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Scientific Data Documentation
Epidemiologic Followup Study, 1982-84 Health Care Facility Stay
DSN:  CC37.HANES1FU.FCLY824

                   NHANES EPIDEMIOLOGIC FOLLOWUP STUDY
                   HEALTH CARE FACILITY STAY  1982-84


Abstract 1982-84

 Sandra T. Rothwell

 Enclosure Date: September 10, 1990

 From:           NHEFS Statistical Staff
                 Division of Analysis, NCHS

 Subject:        1982-84 NHANES I Epidemiologic Followup Study
                 Revised Health Care Facility Stay Public Use Data Tape

 To:             Project Officers and Investigators
                 See Addressees Below

 The revision of the 1982-84 Health Care Facility Stay (HCFS) file has been
 completed.  The original file, the 1982-84 Health Care Facility Record file,
 only contained information from the medical records obtained from health care
 facilities.  The 1986, the 1987 and the revised 1982-84 Health Care Facility
 Stay data files include both descriptive information reported by the
 respondent and the medical information returned from the health care
 facility.  This new format, then, includes information about all possible
 stays in health care facilities whether or not an actual health care facility
 record was obtained.

 At the time the 1986 and 1987 Health Care Facility Stay files were
 constructed, a comparable 1982-84 file did not exist.  However, it was
 possible to construct a comparable file for 1982-84 because the respondent's
 descriptive information needed to replicate the content of the 1986 and 1987
 files was available in the 1982-84 interview.  This information was linked
 with the medical information on the original file to create the revised file.

 In addition, during data collection for the 1986 and 1987 files, more medical
 records for the 1982-84 followup period were obtained.  These have been
 included in the revised file.  The resulting data set is more complete than
 the original and can be used in conjunction with the Health Care Facility
 Stay files for later followup periods.

 This Revised 1982-84 Health Care Facility Stay Data File has been finalized
 and is being released to all collaborators.  It replaces the 1982-84 Health
 Care Facility Record Data file released in 1987.  A memo has been sent to
 your contact person which describes the tape characteristics for this file.
 Please contact that person for information about accessing your tape.


Use of NHEFS Data

 With the goal of mutual benefit, NCHS requests the cooperation of recipients
 of data tapes in certain actions related to their use:

 A.    Any published material derived from the data should acknowledge the
       National Center for Health Statistics (NCHS) as the original source. It
       should also include a disclaimer which credits any analyses,
       interpretations, or conclusions reached to the author (recipient of the
       tape) and not to NCHS, which is responsible only for the initial data.

 B.    Consumers who wish to publish a technical description of the data will
       make a reasonable effort to insure that the description is not
       inconsistent with that published by NCHS.  This does not mean, however,
       that NCHS will review such descriptions.

 C.    Authors should provide NCHS with a reprint of published articles which
       utilize the 1982-84 NHEFS data.  Please send reprints to:

              NHEFS Data Management Staff
              Division of Analysis
              National Center for Health Statistics
              Presidential Building, Room 1080
              6525 Belcrest Road
              Hyattsville, MD  20782


Errors in the Data Tapes

 The NHEFS Public Use data tapes have been subjected to a great deal of
 careful editing.  However, due to the large volume of data in the series, it
 is likely that a small number of errors or discrepancies remain undetected.

 Some continuous data items have extremely high or low values and we have
 verified that the values have not been incorrectly keyed.

 In general, the NHEFS data management team has not attempted to resolve
 substantive data discrepancies that may exist 1) within the 1982-84 NHEFS
 data tapes, or 2) between the 1982-84 NHEFS data tapes and the data tapes of
 the original National Health and Nutrition Examination Survey (NHANES I) and
 other NHEFS followup waves.

BACKGROUND

 Background 1982-84

 The first National Health and Nutrition Examination Survey (NHANES I)
 collected data from a national probability sample of the civilian
 noninstitutionalized population.  The survey, which included a standardized
 medical examination and questionnaires that covered various topics, took
 place from 1971 through 1974 and was augmented by an additional national
 sample in 1974-75.  The NHANES I sample included 20,729 persons 25 to 74
 years of age, 14,407 (70 percent) of whom underwent the medical examination.

 Although NHANES I provides a wealth of information on the prevalence of
 health conditions and risk factors, the cross-sectional nature of the
 original survey limits its usefulness in studying the effects of clinical,
 environmental, and behavioral factors and in tracing the natural history of
 disease.  Therefore, the NHANES I Epidemiologic Followup Study (NHEFS) was
 designed to investigate the association between factors measured at the base-
 line with the development of specific health conditions.

 The followup study originated as a joint project between the National Center
 for Health Statistics (NCHS) and the National Institute on Aging (NIA).  The
 1982-84 initial followup of the cohort was funded primarily by NIA, with
 additional financial support from the following components of the National
 Institutes of Health (NIH) and Public Health Service agencies: National
 Cancer Institute; National Institute of Mental Health; National Institute on
 Alcohol Abuse and Alcoholism; National Heart, Lung, and Blood Institute;
 National Institute of Neurologic and Communicative Disorders and Stroke;
 National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases;
 National Institute of Allergy and Infectious Diseases; and the National
 Institute of Child Health and Human Development.  All of these agencies were
 involved in both developing topics of import in their specialty areas and
 designing procedures to collect data that would address these issues.

 The size and scope of the population in the NHEFS provides a unique
 opportunity to examine causal relationships in a large, heterogeneous,
 nationally representative population.  The followup study population included
 the 14,407 participants who were 25 to 74 years of age when they were
 examined in NHANES I (1971-75).  Tracing of subjects began in 1981.  Data
 collection for the followup was conducted from 1982 to 1984, with all data
 collection completed in August 1984.

 Copies of all pertinent study materials (tracing materials, questionnaires,
 authorization forms, and health facility data collection forms) can be found
 in Appendix VI of the Plan and Operation of the NHANES I Epidemiologic
 Followup Study 1982-84.  (Vital and Health Statistics), Series 1, No. 22.

 The design of NHEFS consisted of five steps:

       tracing the subjects or their proxies to a current address;

       acquiring death certificates;

       performing in-depth interviews with the subjects or with their proxies;

       taking pulse, blood pressure, and weight measurements of surviving
       subjects;

       obtaining hospital and nursing home records, including pathology
       reports and electrocardiograms.

 The first phase of the project was to trace and locate all subjects in the
 cohort and to determine their vital status.  All persons who could not be
 traced were considered lost to followup.  The fact of death had to be
 confirmed by a death certificate or a proxy interview.  In some cases,
 information about the death of a subject was obtained from neighbors or other
 tracing contacts.  Although this information was noted in the record, these
 persons were considered lost to followup unless the information was verified
 by a proxy interview or a death certificate.

 For subjects who had died, date and place of death were obtained through the
 tracing process.  This information was used to obtain a copy of the death
 certificate from the appropriate State Vital Statistics office.  The tracing
 process was also used to obtain the current address of surviving subjects as
 well as to identify a knowledgeable proxy respondent for deceased subjects.
 Respondents who were identified and located through the tracing procedure
 were then contacted and asked to participate in a personal interview.  In a
 few cases, respondents who had been traced successfully could not be
 relocated for the interview.  Only vital status as of tracing was available
 for those subjects.

 Attempts were made to interview all subjects identified during tracing.
 Interviews were conducted wherever the respondent resided, including in
 nursing homes, prisons, mental health facilities, or occasionally at some
 other convenient location (for example, a parent's home).  For surviving
 subjects, attempts were made to measure the subject's pulse rate, blood
 pressure (three consecutive readings), and weight.  After the physical
 measurements were completed, the subjects were given written reports of the
 measurements.

 The interview was designed to gather information on selected aspects of the
 subject's health history since the time of the NHANES I exam.  This
 information included a history of the occurrence or recurrence of selected
 medical conditions, an assessment of behavioral, social, nutritional, and
 medical risk factors believed to be associated with these conditions, and an
 assessment of various aspects of functional status.  Whenever possible, the
 questionnaire was designed to retain item comparability between NHANES I and
 NHEFS in order to measure change over time.  However, questionnaire items
 were modified, added, or deleted when necessary to take advantage of current
 improvements in questionnaire methodology.

 Parts D, E, and G of the questionnaire contain items to determine whether or
 not the subject had an overnight stay in a health care facility after 1970.
 If a stay was reported, information on the name and address of the facility,
 the date of the stay, and the reason for the stay was recorded on a special
 Hospital and Health Care Facility (HHCF) chart on the back cover of the self-
 administration booklet.  The hospitals and nursing homes in which study
 subjects had reported stays were later contacted and asked to review the
 subject's medical records for all stays occurring between January 1 of the
 year of the NHANES I exam up to the date of the 1982-84 interview and to
 return information abstracted from their records.  Limited data were
 requested on the hospital and nursing home abstract forms.  The major items
 requested were the dates of admission and discharge, the discharge diagnoses
 and any procedures that may have been performed.  For nursing homes the
 admission diagnoses were reported.  In addition to completing abstract forms,
 facilities were requested to submit photocopies of the "face sheet," and
 "discharge summary," the third day EKG for myocardial infarction diagnoses,
 (410 in the International Classification of Diseases, 9th Revision, Clinical
 Modification (ICD-9-CM) and of pathology reports for any admission where a
 new malignancy was diagnosed.  Respondents who reported facility stays were
 asked to sign a Medical Authorization Form that would be used to request the
 release of hospital record information.  These authorization forms were
 retained on file and a photocopy was sent to each hospital that the respon-
 dent had identified during the interview.  This data collection was conducted
 between April 1983 and August 1984.  The resulting facility abstract records
 were released in 1987 as the Health Care Facility Record file.

 As of August 1984, 13,383 (93 percent) of the 14,407 members of the 1982-84
 NHEFS cohort had been successfully traced.  Interviews were conducted for
 12,220 subjects (91 percent of those successfully traced).  In addition,
 17,127 facility stay records were collected for 6,477 subjects using
 information obtained from the interview, death certificate, or some other
 source.  Death certificates were obtained for 1,935 (96 percent) of the 2,022
 subjects who were known to have died since the NHANES I examination.

 The data collected from the 1982-84 NHEFS are stored on four separate tapes,
 the first three of which have been available since 1987.

       1)     Vital and Tracing Status tape -- contains summary information
              about the status of the cohort.

       2)     Interview tape -- contains the data collected from the 1982-84
              NHEFS subject and proxy interviews.

       3)     Mortality Data tape -- contains data abstracted from the death
              certificates for 1982-84 decedents.

       4)     Revised Health Care Facility Stay tape -- contains information
              collected on reports of stays in hospitals and non-hospital
              health care facilities (e.g., nursing home, mental health care
              facility) as well as information abstracted from facility
              medical records.  This fourth file, originally titled the Health
              Care Facility Record Data Tape and released in 1987, has been
              substantially revised.  The revised tape contains 25,436 health
              care facility stay records for 8,270 subjects.  The tape is
              described in detail in the following pages.


 Description of Tape Revision

 The 1982-84 Health Care Facility Record tape has been restructured to produce
 the Revised 1982-84 Health Care Facility Stay Data Tape.  The original file
 contained only the coded medical abstracts obtained from health care
 facilities.  However, the Health Care Facility Stay data files produced for
 the 1986 and 1987 followups include both the descriptive information reported
 by the respondent and the medical information returned from the health care
 facility.  This new format includes information about all possible stays in
 health care facilities whether or not an actual health care facility record
 was obtained.  It was created to facilitate the use of the health care
 facility data.

 At the time that the 1986 and 1987 Health Care Facility Stay files were
 constructed, a comparable 1982-84 Health Care Facility Stay file did not
 exist.  However, it has been possible to reconstruct such a file for 1982-84
 because most of the information needed to replicate the content and proces-
 sing of the 1986 and 1987 files was available.  The 1982-84 interview con-
 tained detailed reports of the conditions leading to each stay in a health
 care facility, the dates of each stay and the names of the facilities where
 the stays occurred.  This information could be linked to the medical records
 that were obtained from the facilities and which appeared on the 1982-84
 Health Care Facility Record file as it was originally released.

 In addition, during data collection for the 1986 and 1987 files, additional
 medical records for the 1982-84 followup period were obtained.  These have
 been included in the revised file.  The resulting data set is more complete
 than the original; it can be used in conjunction with Facility Stay files for
 later followup periods; and it provides information on stays in health care
 facilities that were reported but not confirmed by the receipt of a facility
 abstract.

 The Revised 1982-84 NHEFS Health Care Facility Stay (HCFS) file contains
 information on all overnight health care facility stays for members of the
 1982-84 followup cohort.  The 1982-84 Followup cohort consisted of the 14,407
 subjects who were between 25 and 74 years old at their NHANES I examination.
 Followup cohort members who have either an interview or a death certificate
 on the 1982-84 NHEFS data files or who returned a mail questionnaire were
 eligible for the health care facility records component.  The aim of this
 component was to present a complete set of health care facility (i.e.,
 hospital and nursing home) records for each 1982-84 Followup cohort member.
 These records are intended to cover the period from the NHANES I examination
 to the date of the 1982-84 interview for surviving subjects and the period
 from exam to the date of death for deceased subjects.  This is referred to as
 the "in-scope" period.  Stays that were reported prior to or after the in-
 scope period were defined as out-of-scope for the 1982-84 followup.  The
 procedures for constructing this file are briefly described below.

 Restructuring the 1982-84 Health Care Facility Record File:

 When the 1986 NHANES I Epidemiologic Followup was designed, it was decided to
 combine the information which respondents reported concerning overnight
 health care facility stays with the abstracted information received from the
 facilities.  The resulting file was built using a computerized tracking
 system.  In order to reprocess the 1982-84 data file and make it comparable
 with the 1986 format, it was necessary to review the 1982-84 interviews and
 enter the data into the tracking system developed for the 1986 wave.
 Abstracts that had been received during the 1982-84 followup were matched to
 the interview information that had been entered into the tracking system in
 the same manner as the 1986 and 1987 abstracts were being matched to inter-
 view information.  The results of the matching process were then used to
 build the revised 1982-84 file.  Occasionally, facilities which were being
 contacted as part of the 1986 or 1987 followups would send abstracts for
 stays that had been reported in the 1982-84 followup, but for which an
 abstract had not been received during the appropriate collection period.
 These abstracts were also entered into the tracking system.  The resulting
 restructured file was renamed the Revised 1982-84 Health Care Facility Stay
 file and is comparable in format to the 1986 to 1987 Health Care Facility
 Stay files.

 Matching Records:

 When the abstracts were reviewed, they were checked against report informa-
 tion in the tracking system to determine if the abstract "matched" any of the
 reported stays.  Date of admission and diagnosis were used as matching
 criteria but exact matches on date or diagnosis were not required for a stay
 to be considered matched.  Abstracts were matched to reports if the reported
 date of admission was within a year of the actual date of admission and if
 the reported reason for admission involved the same body system as at least
 one of the diagnoses present on the abstract.  Cases that did not meet these
 specific criteria were reviewed by NCHS staff and matched when appropriate.
 Since the matching rules allowed for an admission date of up to one year
 before or after the reported date of admission, some stay records are present
 on the file with an out-of-scope report date, but an in-scope date on the
 matched abstract.  These records are identified by a Type C flag in position
 199 of the record (see further explanation of the Type C flag below).

 Each record on the file represents an overnight facility stay. Therefore, one
 or more records will exist for some 1982-84 Followup cohort subjects, while
 other subjects will have no records on the file.  The structure of the data
 file reflects the system used to obtain and process stay information.  The
 record is divided into four major sections:  1) the report section,  2) the
 record status section,  3) the abstract section, and,  4) the related stay
 section.  An example of the record layout is provided in figure 1.

 The subject identification number (i.e., the sample sequence number) is in
 positions 1-5 on each record.  This number is unique for each subject and is
 used when linking the Health Care Facility Stay tape to all other NHEFS and
 NHANES I Public Use Data Tapes.  The total number of records per subject is
 found in positions 6-7 on the file.  The first section of the record is the
 report section (positions 29-59 and 63-204) which contains information from
 the reporting source as well as stay identification numbers assigned by NCHS.
 Each stay entered into the report section is assigned a health care facility
 stay id number (positions 29-33).  When used in conjunction with the sample
 sequence number, this number uniquely identifies each record on the file. The
 reported date of admission is found in positions 47-54.  This date is used in
 conjunction with the date of exam to determine whether reported stays were
 in-scope for the NHEFS 1982-84 survey (position 199).

 The record status section (positions 60-62) contains a code for the result of
 the abstract review i.e., match or non-match status.  If there existed an
 abstract that matched a report then a record status code of MAT (match) was
 assigned.  An abstract that did not match any report but was in-scope for the
 1982-84 survey period was assigned the record status code of ASF (additional
 stay found).  If no matching abstract was found, the appropriate non-match
 code was assigned.

 The abstract section (positions 205-379) contains the information obtained
 from the facility records including actual dates of admission, discharge and
 diagnoses.  The diagnoses on the abstracts were coded using the ICD-9-CM
 according to the medical coding specifications detailed in the following
 section of this codebook.  The abstract section of each record is similar to
 the original 1982-84 NHEFS Health Care Facility record file released in
 August 1987.  The other three sections are those that were added for compar-
 ability with the 1986 and 1987 HCFS files.

 Information will be present in one or more sections of the record depending
 on whether a report was obtained, and whether an abstract was received.  The
 presence or absence of information in the first three sections results in
 three different record profiles.  Figure 2 illustrates these three profiles.
 The first is the successfully matched stay record, where an abstract was
 received which matched a report.  Abstract information is added to the
 report and the code of MAT was entered into the record status section.
 Complete information is available in the first three sections of the record
 for these stays.  The second type occurs when an abstract was not matched to
 a report and, therefore, no data is contained in the abstract section.  The
 appropriate non-match code was entered in the record status section.  The
 third type of record is one which was generated solely by the existence of a
 facility abstract.  This type of record resulted from an existing in-scope
 abstract that did not match with any report on the tracking system.  When
 this occurred, the abstract was entered on the file, and stay identifiers
 were assigned in the report section of the record but no other information
 in the report section is present.  An ASF (additional stay found) code was
 entered in the record status section.

 In some cases requests were made to facilities for information about stays
 with reported admission dates that preceded the date of the NHANES I exam
 (i.e., were out-of-scope).  This was done to maximize the collection of
 reports of hospital or nursing home stays.  Reports of stays with a reported
 date of admission more than one year prior to the exam were retained on the
 file when they represented the only mention of visits to a specific health
 care facility for a given subject.  These were flagged with a Type D in
 position 199.  All stays with reported dates within the year immediately
 preceding the exam were kept and flagged with a Type C in position 199.

 After the receipt of information from the health care facility, it was
 necessary to remove stays from the tracking system that had been out-of-scope
 and to incorporate information on in-scope stays that was generated from the
 "out-of-scope" reports.  If an in-scope abstract was received from a facility
 named on a Type D report, the in-scope abstract was added to the file with a
 record status code of ASF and the Type D report was deleted from the file.
 The Type D report was also deleted from the file if the facility responded to
 the Type D request, but sent no in-scope abstracts.  In this case it was
 presumed that the respondent had correctly reported the date as out-of-scope.
 In 47 cases the Type D reports remain on the final version of the file.  This
 occurred when it had been impossible to contact the facility or when
 authorization to obtain hospital records had not been granted.  These records
 for unconfirmed reports of out-of-scope stays can be eliminated from analyses
 at the analysts' discretion.  In the case of Type C reports, if an in-scope
 abstract was returned which matched the Type C report, the report was
 assigned a record status code of MAT (n=144).  (Recall the matching rules
 permitted an admission date of up to one year before or after the reported
 date of admission.)  If the facility responded but no in-scope abstract was
 received, the Type C report was removed from the file.  Again it was assumed
 that the correct date had been reported and the stay was truly out-of-scope.
 There are 42 Type C reports that remain on the file.  These reports were
 given by respondents who did not grant permission to obtain abstracts or they
 involved facilities that could not be contacted, refused to participate or
 did not respond.  These unconfirmed reports of out-of-scope stays are
 identified by the non-match status in positions 60-62 and a Type C flag in
 position 199.

 The final section of the record contains related stay codes (positions 380-
 429).  These related stay codes are used to identify stays which are
 contained within other stays.  This occurred most often when nursing home
 residents had a brief hospital stay but then returned to the nursing home.
 A detailed example of the related stay section is presented below.  In panel
 A, a chronologic history of a subject's hospital and nursing home stays is
 presented in order to facilitate the discussion of the related stay codes.
 This subject was admitted to the nursing home on March 1, 1981, and
 discharged to the hospital on April 1, 1981.  He returned to the original
 nursing home on April 8 and stayed until April 22 when he required readmis-
 sion to the hospital.  He returned from the hospital to the nursing home on
 April 25, 1981 where he remained until April 30, 1981.

 Panel A:     Chronologic profile of hospital and nursing home stays:
 Location           Admission             Discharge
 Nursing home       03/01/81              04/01/81
 Hospital           04/01/81              04/08/81
 Nursing home       04/08/81              04/22/81
 Hospital           04/22/81              04/25/81
 Nursing home       04/25/81              04/30/81

 Panel B illustrates how these stays are present in the final file.  The three
 nursing home stays were collapsed into one long stay with two related
 hospitalizations.  The related stay codes were added to demonstrate the
 relationship between the hospital and nursing home stays.

 Panel B:     Final file layout
 Variable Position:
 29-33              209           210-215     216-221     380-384      385-389

 Variable Name:

 Stay                                         Dis-        First        Second
 Number             Type          Admit       charge      Related      Related

 10201              N. Home       03/01/81    04/30/81    10101        10102
 10101              Hosp.         04/01/81    04/08/81    10201
 10102              Hosp.         04/22/81    04/25/81    10201

 Medical Coding Specifications

 Medical coding for the NHEFS 1982-84 data tape was based on the International
 Classification of Diseases-9th Revision-Clinical Modification (ICD-9-CM). The
 health care facility was asked to abstract all diagnoses and procedures onto
 a special form.  In most cases, a copy of the hospital discharge summary and/
 or medical records facesheet was attached to the abstract.  The diagnoses and
 procedures listed on the discharge summary or facesheet were then compared
 with those provided by coding the diagnoses or procedures as provided on the
 discharge summary or the facesheet.

 All diagnoses were coded to the highest level of specificity possible.  The
 fourth-digit subcategory for diagnosis and procedure codes was used whenever
 possible.  The fifth-digit subclassification of disease for diagnosis codes
 was also used when appropriate.  A three-digit ICD code was used only if it
 could not be further subdivided.  The following rules were used to code
 diagnoses and procedures.

 Rules Governing Medical Coding of Diagnoses:

 All medical diagnoses listed on the health care facility abstract form or the
 discharge summary are coded in the order in which the diagnoses were listed.
 The principal diagnosis is the condition established after study to be
 chiefly responsible for occasioning the admission of the patient to the
 health care facility.  The admitting diagnosis is not used as the principal
 diagnosis unless the admitting and discharge diagnoses are the same.

       Ex:   Patient admitted with a diagnosis of bronchopneumonia.  After
       workup and treatment, x-ray findings, etc., the patient was discharged
       with a final diagnosis of bronchopneumonia.  The principal diagnosis is
       coded 485 for bronchopneumonia.

 Note that the facility was asked to select the principal diagnosis and not
 review of the records was made to determine if the current diagnosis was
 selected.

 All other diagnoses or conditions existing at the time of admission or that
 developed subsequently during the stay are coded.

       Ex:   Patient was admitted with a diagnosis of uncontrolled diabetes
       mellitus, and during the course of examination and treatment, phlebitis
       was discovered.  The diabetes and the phlebitis are coded.

 Diagnoses documented as probable, possible, suspected, question of, sug-
 gestive of, compatible with, or questionable are coded and prefixed with a
 "P".

       Ex:   If the diagnosis is stated possible myocardial infarction, the
       diagnosis code is P410.9.

 If a diagnosis is stated as "rule out" or "R/O", the condition is coded as if
 it exists and the "P" prefix is not used.  If a diagnosis is stated as "ruled
 out", the condition is not coded.

       Ex:   If "R/O M.I." appears on the facesheet, the code is 410.9.  If
       "M.I. ruled out" appears, the condition is not coded.

 When the abstract included an infarction as one of the discharge diagnoses
 and it was clear from other information in the abstract or the final
 diagnoses sections of the facesheet and discharge summary that the infection
 was a result of a hospital procedure, the appropriate external cause of
 injury code was added.

 Malignant neoplasms are coded according to ICD-9-CM coding specifications
 which indicate primary site of origin.

 Injuries and poisonings are coded, where applicable, using both the nature of
 the injury and the external cause of injury code (E800-E999).

       Ex:   Patient sustained comminuted fracture of the femur due to a fall
       down stairs.  Nature of injury code is 821.00 and external cause of
       injury code is E880.9.

 "History of" conditions are not coded with the following exceptions:

       Old myocardial infarction (more than 8 weeks since last occurrence)
       Status post bypass surgery
       Malignant neoplasm (cancer in remission or under treatment)
       Old cerebrovascular accident
       Sterilization
       Normal pregnancy undelivered
       Manipulation of an IUD

 These diagnoses are coded using "V" codes and were used on a limited basis.
 Recurrent malignancy codes are prefixed with an "R".

 Symptoms (ICD-9-CM) codes 7800-7999) were coded using the following
 guidelines:

       1.    When the only diagnosis listed on the abstract form, facesheet,
             and/or discharge summary is a symptom, the symptom is coded.

             Ex:    The only discharge diagnosis listed is "chest pain".  The
             code number 786.50 (chest pain, unspecified) is assigned.

       2.    When a symptom is listed that is unrelated to any of the diag-
             noses listed, the symptom is coded.

             Ex:    The discharge diagnoses listed are acute myocardial
             infarction, diabetes mellitus, and hepatomegaly.  The hepato-
             megaly is also coded.

       3.    When a symptom is listed and is related to a listed discharge
             diagnosis the symptom is not coded.


             Ex:    The discharge diagnoses listed are diabetes mellitus,
             acute appendicitis, severe abdominal pain.  Only the diabetes and
             the appendicitis are coded.  The abdominal pain is not coded.

 Rules Governing Medical Codes for Procedures:

 The same general rules apply to coding procedures as to coding diagnoses.
 Medical procedures are coded and sequenced in accordance with the principal
 and secondary procedures described on the health care facility abstract form
 or the discharge summary/facesheet.

 The principal procedure is the primary procedure most related to the princi-
 pal diagnosis and is performed for definitive treatment as opposed to diag-
 nostic and/or exploratory purposes.

       Ex:   Diagnosis = uterine fibroids.
              Procedures = biopsy of uterus, total abdominal hysterectomy,
             incidental appendectomy.

             The hysterectomy is coded as the principal procedure and the
             appendectomy and the biopsy are coded as secondary procedures.

 All procedures documented on the discharge summary and/or facesheet are coded
 if they fall into the following categories:

       Biopsies (if related to the principal diagnosis and procedure or if
       related to the other listed diagnoses)

       Surgical procedures

       Cardiac catheterizations

       D and C (following delivery or abortion only)

 The following procedures are not coded:

       Surgical approach

       Operative cholangiogram

       Lumbar puncture

       CT scan

       Endoscopy

       Diagnostic D and C

       Diagnostic radiology

       Examination (under anesthesia, physical exam, etc.)

       Manipulations

       Physical therapy

       Application or removal of casts, splints, etc.

 Medical Coding Conventions:

 Diagnostic codes--Up to ten diagnoses are coded for each hospital and nursing
 home stay.  The format for each diagnosis code is six positions.  The
 following conventions were used when entering diagnostic codes on the data
 tape:

       1.    ICD-9-CM diagnostic codes (including "V" codes) were entered
             beginning with the second position of the variable field
             continuing through the sixth position.  There is an implied
             decimal point between the fourth and fifth positions of the
             variable field.

       2.    If the diagnoses codes required less than five digits the
             remaining tape positions are blank.

       3.    Prefix codes "P" and "R" are coded in the first tape position. If
             the diagnosis code has no prefix the first position is blank.

                    Ex. 1:  _ 4 2 2 9 0   Code is 422.90

                    Ex. 2:    V 7 1 1     Code is V71.1

                    Ex. 3:    4 3 6       Code is 436

                    Ex. 4:  P 1 8 0 0     Code is P180.0

                    Ex. 5:  R 1 7 4 9     Code is R174.9

       4.    E codes - External cause of injury codes

             An external cause of injury code is provided, when applicable,
             immediately after the medical diagnosis code which describes the
             nature of the injury.  E codes were entered on the data tape
             beginning in the first position of the variable field and
             continuing through the fifth position.  There is an implied
             decimal point between the fourth and fifth positions of the
             variable field.  If an E code required less than five positions
             the remaining positions are blank.  If an E code is not applica-
             ble (i.e., the medical diagnosis code is not a nature of injury
             code) or could not be coded, the variable field is blank.

                    Ex. 1:  E 9 0 6 1   Code is E906.1

                    Ex. 2:  E 8 5 1     Code is E851


 Procedure codes--Up to five procedures are coded for each health care facili-
 ty record.  Each procedure code is formatted in a field containing four
 positions.  Procedure codes were entered beginning with the first positions.
 Procedure codes were entered beginning with the first position of the varia-
 ble field continuing through the fourth position.  There is an implied deci-
 mal point between the second and third positions of the variable field.  If a
 procedure code required less than four positions the remaining positions are
 blank.

                    Ex. 1:  4 2 9 2    Code is 42.92

                    Ex. 2:  0 3 1      Code is 03.1


RECORD LAYOUT

 Stay Tape Codebook

 Tape
 Position    Frequencies      Variable Description and Codes

 (1-28)                       SUBJECT INFORMATION

 1-5         25,436           NHANES I Sample Sequence Number

 6-7                          Record Count

             25,436           01-55 = Total number of records

                              Note:  Each record on the file represents an
                              overnight stay in a health care facility (hospi-
                              tal or nursing home).  This variable identifies
                              for each subject the total number of records on
                              the file.  It will be the same for each record
                              the subject has on the file.

 8-28        25,436           Blank

 (29-59,                      STAY IDENTIFIERS AND REPORTED
  63-204)                     INFORMATION ON FACILITY STAYS

                              Note:  The report section of the record (posi-
                              tions 29-59 and 63-204) contains the information
                              on health care facility stays that was reported
                              on the questionnaire, on a death certificate, on
                              another hospital/nursing home abstract form, or
                              obtained from other sources.

 (29-33)                      Health Care Facility Stay ID Number

                              Note:  When used in conjunction with the sample
                              sequence number this number uniquely identifies
                              each record on the tape.  It is composed of
                              three variables:  Survey Period Identifier,
                              Facility Number and Stay Number Within Facility.
                              For example: a Stay Number of 10102 refers to a
                              facility stay reported during the NHEFS 1982-84
                              wave (1) in the first facility reported for that
                              subject (01) but the second admission to that
                              facility (02).

 29                           Survey Period Identifier

             25,436           1 = NHEFS 1982-84

                              Note:  For each NHEFS subject, a two digit num-
                              ber was assigned to each facility in which a
                              stay occurred.  Thus, if a subject had multiple
                              stays at the same facility, all stays will have
                              the same facility number.

                              Facility numbers were assigned consecutively.
                              However, due to tape editing, there are missing
                              numbers in the sequence of facility numbers.

 30-31                        Facility Number
             25,436           01-09 = Hospital/nursing home number

                              Note:  For each NHEFS subject, a two digit
                              number was assigned to each facility in which a
                              stay occurred.  Thus, if a subject had multiple
                              stays at the same facility, all stays will have
                              the same facility number.

                              Facility numbers were assigned consecutively.
                              However, due to tape editing, there are missing
                              numbers in the sequence of facility numbers.

 32-33                        Stay Number Within Facility

             25,436           01-45 = Stay number
                                 00 = D stay record

                              Note:  The two digit stay numbers were assigned
                              to identify different stays in the same facili-
                              ty.  Type D stay records were assigned a stay
                              number of "00".  A type D stay record is defined
                              as a stay with a reported admission date more
                              than one year prior to the date of the NHANES I
                              Examination (see position 199).

                              Stay numbers within facilities were assigned
                              consecutively.  However, due to tape editing,
                              three are missing numbers in the sequence of
                              stay numbers within facilities.

 34-35                        Facility ID Profile

             24,457           01 = Hospital
                664           02 = Nursing home
                315           03 = Out of country, don't know, or not
                              ascertained


                              Note:  This variable identifies the type of
                              facility to which the request for a stay record
                              was mailed.

 36-46       25,436           Blank

 (47-54)                      Reported Admission Date/Range

                              Respondents were asked to provide information on
                              the month, day and year of admission for each
                              stay to a facility.  A range of years was coded
                              when the respondent was unable to recall the
                              exact year of admission.  When the year of
                              admission was reported as a range, the beginning
                              year of the range is found in positions 51-52
                              and the ending year of the range is found in
                              positions 53-54.  Except for type D (position
                              199) records the reported date of admission is
                              present for all source code 2 and 4 records (see
                              position 200).

 47-48                        Reported Month of Admission

              1,136           01-12 = Month of admission
                  4              98 = Don't know
             18,453              99 = Not ascertained
              5,843           Blank = Type D (position 199), record status
                                      code
                                      ASF (positions 60-62), or source code 1
                                      or 3 (positions 200)

 49-50                        Reported Day of Admission

                188           01-31 = Day of admission
                  3              98 = Don't know
             19,402              99 = Not ascertained
              5,843           Blank = Type D (position 199), record status
                                      code
                                      ASF (positions 60-62), or source code 1
                                      or 3 (position 200)

 Tape
 Position    Frequencies      Variable Description and Codes

 51-52                        Reported Year of Admission or Beginning Year of
                              Range

             18,973           68-84 = Year of admission or beginning year of
                                          range (1968-1984)
                505              98 = Don't know
                115              99 = Not ascertained
              5,845           Blank = Type D (position 199), record status
                                          code ASF (positions 60-62), or
                                          source code (position 200) 1 or 3

 53-54                        Reported Year of Admission - Ending Year of
                              Range

              1,452           70-84 = Ending year of range (1970-1984)
             23,984           Blank = No range given for reported year of
                              admission, type D (position 199), record status
                              code ASF (positions 60-62), or source code
                              (position 200) 1 or 3

 55-59       25,436           Blank

 (60-62)                      RECORD STATUS

                              Note:  The record status section of the record
                              (positions 60-62) contains information on the
                              outcome of the request for a health care facili-
                              ty stay.

 60-62                        Record Status Code

                              Note:  See Appendix A for an explanation of the
                              record status codes.

             25,436           ANO - XRD = Record status code

 (63-198)                     Reported Conditions and Codes

                              During the process of completing the Hospital
                              and Health Care Facility Chart (HHCF) respon-
                              dents described the conditions that led to their
                              overnight facility stays.  This information is
                              included as a text field on the stay record.
                              Space is allotted for the recording of up to
                              four reasons for the hospital or nursing home
                              stay (see positions 67-96, 101-130, 135-164 and
                              169-198).

                              A numeric code was assigned to each text
                              description to aid the researcher in the use of
                              this information (see positions 63-66, 97-100,
                              131-134, 165-168).  These variables should be
                              used in conjunction with information in the
                              abstract section, i.e., ICD-9-CM diagnosis
                              codes, present on records with a record status
                              code of MAT or ASF.  Appendix B contains a com-
                              plete description of these fields along with
                              guidelines for their use.

 (63-96)                      First Reported Condition

 63-66                        Condition Code

             19,388           01-37 = Condition code (See Appendix B)
              6,048           Blank = Source Code not equal to 4, D stay
                                      record, or Record Status Code ASF.

 67-96                        Condition Text

             19,388           Description of reason for facility stay
              6,048           Blank = Source Code not equal to 4, D stay
                                      record, or Record Status Code ASF

 (97-130)                     Second Reported Condition

 97-100                       Condition Code

              5,748           01-37 = Condition code (See Appendix B)
             19,688           Blank = Source Code not equal to 4, D stay
                                      record, or Record Status Code ASF,
                                      or only one condition reported.

 Tape
 Position    Frequencies      Variable Description and Codes

 101-130                      Condition Text

              5,748           Description of reason for facility stay
             19,688           Blank = Source Code not equal to 4, D stay
                                      record or Record Status Code ASF,
                                      or only one condition reported.

 (131-164)                    Third Reported Condition

 131-134                      Condition Code

              1,346           01-37 = Condition code (See Appendix B)
             24,090           Blank = Source Code not equal to 4, D stay
                                      record or Record Status Code ASF,
                                      or less than three conditions
                                      reported.

 135-164                      Condition Text

              1,346           Description of reason for facility stay
             24,090           Blank = Source Cod not equal to 4, D stay
                                      record or Record Status Code ASF,
                                      or less than three conditions
                                      reported. Tape

 Tape
 Position    Frequencies      Variable Description and Codes

 (165-198)                    Fourth Reported Condition

 165-168                      Condition Code

                288           01-37 = Condition code (See Appendix B)
             25,148           Blank = Source code not equal to 4, D stay
                                      record or Record Status Code ASF,
                                      or less than four conditions reported.

 199                          Type of Stay Flag

                186           C =  A reported stay with admission date up to
                                   one year prior to the date of NHANES I
                                   Examination.

                 47           D =  A reported stay with admission date more
                                   than one year prior to date of NHANES I
                                   exam.  If there were multiple reported
                                   stays in the same facility that were all
                                   type D (more than one year prior to exam)
                                   these stays were consolidated into one
                                   entry in the tracking system.  If an in-
                                   scope abstract was received in response to
                                   a type D report, the abstract was never
                                   matched to the type D report, but was
                                   assigned a record status code of ASF
                                   (positions 60-62).  The type D report was
                                   then removed from the file.  The 47 type D
                                   reports that remain on the file were unable
                                   to be resolved either because the facility
                                   could not be contacted (status of FNC) or
                                   because authorization to collect facility
                                   data was not obtained (status of ANO).

             25,203         Blank =    In-scope stay; a reported date of
                                       admission after the exam date.  This
                                       field is also blank for records with
                                       status codes of ASF.

                                   Note: This variable identifies reported
                                   facility stays as in-scope or out-of-scope
                                   for the NHEFS 1982-84 interview period.
                                   Reported dates of admission of don't know
                                   (989898) or not ascertained (999999) in
                                   positions 47-52 were considered in-scope.

 200                          Source of Report of Stay that Initiated Request
                              for Abstract
                126               1 = Information from death certificate
                205               2 = Information from hospital abstract
                                          report
                141               3 = Information from other source
             19,435               4 = Information from NHEFS 1982-84
                                          interview
              5,529           Blank = Not a requested stay.  Additional stay
                                          information obtained from facility
                                          (record status code ASF positions 60
                                          -62).  ASF may also be coded as
                                          source code 3.

 Tape
 Position    Frequencies      Variable Description and Codes


 201-204     25,436           Blank

 (205-379)                    ABSTRACT DATA

                              Note:  The abstract data portion of the record
                              (positions 205-379) contains information ob-
                              tained from an abstract form returned by the
                              facility.  This section of the stay record
                              (excluding positions 207-208) will be blank when
                              a facility did not return an abstract form for a
                              stay (n=6933).

 205-206                      Abstract Number

             18,503           01-53 = Number of abstract
              6,933           Blank = Stay reported, no abstract form received

                              Note:  For each subject, a two digit number was
                              assigned consecutively to each abstract form
                              received.

 207-208                      Total Number of Abstracts Received

             25,436           00-53 = Total number of abstracts received

                              Note:  This number represents the total number
                              of abstracts received for each subject.  The
                              total number is repeated on each subject record.

 209                          Facility Record Type

             18,085               1 = Hospital
                418               2 = Nursing home
              6,933           Blank = Stay reported, no abstract form received

 (210-215)                    Date of Admission

 210-211                      Month of Admission

             18,501           01-31 = Day of admission
                  6              99 = Not ascertained
              6,933           Blank = Stay reported, no abstract form received

 212-213                      Day of Admission

             18,497           01-31 = Day of admission
                  6              99 = Not ascertained
              6,933           Blank = Stay reported, no abstract form
                                          received

 214-215                      Year of Admission

             18,503           71-84 = Year of admission (1971-1984)
              6,933           Blank = Stay reported, no abstract form received

 (216-221)                    Date of Discharge

                              Note:  When a subject had a brief break in a
                              nursing home stay, the nursing home stays were
                              combined into one long stay with the latest
                              discharge date assigned to the stay.  The
                              information contained in the report and abstract
                              sections of the stay is from the earliest
                              abstract.

                              For example:  subject A was in a nursing home
                              from 10-31-81 to 12-22-81.  The subject was
                              readmitted to the same nursing home 1-3-82.
                              These 2 stays would appear on the file as 1 stay
                              from 10-31-81 to 3-5-82.  Length of stay would
                              be calculated on the entire stay (see positions
                              222-225).  If the break in the nursing home was
                              due to an interspersed hospitalization, the
                              nursing home stays were collapsed as described
                              above and a code was entered in the related stay
                              section (see positions 380-429).

 216-217                      Month of Discharge

             18,350           01-12 = Month of discharge
                145              97 = Inapplicable (still at facility on date
                                      of 1982-84 interview)
                  8              99 = Not ascertained
              6,933           Blank = Stay reported, no abstract from received

 218-219                      Day of Discharge

             18,346           01-31 = Day of discharge
                145              97 = Inapplicable (still at facility on date
                                      of 1982-84 interview)
                 12              99 = Not ascertained
              6,933           Blank = Stay reported, no abstract form received

 220-221                      Year of Discharge

             18,353           71-84 = Year of discharge (1971-1984)
                145              97 = Inapplicable (still at facility on date
                                      of 1982-84 interview)
                  5              99 = Not ascertained
              6,933           Blank = Stay reported, no abstract form received

 222-225                      Length of Record Stay

                 80           0000      = Died on day of admission
             18,243           0001-3380 = Total number of days in facility
                145           9997      = Inapplicable (still at facility on
                                          date of 1982-84 interview)
                 15           9999      = Not ascertained
              6,933           Blank     = Stay reported, no abstract form
                                          received

                              Note:  Length of stay is calculated by subtract-
                              ing the date of admission from the date of dis-
                              charge.  For subjects with nursing home stays,
                              brief breaks were collapsed into one continuous
                              nursing home stay (see positions 216-221).  For
                              subjects with information coded in the related
                              stays section (see positions 380-429) length of
                              stay will include time spent in other facili-
                              ties.  Length of stay is not ascertained if
                              either the admission or discharge date contains
                              a code of 99.

 226                          Was the Patient in Cardiac Intensive Care Unit?

              1,124               1 = Yes
             15,811               2 = No
                418               7 = Inapplicable (facility is a nursing
                                      home)
              1,150               9 = Not ascertained
              6,933           Blank = Stay reported, no abstract form received

 227-229                      Number of Days in Cardiac Intensive Care Unit

              1,053           000-076 = Number of days
             17,379               997 = Inapplicable (position 226 = 2,7,or 9)
                 71               999 = Not ascertained
              6,933             Blank = Stay reported, no abstract form re-
                                        ceived

                              Note:  A length of stay of 0 days occurred when
                              a subject was admitted to the CCU and was dis-
                              charged on the day of admission.

 230                          Was the Patient In Other Intensive Care Unit?

                877               1 = Yes
             14,979               2 = No
                418               7 = Inapplicable (facility is a nursing
                                      home)
              2,229               9 = Not ascertained
              6,933           Blank = Stay reported, no abstract form received

 231-233                      Number of Days in Other Intensive Care Unit

                832           000-129 = Number of days
             17,626               997 = Inapplicable (Position 230 = 2,7,or 9)
                 45               999 = Not ascertained
              6,933             Blank = Stay reported, no abstract form
                                        received

                              Note:  A length of stay of 0 days occurred when
                              a subject was admitted to the ICU and was dis-
                              charged on the day of admission.

 234                          Patient Admitted to Nursing Home From:

                 99               1 = Private residence
                235               2 = Acute care hospital
                  8               3 = Chronic disease hospital
                 58               4 = Other nursing home
             18,085               7 = Inapplicable (facility is a hospital)
                 18               9 = Not ascertained
              6,933           Blank = Stay reported, no abstract form received


 235                          Disposition of Hospital Patient

             15,819               1 = Routine discharge/discharged home
                 70               2 = Left against medical advice
                883               3 = Discharged/transferred to another faci-
                                      lity or organization
                215               4 = Discharged/referred to organized home
                                      care service
                729               5 = Died
                 15               6 = Not discharged/still in hospital on the
                                      date of 1982-84 interview
                418               7 = Inapplicable (facility is a nursing
                                      home)
                354               9 = Subject discharged, disposition not
                                      ascertained
              6,933           Blank = Stay reported, no abstract form received

 236                          Disposition of Nursing Home Patient

                130               1 = Not discharged/still in a nursing home
                                      on date of 1982-84 interview
                 23               2 = Discharged to private residence/referral
                                      to organized home care services
                122               3 = Died
                 59               4 = Discharged to private residence/no re-
                                      ferral
                 81               5 = Transferred to another facility
             18,085               7 = Inapplicable (facility is a hospital)
                  3               9 = Not ascertained
              6,933           Blank = Stay reported, no abstract form received

 237                          Transferred to Another Health Care Facility

                 41               1 = Acute care hospital
                 32               2 = Another nursing home
                  0               3 = Chronic disease hospital
                  5               4 = Other
             18,422               7 = Inapplicable (Position 236 = 1, 2, 3, 4,
                                      7, or 9)
                  3               9 = Not ascertained
              6,933           Blank = Stay reported, no abstract form received

 238-239                      Number of Diagnoses

             18,493           01-21 = Number of diagnoses
                 10              99 = Not ascertained
              6,933           Blank = Stay reported, no abstract form received

                              Note:  This variable identifies the total number
                              of diagnoses entered on the abstract.  The num-
                              ber of coded diagnoses may exceed the maximum
                              number (10) allowed on the data tape.

 240-245                      Principal Diagnosis

             18,493           ICD-9-CM Code
                 10           999999 = Not ascertained
              6,933           Blank  = Stay reported, no abstract form re-
                                       ceived

                              Note:  See medical coding specifications.

 246-250                      Principal Diagnosis E Code

              1,380           ICD-9-CM Code
             24,056           Blank = Stay reported, no abstract form received
                                      or principal diagnosis does not require
                                      E code

                              Note:  See medical coding specifications

 Tape
 Position    Frequencies      Variable Description and Codes


 251-256                      Second Diagnosis

             13,083           ICD-9-CM Code
              5,420           999997 = Inapplicable (only one diagnosis coded)
              6,933           Blank  = Stay reported, no abstract form re-
                                       ceived

                              Note:  See medical coding specifications.

 257-261                      Second Diagnosis E Code

                376           ICD-9-CM Code
              5,420           99997 = Inapplicable (only one diagnosis coded)
             19,640           Blank = Stay reported, no abstract form received
                                      or second diagnosis does not require E
                                      code

                              Note:  See medical coding specifications.

 262-267                      Third Diagnosis

              8,552           ICD-9-CM Code
              9,951           999997 = Inapplicable (less than three diagnoses
                                       coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 268-272                      Third Diagnosis E Code

                214           ICD-9-CM Code
              9,951           99997 = Inapplicable (less than three diagnoses
                                      coded)
             15,271           Blank = Stay reported, no abstract form received
                                      or third diagnosis does not require E
                                      code

                              Note:  See medical coding specifications.

 273-278                      Fourth Diagnosis

              5,420           ICD-9-CM Code
             13,083           999997 = Inapplicable (less than four diagnoses
                                       coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 279-283                      Fourth Diagnosis E Code

                163           ICD-9-CM Code
             13,083           99997 = Inapplicable (less than four diagnoses
                                      coded)
             15,271           Blank = Stay reported, no abstract form received
                                      or fourth diagnosis does not require E
                                      code

                              Note:  See medical coding specifications.

 284-289                      Fifth Diagnosis

              3,300           ICD-9-CM Code
             15,203           999997 = Inapplicable (less than five diagnoses
                                       coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.
 290-294                      Fifth Diagnosis E Code

                100           ICD-9-CM Code
             15,203           99997 = Inapplicable (less than five diagnoses
                                      coded)
             10,133           Blank = Stay reported, no abstract form received
                                      or fifth diagnosis does not require E
                                      code

                              Note:  See medical coding specifications.

 295-300                      Sixth Diagnosis

              1,956           ICD-9-CM Code
             16,547           999997 = Inapplicable (less than six diagnoses
                                       coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 Tape
 Position    Frequencies      Variable Description and Codes

 301-305                      Sixth Diagnosis E Code

                 72           ICD-9-CM Code
             16,547           99997 = Inapplicable (less than six diagnoses

                                      coded)
              8,817           Blank = Stay reported, no abstract form received
                                      or sixth diagnosis does not require E
                                      code

                              Note:  See medical coding specifications.

 306-311                      Seventh Diagnosis

              1,039           ICD-9-CM Code
             17,464           999997 = Inapplicable (less than seven diagnoses
                                       coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 312-316                      Seventh Diagnosis E Code

                 37           ICD-9-CM Code
             17,464           99997 = Inapplicable (less than seven diagnoses
                                      coded)
              8,817           Blank = Stay reported, no abstract form received
                                      or seventh diagnosis does not require E
                                      code

                              Note:  See medical coding specifications.

 317-322                      Eighth Diagnosis

                568           ICD-9-CM Code
             17,935           999997 = Inapplicable (less than eight diagnoses

                                       coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 323-327                      Eighth Diagnosis E Code

                 12           ICD-9-CM Code
             17,935           99997 = Inapplicable (less than eight diagnoses

                                      coded)
              8,817           Blank = Stay reported, no abstract form received
                                      or eighth diagnosis does not require E
                                      code

                              Note:  See medical coding specifications.

 328-333                      Ninth Diagnosis

                310           ICD-9-CM Code
             18,193           999997 = Inapplicable (less than nine diagnoses

                                       coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 334-338                      Ninth Diagnosis E Code

                  9           ICD-9-CM Code
             18,193           99997 = Inapplicable (less than nine diagnoses

                                     coded)
              7,234           Blank = Stay reported, no abstract form received
                                      or ninth diagnosis does not require E
                                     code

                              Note:  See medical coding specifications.

 339-344                      Tenth Diagnosis

                165           ICD-9-CM Code
             18,338           999997 = Inapplicable (less than ten diagnoses

                                       coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 345-349                      Tenth Diagnosis E Code

                  2           ICD-9-CM Code
             18,338           99997 = Inapplicable (less than ten diagnoses

                                      coded)
              7,096           Blank = Stay reported, no abstract form received
                                      or tenth diagnosis does not require E
                                      code

                              Note:  See medical coding specifications.

 350-351                      Number of Procedures

             18,085           00-05 = Number of procedures
                418              97 = Inapplicable (facility is a nursing
                                      home)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  This variable identifies the total number
                                     of procedures coded on the facility
                                     abstract.

 Tape
 Position    Frequencies      Variable Description and Codes

 352-355                      First Procedure

              7,264           ICD-9-CM Code
             11,239           9997 = Inapplicable (facility is a nursing home
                                     or no procedures coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 356-359                      Second Procedure

              2,635           ICD-9-CM Code
             15,868           9997 = Inapplicable (facility is a nursing home
                                     or only one procedure coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 360-363                      Third Procedure

                774           ICD-9-CM Code
             17,729           9997 = Inapplicable (facility is a nursing home
                                     or less than three procedures coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 364-367                      Fourth Procedure

                234           ICD-9-CM Code
             18,269           9997 = Inapplicable (facility is a nursing home
                                     or less than four procedures coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 368-371                      Fifth Procedure

                 55           ICD-9-CM Code
             18,448           9997 = Inapplicable (facility is a nursing home
                                     or less than five procedures coded)
              6,933           Blank = Stay reported, no abstract form received

                              Note:  See medical coding specifications.

 (372-373)                    Presence of Documents

 372                          Pathology Report

                560               1 = Required and present
                119               2 = Required and not present
             17,406               6 = Not required
                418               7 = Inapplicable (facility is a nursing
                                      home)
              6,933           Blank = Stay reported, no abstract form received

 373                          Third Day EKG Report

                377               1 = Required and present
                151               2 = Required and not present
             17,557               6 = Not required
                418               7 = Inapplicable (facility is a nursing
                                      home)
              6,933           Blank = Stay reported, no abstract form received

 374-379     25,436           Blank Tape

 (380-429)                    RELATED STAY CODES

                              Note:  Residents in nursing homes are often
                              admitted to hospitals during the course of their
                              stays in the nursing home.  The related stay
                              section of the record cross-links nursing home
                              stays with interspersed hospital stays.

                              In the case of nursing home records, this set of
                              variables identifies hospital stays that occur-
                              red during the nursing home stay.  Up to 10 rel-
                              ated stays can be listed.

                              In the case of hospital records, this set of
                              variables identifies the nursing home stay with-
                              in which the hospital stay occurred.

                              The Related Stay is identified by the Health
                              Care Facility Stay ID Number (positions 29-33)
                              of that stay.

                              An example of the usage of the related stay sec-
                              tion is found in the introduction to this code-
                              book.

 (380-384)                    ID of First Related Stay

 380                          Survey Period Identifier

                231               1 = NHEFS 1982-84
             25,205           Blank = No related stays

 381-382                      Facility Number

                231           01-07 = Hospital/nursing home number
             25,205           Blank = No related stays

 383-384                      Stay Number Within Facility

                231           01-20 = Stay number
             25,205           Blank = No related stays

 (385-389)                    ID of Second Related Stay

 385                          Survey Period Identifier

                 34               1 = NHEFS 1982-84
             25,402           Blank = No second related stay

 386-387                      Facility Number

                 34           01-07 = Hospital/nursing home number
             25,402           Blank = No second related stay

 388-389                      Stay Number Within Facility

                 34           01-18 = Stay number
             25,402           Blank = No second related stay

 (390-394)                    ID of Third Related Stay

 390                          Survey Period Identifier

                 15               1 = NHEFS 1982-84
             25,421           Blank = No third related stay

 391-392                      Facility Number

                 15           02-07 = Hospital/nursing home number
             25,421           Blank = No third related stay

 393-394                      Stay Number Within Facility

                 15           01-11 = Stay number
             25,421           Blank = No third related stay

 (395-399)                    ID of Fourth Related Stay

 395                          Survey Period Identifier

                  6               1 = NHEFS 1982-84
             25,430           Blank = No fourth related stay

 396-397                      Facility Number

                  6           02-03 = Hospital/nursing home number
             25,430           Blank = No fourth related stay

 398-399                      Stay Number Within Facility

                  6           01-07 = Stay number
             25,430           Blank = No fourth related stay

 (400-404)                    ID of Fifth Related Stay

 400                          Survey Period Identifier
             25,436           Blank = No fifth related stay

 Tape
 Position    Frequencies      Variable Description and Codes

 401-402                      Facility Number

             25,436           Blank = No fifth related stay

 403-404                      Stay Number Within Facility

             25,436           Blank = No fifth related stay

 (405-409)                    ID of Sixth Related Stay

 405                          Survey Period Identifier

             25,436           Blank = No sixth related stay

 406-407                      Facility Number

             25,436           Blank = No sixth related stay

 408-409                      Stay Number Within Facility

             25,436           Blank = No sixth related stay

 (410-414)                    ID of Seventh Related Stay

 410                          Survey Period Identifier

             25,436           Blank = No seventh related stay

 411-412                      Facility Number

             25,436           Blank = No seventh related stay

 413-414                      Stay Number Within Facility

             25,436           Blank = No seventh related stay

 (415-419)                    ID of Eighth Related Stay

 415                          Survey Period Identifier

             25,436           Blank = No eighth related stay

 419-417                      Facility Number

             25,436           Blank = No eighth related stay

 418-419                      Stay Number Within Facility

             25,436           Blank = No eighth related stay

 (420-424)                    ID of Ninth Related Stay

 420                          Survey Period Identifier

             25,436           Blank = No ninth related stay

 421-422                      Facility Number

             25,436           Blank = No ninth related stay

 423-424                      Stay Number Within Facility

             25,436           Blank = No ninth related stay

 (425-429)                    ID of Tenth Related Stay

 425                          Survey Period Identifier

             25,436           Blank = No tenth related stay

 426-427                      Facility Number

             25,436           Blank = No tenth related stay

 428-429                      Stay Number Within Facility

             25,436           Blank = No tenth related stay



Figure 1
 Health Care Facility Record Layout

                              Figure 1

                    NHANES I Epidemiologic Followup Study (NHEFS)
                          Health care facility record layout

   Facility identifiers               . Actual dates      . Codes assigned by
   Reported date of           Match     admission and       NCHS to identify
   admission                    or      discharge           stays contained
   Reported cause of    reason for    . ICD-9-CM diagnoses  within other stays
   admission            non-match     . Discharge status
   Source of report                     from hospitals and
                                        nursing homes

                    Record                                Related
 Report Section     Status Section    Abstract Section    Stay section


Figure 2
 Examples of Matching Process and Record Status Codes

                              Figure 2

                     NHANES I Epidemiologic Followup Study (NHEFS)
                 Examples of matching process and record status codes

 Record status code

       Match                  Report Section  Mat  Abstract Section


                                              non-
       Non-match              Report Section  match  No Abstract
                                              code     received


    Additional abstract       No report       ASF  Abstract Section
       found                   section



APPENDIX A 1982-84

 RECORD STATUS CODES
 Code  Frequency    Description

 ANO-  268          "Authorization Not Obtained."  This code indicates that
                    the subject or proxy refused to sign the Medical Authori-
                    zation Form (MAF).  Information on these stays were not
                    requested from the reported facilities.

 ASF-  5668         "Additional Stay Found."  This code was assigned when a
                    returned in-scope abstract could not be matched to a
                    reported stay.  This code was also assigned to in-scope
                    abstracts that were received as a result of an inquiry
                    generated by a type D report (Position 199).  The type D
                    report was deleted from the final file.

 FNC-  407          "Facility Never Contacted."  This code was assigned when
                    the facility was not contacted for the following reasons:
                    the respondent could not recall the name of the facility;
                    the facility was closed; the facility could not be lo-
                    cated; and facility was located outside the United States.

 MAT-  12,835       "Record Match."  This code was assigned when a received
                    abstract matched a reported stay.  This code was assigned
                    to in-scope and type C (position 199) reports, but never
                    to type D reports.  In-scope abstracts that were received
                    as the result of a type D report were assigned an ASF
                    code. (See ASF.)

 ONR-  1196         "Other Non-Response."  This code was assigned to a stay
                    when no response for the stay request had been received
                    from the facility by the end of the study period.

 REF-  184          "Refused."  This code was assigned if a facility refused
                    to send back the abstract requested.  It is record, not
                    subject specific.  For example, a facility may have sent
                    some abstracts for a subject but refused to send others.

 XNH-  587          "Subject Never at Facility."  This code was used when the
                    facility indicated that the patient was never admitted to
                    that facility.

 XNS-  4194         "Other - No Stay Found."  This code was assigned when a
                    facility responded it was unable to send abstracts because
                    no in-scope stay was found at the facility, or when the
                    facility returned the request form without abstracts and
                    provided no explanation for the failure to do so.

 Code Frequency    Description

 XRD-     97        "Record Destroyed or No Longer Available."  This code was
                    assigned if the facility attempted to locate the abstract
                    but stated that it no longer existed, i.e., was destroyed,
                    or lost.

 NOTE: Additional information concerning the assignment of the record status
 codes is found in the introduction to this section.


APPENDIX B 1982-84
Codes for Health Care Facility Stay Records
                       NUMERIC CODES FOR REPORTED CONDITIONS ON
                           HEALTH CARE FACILITY STAY RECORDS


 Code for reported            Condition
 Condition                    Description

       01                     Arthritis

       02                     Gout

       03                     Heart attack

       04                     Another heart condition besides heart attack

       05                     Coronary bypass surgery

       06                     Pacemaker repair, insertion and/or replacement

       07                     T.I.A. small stroke

       08                     Stroke or CVA (cerebrovascular accident)

       09                     Diabetes

       10                     High blood pressure

       11                     Cancer and/or cancer treatment

       12                     Fractured hip

       13                     Another type of bone fracture besides a hip
                              fracture

       14                     Pneumonia or influenza

       15                     Surgery

       16                     Don't know

       17                     Not ascertained

       18                     Tests/observation/x-rays/physical exam

 Code for reported           Condition
 Condition                    Description

       19                     Digestive/endocrine condition
       1901                   Colon condition
       1902                   Ulcers
       1903                   Liver condition
       1904                   Colitis or enteritis
       1905                   Diverticulitis
       1907                   Gallbladder disease

       20                     Respiratory condition (other than influenza
                              and pneumonia)
       2001                   Asthma
       2002                   Chronic bronchitis or emphysema

       21                     Infection

       22                     Kidney/bladder/urinary condition

       23                     Debility/pain
       2301                   Headache

       24                     Male reproductive condition

       25                     Musculoskeletal problem or injury other than a
                              fracture
       2501                   Neck pain
       2502                   Back pain
       2503                   Hip pain
       2504                   Dislocated hip
       2505                   Other joint pain

       26                     Circulatory condition

       27                     Female reproductive condition

       28                     Mental illness
       2801                   Nervous breakdown

       29                     Neurologic condition
       2901                   Parkinson's disease
       2902                   Multiple sclerosis
       2903                   Epilepsy

       30                     Nutritional condition or dehydration

       31                     Bleeding or blood disorder

       32                     Skin condition

       33                     Condition not elsewhere coded
 Code for reported            Condition
 Condition                    Description

       34                     Admission to a facility other than an acute care
                              hospital

       35                     In a facility at time of death

       36                     Cataracts
       3601                   Glaucoma
       3602                   Detached retina
       3603                   Eye problem other than cataracts, detached
                              retina or glaucoma

       37                     A fall


 Background

       During the process of completing the Hospital and Health Care Facility
 (HHCF) chart respondents were asked to describe the conditions that led to
 their facility stays and this information is included as a text field on the
 stay record.  The text portion of the reported condition contains standard
 nomenclature words.  If necessary the respondent's description was edited to
 fit into the 30 positions available in the record.  A numeric code was also
 assigned to each description.  This was done so that users would not have to
 deal with alphabetic description fields when investigating reasons for
 facility stays.  Space is allotted on the report section of the facility stay
 record for recording of up to four reasons for the hospitalization or nursing
 home stay (positions 63-198 of the HCFS record).

       Note that code 1906 is not included in the coding structure for the
 1982-84 file.  This code had been designated for reports of overnight hospi-
 tal stays for thyroid disease.  No such stays were reported.

       Reported conditions and their associated codes can be divided into six
 types depending on where in the interview the was reported and the amount of
 information obtained:  specific conditions included in either the subject or
 proxy interview (Type A); conditions which are well-defined but for which no
 question exists in the interview (Type B); unknown conditions (Type C);
 conditions about which there is no specific question in the interview but for
 which sufficient information is available to attribute them to disorders of a
 major body system (Type D); conditions that are broadly defined and/or cannot
 be attributed to a single major body system (Type E); and conditions that
 cannot be classified into any of the above categories (Type F).  Each
 condition type, the associated codes and the rules for assigning the reported
 conditions to the categories of the coding structure are described in detail
 below.
       Type A - Conditions about which the respondent was asked in the
 interview.  For example, if a respondent answered "yes" to question G-26
 ("Since 1970, had (he/she) ever stayed overnight in a hospital for
 arthritis?"), then a condition code of "01" and a test field containing
 "arthritis" would be included on the facility stay record.  Type A conditions
 are listed below with the corresponding interview question number in
 parentheses.  Unless otherwise indicated, the question is found in both the
 subject and proxy questionnaires.


       01    Arthritis (G-26 of the proxy questionnaire)
       03    Heart attack (G-17)
       04    Other heart conditions (G-15 and G-16)
       07    T.I.A., small stroke (G-21)
       08    Stroke (G-22)
       09    Diabetes (G-40 on the subject questionnaire and D-22 on the proxy
             questionnaire)
       10    High blood pressure (D-5)
       11    Cancer (D-65 and D-54 on the subject questionnaire and D-22 on
             the proxy questionnaire)
       12    Fractured hip (E-94 on the subject questionnaire)
       1901  Colon problem (G-8)
       1902  Ulcers (G-5)
       1903  Cirrhosis of the liver (G-9)
       1904  Colitis or enteritis (G-14)
       1905  Diverticulitis (G-19)
       1907  Gallbladder disease (D-47 on the subject questionnaire and D-14
             on the proxy questionnaire)
       2001  Asthma (G-1)
       2002  Chronic bronchitis and emphysema (G-2)
       22    Kidney, bladder or urinary problem (G-6 and G-7)
       2301  Headache (G-3)
       2501  Neck pain (E-26 on the subject questionnaire)
       2502  Back pain (E-46 on the subject questionnaire)
       2503  Hip pain (E-59 on the subject questionnaire)
       2504  Dislocated hip (E-99 on the subject questionnaire)
       2505  Other joint problem (E-99 on the subject questionnaire)
       2801  Nervous breakdown (G-12)
       2901  Parkinson's disease (G-10)
       2902  Multiple sclerosis (G-11)
       2903  Epilepsy (G-50 on the subject questionnaire G-25 on the proxy
             questionnaire)
       34    Care in non-acute care facility (G-62 on the subject question-
             naire and G-31 on the proxy questionnaire)
       35    In a facility at death (V-3 on the proxy questionnaire)
       36    Cataracts (G-18)
       3601  Glaucoma (G-19)
       3602  Detached retina (G-20)

       Complete agreement between responses to the questions in the interview
 and Type A condition codes on the facility stay file should not be expected.
 There are several reasons for a lack of agreement between these two data
 sources.

       First, the respondent may report a facility stay for a given condition
 in the interview and yet no facility stay record containing the condition may
 appear on the NCFS file.  This would result if: (1) it was determined that
 the hospitalization did not last overnight causing the stay to be deleted
 from the HCFS file; or (2) the reported stay was found to be "out-of-scope".
 (See the introduction to this codebook and the Plan and Operation for defini-
 tions of out-of-scope stays.)

       Second, data may be inconsistent between the interview and the HCFS
 file of the respondent remembered and reported a condition after responding
 to the corresponding question in the interview.  This tended to occur at the
 time the interviewer was recording information on the HHCF chart.  For ex-
 ample, while recording information on a stay for high blood pressure, the
 respondent may add that he/she was also hospitalized at that time for a heart
 condition.  The respondent may not have reported the hospitalization when
 asked about heart conditions in question G-15 and the Section G information
 may not have been updated to reflect this additional condition.  However,
 heart condition would appear on the HCFS file.

       Type B - Conditions which do not have a corresponding question in the
 interview but for which sufficient descriptive information is available to
 allow them to be easily coded:

       02    Gout
       05    Coronary bypass surgery
       06    Procedures for pacemakers
       13    Bone fracture
       14    Pneumonia and influenza
       18    Test and observation
       37    A fall


       Type C - Unknown conditions:

       16    Don't know
       17    Not ascertained


       Type D - Conditions for which there is not a specific question in the
 interview but which can be attributed to disorders of a major body system:

       19    A condition of the digestive/endocrine system not found in the
             detailed conditions of the 1990 series codes (see Type A)
       20    Respiratory conditions other than pneumonia, influenza, chronic
             bronchitis, emphysema or asthma
       24    The male reproductive system
       25    A condition of the musculoskeletal system not found in the
             detailed conditions of the 2500 series codes (see Type A)
       26    The circulatory system (except strokes)
       27    The female reproductive system
       29    A neurologic disorder not found in the detailed conditions of the
             2900 series codes (see Type A)
       31    Blood disorders and bleeding
       32    Skin problem
       3603  Eye problem other than cataracts, detached retina or glaucoma


       Type E - Conditions which are broadly defined or are attributed to
 problems of more than one major body system:

       15    Surgery
       21    Infections
       23    Debility and pain other than headache
       28    Mental illness other than nervous breakdown
       30    Nutrition and dehydration


       Type F - All conditions that cannot be assigned to one of the above
 codes:

       33    Other conditions

       Additional information on reasons for a facility stay is available in
 the abstract section of the record (positions 205-379) if an abstract has
 been matched to the report.  In general, information from the abstract is
 considered a more accurate determination of the conditions associated with
 the stay than are the reported conditions.  The condition codes in the report
 section of stay records do provide useful information in the absence of a
 medical abstract.  Both flexibility and caution should be exercised when
 selecting stays based on these codes.  In order to help the analyst use these
 condition codes effectively, a description of the code assignment procedure
 along with an example is provided.

 Rules for Assignment

       The numeric codes were assigned to the respondent's non-technical
 descriptions by trained medical coders.  In order to minimize variation among
 the coders assigning these codes, precedence rules were defined.  Generally,
 a condition was coded to the most specific category in which it could be
 placed.  The assignment rules are described below in primary order, e.g. Rule
 2 was used only if Rule 1 did not apply and so forth.

 Rule 1:     If a condition was one about which there was a specific question
             in either the subject or proxy interview, the code appropriate
             for that question was assigned.  (Type A conditions)

 Rule 2:     If the textual description could be coded to a narrowly defined
             condition not referenced in the interview or to the unknown
             category, the appropriate Type B or Type C code was assigned.

 Rule 3:     Conditions that could not be coded to a specific question but
             could be coded to a major body system were assigned the
             appropriate Type D code.

 Rule 4:     General descriptions, symptoms and conditions not coded by rules
             1 through 3 were coded at the discretion of the medical coders,
             again with emphasis on as much specificity as possible.  For
             example, "PAIN IN THE KNEES" would be coded to "25 - Debility and
             pain".  (Type D or Type E conditions)

 Rule 5:     Everything that could not be assigned a code after applying the
             above rules was coded to "33 - Other conditions".  (Type F
             conditions)

 Considerations for the Data User
 
      These precedence rules were used for all three followups.  However,
 since the questionnaires used in each followup differed slightly, the
 assignment of codes also differed.  Questions about specific conditions were
 not always included in all three questionnaires.  For example, Question B-63
 in the 1986 interview asked about overnight stays for surgery making condi-
 tion code "15-Surgery" a Type A condition in the 1986 followup.  There is no
 similar question in the 1982-84 or 1987 interview, therefore, surgery is a
 Type E condition in the 1982-84 and the 1987 files.  In other cases, groups
 of conditions are combined into one question on one questionnaire but asked
 separately on another.  For example, T.I.A.'s and other strokes are combined
 in one question in 1987.  Since it was not possible to separate reports of
 T.I.A.'s from other strokes in the 1987 file, there are no conditions assign-
 ed to codes "07" in this file.  There are reports assigned to "07" in the
 1982-84 and 1986 files since separate T.I.A. and stroke questions were asked.
 An attempt was made to include as much detail in the code as possible.

       The questionnaire in the 1982-84 followup included enough detail to
 separate specific digestive conditions, such as colitis and gallbladder
 problems, from the general category of digestive disorders.  Therefore, the
 1982-84 HCFS data file, includes sub-codes under "19 - Digestive/endocrine
 system".  Thus, analysts interested in colitis can identify cases from the
 reported condition section of the 1982-84 file but not from the 1986 or 1987
 files.  However, all files can be used to identify cases of the
 digestive/endocrine system in general.  The analyst should refer to the
 questionnaire and the condition coding structure in the HCFS data tape
 codebook for the period of interest in order to obtain the maximal amount of
 information available.

       In using the condition codes to select records of interest, two
 characteristics of the coding structure should be considered: (1) the
 condition of interest may be found under more than one numeric code and (2)
 each numeric code covers more than one condition.

       To illustrate the first situation, consider a search for all reported
 stays with breast biopsies.  A respondent might report a breast biopsy in
 response to the question relating to cancer and cancer treatment.  In this
 case the textual field would contain a description such as "BIOPSY OF RIGHT
 BREAST" and the numeric code assigned would be 11 (indicating a response to
 the cancer stay question).  Breast biopsies could also be reported in re-
 sponse to the surgery question in the 1986 followup and be assigned the code
 of 15. If the biopsy was reported in response to question G-61 on the 1982-84
 questionnaire, "Have you stayed in a hospital for any other reason...?", it
 would be assigned to code 18 - Tests and observation".  To identify breast
 biopsy cases it would be necessary to search the alphabetic fields for codes
 11, 15 and 18.  In addition, the reports of breast biopsies include several
 wording variations, for example, "BREAST BIOPSY", "BIOPSY OF BREAST".  The
 analysts needs to investigate all possible wordings.

       To illustrate the second situation, consider code 18 - "Tests and
 observation".  Over 250 different verbal descriptions have been coded to this
 category including a variety of radiological procedures, surgeries and
 physical examinations.  Selecting just on code 18 will result in a wide
 variety of procedures.  Those of a specific interest need to be identified by
 the textual description.

       Analysts who wish to use these reports, should print and review all the
 reported condition codes and alphabetic descriptions from the Health Care
 Facility Stay data files.  Such a review will aid in (1) finding all the
 numeric condition codes under which the condition of interest will be found
 and (2) insuring that, within any numeric condition code, only the reports of
 interest will be selected.

       Finally, the condition codes in the report section should be used in
 conjunction with the information in the abstract section if it is available.
 Returned abstracts were matched to reports if one of the reported conditions
 matched one of the discharge diagnoses on the abstract.  Other conditions
 reported for the same stay may or may not be confirmed in the matched medical
 abstract.  If the condition of interest is not indicated as a discharge
 diagnosis on the medical record, the analyst may not want to accept the
 reported condition as a reason for the stay.  Similarly, conditions may be
 listed as discharge diagnoses that do not appear on the report section.  See
 the introduction to this codebook for a description of the match criteria.




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