31 Bleeding or blood disorder 32 Skin condition 33 Condition not elsewhere coded 34 Admission to a facility other than an acute care hospital 35 In a facility at time of death 36 Cataracts 37 A fall During the process of completing the Hospital and Health Care Facility (HHCF) chart respondents were asked to describe the conditions that led to their facility stays and this information is included as a text field on the stay record. The text portion of the reported condition contains the respondent's own words if possible or a summary of the respondent's description which was edited to fit into the 30 positions. A numeric code was also assigned to each description. This was done so that users would not have to deal with alphabetic description fields when investigating reasons for facility stays. Space is allotted on the report section of the facility stay record for recording of up to four reasons for the hospitalization or nursing home stay (positions 63-198 of the HCFS record). Note that code "17" is not included in the coding structure for the 1986 file. This code was designated for use when the reported condition is "not ascertained", a situation which never arose during the construction of the 1986 HCFS file. Reported conditions and their associated codes can be divided into six types depending on where in the interview the stay was reported and the amount of information obtained: specific conditions included in Section B or F of the interview (Type A); conditions which are well-defined but for which no question exists in Section B of the interview (Type B); unknown conditions (Type C); conditions about which there is no specific question in Section B but for which sufficient information is available to attribute them to disorders of a major body system (Type D); conditions that are broadly defined and/or cannot be attributed to a single major body system (Type E); and conditions that cannot be classified into any of the above categories (Type F). Each condition type, the associated codes and the rules for assigning the reported conditions to the categories of the coding structure are described in detail below. Type A Type A - Conditions about which the respondent was asked in section B or F of the interview. For example, if a respondent answered "yes" to question B-13a ("Were you hospitalized for your arthritis?"), then a condition code of "01" and a text field containing "arthritis" would be included on the facility stay record. Type A conditions are: 01 Arthritis (B-13a) 02 Gout (B-13a) 03 Heart attack (B-19a) 04 Other heart conditions (B-19b) 05 Coronary bypass surgery (B-20b) 06 Procedures for pacemakers (B-20d) 07 T.I.A., small stroke (B-26) 08 Stroke (B-32) 09 Diabetes (B-39) 10 High blood pressure (B-45) 11 Cancer (B-48 or B-51) 12 Fractured hip (B-57) 13 Bone fracture other than hip (B-61) 14 Pneumonia or influenza (B-62) 15 Surgery (B-63) 34 Care in non-acute care facility (B-69) 35 In a facility at death (B-80 proxy questionnaire) 36 Cataracts (F-5) Note: This question was located in Section F. Complete agreement between responses to the questions in section B and F and Type A condition codes on the facility stay file should not be expected. There are several reasons for a lack of agreement between these two data sources. First, the respondent may report a facility stay for a given condition in the interview and yet no facility stay record containing the condition may appear on the HCFS file. This would result if: (1) it was determined that the hospitalization did not last overnight causing the stay to be deleted from the HCFS file; or (2) the reported stay was found to be "out-of- scope". (See the introduction to this codebook and the Plan and Operation for definitions of out-of-scope stays.) Second, data may be inconsistent between the interview and the HCFS file if the respondent remembered and reported a condition after responding to the corresponding question in Section B or F of the interview. This tended to occur at the time the interviewer was recording information on the HHCF chart. For example, while recording information on a stay for high blood pressure, the respondent may add that he/she was also hospitalized at that time for a heart condition. The respondent may not have reported the hospitalization when asked about heart conditions in question B-19a and the Section B information may not have been updated to reflect this additional condition. However, heart condition would appear on the HCFS file. Type B Type B - Conditions which do not have a corresponding question in Section B of the interview but for which sufficient descriptive information is available to allow them to be easily coded: 18 Tests and observation 37 A fall Type C Type C - Unknown conditions: 16 Don't know Type D Type D - Conditions for which there is not a specific question in Section B of the interview but which can be attributed to disorders of a major body system: 19 The digestive/endocrine system 20 The respiratory system (excluding flu or pneumonia) 22 Kidney, bladder or urinary problem 24 The male reproductive system 25 The musculoskeletal system 26 The circulatory system (except strokes) 27 The female reproductive system 29 Neurologic disorders 31 Blood disorder/bleeding 32 Skin problem Type E Type E - Conditions which are broadly defined or are attributed to problems of more than one major body system: 21 Infections 23 Debility and pain 28 Mental illness 30 Nutrition and dehydration Type F Type F - All conditions that cannot be assigned to one of the above codes: 33 Other conditions Additional Information Additional information on reasons for a facility stay is available in the abstract section of the record (positions 205-379) if an abstract was received from the facility. In general information from the abstract is considered a more accurate determination of the conditions associated with the stay than are the reported conditions. The condition codes in the report section of stay records do provide useful information in the absence of a medical abstract. Both flexibility and caution should be exercised when selecting stays based on these codes. In order to help the analyst use these condition codes effectively, a description of the code assignment procedure along with an example is provided. Rules for Assignment The numeric codes were assigned to the respondent's non-technical descriptions by trained medical coders. In order to minimize variation among the coders assigning these codes, precedence rules were defined. Generally, a condition was coded to the most specific category in which it could be placed. The assignment rules are described below in priority order, e.g. Rule 2 was used only if Rule 1 did not apply and so forth. Rule 1: If a condition was one about which there was a specific question in Section B or F of the interview, the code appropriate for that question was assigned. (Type A conditions) Rule 2: If the textual description could be coded to a narrowly defined condition not referenced in Section B or to the unknown category, the appropriate Type B or Type C code was assigned. Rule 3: Conditions that could not be coded to a specific question but could be coded to a major body system were assigned the appropriate Type D code. Rule 4: General descriptions, symptoms and conditions not coded by rules 1 through 3 were coded at the discretion of the medical coder, again with emphasis on as much specificity as possible. For example, "HEADACHES, BRAIN TUMOR" would be coded to "29 - Neurologic disorders", not to "23 - Debility and pain". (Type D or Type E conditions). Rule 5: Everything that could not be assigned a code after applying the above rules was coded to "33 - Other conditions". (Type F conditions). Considerations for the Data User These precedence rules were used for all three followups. However, since the questionnaires used in each followup differed slightly, the assignment of codes also differed. Questions about specific conditions were not always included in all three questionnaires. For example, Question B-63 in the 1986 interview asked about overnight stays for surgery making condition code "15 -Surgery" a Type A condition in the 1986 followup. There is no similar question in the 1982-84 or 1987 interview, therefore, surgery is a Type E condition in the 1982-84 and 1987 files. In other cases, groups of conditions are combined into one question on one questionnaire but asked separately on another. For example, T.I.A.'s and other strokes are combined in one question in 1987. Since it was not possible to separate reports of T.I.A.'s from other strokes in the 1987 file, there are no conditions assigned to codes "07" in this file. There are reports assigned to "07" in the 1982-84 and 1986 files since separate T.I.A. and stroke questions were asked. An attempt was made to include as much detail in the code as possible. The questionnaire in the 1982-84 followup included enough detail to separate specific digestive conditions, such as colitis and gallbladder problems, from the general category of digestive disorders. Therefore, the 1982-84 HCFS data file, includes sub-codes under "19 - Digestive/endocrine system". Thus, analysts interested in colitis can identify cases from the reported condition section of the 1982-84 file but not from the 1986 or 1987 files. However, all files can be used to identify cases of the digestive/endocrine system in general. The analyst should refer to the questionnaire and the condition coding structure in the HCFS data tape codebook for the period of interest in order to obtain the maximal amount of information available. In using the condition codes to select records of interest, two characteristics of the coding structure should be considered: (1) the condition of interest may be found under more than one numeric code and (2) each numeric code covers more than one condition. To illustrate the first situation, consider a search for all reported stays with breast biopsies. A respondent might report a breast biopsy in response to the question relating to cancer and cancer treatment. In this case the textual field would contain a description such as "BIOPSY OF RIGHT BREAST" and the numeric code assigned would be 11 (indicating a response to the cancer stay question). Breast biopsies could also be reported in response to the surgery question in the 1986 followup and be assigned the code of 15. If the biopsy was reported in response to question B-83 on the 1987 questionnaire, "Have you stayed in a hospital for any other reason...?", it would be assigned to code 18 - Tests and observation". To identify breast biopsy cases it would be necessary to search the alphabetic fields for codes 11, 15 and 18. In addition, the reports of breast biopsies include several wording variations, for example, "BREAST BIOPSY", "BIOPSY OF BREAST". The analyst needs to investigate all possible wordings. To illustrate the second situation, consider code 18 - "Tests and observation". Over 250 different verbal descriptions have been coded to this category including a variety of radiological procedures, surgeries and physical examinations. Selecting just on code 18 will result in a wide variety of procedures. Those of a specific interest need to be identified by the textual description. Analysts who wish to use these reports, should print and review all the reported condition codes and alphabetic descriptions from the Health Care Facility Stay data files. Such a review will aid in (1) finding all the numeric condition codes under which the condition of interest will be found and (2) insuring that, within any numeric condition code, only the reports of interest will be selected. Finally, the condition codes in the report section should be used in conjunction with the information in the abstract section if it is available. Returned abstracts were matched to reports if one of the reported conditions matched one of the discharge diagnoses on the abstract. Other conditions reported for the same stay may or may not be confirmed in the matched medical abstract. If the condition of interest is not indicated as a discharge diagnosis on the medical record, the analyst may not want to accept the reported condition as a reason for the stay. Similarly, conditions may be listed as discharge diagnoses that do not appear on the report section. See the introduction to this codebook for a description of the matching rules.
