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Scientific Data Documentation
National Hospital Ambulatory Medical Care Survey, 1992
DSN: CC37.NHAMCS92.EMRGENCY (Emergency Department File) CC37.NHAMCS92.OPATIENT (Out-Patient Department File) ABSTRACT This report provides documentation for users of the 1992 National Hospital Ambulatory Medical Care Survey (NHAMCS) Micro-Data Tape for patient visits and drug mentions. Section I, "Description of the National Hospital Ambula- tory Medical Care Survey," includes information on the sample design, data collection activities, medical coding procedures, population estimates, and relative standard errors. Section II provides technical details of the tapes (number of tracks, record length, etc.), and a detailed description of the contents of each data record by location. Section III contains marginal data for selected data items. The appendixes contain sampling errors, instructions, and definitions for completing the Patient Record Forms, and lists of codes used in the survey. INTRODUCTION DESCRIPTION OF NHAMCS The National Hospital Ambulatory Medical Care Survey (NHAMCS) was inaugurated to learn more about the ambulatory care rendered in hospital emergency and outpatient departments in the United States. Ambulatory medical care is the predominant method of providing health care services in the United States. Since 1973 data on ambulatory patient visits to physicians' offices have been collected through the National Ambulatory Medical Care Survey (NAMCS). However, visits to hospital emergency and outpatient departments, which represent a significant segment of total ambulatory medical care, are not included in the NAMCS.1/ Furthermore, hospital ambulatory patients are known to differ from office patients in their demographic characteristics and are also thought to differ in medical aspects.2/ Therefore, the omission of hospital ambulatory care from the ambulatory medical care database leaves a significant gap in coverage and limits the utility of the current NAMCS data. The NHAMCS fills this data gap. This survey was endorsed by the American Hospital Association, the Emer- gency Nurses Association, and the American College of Emergency Physicians. A complete description of the NHAMCS is contained in the publication entitled: "Plan and Operation of the National Hospital Ambulatory Medical Care Survey, United States, 1994."3/ This micro-data tape comprises the data collected by the NHAMCS in 1992, conducted by the Ambulatory Care Statistics Branch of the National Center for Health Statistics, Centers for Disease Control and Prevention. The NHAMCS provides data from samples of patient records selected from the emergency departments (ED's) and outpatient departments (OPD's) of a national sample of hospitals. The national estimates produced from these studies describe the utilization of hospital ambulatory medical care services in the United States. In 1992 there were 36,271 Patient Record Forms provided by 437 ED's and 35,114 Patient Record Forms provided by 314 OPD's that participated in the survey. This micro-data tape contains both data files. There are two important points relative to analyzing data from this micro- data tape that should be noted: 1. Micro-data tape users should be fully aware of the importance of "patient visit weight" and how it must be used. Information about the patient visit weight is presented on page 17. If more information is needed the staff of the Ambulatory Care Statistics Branch can be consulted by calling 301/436-7132 during regular working hours. 2. Users should also be aware of the reliability or unreliability o certain estimates, particularly the smaller estimates. The National Center for Health Statistics, which conducts many health surveys of the American people, considers an estimate to be reliable if it has a relative standard error of 30% or less. Therefore, it is important to know the value of the lowest possible estimate in this survey that is considered reliable, so as not to present data in a journal article or paper that may be unreliable. Most data tape users can obtain an adequate working knowledge of the relative standard error from the information presented in Appendix I. If you would like more information, do not hesitate to consult the staff of the Ambulatory Care Statistics Branch. 1SAMPLE DESIGN The 1992 NHAMCS included a national probability sample of visits to the emergency and outpatient departments of noninstitutional general and short- stay hospitals, exclusive of Federal, military, and Veterans Administration hospitals, located in the 50 states and the District of Columbia. The NHAMCS was designed to provide estimates based on the following priority of survey objectives: U.S.; region; emergency and outpatient departments; and type of ownership. The NHAMCS used a four-stage probability design with samples of PSUs, hospitals within PSUs, clinics within hospitals, and patient visits within clinics. Each stage of sampling is described below. Primary Sampling Units The first-stage sample consisted of 112 PSUs which comprised a probability subsample of the PSUs used in the 1985-94 NHIS. The NHAMCS PSU sample included with certainty the 26 NHIS PSUs with the largest populations. In addition, the NHAMCS sample included half of the next 26 largest PSUs, and one PSU from each of the 73 PSU strata formed from the remaining PSUs for the NHIS sample. The NHIS PSU sample was selected from approximately 1,900 geographically defined PSUs which covered the 50 States and the District of Columbia. A PSU consists of a county, a group of counties, county equivalents (such as parishes and independent cities), towns, townships, minor civil divisions (for some PSUs in New England), or a metropolitan statistical area (MSA). MSAs were defined by the U.S. Office of Management and Budget on the basis of the 1980 Census. The 1,900 PSUs were stratified by socioeconomic and demo- graphic variables and then selected with a probability proportional to their size. Stratification was done within four geographical regions by MSA or non-MSA status. A detailed description of the 1985-94 NHIS PSU sample design is presented in a Vital and Health Statistics Series 2 report.4/ Hospitals The sampling frame for the 1992 NHAMCS was compiled from the hospitals listed on the April 1991 SMG Hospital Market Data Base. Hospitals with an average length of stay for all patients of less than 30 days (short-stay) or hospitals whose specialty was general (medical or surgical) or children's general were eligible for the NHAMCS. Excluded were Federal hospitals, hospital units of institutions, and hospitals with less than six beds staffed for patient use. The SMG Hospital Market Data Base contained 6,249 hospitals which met this eligibility criteria. Of the eligible hospitals, 5,582 (89 percent) had emergency departments (ED) and 5,654 (90 percent) had outpatient departments (OPD). Hospitals were defined to have an ED if the hospital file indicated the presence of such a unit or if the file indicated a non-zero number of visits to such a unit. A similar rule was used to define the presence of an OPD. Hospitals were classified into four classes: those with only an ED; those with an ED and an OPD; those with only an OPD; and those with neither an ED nor an OPD. Hospitals in the last class were considered as a separate stratum and a small sample (50 hospitals) was selected from this stratum to allow for estimation to the total universe of eligible hospitals and the opening and closing of EDs and OPDs in the sample hospitals. The hospital selections were made so that each hospital would be chosen only once to avoid multiple inclusion of very large hospitals. Table I contains the response rates of the 524 hospitals that were selected in the sample. Outpatient Clinics and Emergency Service Areas Within each hospital, either all outpatient clinics and emergency service areas or a sample of such units were selected. Clinics were in scope if ambulatory medical care was provided under the supervision of a physician and under the auspices of the hospital. Clinics were required to be "organized" in the sense that services were offered at established locations and schedules. Clinics where only ancillary services were provided or other settings in which physician services were not typically provided were out of scope. In addition, freestanding clinics were out of scope since they are included in the NAMCS, and ambulatory surgery centers, whether in hospitals or freestanding, were out of scope since they are to be included in the National Survey of Ambulatory Surgery which will be fielded in 1994. A list of in scope and out of scope clinics is provided on pages 57-59. The OPD clinic definition excluded the "hospital as landlord" arrangement in which the hospital only rented space to a physician group and was not otherwise in- volved in the delivery of services. These physicians are considered office- based and are currently included in the NAMCS. Emergency services provided under the "hospital as landlord" arrangement, however, were eligible for the study. An emergency department was in scope if it was staffed 24 hours a day. If an inscope emergency department had an emergency service area that was staffed less than 24 hours a day, then it was considered an outpatient clinic. Hospitals may define the term "separate clinic" differently, for example, by physical location within the hospital, by staff providing the services, by specialty or subspecialty, by schedules, or by patients' source of payment. Because of these differences, "separate clinics" in the NHAMCS were defined as the smallest administrative units for which the hospital kept patient volume statistics. During the visit by a field representative to induct a hospital into the survey, a list of all emergency service areas and outpatient clinics was obtained from the sample hospital. Each outpatient department clinic's function, specialty, and expected number of visits during the assigned reporting period were also collected. In approximately 20 percent of the hospitals the outpatient department had more than 5 clinics. Generally, these outpatient departments had fewer than 20 clinics, but several had more than 100 clinics. If there were 5 or fewer clinic sampling units, then all were included in the sample. If there were more than 5 clinic sampling units, then 5 units were randomly selected. The individual clinics were listed first by five clinic categories: general medicine, surgery, pediatrics, obstetrics/gynecology, and other. During data processing, substance abuse clinics were removed from the "other" category and placed in a separate stratum. Within each category, clinics were listed in order of clinic size, from smallest to largest. Clinic size was defined as the expected number of patient visits during the assigned 4-week reporting period. Within each clinic group, if a clinic expected fewer than 30 visits, it was grouped with one or more other clinics to form a sampling unit. Over 90 percent of the clinics were large enough to form their own sampling unit. After grouping the clinics into sampling units, 5 of these sampling units were selected based on probability proportional to the size of the sampling unit. If clinic sampling was required, the sampling was completed by Census headquarters staff in Washington, DC. The 1992 NHAMCS included 854 clinics from 314 outpatient departments. The emergency department was treated as a separate stratum and all emergency service areas were selected with certainty. In the rare instance that a sample hospital had more than 5 emergency service areas, a sample of five emergency service areas was selected based on probability proportional to size. Only one hospital in the 1992 NHAMCS reported having more than five emergency service areas and required sampling. The 1992 NHAMCS included 462 emergency service areas from 437 emergency departments. Visits The basic sampling unit for the NHAMCS is the patient visit or encounter. Only visits made in the United States by patients to ED's and OPD's of nonfederal, short-stay, or general hospitals were included in the 1992 NHAMCS. Ambulatory encounters not included in the NHAMCS were those made by telephone. Within emergency service areas or outpatient department clinics, patient visits were systematically selected over a randomly assigned 4-week reporting period. A visit was defined as a direct, personal exchange between a patient and a physician, or a staff member acting under a physician's direction, for the purpose of seeking care and rendering health services. Visits solely for administrative purposes, such as payment of a bill, and visits in which no medical care was provided, such as visits to deliver a specimen, were out of scope. The target numbers of Patient Record Forms to be completed for ED's and OPD's were 50 and 150, respectively. In clinics with volumes higher than these desired figures, visits were sampled by a systematic procedure which selected every nth visit after a random start. Visit sampling rates were determined from the expected number of patients to be seen during the reporting period and the desired number of completed Patient Record Forms. During the 1992 NHAMCS, Patient Record Forms were completed for 36,271 ED visits and 35,114 OPD visits. Original specifications for visit sampling called for a maximum sampling rate of 1 in 20 visits or a maximum of 500 visits, whichever yielded the smaller sample size. Field experience in the early part of the 1992 study indicated the potential for heavy respondent burden for clinics with high volume. Therefore, the maximum number of sampled visits was reduced to 200 and the sampling rates were increased accordingly. DATA COLLECTION PROCEDURES Field Training The Bureau of the Census was the data collection agent for the 1992 NHAMCS. Census Headquarters staff were responsible for overseeing the data collection process, training the Census Regional Office staff, and writing the field manual. Regional Office staff were responsible for training the field representatives and monitoring hospital data collection activities. Field representative training included approximately 4 hours of self-study and 1 1/2 to 2 days classroom training. Field representatives inducted the hospital and trained the hospital staff on visit sampling and completion of the Patient Record Forms. Hospital Induction Approximately 3 months prior to the hospital's assigned reporting period, NCHS sent an personally signed introductory letter from the Director of NCHS to hospital administrator or chief executive officer of each sampled hospital. The names of the hospital officials were obtained from the American Hospital Association (AHA) Guide To Health Care. In addition to the introductory letter, NCHS also enclosed endorsement letters from the AHA, the Emergency Nurses Association, and the American College of Emergency Physicians to emphasize the importance of the study to the medical community. Approximately a week after the mailing of the introductory letter, the Census field representative called the hospital administrator to arrange for an appointment to further explain the study and to verify hospital eligibility for the survey. Earlier studies indicated that the three-month lead time was necessary to obtain a meeting with the administrator, gain hospital approval, collect the required information about the hospital's ambulatory care services, develop the sampling plan, and train participating hospital staff.5/-6/ Outpatient Clinic and Emergency Service Area Induction After the initial visit and the development of the sampling plan, the field representative contacted the hospital coordinator to arrange for induction of the sample emergency service areas and outpatient clinics and for instruction of the hospital staff. At these visits, the field representative described the purpose and use of the survey data, explained the data collection process, including the visit sampling procedures, and presented the Patient Record Forms. Data Collection The actual visit sampling and data collection for the NHAMCS was primarily the responsibility of hospital staff. This procedure was chosen for several reasons. First, the lack of a standard form or record coversheet in hospital and the individuality of the hospital recordkeeping made field representative training difficult. Second, for confidentiality reasons, numerous hospitals did not want the field representatives to review patient logs or see actual medical records. Third, hospital staffs were better qualified to abstract data since they were familiar with the medical terms and coding, knew the recordkeeping systems, and could complete the Patient Record Forms at or near the time of the visit when the information was the most complete and easiest to retrieve. Hospital staff responsible for completing the Patient Record Forms were instructed how to complete each item by the field representatives. Separate instruction booklets for emergency service areas and outpatient department clinics were prepared and provided to guide hospital staff in this task. These booklets provided an overview of the survey, sampling instructions, instructions for completing the Patient Record Forms, and definitions. A brief, one page Patient Record Form consisting of two sections was com- pleted for each sample visit. To account for the differences in emergency and outpatient care, different Patient Record Forms were developed for each of these settings. The top section of each Patient Record Form, which contains the patient's name and record number, was separated from the bottom section by a perforation running across the page. The top section remained attached to the bottom until the entire Patient Record Form was completed. To ensure confidentiality, before collecting the completed Patient Record Forms, the top section was detached and given to the hospital staff. The field representatives instructed hospital staff to keep this portion for a period of four weeks, in case it was necessary to retrieve missing information or clarify information that had been recorded. The Patient Record Forms were patterned after the NAMCS and can be completed in 2-3 minutes. The OPD Patient Record Form most closely resembles the NAMCS Patient Record Form, while the ED Patient Record Form has been designed to reflect the type of care provided in that setting. Copies of the 1992 NHAMCS Patient Record Forms are shown in Figures I and II. Terms and definitions relating to the Patient Record Forms are shown in Appendix I. FIELD QUALITY CONTROL The field representative visited the sampled emergency service areas and clinics each week during the data collection period and maintained telephone contact with the hospital staff involved in the data collection effort. The field representative reviewed the log or other records used for visit sampling to determine if any cases were missing and also edited completed forms for missing data. Attempts were made to retrieve both missing cases and missing data on specific cases, either by consulting with the appropriate hospital staff or by reviewing the pertinent medical records. On the final visit, the field representative collected the remaining Patient Record forms and obtained or verified the total count of visits occurring during the reporting period by reviewing the log used for sample selection or by obtaining counts directly from hospital staff. Because this information was critical to the estimation process, extensive effort was made to ensure the accuracy of this number. At the end of the hospital's reporting period the field representative sent the administrator a personalized "Thank You" letter. CONFIDENTIALITY Assurance of confidentiality was provided to all hospitals according to Section 308 (d) of the Public Health Service Act (42 USC 242m). Strict procedures were utilized to prevent disclosure of NHAMCS data. All information which could identify the hospital or their facilities was confidential and was seen only by persons engaged in the NHAMCS, and was not disclosed or released to others for any other purpose. Names or other identifying information for individual patients were not removed from the hospitals or individual facilities. MEDICAL CODING The Patient Record Forms for the NHAMCS contain five medical items requiring three separate coding systems. The three coding systems are described briefly below. A dependent verification procedure was used to control the medical coding operation. Differences between coders were adjudicated by a third coder. Definitions of the five medical items are on pages 50, 51 and 53 of this documentation. (A) Patient's Reason for Visit: Information contained in item 10 of the OPD, and item 11 of the ED Patient Record Forms was coded according to an updated version of A Reason for Visit Classification for Ambulatory Care (RVC).7/ The updated classification has not been published as of this writing but the list of codes is contained in Appendix II. The classification was updated to incorporate several new codes as well as changes to existing codes. The system continues to utilize a modular structure composed of seven modules. The digits 1 through 8 precede the 3-digit RVC codes to identify the various modules as follows: Prefix Module "1" = symptom module "2" = disease module "3" = diagnostic, screening, and preventive module "4" = treatment module "5" = injuries and adverse effects module "6" = test results module "7" = administrative module "8" = Uncodable entries "9" = special code = blank A maximum of 3 Reasons for Visit were coded in sequence; coding instructions are contained in the NAMCS Medical Coding Manual.8/ Copies are available upon request. (B) Physician's Diagnoses: Diagnostic information in item 11 of the OPD and item 12 of the ED Patient Record Forms was coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).9/ The 1992 NHAMCS micro-data tape codes for diagnoses have the following characteristics: 1. The prefix "1" preceding the diagnostic codes has been added to identify all codes in the range 001.00-999.90, e.g. '138100' = '381.00' = Acute nonsupporative otitis media, unspecified. 2. The prefix "20" preceding diagnostic codes represents V code diagnoses V01.00-V82.90, e.g. '201081' = 'V10.81' = personal history of malignant neoplasm of bone. NOTE: The use of prefixes facilitates the calculation of percent distributions, while substituting "20" for the letter "V" allows that all diagnostic fields on the data tape will contain numerical data. 3. In addition to the diagnostic codes from the ICD-9-CM there are 3 unique codes in the diagnostic fields that were developed by the NAMCS staff: 209900 = - noncodable diagnosis - insufficient information for coding - illegible diagnosis 209970 = diagnosis of "none" 900000 = blank diagnosis A maximum of three diagnoses were coded in sequence: coding instructions concerning diagnoses are contained in the NAMCS Medical Coding Manual.8/ Cause of Injury: (ED ONLY) Information contained in Item 10 of the Patient Record Form (cause of injury) was coded also according to the ICD-9-CM9/, using the Supplemental Classification of External Causes of Injury and Poisoning (E codes). A maximum of three causes of injury were coded, in sequence: coding instructions are contained in the NHAMCS Coding Requirements Manual, Volume I. Copies are available upon request. Surgical Procedures: (OPD ONLY) Surgical information in item 13 of the Patient Record Form was also coded according to the (ICD-9-CM),9/ using the four digit surgical codes in Volume 3. A maximum of two surgical procedures were coded for each form. (C) Medication Therapy This Visit: in item 17 on the ED and item 16 on the OPD Patient Record Forms have been classified and coded according to a unique classification scheme10/ developed at NCHS. The scheme is based on the American Society of Hospital Pharmacists' Drug Product Information File which is maintained by the American Druggist Blue Book Data Center. A list of the drug codes are in Appendix III. The Patient Record Forms allow for the recording of up to 5 drugs. It should be noted that starting in 1992 the Ambulatory Care Statistics Branch will no longer produce separate public use tapes for patient visits and drug mentions. The data will be combined on one tape and the length of the record will be expanded to include the additional information on drugs that was previously available only on the public use tape for drug mentions. The additional information includes: Generic name code: A unique, 5-digit code assigned to each official generic name assigned to every drug entity by the United States Pharmacopeia or other responsible authority. Prescription status code: A code designed to identify the legal status (prescription or nonprescription) of the drug entry. Controlled substance status code: A code used to denote the degree of potential abuse and federal control of a drug entry. Composition status code: A code used to distinguish between single- ingredient and combination drugs. Note: If the user is searching for single ingredient (or single entity) drugs, then he or she should utilize the composition status code = '1', in conjunction with the "generic name code" field. A single ingredient drug will have one generic code in the "generic name code" field, and blanks in the five "ingredient codes" fields. Ingredient codes should not be used when analyzing single entity drugs. On the other hand, if the user is searching for combination drugs, then he or she should utilize composition status code = '2' in conjunction with the "ingredient codes" fields. A combination drug will have a blank generic code in the "generic name code" field, and from one to five generic codes in the "ingredient codes" fields. The "generic name code" field should not be used when analyzing combination drugs. Ingredient codes: Codes used to identify the active generic ingredients of combination drugs. A maximum of 5 ingredients can be identified for each combination drug. Drug class code: A code used to identify each of the 20 major classes to which the drug entry may belong. (Based on the Standard Drug Classifications used in National Drug Code Directory, 1985 edition 11/). Most data users are interested primarily in visit data so the combining of the tapes will have little or no effect on their particular needs. For those users who are interested in analyzing drug data only they will need to isolate those records with drugs, or drug mentions, and create a subset of drug mentions. Each Patient Record Form can have anywhere from one to five drug mentions recorded, so whatever subset is created will need to include all of them. This documentation contains marginal data on drug mentions and appropriate relative standard errors. Should the data user need additional assistance in analyzing data on drug mentions the staff of the Ambulatory Care Statistics Branch is available on 301-436-7132. POPULATION FIGURES The base population used in computing annual visit rates is presented in Table II. These figures are based on provisional estimates for the civilian noninstitutionalized population as of July 1, 1992, provided by the U.S. Bureau of the Census. The population estimates are presented here solely for the purpose of providing denominators for rate computation and should not be considered as official population estimates. DATA PROCESSING Edits In addition to followups for missing and inconsistent data made by the field staff, numerous clerical edits were performed on data received for central data processing. Detailed editing instructions were provided to manually review the patient records and to reclassify or recode "other" entries. Computer edits for code ranges and inconsistencies were also performed. Quality control All medical and drug coding and keying operations were subject to quality control procedures. Quality control for the medical and drug coding operation, as well as straight-key items, involved a two-way 10-percent independent verification procedure. As an additional quality control, all Patient Record Forms with differences between coders or with illegible en- tries for the reason for visit, diagnosis, E-code, and medication items were reviewed and adjudicated at NCHS.The average keying error rate for nonmedical items was 0.5 percent. For items which required medical coding, discrepancy rates averaged less than 5 percent. Imputations Item nonresponse was quite low, three percent or less, for all data items with the following exceptions: race (8 percent), ethnicity (15 percent), whether the patient had been seen previously for the same condition, item 12 on the OPD form (7 percent), and whether the visit was alcohol or drug-related item 14 on the ED form (8 percent). Incomplete data items were imputed using "hot deck" procedure by assigning a value from a randomly selected Patient Record Form with similar characteristics. For item 13 (urgency) on the ED Patient Record Form, the sorting used was ED size by the 3-digit ICD-9-CM code for principal diagnosis. For other ED variables {i.e., item 4 (date of birth), item 5 (sex), item 6 (race), item 7 (ethnicity), item 14 (problem alcohol- or drug-related), item 18 (disposition), and item 19 (providers)}, the sort used was ED size by urgency by the 3-digit ICD-9-CM code for principal diagnosis. For the OPD,imputation procedures were performed for the following variables: item 4 (date of birth), item 5 (sex), item 6 (race), item 7 (ethnicity), item 9 (referral), item 12 (patient seen before), item 17 (disposition), and item 18 (providers). The sorting used was OPD size by clinic type by the 3-digit ICD-9-CM code for principal diagnosis. ED and OPD records with imputed variables were flagged on the public use data tape. ESTIMATION PROCEDURES The probability sample design of the NHAMCS allowed the sample data to be weighted to produce national estimates for the U.S. Unweighted data are not used for analysis as unweighted data ignore the disproportionate sampling used in the NHAMCS. Statistics from the NHAMCS were derived by a multistage estimation procedure that produces essentially unbiased national estimates. Separate national estimates were produced for visits to hospital emergency and outpatient departments. The weight included three basic components: (1) inflation by reciprocals of the probabilities of selection, (2) adjustment for nonresponse, and (3) ratio adjustment to fixed totals. Each component is briefly described below. (1) Inflation by reciprocals of probabilities of selection Because the survey utilized a four-stage sample design, four probabilities of selection existed: (A) the probability of selecting the PSU; (B) the probability of selecting the hospital within the PSU; (C) the probability of selecting the emergency service area or outpatient clinic within the hospital; and (D) the probability of selecting the visit within the particular emergency service area or clinic. The overall probability of including a hospital in the sample was the product of the probability of the PSU being selected multiplied by the probability of the hospital being selected. The proba- bility of selecting the hospital was 1.0 for hospitals in noncertainty PSUs with fewer than five hospitals and was the hospital size divided by a sampling interval for all other hospitals. The sampling intervals for PSUs with more than five hospitals was the cumulative sum of the hospital sizes (the total of ED and OPD visits) in each PSU divided by five. The sampling interval for the certainty PSUs was the cumulative sum of all hospitals in these PSUs divided by 240. The probability of selecting a clinic within a hospital was 1.0 for clinics in hospitals with five or fewer clinics and was the clinic size divided by the sampling interval for clinics in hospitals with more than five clinics. The sampling interval was defined to be the cumulative sum of sizes for the clinics (the expected number of visits during the reporting period) in the hospital divided by five. The probability of selecting a visit was defined as the actual number of visits during the hospital's assigned reporting period divided by the number of Patient Record Forms completed. Estimates were adjusted to account for the extended data collection period for the 1992 survey which included 14 four week reporting periods from December 2, 1991 through December 27, 1992. Subsequent survey years will include 13 four-week reporting periods which will be inflated to derive annual estimates. (2)Adjustment for nonresponse Estimates from NHAMCS data were adjusted to account for sample units that were in scope, but did not participate in the study. These adjustments were calculated to minimize the impact of nonresponse on final estimates by imputing to nonresponding units the characteristics of similar responding units. As nonresponse may occur at each stage of sampling, several adjustments were required. For these adjustments, hospitals were judged similar if they had the same ownership and were in the same PSU or region and MSA status. Clinics were judged similar if they were of the same clinic type and were in the same PSU. Visits were judged similar if they occurred in the same clinic. (3)Ratio adjustment NHAMCS estimates were adjusted within 12 strata defined by region and ownership. Separate poststratification adjustments were made for emergency and outpatient department estimates. For ED estimates, the ratio adjustment for each stratum was a multiplication factor which had as its numerator the number of ED visits in the universe in the stratum and as its denominator the estimated number of ED visits in that stratum. For OPD estimates, the ratio adjustment for each stratum was a multiplication factor which had as its numerator the number of hospitals with an OPD in the universe in the stratum and as its denominator the estimated number of hospitals with OPD's in that stratum. The data for the numerator and denominator of both adjustments were based on figures from the SMG Hospital Market Data Base. 1PATIENT VISIT WEIGHT The "patient visit weight" is a vital component in the process of producing national estimates from sample data and its use should be clearly understood by all micro-data tape users. The statistics contained on the micro-data tape reflect data concerning only a sample of patient visits--and not a complete count of all the visits that occurred in the United States. Each record on the ED data tape represents one visit in the sample of 36,271 visits, and each record on the OPD data tape represents one visit in the sample of 35,114 visits. In order to obtain national estimates from the two samples, each record is assigned an inflation factor called the "patient visit weight." By aggregating the "patient visit weights" on the 36,271 ED sample records for 1992 the user can obtain the total of 89,795,736 estimated visits made by all patients to ED's in the United States. Also, by aggregating the "patient visit weights" on the 35,114 OPD sample records for 1992 the user can obtain the total of 56,604,704 estimated visits made by all patients to OPD's in the United States. The marginal tables on pages 42-45 contain data on numbers of records for selected variables as well as the corresponding national estimated number of visits and drug mentions obtained by aggregating the "patient visit weights" on those records. HOSPITAL CODE The purpose of this code is to allow for greater analytical depth by permitting the user to link individual Patient Record Forms on the public use tape with individual hospitals. This linking code will enable users to conduct more comprehensive analysis without violating the confidentiality of patients or hospitals. CLINIC TYPE CODE (For OPD's only) The purpose of this code is the same as that of the hospital code. REFERENCES 1. Current Estimates from the National Health Interview Survey. 1991. National Center for Health Statistics. Vital Health Stat 10(184). 1992. 2. Loft JD, Sheatsley PB, Frankel MR. Comparison Report on the Hospital Ambulatory Medical Care Evaluation Study. Contract No. 282-82-2111. Chicago, Illinois: National Opinion Research Center, 1985. 3. McCaig LF, McLemore T. Plan and Operation of the National Hospital Ambulatory Medical Care Survey, 1992. National Center for Health Statistics. Vital and Health Stat 1(34). 1994. 4. Massey JT, Moore TF, Parsons VL, Tadros W. Design and estimation for the National Health Interview Survey, 1985-94. National Center for Health Statistics. Vital Health Stat 2(110). 1989. 5. Methodological Report on the Hospital Ambulatory Medical Care Evaluation Study. Contract No. 282-82-2111. Chicago, Illinois. National Opinion Research Center. 1984. 6. Final Report - Survey of Hospital Emergency and Outpatient Departments. Contract No. 200-88-7017. Rockville, Maryland. Westat. 1990. 7. Schneider D, Appleton L, McLemore T. A Reason for Visit Classification for Ambulatory Care. National Center for Health Statistics. Vital Health Stat 2(78). 1979. 8. National Ambulatory Medical Care Survey: Medical Coding Manual (updated annually). 9. Public Health Service and Health Care Financing Administration. International Classification of Diseases, 9th Revision, Clinical Modification. Washington: Public Health Service. 1980. 10. Koch h, Campbell W. The Collection and Processing of Drug Information. National Ambulatory Medical Care Survey, 1980. National Center for Health Statistics. Vital and Health Stat 2 (90). 1982. 11. Food and Drug Administration. National Drug Code Directory, 1985 Edition. Washington: Public Health Service. 1985. 1992 Format For Emergency Department Micro Data Tape This section consists of a detailed breakdown of the data tape record, providing a brief description of each item of data included in the records. The data are arranged sequentially according to their physical location on the tape record. Unless otherwise stated in the "item description" column, the data are derived from the Emergency Department (ED) Patient Record Form (page 9). The AMA, the hospital induction questionnaire, and the SMG Hospital Market Data Base are alternate sources of data, while the computer generates other items by recoding selected data items. RECORD LAYOUT FOR EMERGENCY FILE Item Field Tape No. Length Location Item Description and Codes - Emergency Departments ____ ______ ________ __________________________________________________ 1 6 1-6 Date of visit _____________ 1.1 2 1-2 Month of visit 01-12: January-December 1.2 2 3-4 Day of visit 01-31 1.3 2 5-6 Year of visit Last 2 digits of year (91 or 92)* 2 2 7-8 Patient age (in years; derived from date of birth) ___________ 00-99 3 1 9 Sex ___ 1 = Female 2 = Male 4 1 10 Race ____ 1 = White 2 = Black 3 = Asian/Pacific Islander 4 = American Indian/Eskimo/Aleut 5 1 11 Ethnicity _________ 1 = Hispanic origin 2 = Not Hispanic 6 9 12-20 Expected source(s) of payment _____________________________ 6.1 1 12 Medicare (1=Yes, and 0=No) 6.2 1 13 Medicaid " 6.3 1 14 Other government " 6.4 1 15 Private/commercial " 6.5 1 16 HMO/other prepaid " 6.6 1 17 Patient paid " 6.7 1 18 No charge " 6.8 1 19 Other " 6.9 1 20 Unspecified " * The 1992 NHAMCS included data collected from Dec. 2, 1991 to Dec. 27, 1992. Item Field Tape No. Length Location Item Description and Codes - Emergency Departments ____ ______ ________ __________________________________________________ 7 1 21 Major reason for this visit ___________________________ 1 = Injury, first visit 2 = Injury, follow-up 3 = Illness, first visit 4 = Illness, follow-up 5 = Other reason 9 = Blank or invalid 8 15 22-36 Cause of injury (see page 12 and reference 9) 8.1 5 22-26 Injury # 1: 88000-89999 = E8000-E9999 80000 = Blank 80010 = Illegible 8.2 5 27-31 Injury # 2: 88000-89999 = E8000-E9999 80000 = Blank 80010 = Illegible 8.3 5 32-36 Injury # 3: 88000-89999 = E8000-E9999 80000 = Blank 80010 = Illegible 9 15 37-51 Patient reasons for visit (see pages 11 and 61-84) 9.1 5 37-41 Reason # 1: 10050-89990 = 10050-89990 90000 = Blank 9.2 5 42-46 Reason # 2: 10050-89990 = 10050-89990 90000 = Blank 9.3 5 47-51 Reason # 3: 10050-89990 = 10050-89990 90000 = Blank 10 18 52-69 Physician's diagnoses (see page 12 and reference 9) 10.1 6 52-57 Diagnosis # 1: 100100-209970 = 00100-V9970 900000 = Blank 10.2 6 58-63 Diagnosis # 2: 100100-209970 = 00100-V9970 900000 = Blank 10.3 6 64-69 Diagnosis # 3: 100100-209970 = 00100-V9970 900000 = Blank 11 1 70 Urgency of this visit _____________________ 1 = Urgent/Emergent 2 = Non-urgent 12 1 71 Is problem alcohol- or drug related? ____________________________________ 1 = Neither 2 = Alcohol-related 3 = Drug-related 4 = Both Item Field Tape No. Length Location Item Description and Codes - Emergency Departments ____ ______ ________ ___________________________________________________ 13 1 72 Were medications ordered or provided at this visit? ___________________________________________________ 0 = Yes 1 = No 14 1 73 Number of medications coded for this visit __________________________________________ 0-5 15 25 74-98 Medications (see pages 13 and 85-95) 15.1 5 74-78 Medication Code # 1 ___________________ 00005-92190 = 00005-92190 90000 = Blank 99980 = Unknown entry; Other 99999 = Illegible entry 15.2 5 79-83 Medication code # 2 ___________________ 00005-92190 = 00005-92190 90000 = Blank 99980 = Unknown entry; Other 99999 = Illegible entry 15.3 5 84-88 Medication code # 3 ___________________ 00005-92190 = 00005-92190 90000 = Blank 99980 = Unknown entry; Other 99999 = Illegible entry 15.4 5 89-93 Medication code # 4 ___________________ 00005-92190 = 00005-92190 90000 = Blank 99980 = Unknown entry; Other 99999 = Illegible entry 15.5 5 94-98 Medication code # 5 ___________________ 00005-92190 = 00005-92190 90000 = Blank 99980 = Unknown entry; Other 99999 = Illegible entry Item Field Tape No. Length Location Item Description and Codes - Emergency Departments ____ ______ ________ ___________________________________________________ 16 12 99-110 Diagnostic/screening services 16.1 1 99 None (1=Yes, and 0=No) 16.2 1 100 Blood pressure check " 16.3 1 101 Urinalysis " 16.4 1 102 HIV serology " 16.5 1 103 Other blood test " 16.6 1 104 EKG " 16.7 1 105 Mental status exam " 16.8 1 106 Chest x-ray " 16.9 1 107 Extremity x-ray " 16.10 1 108 Ct scan/MRI " 16.11 1 109 Other diagnostic imaging " 16.12 1 110 Other (Specify) " 17 11 111-121 Procedures 17.1 1 111 None (1=Yes,and 0=No) 17.2 1 112 Endotracheal intubation " 17.3 1 113 CPR " 17.4 1 114 IV fluids " 17.5 1 115 NG tube/gastric lavage " 17.6 1 116 Wound care " 17.7 1 117 Eye/ENT care " 17.8 1 118 Orthopedic care " 17.9 1 119 Bladder catheter " 17.10 1 120 Lumbar puncture " 17.11 1 121 Other(s)(specify) " 18 10 122-131 Disposition of this visit 18.1 1 122 Return to ED P.R.N. (1=Yes, and 0=No) 18.2 1 123 Return to ED-appointment " 18.3 1 124 Return to referring physician " 18.4 1 125 Refer to other physician/clinic " 18.5 1 126 Admit to hospital " 18.6 1 127 Transfer to other facility " 18.7 1 128 DOA/died in ED " 18.8 1 129 Left AMA " 18.9 1 130 No follow-up planned " 18.10 1 131 Other (specify) " 19 8 132-139 Providers seen this visit 19.1 1 132 Resident/Intern (1=Yes, and 0=No) 19.2 1 133 Staff physician " 19.3 1 134 Other physician " 19.4 1 135 Physician assistant " 19.5 1 136 Nurse practitioner " 19.6 1 137 Registered nurse " 19.7 1 138 Licensed practical nurse " 19.8 1 139 Nurse's aid " Item Field Tape No. Length Location Item Description and Codes - Emergency Departments ____ ______ ________ ___________________________________________________ 20 5 140-144 Patient visit weight (see page 17) A right justified, alphanumeric integer developed by the NHAMCS staff for the purpose of producing national estimates from sample estimates. 21 1 146 Geographic region (based on actual location of physician's practice) 1 = Northeast 2 = Midwest 3 = South 4 = West 22 1 147 Metropolitan/nonmetropolitan Based on actual location, in conjunction with the definition of the Bureau of the Census and the U.S. Office of Management and Budget. 1 = MSA (Metropolitan Statistical Area) 2 = Non-MSA 23 1 148 Hospital ownership __________________ 1 = Voluntary non-profit 2 = Government 3 = Proprietary 24 3 149-151 Hospital code 001-605 : A unique code assigned to all the records from a particular hospital 25 8 152-159 Imputations ___________ (1 = data imputed; blank = data not computed) 25.1 1 152 Birth year (Item 4) * 25.2 1 153 Sex (Item 5) * 25.3 1 154 Race (Item 6) * 25.4 1 155 Ethnicity (Item 7) * 25.5 1 156 Urgency (Item 13)* 25.6 1 157 Alcohol- or drug-related (Item 14)* 25.7 1 158 Disposition of visit (Item 18)* 25.8 1 159 Providers (Item 19)* * These refer to items on the Patient Record Form on page 9. Item Field Tape No. Length Location Item Description and Codes - Emergency Departments ____ ______ ________ ___________________________________________________ 26-31 35 160-194 Drug related information for medication code # 1 26 5 160-164 Generic name code (see pages 96-103 for codes and names) 50001-92506 : Specific generic code 50000 : Generic name undetermined 27 1 165 Prescription status code ________________________ 1 = Prescription drug 2 = Nonprescription drug 3 = Undetermined 28 1 166 Controlled substance status code ________________________________ 1 = Schedule I (research only) 2 = Schedule II 3 = Schedule III 4 = Schedule IV 5 = Schedule V 6 = No control 7 = Undetermined 29 1 167 Composition status code _______________________ 1 = Single entity drug 2 = Combination drug 3 = Undetermined 30 2 168-169 Drug classes ____________ 01-19 : Major NDC drug class 20 : Other or undetermined blank : blank (See page 104 for list of major NDC drug class codes and names) 31 25 170-194 Ingredient codes (Ingredients of combination drugs; maximum of 5 generic name codes) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Item Field Tape No. Length Location Item Description and Codes - Emergency Departments ____ ______ ________ ___________________________________________________ 32-37 35 195-229 Drug related information for medication code # 2 32 5 195-199 Generic name code (see pages 96-103 for codes and names) 50001-92506 : Specific generic code 50000 : Generic name undetermined 33 1 200 Prescription status code ________________________ 1 = Prescription drug 2 = Nonprescription drug 3 = Undetermined 34 1 201 Controlled substance status code ________________________________ 1 = Schedule I (research only) 2 = Schedule II 3 = Schedule III 4 = Schedule IV 5 = Schedule V 6 = No control 7 = Undetermined 35 1 202 Composition status code _______________________ 1 = Single entity drug 2 = Combination drug 3 = Undetermined 36 2 203-204 Drug classes ____________ 01-19 : Major NDC drug class 20 : Other or undetermined blank : blank (See page 104 for list of major NDC drug class codes and names) 37 25 205-229 Ingredient codes (Ingredients of combination drugs; maximum of 5 generic name codes) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Item Field Tape No. Length Location Item Description and Codes - Emergency Departments ____ ______ ________ ___________________________________________________ 38-43 35 230-264 Drug related information for medication code # 3 38 5 230-234 Generic name code (see pages 96-103 for codes and names) 50001-92506 : Specific generic code 50000 : Generic name undetermined 39 1 235 Prescription status code ________________________ 1 = Prescription drug 2 = Nonprescription drug 3 = Undetermined 40 1 236 Controlled substance status code ________________________________ 1 = Schedule I (research only) 2 = Schedule II 3 = Schedule III 4 = Schedule IV 5 = Schedule V 6 = No control 7 = Undetermined 41 1 237 Composition status code _______________________ 1 = Single entity drug 2 = Combination drug 3 = Undetermined 42 2 238-239 Drug classes ____________ 01-19 : Major NDC drug class 20 : Other or undetermined blank : blank (See page 104 for list of major NDC drug class codes and names) 43 25 240-264 Ingredient codes (Ingredients of combination drugs; maximum of 5 generic name codes) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Item Field Tape No. Length Location Item Description and Codes - Emergency Departments ____ ______ ________ ___________________________________________________ 44-49 35 265-299 Drug related information for medication code # 4 44 5 265-269 Generic name code (see pages 96-103 for codes and names) 50001-92506 : Specific generic code 50000 : Generic name undetermined 45 1 270 Prescription status code ________________________ 1 = Prescription drug 2 = Nonprescription drug 3 = Undetermined 46 1 271 Controlled substance status code ________________________________ 1 = Schedule I (research only) 2 = Schedule II 3 = Schedule III 4 = Schedule IV 5 = Schedule V 6 = No control 7 = Undetermined 47 1 272 Composition status code _______________________ 1 = Single entity drug 2 = Combination drug 3 = Undetermined 48 2 273-274 Drug classes ____________ 01-19 : Major NDC drug class 20 : Other or undetermined blank : blank (See page 104 for list of major NDC drug class codes and names) 49 25 275-299 Ingredient codes (Ingredients of combination drugs; maximum of 5 generic name codes) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Item Field Tape No. Length Location Item Description and Codes - Emergency Departments ____ ______ ________ ___________________________________________________ 50-55 35 300-334 Drug related information for medication code # 5 50 5 300-304 Generic name code (see pages 96-103 for codes and names) 50001-92506 : Specific generic code 50000 : Generic name undetermined 51 1 305 Prescription status code ________________________ 1 = Prescription drug 2 = Nonprescription drug 3 = Undetermined 52 1 306 Controlled substance status code ________________________________ 1 = Schedule I (research only) 2 = Schedule II 3 = Schedule III 4 = Schedule IV 5 = Schedule V 6 = No control 7 = Undetermined 53 1 307 Composition status code _______________________ 1 = Single entity drug 2 = Combination drug 3 = Undetermined 54 2 308-309 Drug classes ____________ 01-19 : Major NDC drug class 20 : Other or undetermined blank : blank (See page 104 for list of major NDC drug class codes and names) 55 25 310-334 Ingredient codes (Ingredients of combination drugs; maximum of 5 generic name codes) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) Ingredient code (50001-92506, or 50000) RECORD LAYOUT This section consists of a detailed breakdown of the data tape record, providing a brief description of each item of data included in the records. The data are arranged sequentially according to their physical location on the tape record. Unless otherwise stated in the "item description" column, the data are derived from the Outpatient Department (OPD) Patient Record Form (page 10). The AMA, the hospital induction questionnaire, and the SMG Hospital Market Data Base are alternate sources of data, while the computer generates other items by recoding selected data items. Item Field Tape No. Length Location Item Description and Codes - Outpatient Departments ____ ______ ________ ___________________________________________________ 1 6 1-6 Date of visit _____________ 1.1 2 1-2 Month of visit 01-12: January-December 1.2 2 3-4 Day of visit 01-31 1.3 2 5-6 Year of visit Last 2 digits of year (91 or 92)* 2 2 7-8 Patient age (in years; derived from date of birth) ___________ 00-99 3 1 9 Sex ___ 1 = Female 2 = Male 4 1 10 Race ____ 1 = White 2 = Black 3 = Asian/Pacific Islander 4 = American Indian/Eskimo/Aleut 5 1 11 Ethnicity _________ 1 = Hispanic origin 2 = Not Hispanic 6 9 12-20 Expected source(s) of payment _____________________________ 6.1 1 12 Medicare (1=Yes, and 0=No) 6.2 1 13 Medicaid " 6.3 1 14 Other government " 6.4 1 15 Private/commercial " 6.5 1 16 HMO/other prepaid " 6.6 1 17 Patient paid " 6.7 1 18 No charge " 6.8 1 19 Other " 6.9 1 20 Unspecified " * The 1992 NHAMCS included data collected from Dec. 2, 1991 to Dec. 27, 1992. Item Field Tape No. Length Location Item Description and Codes - Outpatient Departments ____ ______ ________ ___________________________________________________ 7 1 21 Was patient referred by another physician? __________________________________________ 1 = Yes 2 = No 8 15 22-36 Patient reasons for visit (see pages 11 and 61-84) 8.1 5 22-26 Reason # 1: 10050-89990 = 10050-89990 90000 = Blank 8.2 5 27-31 Reason # 2: 10050-89990 = 10050-89990 90000 = Blank 8.3 5 32-36 Reason # 3: 10050-89990 = 10050-89990 90000 = Blank 9 18 37-54 Physician's diagnoses (see page 12 and reference 9) 9.1 6 37-42 Diagnosis # 1: 100100-209970 = 00100-V9970 900000 = Blank 9.2 6 43-48 Diagnosis # 2: 100100-209970 = 00100-V9970 900000 = Blank 9.3 6 49-54 Diagnosis # 3: 100100-209970 = 00100-V9970 900000 = Blank 10 10 55-64 Ambulatory surgical procedures (see page 12 and ref. 10.1 4 55-58 Surgical procedure code # 1 ___________________________ 0101-9998 = 0101-9998 0000 = Blank 9999 = Other and uncodable 10.2 1 59 Scheduled/performed ___________________ 0 = Not applicable (if no code entered) or Unspecified (if a code is entered) 1 = Scheduled 2 = Performed 10.3 1 60 Type of anesthesia __________________ 0 = Not applicable (if no code entered) or Unspecified (if a code is entered) 1 = Local 2 = Regional 3 = General 10.4 4 61-64 Surgical procedure code # 2 ___________________________ 0101-9998 = 0101-9998 0000 = Blank 9999 = Other and uncodable Item Field Tape No. Length Location Item Description and Codes - Outpatient Departments ____ ______ ________ ___________________________________________________ 11.1 1 65 Have you seen patient before? _____________________________ 1 = Yes.... 2 = No 11.1 1 66 If yes, for the condition in item 11a? ______________________________________ 0 = Not applicable 1 = Yes 2 = No 12 19 67-85 Diagnostic/screening services _____________________________ 12.1 1 67 None (1=Yes, and 0=No) 12.2 1 68 Blood pressure " 12.3 1 69 Urinalysis " 12.4 1 70 EKG - resting " 12.5 1 71 EKG - exercise " 12.6 1 72 Mammogram " 12.7 1 73 Chest x-ray " 12.8 1 74 Other radiology " 12.9 1 75 Allergy testing " 12.10 1 76 Spirometry " 12.11 1 77 Pap test " 12.12 1 78 Strep throat test " 12.13 1 79 HIV serology " 12.14 1 80 Cholesterol measure " 12.15 1 81 Other lab test " 12.16 1 82 Hearing test " 12.17 1 83 Visual acuity " 12.18 1 84 Mental status exam " 12.19 1 85 Other " 13 17 86-102 Therapeutic services ____________________ 13.1 1 86 None (1=Yes, and 0=No) 13.2 1 87 Diet " 13.3 1 88 Exercise " 13.4 1 89 Cholesterol reduction " 13.5 1 90 Weight reduction " 13.6 1 91 Drug abuse " 13.7 1 92 Alcohol abuse " 13.8 1 93 Smoking cessation " 13.9 1 94 Family/social " 13.10 1 95 Growth/development " 13.11 1 96 Family planning " 13.12 1 97 Other counseling " 13.13 1 98 Psychotherapy " 13.14 1 99 Corrective lenses " 13.15 1 100 Hearing aid " 13.16 1 101 Physiotherapy " 13.17 1 102 Other therapy " Item Field Tape No. Length Location Item Description and Codes - Outpatient Departments ____ ______ ________ ___________________________________________________ 14 30 103-132 Medications (see pages 13 and 85-95) ___________ 14.1 5 103-107 Medication Code # 1 ___________________ 00005-92190 = 00005-92190 90000 = Blank 99980 = Unknown entry; Other 99999 = Illegible entry 14.2 1 108 New medication?: ________________ 0 = Unspecified 1 = Yes 2 = No 14.3 5 109-113 Medication code # 2 ___________________ 00005-92190 = 00005-92190 90000 = Blank 99980 = Unknown entry; Other 99999 = Illegible entry 14.4 1 114 New medication?: ________________ 0 = Unspecified 1 = Yes 2 = No 14.5 5 115-119 Medication code # 3 ___________________ 00005-92190 = 00005-92190 90000 = Blank 99980 = Unknown entry; Other 99999 = Illegible entry 14.6 1 120 New medication?: ________________ 0 = Unspecified 1 = Yes 2 = No 14.7 5 121-125 Medication code # 4 ___________________ 00005-92190 = 00005-92190 90000 = Blank 99980 = Unknown entry; Other 99999 = Illegible entry 14.8 1 126 New medication?: ________________ 0 = Unspecified 1 = Yes 2 = No 14.9 5 127-131 Medication code # 5 ___________________ 00005-92190 = 00005-92190 90000 = Blank 99980 = Unknown entry; Other 99999 = Illegible entry 14.10 1 132 New medication?: ________________ 0 = Unspecified 1 = Yes 2 = No Item Field Tape No. Length Location Item Description and Codes - Outpatient Departments ____ ______ ________ ___________________________________________________ 15 1 133 Were medications ordered or provided at this visit? ___________________________________________________ 0 = Yes 1 = No 16 1 134 Number of medications coded ___________________________ 0-5 17 8 135-142 Disposition of this visit _________________________ 17.1 1 135 Return to Clinic P.R.N. (1=Yes, and 0=No) 17.2 1 136 Return to Clinic-appointment " 17.3 1 137 Telephone follow-up planned " 17.4 1 138 Return to referring physician " 17.5 1 139 Refer to other physician/clinic " 17.6 1 140 Admit to hospitalned " 17.7 1 141 No follow-up planned " 17.8 1 142 Other (specify) " 18 8 143-150 Providers seen this visit _________________________ 18.1 1 143 Resident/Intern (1=Yes, and 0=No) 18.2 1 144 Staff physician " 18.3 1 145 Other physician " 18.4 1 146 Physician assistant " 18.5 1 147 Nurse practitioner " 18.6 1 148 Registered nurse " 18.7 1 149 Licensed practical nurse " 18.8 1 150 Nurse's aid " 19 5 151-155 Patient visit weight (see page 17) ____________________ A right justified, alphanumeric integer developed by the NAMCS staff for the purpose of producing national estimates from sample estimates. Item Field Tape No. Length Location Item Description and Codes - Outpatient Departments ____ ______ ________ ___________________________________________________ 20 1 156 Geographic region (based on actual location of physician's practice) 1 = Northeast 2 = Midwest 3 = South 4 = West 21 1 157 Metropolitan/nonmetropolitan ____________________________ Based on actual location, in conjunction with the definition of the Bureau of the Census and the U.S. Office of Management and Budget. 1 = MSA (Metropolitan Statistical Area) 2 = Non-MSA 22 1 158 Hospital ownership __________________ 1 = Voluntary non-profit 2 = Government 3 = Proprietary 23 3 159-161 Hospital code _____________ 001-605 : A unique code assigned to all the records from a particular hospital 24 1 162 Clinic type ___________ 1 = General medicine 2 = Surgery 3 = Pediatrics 4 = Obstetrics/Gynecology 5 = Other 6 = Substance abuse 25 8 163-171 Imputations ___________ (1 = data imputed; blank = data not imputed) 25.1 1 163 Birth year (Item 4) * 25.2 1 164 Sex (Item 5) * 25.3 1 165 Referral (Item 9) * 25.4 1 166 Seen patient before (Item 12)* 25.5 1 167 If yes, for diagnosis in 11a (Item 12)* 25.6 1 168 Disposition (Item 17)* 25.7 1 169 Providers (Item 18)* 25.8 1 170 Race (Item 6) * 25.9 1 171 Ethnicity (Item 7) * * These refer to items on the Patient Record Form on page 10. Item Field Tape No. Length Location Item Description and Codes - Outpatient Departments ____ ______ ________ ___________________________________________________ 26-31 35 172-206 Drug related information for medication code # 1 ________________________________________________ 26 5 172-176 Generic name code (see pages 96-103 for codes and na _________________ 50005-92506 : Specific generic code 50000 : Generic name undetermined 27 1 177 Prescription status code ________________________ 1 = Prescription drug 2 = Nonprescription drug 3 = Undetermined 28 1 178 Controlled substance status code ________________________________ 1 = Schedule I (research only) 2 = Schedule II 3 = Schedule III 4 = Schedule IV 5 = Schedule V 6 = No control 7 = Undetermined 29 1 179 Composition status code _______________________ 1 = Single entity drug 2 = Combination drug 3 = Undetermined 5 = Multivitamin 30 2 180-181 Drug classes ____________ 01-19 : Major NDC drug class 20 : Other or undetermined blank : blank (See page 104 for list of major NDC drug class codes and names) 31 25 182-206 Ingredient codes (Ingredients of combination drugs; maximum of 5 generic name codes) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Item Field Tape No. Length Location Item Description and Codes - Outpatient Departments ____ ______ ________ ___________________________________________________ 32-37 35 207-241 Drug related information for medication code # 2 ________________________________________________ 32 5 207-211 Generic name code (see pages 96-103 for codes and na _________________ 50005-92506 : Specific generic code 50000 : Generic name undetermined 33 1 212 Prescription status code ________________________ 1 = Prescription drug 2 = Nonprescription drug 3 = Undetermined 34 1 213 Controlled substance status code ________________________________ 1 = Schedule I (research only) 2 = Schedule II 3 = Schedule III 4 = Schedule IV 5 = Schedule V 6 = No control 7 = Undetermined 35 1 214 Composition status code _______________________ 1 = Single entity drug 2 = Combination drug 3 = Undetermined 5 = Multivitamin 36 2 215-216 Drug classes ____________ 01-19 : Major NDC drug class 20 : Other or undetermined blank : blank (See page 104 for list of major NDC drug class codes and names) 37 25 217-241 Ingredient codes (Ingredients of combination drugs; maximum of 5 generic name codes) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Item Field Tape No. Length Location Item Description and Codes - Outpatient Departments ____ ______ ________ ___________________________________________________ 38-43 35 242-276 Drug related information for medication code # 3 ________________________________________________ 38 5 242-246 Generic name code (see pages 96-103 for codes and na _________________ 50005-92506 : Specific generic code 50000 : Generic name undetermined 39 1 247 Prescription status code ________________________ 1 = Prescription drug 2 = Nonprescription drug 3 = Undetermined 40 1 248 Controlled substance status code ________________________________ 1 = Schedule I (research only) 2 = Schedule II 3 = Schedule III 4 = Schedule IV 5 = Schedule V 6 = No control 7 = Undetermined 41 1 249 Composition status code _______________________ 1 = Single entity drug 2 = Combination drug 3 = Undetermined 5 = Multivitamin 42 2 250-251 Drug classes ____________ 01-19 : Major NDC drug class 20 : Other or undetermined blank : blank (See page 104 for list of major NDC drug class codes and names) 43 25 252-276 Ingredient codes (Ingredients of combination ________________ drugs; maximum of 5 generic name codes) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Item Field Tape No. Length Location Item Description and Codes - Outpatient Departments ____ ______ ________ ___________________________________________________ 44-49 35 277-311 Drug related information for medication code # 4 ________________________________________________ 44 5 277-281 Generic name code (see pages 96-103 for codes and na _________________ 50005-92506 : Specific generic code 50000 : Generic name undetermined 45 1 282 Prescription status code ________________________ 1 = Prescription drug 2 = Nonprescription drug 3 = Undetermined 46 1 283 Controlled substance status code ________________________________ 1 = Schedule I (research only) 2 = Schedule II 3 = Schedule III 4 = Schedule IV 5 = Schedule V 6 = No control 7 = Undetermined 47 1 284 Composition status code _______________________ 1 = Single entity drug 2 = Combination drug 3 = Undetermined 5 = Multivitamin 48 2 285-286 Drug classes ____________ 01-19 : Major NDC drug class 20 : Other or undetermined blank : blank (See page 104 for list of major NDC drug class codes and names) 49 25 287-311 Ingredient codes (Ingredients of combination ________________ drugs; maximum of 5 generic name codes) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Item Field Tape No. Length Location Item Description and Codes - Outpatient Departments ____ ______ ________ ___________________________________________________ 50-55 35 312-346 Drug related information for medication code # 5 ________________________________________________ 50 5 312-316 Generic name code (see pages 96-103 for codes and na _________________ 50005-92506 : Specific generic code 50000 : Generic name undetermined 51 1 317 Prescription status code ________________________ 1 = Prescription drug 2 = Nonprescription drug 3 = Undetermined 52 1 318 Controlled substance status code ________________________________ 1 = Schedule I (research only) 2 = Schedule II 3 = Schedule III 4 = Schedule IV 5 = Schedule V 6 = No control 7 = Undetermined 53 1 319 Composition status code _______________________ 1 = Single entity drug 2 = Combination drug 3 = Undetermined 5 = Multivitamin 54 2 320-321 Drug classes ____________ 01-19 : Major NDC drug class 20 : Other or undetermined blank : blank (See page 104 for list of major NDC drug class codes and names) 55 25 322-346 Ingredient codes (Ingredients of combination drugs; maximum of 5 generic name codes) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) Ingredient code (50005-92506, or 50000) MARGINAL DATA Marginal Data for Emergency Department Patient Visits PATIENT AGE TOTAL < 15 15-24 25-44 45-64 65-74 75+ _________ _________ _________ _________ _________ _________ _______ ALL 36271 9212 5873 11231 4917 2288 2750 89795736 22522543 14847861 27239895 12509277 5805530 6870630 100.000 25.082 16.535 30.335 13.931 6.465 7.651 PATIENT SEX TOTAL FEMALE MALE _________ _________ _________ ALL 36271 18778 17493 RECORDS 89795736 46611996 43183740 VISITS 100.000 51.909 48.091 PERCENT PATIENT RACE WHITE BLACK ASIAN/PA AMERIN/ TOTAL ISLANDER ESK/ALEU _________ _________ _________ _________ _________ ALL 36271 27471 7730 791 279 RECORDS 89795736 70477789 17149703 1399595 768649 VISITS 100.000 78.487 19.099 1.559 0.856 PERCENT ETHNICITY HISPANIC NOT TOTAL HISPANIC _________ _________ _________ ALL 36271 4664 31607 RECORDS 89795736 9503457 80292279 VISITS 100.000 10.583 89.417 PERCENT SOURCE OF MEDICARE MEDICAID OTHER PRIVATE/ HMO/OTHER PATIENT PAYMENT TOTAL GOVT COMMER PREPAID PAID _________ _________ _________ _________ _________ _________ ______ ALL 36271 5271 8425 1622 11931 3321 5298 89795736 13582252 20339368 4032150 32331413 6566039 12402458 100.000 15.126 22.651 4.490 36.006 7.312 13.812 NO OTHER NO CHARGE ANSWER _________ _________ _________ 200 2640 656 RECORDS 778070 6116894 1505422 VISITS 0.866 6.812 1.676 PERCENT MAJOR REASON INJURY INJURY ILLNESS ILLNESS OTHER BLANK OR FOR THIS TOTAL 1ST VISIT FOLLOW-UP 1ST VISIT FOLLOW-UP REASON INVALID VISIT _________ _________ _________ _________ _________ _______ _________ ALL 36271 11143 1248 20184 1181 1979 536 89795736 28388457 3178320 49690585 2836619 4430440 1271315 100.000 31.614 3.539 55.337 3.159 4.934 1.416 URGENCY OF URGENT/ NON- THIS VISIT TOTAL EMERGENT URGENT _________ _________ _________ ALL 36271 16675 19596 RECORDS 89795736 40078495 49717241 VISITS 100.000 44.633 55.367 PERCENT IS PROBLEM NEITHER ALCOHOL DRUG BOTH ALCOHOL OR TOTAL RELATED RELATED DRUG RELATED? _________ _________ _________ _________ _________ ALL 36271 34739 970 408 154 RECORDS 89795736 86014107 2458996 995529 327104 VISITS 100.000 95.789 2.738 1.109 0.364 PERCENT Marginal Data for Emergency Department Drug Mentions PATIENT AGE TOTAL < 15 15-24 25-44 45-64 65-74 75+ _________ _________ ________ _________ _________ ________ _______ ALL 45844 10226 6432 14322 7449 3521 3894 117418882 25441186 16889626 36196345 19772429 9253241 9866055 100.000 21.667 14.384 30.827 16.839 7.881 8.402 PATIENT SEX TOTAL FEMALE MALE _________ _________ _________ ALL 45844 24471 21373 RECORDS 117418882 63296149 54122733 MENTIONS 100.000 53.906 46.094 PERCENT PATIENT RACE WHITE BLACK ASIAN/PA AMER IN/ TOTAL ISLANDER ESK/ALEU _________ _________ _________ _________ _________ ALL 45844 35152 9312 994 386 RECORDS 117418882 92796663 21975123 1626858 1020238 MENTIONS 100.000 79.030 18.715 1.386 0.869 PERCENT ETHNICITY NOT TOTAL HISPANIC HISPANIC _________ _________ _________ ALL 45844 5722 40122 RECORDS 117418882 12164555 105254327 MENTIONS 100.000 10.360 89.640 PERCENT SOURCE OF MEDICARE MEDICAID OTHER PRIVATE/ HMO/OTHER PATIENT PAYMENT TOTAL GOVT COMMER PREPAID PAID _________ _________ _________ ________ _________ _________ _________ ALL 45844 7823 10780 1995 15377 4448 6399 117418882 20953208 27291795 5124712 42710885 8211439 15757616 100.000 17.845 23.243 4.364 36.375 6.993 13.420 NO NO CHARGE OTHER ANSWER _________ _________ _________ 169 2914 623 RECORDS 1079721 6830633 1424909 MENTIONS 0.920 5.817 1.214 PERCENT MAJOR REASON INJURY INJURY ILLNESS ILLNESS OTHER BLANK OR FOR THIS TOTAL 1ST VISIT FOLLOW-UP 1ST VISIT FOLLOW-UP REASON INVALID VISIT _________ _________ _________ _________ _________ ________ ________ ALL 45844 11494 832 29362 1674 1881 601 117418882 29939678 2109516 75178547 4088368 4568684 1534089 100.000 25.498 1.797 64.026 3.482 3.891 1.307 PRESCRIPTION NON STATUS PRESCRIP- PRESCRIP- UNDETER- TOTAL TION DRUG TION DRUG MINED _________ _________ _________ _________ ALL 45844 35746 7757 2341 RECORDS 117418882 92251104 19115184 6052594 MENTIONS 100.000 78.566 16.279 5.155 PERCENT IS PROBLEM ALCOHOL DRUG ALCOHOL OR TOTAL NEITHER RELATED RELATED BOTH DRUG RELATED? _________ _________ _________ _________ _________ ALL 45844 43879 1247 531 187 RECORDS 117418882 112445807 3154265 1383596 435214 MENTIONS 100.000 95.765 2.686 1.178 0.371 PERCENT Marginal Data for Outpatient Department Patient Visits PATIENT AGE TOTAL < 15 15-24 25-44 45-64 65-74 75+ _________ _________ _________ _________ ________ ________ _______ ALL 35114 7605 4979 10440 6814 3099 2177 56604704 12712696 7241933 16484282 11295379 5030767 3839647 100.000 22.459 12.794 29.122 19.955 8.888 6.783 PATIENT SEX TOTAL FEMALE MALE _________ _________ _________ ALL 35114 21689 13425 RECORDS 56604704 34741328 21863376 VISITS 100.000 61.375 38.625 PERCENT PATIENT RACE ASIAN/PA AMER IN/ TOTAL WHITE BLACK ISLANDER ESK/ALEU _________ _________ _________ _________ _________ ALL 35114 26185 7827 986 116 RECORDS 56604704 42033459 12549117 1608598 413530 VISITS 100.000 74.258 22.170 2.842 0.731 PERCENT ETHNICITY NOT TOTAL HISPANIC HISPANIC _________ _________ _________ ALL 35114 4730 30384 RECORDS 56604704 9635178 46969526 VISITS 100.000 17.022 82.978 PERCENT SOURCE OF MEDICARE MEDICAID OTHER PRIVATE/ HMO/OTHER PATIENT PAYMENT TOTAL GOVT COMMER PREPAID PAID _________ _________ _________ _________ _________ ________ _______ ALL 35114 5471 11162 2122 8747 2856 4434 56604704 9239617 17647144 3683830 13477922 4364114 7747591 100.000 16.323 31.176 6.508 23.811 7.710 13.687 NO NO CHARGE OTHER ANSWER _________ _________ _________ 803 2156 1059 RECORDS 1640364 3115824 1711791 VISITS 2.898 5.505 3.024 PERCENT PATIENT TOTAL YES NO REFERRAL _________ _________ _________ STATUS ALL 35114 4482 30632 RECORDS 56604704 6421516 50183188 VISITS 100.000 11.344 88.656 PERCENT VISIT OLD PAT OLD PAT STATUS TOTAL NEW PAT NEW PROB OLD PROB _________ _________ _________ _________ ALL 35114 8945 4845 21324 RECORDS 56604704 12425178 8545076 35634450 VISITS 100.000 21.951 15.096 62.953 PERCENT WERE MEDICATIONS TOTAL YES NO ORDERED OR _________ _________ _________ PROVIDED AT THIS ALL 35114 18363 16751 RECORDS VISIT? 56604704 30155994 26448710 VISITS 100.000 53.275 46.725 PERCENT Marginal Data for Outpatient Department Drug Mentions PATIENT AGE TOTAL < 15 15-24 25-44 45-64 65-74 75+ _________ _________ _________ _________ _______ ________ _______ ALL 38507 7429 3938 9859 9266 4513 3502 63298431 11822475 5345628 16845304 15695042 7452868 6137114 100.000 18.677 8.445 26.613 24.795 11.774 9.696 PATIENT SEX TOTAL FEMALE MALE _________ _________ _________ ALL 38507 23823 14684 RECORDS 63298431 38861084 24437347 MENTIONS 100.000 61.393 38.607 PERCENT PATIENT RACE ASIAN/PA AMER IN/ TOTAL WHITE BLACK ISLANDER ESK/ALEU _________ _________ _________ _________ _________ ALL 38507 28008 9298 1026 175 RECORDS 63298431 46046215 15077604 1697594 477018 MENTIONS 100.000 72.745 23.820 2.682 0.754 PERCENT ETHNICITY NOT TOTAL HISPANIC HISPANIC _________ _________ _________ ALL 38507 4579 33928 RECORDS 63298431 9652943 53645488 MENTIONS 100.000 15.250 84.750 PERCENT SOURCE OF MEDICARE MEDICAID OTHER PRIVATE/ HMO/OTHER PATIENT PAYMENT TOTAL GOVT COMMER PREPAID PAID _________ _________ _________ _________ _________ ________ _______ ALL 38507 8661 12739 2337 9843 2654 4438 63298431 14495065 20326663 3899882 15361950 4841802 7617630 100.000 22.900 32.112 6.161 24.269 7.649 12.034 NO NO CHARGE OTHER ANSWER _________ _________ _________ 640 2138 994 RECORDS 1454114 3376809 1591678 MENTIONS 2.297 5.335 2.515 PERCENT PATIENT TOTAL YES NO REFERRAL _________ _________ _________ STATUS ALL 38507 3762 34745 RECORDS 63298431 5054125 58244306 MENTIONS 100.000 7.985 92.015 PERCENT VISIT OLD PAT OLD PAT STATUS TOTAL NEW PAT NEW PROB OLD PROB _________ _________ _________ _________ ALL 38507 9155 5377 23975 RECORDS 63298431 11075770 9277633 42945028 MENTIONS 100.000 17.498 14.657 67.845 PERCENT IS THIS TOTAL YES NO UNSPECIFD A NEW _________ _________ _________ _________ MEDICATION? ALL 38507 14400 20684 3423 RECORDS 63298431 21128622 36884549 5285260 MENTIONS 100.000 33.379 58.271 8.350 PERCENT PRESCRIPTION NON STATUS PRESCRIP- PRESCRIP- UNDETER- TOTAL TION DRUG TION DRUG MINED _________ _________ _________ _________ ALL 38507 30423 5197 2887 RECORDS 63298431 50403224 8480457 4414750 MENTIONS 100.000 79.628 13.398 6.975 PERCENT APPENDIX 1 Relative Standard Errors The standard error is primarily a measure of the sampling variability that occurs by chance because only a sample is surveyed, rather than the entire universe. The relative standard error (R.S.E.) of an estimate is obtained by dividing the standard error of the estimate by the estimate itself and is expressed as a percentage of the estimate. TABLE III. Relative standard errors for estimated numbers of PATIENT VISITS and DRUG MENTIONS: National Hospital Ambulatory Medical Care Survey, 1992. ______________________________________________________________________________ } PATIENT VISITS } DRUG MENTIONS _______________________________________}______________________________________ } Estimate Relative Standard Error } Estimate Relative Standard Error ________ ________________________ ________ _________________________ (x 1000) ED'S OPD'S } (x 1000) ED'S OPD'S _______________________________________}______________________________________ } 10 ....... 71.1 87.2 } 10 ....... 71.9 75.2 20 ....... 50.4 62.0 } 20 ....... 50.9 53.9 30 ....... 41.2 51.0 } 30 ....... 41.6 44.5 40 ....... 35.7 44.4 } 40 ....... 36.1 39.0 57 ....... 30.0* 37.5 } 58.5....... 30.0* 32.9 80 ....... 25.4 32.1 } 72.5....... 27.0 30.0* 93 ....... 23.6 30.0* } 90 ....... 24.3 27.4 100 ....... 22.8 29.0 } 100 ....... 23.1 26.3 200 ....... 16.4 21.6 } 200 ....... 16.6 20.4 400 ....... 11.9 16.7 } 400 ....... 12.2 16.7 1,000 ....... 8.1 12.9 } 1,000 ....... 8.5 14.0 5,000 ....... 5.1 10.3 } 5,000 ....... 5.5 12.3 10,100 ....... 4.6 9.9 } 10,000 ....... 5.0 12.1 50,000 ....... 4.1 9.6 } 50,000 ....... 4.6 11.9 100,000 ....... 4.0 9.6 } 100,000 ....... 4.5 11.9 ______________________________________________________________________________ * The lowest reliable estimate. Example of use of table: An aggregate estimate of 1 million patient visits to OPD's has a relative standard error of 12.9%, or a standard error of 129,000 patient visits (12.9 percent of 1 million). For aggregate estimates, relative standard errors may be calculated using the following general formula, where "x" is the aggregate of patient visits or drug mentions in thousands, and coefficients "A" and "B" are obtained from Table IV. For estimates of percentages, relative standard errors may be calculated using the following general formula, where "p" is the percent of visits or mentions, "X" is the denominator of the percent in thousands, and coefficient "B" is obtained from Table IV. Table IV. Coefficients appropriate for determining relative standard errors of patient visit or drug mention estimates (in 1,000'S) for ED's or OPD's: National Hospital Ambulatory Medical Care Survey, 1992. ______________________________________________________________________________ Coefficient ___________________________ A B ______________________________________________________________________________ Patient visits Emergency Departments...................... 0.00158 5.0405 Outpatient Departments..................... 0.00912 7.5165 Drug mentions Emergency Departments...................... 0.002 5.142932 Outpatient Departments..................... 0.014 5.519726 ______________________________________________________________________________ ______________________________________________________________________________ For estimates of visit rates, in which the numerator is the number of visits for a particular characteristic, and the denominator is the total United States population, the relative standard error is equivalent to the relative standard error of the numerator, as shown in the previous paragraph on aggregate estimat PATIENT RECORD FORM DATA ITEMS DEFINITIONS AND INSTRUCTIONS Item 3 - DATE OF VISIT Self-explanatory ITEM 4 - DATE OF BIRTH Record exact date. Estimate year if date is unknown. ITEM 5 - SEX Self-explanatory ITEM 6 - COLOR OR RACE Record according to observation or knowledge of patient. If the patient's race is not obvious, the hospital staff are instructed to mark the appropriate category based on the hospital's usual practice or knowledge. 1. White: A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. 2. Black: A person having origins in any of the black racial groups of Africa. 3. Asian/Pacific Islander: A person having origins in any of the original peoples of Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes for example, China, India, Japan, Korea, the Philippine Islands and Samoa. 4. American Indian/Eskimo/Aleut: A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition. ITEM 7 - ETHNICITY Record according to observation or knowledge of the patient. If the patient's ethnicity is not obvious, the hospital staff are instructed to mark the appropriate category based on the hospital's usual practice or knowledge. 1 - Hispanic Origin: A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin. regardless of race. 2 - Not Hispanic: Check "Not Hispanic" for all persons who are not of Hispanic origin. ITEM 8 - EXPECTED SOURCE(S) OF PAYMENT Hospital staff are instructed to check the source(s) that would pay for the visit. Source Definition 1. Medicare: Changes paid in part or in full by a Medicare plan. Includes payments made directly to the hospital as well as payments reimbursed to the patient. 2. Medicaid: Changes paid in part or in full by a medicaid plan. Includes payments made directly to the hospital as well as payments reimbursed to the patient. 3. Other government: Includes payments made under any other local, state, or Federal health care programs, such as workman's compensation programs and Civilian Health and Medical Programs of Uniformed Services (CHAMPUS). 4. Private/Commercial: Charges paid in part or in full by a private insurance company. Includes payments made directly to the hospital as well as payments reimbursed to the patients. 5. HMO/Other prepaid: Charges included under a prepayment plan. Includes Health Maintenance Organizations (HMO'S), Independent Practice Associations (IPA'S), Preferred Provider Organizations (PPO's), etc. 6. Patient paid: Charges paid in part or in full by the patient or the patient's family, which will not be reimbursed by a third party. Includes "co-payments" and "insurance deductibles". Excludes prepaid plan visits for which no co-payment is charged. 7. No charge: Visits for which no fee is charged. 8. Other: Any other source of payment not covered in the categories above. ITEM 9-(OPD) - WAS PATIENT REFERRED FOR THIS VISIT BY ANOTHER PHYSICIAN? Referrals are any visits that are made at the advice or direction of a physician other than the one being visited. The interest is in referrals for the current visit and not in referrals for any prior visit. ITEM 9-(ED) - MAJOR REASON FOR THIS VISIT Hospital staff are instructed to indicate whether this visit is the first visit or follow-up visit for an injury or illness. 1. Injury, first visit: Self-explanatory 2. Injury, follow-up: Self-explanatory 3. Illness, first visit: Self-explanatory 4. Illness, follow-up: Self-explanatory 5. Other reason: Includes general health maintenance examinations, routine periodic examinations of presumably health persons, both children and adults, and malingering. ITEM 10-(ED) - CAUSE OF INJURY Hospital staff are instructed to describe in detail the events and circumstances surrounding the injury, for example, the place and cause of injury. ITEM 10 OR 11 - PATIENT'S COMPLAINT(S), SYMPTOM(S), OR OTHER REASON(S) FOR THIS VISIT (in patient's own words) The patient's problem, complaint, symptom, or other reason for this visit as expressed by the patient. Hospital staff are instructed to record key words or phrases verbatim from the patient, to the extent possible. The physician may recognize right away, or may find out after examination, that the real problem is something entirely different, but the physician's diagnosis is recorded in the following item and should not be reported here. Example: "pain in chest" "Cramps after eating". There will, of course, be visits by patients for reasons other than some complaint or symptom. Examples might be: annual checkup, routine prenatal or postnatal care. In such cases, simply record the reason for the visit. If the reason for the patient visit was only to pay a bill or ask the physician to fill out an insurance form or to drop off a specimen, no Patient Record Form should be completed. Space has been allotted for up to three patient problems and they should be recorded in the order of importance. ITEM 11 OR 12 - PHYSICIAN'S DIAGNOSES (1) This item should never be blank. The principal, or first listed diagnosis, is the physician's best assessment of diagnosis of the patient's most important problem, complaint or symptom--at the time of the visit. (2) The diagnosis may be tentative, provisional, or definitive. (3) If no diagnosis exists for the patient's visit (e.g., a visit for a well-person exam), enter "well person" or other appropriate description of the situation. (4) Space has been allotted to record up to two other diagnoses which exist at the time of visit, whether or not they are of direct concern to this visit. ITEM 13-(ED) - URGENCY OF THIS VISIT Hospital staff are instructed to check the category which best indicates the visit. (1) Urgent/Emergent patient requires immediate attention for acute illness or injury that threatens life or function. Delay would be harmful to the patient. (2) Non-Urgent patient does not require attention immediately or within a few hours. ITEM 14-(ED) - IS PROBLEM ALCOHOL OR DRUG RELATED? This item refers to the patient's most important presenting problem. Simply check the correct box. ITEM 12-(OPD) - HAS PATIENT BEEN SEEN IN THIS CLINIC BEFORE? "Seen" means "provided care for" at any time in the past. If "yes", also answer whether it was for the condition diagnosed in ITEM 11. ITEM 13-OPD - AMBULATORY SURGICAL PROCEDURE(S) Hospital staff are instructed to record up to two outpatient surgical procedures that were performed in the clinic or scheduled to be performed elsewhere on an outpatient basis, including suturing of wounds, reduction of fractures, application or removal of casts, incision and drainage of abscesses, application of supportive materials for fractures and sprains, irrigations, aspirations, dilations, and excisions. Procedures that were performed should be recorded before those that were scheduled. When there is more than one procedure to be recorded, record the more complex procedure first. Also, check the appropriate boxes for the first procedure. ITEM 14 OR 15 - DIAGNOSTIC/SCREENING SERVICES Check ALL appropriate boxes for services ordered or provided. In OPD's, if serum cholesterol level was included in a panel of blood tests, check "cholesterol measure", and "other lab test". For "Other" services describe the service on the line provided. 1. None 13. CT scan/MRi (ED) 2. Blood Pressure 14. Other diagnostic Imaging (ED) 3. Urinalysis 15. Pap test (OPD) 4. EKG-resting 16. Strep throat test (OPD) 5. EKG-exercise 17. HIV serology 6. Mammogram (OPD) 18. Other blood test (ED) 7. Mental Status Exam 19. Cholesterol measure (OPD) 8. Chest X-ray 20. Other lab test (OPD) 9. Extremity X-ray (ED) 21. Hearing test (OPD) 10. Other radiology (OPD) 22. Visual acuity (OPD) 11. Allergy testing (OPD) 23. Other (specify) 12. Spirometry (OPD) ITEM 15 (OPD) - THERAPEUTIC SERVICES Check ALL appropriate boxes for counseling/education AND other therapeutic services ORDERED OR PROVIDED. Check "OTHER COUNSELING" for counseling regarding a current or potential health problem not included in the preceding categories, e.g., instruction on proper use of drugs and devices. Check "OTHER THERAPY" for any treatment or therapeutic services, EXCLUDING MEDICATION, ordered or provided and not included in the specific categories listed. 1. None Counseling/education: 2. Diet 8. Smoking cessation 3. Exercise 9. Family/social 4. Cholesterol reduction 10. Growth/development 5. Weight reduction 11. Family planning 6. Drug abuse 12. Other counseling 7. Alcohol abuse Other therapy: 13. Psychotherapy 16. Physiotherapy 14. Corrective lenses 17. Other therapy (specify) 15. Hearing aid ITEM 16 OR 17 - MEDICATION List ALL prescription and non-prescription drugs ORDERED OR PROVIDED--by any route of administration--at THIS VISIT. Include immunization agents, desensitization agents, and other biologicals. Include drugs prescribed at previous visit if patient was instructed at THIS VISIT to continue the medication. Use SPECIFIC BRAND OR GENERIC DRUG NAMES as entered on prescription or medical records. Do NOT enter broad drug classes, such as "pain medication." Limit entries to DRUG NAME ONLY. Additional information, such as route of administration, dosage, form, strength, or regimen is not required. In OPD'S, check the appropriate box for any new medications. ITEM 16-(ED) - PROCEDURES Hospital staff ar instructed to mark all procedures provided this visit. For "Other" procedure(s) describe up to two other procedures on the lines provided. 1. None 6. Wound Care 2. Endotracheal Intubation 7. Eye/ENT Care 3. CPR 8. Orthopedic Care 4. IV fluids 9. Bladder catheter 5. NG tube/gastric lavage 10. Lumbar puncture 11. Other(s) (Specify) ITEM 17 OR 18 - DISPOSITION THIS VISIT Hospital staff were instructed to mark all categories that apply. DISPOSITION DEFINITION 1. Return to ED or OPD Clinic R.R.N. The patient is instructed to return to the ED or OPD clinic if the patient considers it necessary. (P.R.N. pro re nata, as necessary, as the occasion rises.) 2. Return to ED/OPD Clinic-Appointment The patient is told to schedule an appointment or is given an appointment to return to the ED or OPD clinic at a particular time. 3. Telephone follow-up planned (OPD) The patient is instructed to telephone the physician or other clinic staff on a particular day to report on his or her progress, or to call at any time if he or she has a problem or wishes further consultation. 4. Return to referring physician The patient was referred to the ED or OPD clinic by his or her personal physician or some other physician and is now instructed to return to that physician for further consultation. 5. Refer to other physician/clinic The patient is instructed to consult or seek care from another physician or clinic. 6. Admit to hospital The patient is instructed that further care or treatment will be provided as an inpatient in the hospital. 7. Transfer to other facility (ED) The patient is transferred to a facility other than a facility operated under the auspices of this hospital. 8. DOA/Died in ED If the patient is dead on arrival (DOA) or died in the ED, the patient is still included in the sample. 9. Left AMA If the patient was registered to be seen but left prior to being seen by a health care provider or left "against medical advice" (AMA), this patient is still included in the sample. 10. No-follow-up planned No return visit or telephone contact is scheduled or planned for the patient's problem on this visit. 11. Other (specify) For any other disposition, describe the disposition on the line provided. Item 18 or 19 - PROVIDERS SEEN THIS VISIT Hospital staff were instructed to mark all providers seen by the patient during this visit. Provider Definition 1. Resident/Intern Persons graduated from medical school and in training. 2. Staff physician Physician who is employed by the hospital or the university affiliated with the hospital and is a member of the hospital staff. 3. Other physician Consulting physician and other part-time physicians who are not considered to be members of the hospital staff. 4. Physician assistant Certified health care professional who delivers health care services. 5. Nurse practitioner Registered nurse with advanced training who provides primary health care services. Supervision by a physician is required in some states. 6. Registered nurse Self-explanatory 7. Licensed practical nurse Self-explanatory 8. Nurse's aid Self-explanatory DEFINITIONS Patient-An individual seeking personal health services not currently admitted to any health care institution on the premises. A person under a physician's care for health reasons. Patients are defined as in scope or out of scope as follows: In scope-A patient seen by hospital staff in an in scope emergency service area or clinic except as excluded below. Out of scope-Patients seen by a physician in their private office, nursing home, or other extended care institution or in the patient's home. Patients who contact and receive advice from hospital staff via telephone. Patients who come to the hospital only to leave a specimen, to pick up insurance forms, to pick up medication, or to pay a bill. Visit-A visit is a direct, personal exchange between an ambulatory patient and a physician or other health care provider working under the physician's supervision, for the purpose of seeking care and receiving personal health services. Drug mention-The entry of a pharmaceutical agent ordered or provided-by any route of administration-for prevention, diagnosis, or treatment. Generic as well as brand name drugs are included, as are nonprescription as well as prescription drugs. Along with all new drugs, the hospital staff also records continued medication if the patient was specifically instructed during the visit to continue the medication. Hospital-All hospitals with an average length of stay for all patients of less than 30 days(short-stay) or hospital whose specialty is general(medical or surgical) or children's general are eligible for the National Hospital Ambulatory Medical Care Survey except Federal hospitals and hospital units of institutions, and hospitals with less than six beds staffed for patient use. Ownership-Hospitals are designated according to the primary owner of the hospital based on the SMG Hospital Market Data Base. Voluntary nonprofit-hospitals operated by a church or another nonprofit organization Government, non-Federal-hospitals operated by state or local governments Proprietary-hospitals operated by individuals, partnerships, or corporations for profit. Urbanicity-Hospitals are classified by their location in a metropolitan or non-metropolitan statistical area. MSA-Metropolitan Statistical Area as defined by the U.S. Office of Management and Budget. The definition of an individual MSA involves two considerations: first, a city or cities of specified population that constitute the central city and identify the county in which it is located as the central county; second, economic and social relationships with "contiguous" counties that are metropolitan in character so that the periphery of the specific metropolitan area may be determined. MSAs may cross state lines. In New England, MSAs consist of cities and towns rather than counties. Non-MSA-Non-metropolitan Statistical Area (other than metropolitan). Emergency department-Hospital facility for the provision of unscheduled outpatient services to patients whose conditions require immediate care and which is staffed 24 hours a day. Emergency departments that are open less than 24 hours a day are included as part of the hospital's outpatient department. Emergency service area-Area within the emergency department where emergency services are provided. This includes services provided under the "hospital as landlord" arrangement in which the hospital rents space to a physician group. Outpatient department-Hospital facility where non-urgent ambulatory medical care is provided under the supervision of a physician. Clinic-Administrative unit within an organized outpatient department that provides ambulatory medical care under the supervision of a physician. This excludes the "hospital as landlord" arrangement in which the hospital only rents space to a physician group and is not otherwise involved in the delivery of services. Clinics are grouped into the following six specialty groups for purposes of systematic sampling and non-response adjustment: general medicine, surgery, pediatrics, obstetrics/gynecology, substance abuse, and other. Clinics are defined as in scope or out of scope as follows: In scope-General Medicine AIDS Geriatric Nephrology Allergy Head (Non-Surgical) Neurocutaneous Ambulatory Care Head and Neck (Non- Oncology Anti-coagulation Surgical) Outreach Program Anesthesia/Pain Hematology (General Medicine) Apnea Hemophilia (Adult) Pacemaker Arthritis Homeless Pentamidine Asthma Huntington's Peripheral Vascular Brain Tumor (& Other Disease/Chorea Disease Tumor) Hyperlipidemia Pheresis/Plasma Cardiology Hypertension Pheresis Cerebral Palsy (Adult) Immunology Pigmented Lesion Chest Infectious Diseases Primary Care Coagulant Internal Medicine Pulmonary Cystic Fibrosis Lead Poisoning (Adult) Renal (Adult) Leukemia/Bone Marrow Rheumatology Cytomegalovirus Aspiration Seizure Dermatology Lipid Senior Care Diabetes Liver Sexually Transmitted Diabetic Counseling Lupus (Systemic Lupus Diseases (STD) Digestive Diseases Erythematosus) Sickle Cell (Adult) Down's Syndrome Medical Screening Spina Bifida (Adult) (Adult) Melanoma Thyroid Endocrinology Metabolic Tuberculosis Epilepsy Movement and Memory Urgent Care Family Practice Disorders Walk-in and/or Gastroenterology Multiple Sclerosis Screening General Medicine Muscular Dystrophy Weight Management Genetics (Adult) Myelomeningocele 24 Hour Observation In scope-Surgery Amputee (Surgery and General Surgery Pediatric Urology Rehabilitation) Genitourinary Plastic Surgery Ano-Rectal Genitourinary Surgery Post-Operative Arthroscopy Hand Surgery Proctology Back Care Head and Neck Surgery Pulmonary/Thoracic Breast Knee Surgery Breast Care Lithotripsy Scoliosis (Adult) Bronchoscopy Myelo- (and other Sigmoidoscopy Burn myelo) Spine Cardiothoracic Neurologic Surgery Sports Medicine Cast/Brace Oncologic Surgery Suture Chief Resident Follow- Ophthalmologic Surgery Transplant Surgery up (Surgery) Ophthalmology Trauma Chronic Wound Orthopedic Urodynamics Cleft Palate Orthopedic Surgery Uroloc Surgery Club Foot Ostomy Urology Colon and Rectal Otolaryngology Vascular Surgery Surgery Otolaryngologic Visual Fields Cryosurgery Surgery Cystoscopy Otology Elective Surgery Otorhinolaryngology Endoscopy Pediatric Ear, Nose, ENT (Ear, Nose, and and Throat Throat) Pediatric Orthopedic Eye Surgery Fine Needle Pediatric Aspiration Otolaryngology Fracture Pediatric Surgery In scope-Pediatrics Adolescent/Yong Adult Developmental Newborn Adolescent Medicine Evaluation Oncology (Pediatric) Airway (Pediatric) Diagnostic (Pediatric) Ophthalmology Allergy (Pediatric) Down's Syndrome (Pediatric) Behavior and (Child) Pediatrics Development (Child) Endocrinology Perinatal Birth Defect (Pediatric) Phenylketonuria Cardiology (Pediatric) Gastroenterology Pulmonary (Pediatric) Cerebral Palsy (Child) (Pediatric) Regional Development Child Sexual Assualt Genetics Rheumatic Heart Clotting (Pediatric) Hematology (Pediatric) Rheumatology/Arthritis Congenital Heart Hemoglobinopathy (Pediatric) Continuity (Pediatric) (Pediatric) Scoliosis (Child) Craniofacial Hemophilia (Child) Seizure (Pediatric) Craniomalformation High Risk (Pediatric) Sickle Cell (Child) Critical Care Infant Apnea Spina Bifida (Pediatric) Infectious Diseases Teenage Cystic Fibrosis (Pediatric) Teen-Tot Dermatology Lead Poisoning (Child) Well Child Care (Pediatric) Learning Disorder Developmental Neonatology Disability Nephrology (Pediatric) In scope-Obstetrics/Gynecology Adolescent Gynecology Maternity Prenatal Birth Control Maternal Health Preteen Gynecology Colposcopy Obstetrics Reproductive Dysplasia Obstetrics - High Risk Reproductive Family Planning Obstetrics - Post- Endocrinology Gynecology Partum Well Woman Gynecologic Oncology Obstetrics - Prenatal Women's Care In Vitro Fertilization Pregnancy - Counseling Infertility Pregnancy Verification In scope-Substance Abuse Alcohol Abuse Drug Abuse (excluding Methadone Alcohol Detoxification Maintenance) Alcohol Walk-in Drug Detoxification Chemical Dependency (excluding Substance Abuse Methadone Maintenance) Women's Alcohol Program In scope-Other Adolescent Psychiatry Myasthenia Gravis Psychopharmacology Adult Psychiatry Neurology Sleep Disorder Anxiety Neurophysiology Social Evaluation Biofeedback Pain Management Toxicology Child Psychiatry Partial Eating Disorder Hospitalization General Preventive Program Medicine (Psychiatric) Mental Health Pediatric Neurology Mental Hygiene Preventive Medicine Out of scope Abortion/Pregnancy Employee Health Physical Termination Service Medicine/Therapy Ambulatory Surgery Hemodialysis Podiatry Centers Kidney (Renal) Radiation Blood Bank Dialysis Therapy/Radiation Cardiac Methadone Maintenance Diagnosis/Radiation Catheterization Occupational Safety Oncology Chemotherapy and Health Radiology/Diagnostic Dental/Dental Occupational Therapy x-ray (Imaging) Oncology/Dental Oral Surgery Reading and Language Surgery Pharmacy Rehabilitation Region-Hospitals are classified by location in one of the four geographic regions of the United States that correspond to those used by the U.S. Bureau of the Census. Region States included Northeast.... Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont Midwest...... Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin South........ Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia West......... Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming
