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Scientific Data Documentation
Epidemiologic Followup Study, 1987 Health Care Facility Stay
DSN: CC37.HANES1FU.FCLTY87


                        NHANES EPIDEMIOLOGIC FOLLOWUP STUDY
                         HEALTH CARE FACILITY STAY  1987

Acknowledgments

 The NHANES I Epidemiologic  Followup  Study  (NHEFS), 1987 Health
 Care  Facility  Stay Public Use tape was prepared  by  Sandra  T.
 Rothwell under the  direction  of Jennifer H. Madans.  Assistance
 was provided by other members of  the NHEFS data management team:
 Joel C. Kleinman, Fanchon F. Finucane, Christine S. Cox, Virginia
 M.  Freid,  Brian  A.  Kissel,  Cynthia  A.  Reuben,  Michael  E.
 Mussolino,  Helen  E. Barbano, Madelyn  A.  Lane,  and  Jacob  J.
 Feldman.  Virginia M.  Freid,  Sandra  T.  Rothwell,  and Dawn M.
 Scott  were in charge of data set management.  La-Tonya  D.  Curl
 and Carole  J.  Hunt  were  in  charge of manuscript preparation.
 Special  thanks  are  extended  to Joan  Cornoni-Huntley  of  the
 National Institute on Aging (NIA) who played an important role in
 the development and continuation  of the NHEFS.  The contribution
 of  Westat,  the  contractor  who collected  the  data  for  this
 longitudinal study, is also gratefully acknowledged.

 The  NHEFS originated as a joint  project  between  the  National
 Center  for Health Statistics (NCHS) and NIA.  It has been funded
 primarily  by  NIA,  with  additional  financial support from the
 following components of the National Institutes  of  Health (NIH)
 and  other  Public  Health Service agencies: the National  Cancer
 Institute; the National  Institute  of  Child  Health  and  Human
 Development;  the  National Heart, Lung, and Blood Institute; the
 National Institute on  Alcohol Abuse and Alcoholism; the National
 Institute of Mental Health;  the  National  Institute of Diabetes
 and  Digestive  and  Kidney Diseases; the National  Institute  of
 Arthritis and Musculoskeletal  and  Skin  Diseases;  the National
 Institute  of Allergy and Infectious Diseases; and, the  National
 Institute of Neurological and Communicative Disorders and Stroke.


Use of NHEFS Data

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

 A.      Any  published  material  derived  from  the  data should
         acknowledge  the  National  Center  for Health Statistics
         (NCHS) as the original source.  It should  also include a
         disclaimer  which  credits any analyses, interpretations,
         or conclusions reached  to  the  author (recipient of 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 1987  NHEFS data.  Please send
         reprints to :

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

      Note:  New address effective May 1990.


Errors in the Data Tapes and Survey Differences

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

 In general, the NHEFS  data  management team has not attempted to
 resolve substantive data discrepancies  that  may exist 1) within
 the  1987  NHEFS  data tapes, or 2) between the 1987  NHEFS  data
 tapes and the data  tapes  of  the  original  National Health and
 Nutrition Examination Survey (NHANES I) and other  NHEFS followup
 waves.


Tape Characteristics

 Title:              1987  NHEFS  Health  Care  Facility Stay Data Tape
 Record Length:      429
 Blocksize:          31746
 Number of Records:  7,361
 Number of Reels:    1
 Recording Mode:     FIXED BLOCK, EBCDIC
 Density:            6250 bpi
 Channel:            9 TRACK
 Created by:         Office of Analysis and Epidemiology
                     Division of Analysis
                     National Center for Health Statistics
                     Presidential Building, Room 1080
                     6525 Belcrest Road
                     Hyattsville, Maryland  20782


Background 1987

 The   NHANES   I  Epidemiologic  Followup  Study  (NHEFS)  is   a
 longitudinal study which uses as its baseline those adult persons
 ages 25 to 74 years  who  were  examined  in  the  first National
 Health  and Nutrition Survey (NHANES I).  The NHEFS is  comprised
 of a series  of  followup  surveys,  three  of  which  have  been
 conducted  to  date.   The  first  wave  of  data collection, the
 1982-84 NHEFS, was conducted from 1982 to 1984  and  included all
 persons  who  were  between  25  and  74 years at their NHANES  I
 examination (n=14,407).  The second wave  of data collection, the
 1986  NHEFS, was conducted for members of the  NHEFS  cohort  who
 were 55-74  years  at their baseline examination and not known to
 be deceased at the 1982-84  NHEFS  (n=3,980).   The third wave of
 data  collection,  the 1987 NHEFS, was conducted for  the  entire
 non-deceased  NHEFS  cohort  (n=11,750).   This  series  of  tape
 documentation describes data collected in the 1987 NHEFS.  A plan
 to re-contact the entire  non-deceased  NHEFS  cohort  in 1991 is
 currently under review.


Methods 

 General Information

 NHANES I collected data from a national probability sample of the
 United  States  civilian  noninstitutionalized population between
 the  ages  of  1 and 74 years.   The  survey,  which  included  a
 standardized medical  examination and questionnaires that covered
 various health-related  topics, took place from 1971 through 1974
 and was augmented by an additional  national  sample  in 1974-75.
 The  NHANES  I  sample included 20,729 persons 25 to 74 years  of
 age, of whom 14,407 (70 percent) completed a medical examination.
 The design, content  and operation of NHANES I has been described
 elsewhere (Vital and Health  Statistics, Series 1, Nos. 10a, 10b,
 and 14).

 Although  NHANES  I  provided  a wealth  of  information  on  the
 prevalence   of  health  conditions   and   risk   factors,   the
 cross-sectional   nature   of  the  original  survey  limits  its
 usefulness for studying the  effects  of clinical, environmental,
 and  behavioral  factors and in tracing the  natural  history  of
 disease.  Therefore,  the  NHEFS  was designed to investigate the
 association between factors measured  at  the  baseline  and  the
 development  of  specific  health conditions.  It originated as a
 joint project between the National  Center  for Health Statistics
 (NCHS)  and  the  National Institute on Aging with  collaboration
 from components of  the  National  Institutes of Health and other
 Public Health Service agencies.  The 14,407 participants who were
 25  to  74  years  of age when they were  examined  in  NHANES  I
 (1971-75) were included in the followup study population.

 In the first wave, the  1982-84 NHEFS, data were collected on all
 14,407 subjects (i.e., individuals  examined  at NHANES I) in the
 cohort.   Tracing of subjects began in 1981 and  data  collection
 was conducted  from  1982  to  1984.   Approximately  93  percent
 (n=13,383)  of  the cohort was successfully traced by the end  of
 the survey period.   Detailed information on the design, content,
 and operation of the 1982-84  NHEFS  may be found in the Plan and
 Operation of the NHANES I Epidemiologic  Followup  Study 1982-84,
 Vital and Health Statistics, Series 1, No. 22.  The  basic design
 of the 1982-84 NHEFS consisted of the following components:

         --   tracing  subjects  or  their  proxies  to  a current
              address;

         --   acquiring death certificates for deceased subjects;

         --   performing in-depth interviews with the subjects  or
              with   their   proxies   including,   for  surviving
              subjects, taking pulse, blood pressure,  and  weight
              measurements of subjects; and,

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

 The  second  wave  of  the  NHEFS,  the  1986  NHEFS,   collected
 information on changes in the health and functional status  since
 the last contact with the older members of the NHEFS cohort.   It
 was  restricted  to those subjects who were at least 55 years old
 at their NHANES I  examination  (n=5,677),  which  is  almost  40
 percent  of  the  entire  NHEFS cohort.  The group includes 1,697
 subjects who were deceased  at  the time of the 1982-84 NHEFS and
 3,980 subjects who were not known  to  be deceased at the time of
 the 1982-84 NHEFS.  Tracing and data collection in the 1986 NHEFS
 was undertaken only for the 3,980 subjects  in  the latter group,
 regardless of their tracing or interview status in  1982-84.  The
 remaining  1,697  subjects who were deceased at the time  of  the
 1982-84 NHEFS were  excluded  from  additional data collection in
 the 1986 NHEFS.  Detailed information on the design, content, and
 operation  of  the  1986  NHEFS  may be found  in  the  Plan  and
 Operation  of  the NHANES I Epidemiologic  Followup  Study  1986,
 Vital and Health Statistics, Series 1, No. 25.

 The  1987  NHEFS,   the   third  wave  of  the  NHEFS,  collected
 information on changes in the health and functional status of the
 NHEFS  cohort since the last  contact.   The  1987  NHEFS  cohort
 includes  2,657  subjects  who  were  deceased at the time of the
 1982-84 and 1986 NHEFS and 11,750 subjects  who were not known to
 be  deceased  prior  to  the  1987 NHEFS data collection  period.
 Tracing and data collection in the 1987 NHEFS was undertaken only
 for the non-deceased subjects,  regardless  of  their  tracing or
 interview status in previous NHEFS surveys.  The 2,657 previously
 deceased  subjects  were excluded from additional data collection
 in the 1987 NHEFS.

 The design and data collection  procedures  adopted  in  the 1987
 NHEFS  were  very  similar  to the ones developed in the previous
 surveys: subjects were traced;  subject and proxy interviews were
 conducted;  and,  health  care  facility   abstracts   and  death
 certificates were collected.  All subjects whose vital status was
 not   obtained   through   tracing   procedures  were  considered
 lost-to-followup in the 1987 NHEFS.  In  some  cases, information
 about the death of a subject was obtained from a former neighbor,
 a relative or another tracing source.  Although  this information
 was  noted  in  the  subject's  tracing  record,  he  or she  was
 considered  lost-to-followup unless the information was  verified
 by means of a  death certificate or proxy interview.  A subject's
 death had to be  confirmed by either a death certificate or proxy
 interview.

 In addition to verifying  the subject's vital status, the tracing
 process also was used to obtain  the current address of 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 telephone interview.   In  a few cases,
 subjects who had been traced successfully could not be  relocated
 for  the  interview.   Only their vital status and the date  when
 they were last traced in the 1987 survey are available.

 A major difference between  the  1982-84 and 1987 NHEFS waves was
 the  manner  in  which the interviews  were  conducted.   In  the
 1982-84  NHEFS,  the   two-hour  subject  interview  usually  was
 conducted in-person while,  in  the  1986  and  1987  NHEFS,  the
 interview was shortened to 30 minutes in length and was conducted
 primarily by telephone.  In addition, since the questionnaire was
 not administered in-person, no physical measurements were made in
 the 1986 or the 1987 NHEFS.

 The 1987 NHEFS interviews were conducted over the telephone using
 a  Computer  Assisted Telephone Interviewing (CATI) system.  CATI
 is a telephone interviewing technique that allows the interviewer
 to enter the answers supplied by the respondent directly into the
 computer.   Thus,   editing   and  coding  time  is  reduced  and
 keypunching  from  a hard copy questionnaire  is  eliminated.   A
 computer program drives  the  questionnaire  so  that the correct
 skip  patterns  are  followed  and the appropriate questions  are
 displayed on the computer monitor.   The  skip patterns are based
 on information gathered from previous data collection waves or on
 responses  provided during the interview.  For  example,  certain
 questions  on   pregnancy  and  menstrual  history  in  the  1987
 interview were programmed  to  be  skipped  automatically  if the
 subject  was  male  or  if  the  female  subject  was interviewed
 previously and was 45 years of age or older at the  time  of that
 interview.  Edit and logic checks are incorporated into the  data
 collection system itself, thus improving the quality of the data.

 As of January 25, 1988, the end of the 1987 NHEFS data collection
 period,  11,018  (93.8 percent) of the 11,750 members of the 1987
 NHEFS  cohort  had been  successfully  traced.   Interviews  were
 conducted for 9,998  subjects (90.7 percent of those successfully
 traced).  In addition, 7,361 facility stay records were collected
 for 3,472 subjects using information obtained from the interview,
 death certificate, or some other source.  Death certificates were
 obtained for 524 (94.4  percent)  of  the  555  subjects who were
 known to have died since last contact.

 The  data  collected  from  the  1987  NHEFS are stored  on  four
 separate tapes:

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

         2)   Interview  tape -- contains the data collected  from
              the 1987 NHEFS subject and proxy interviews,

         3)   Mortality Data  tape   --  contains  data abstracted
              from the death certificates from all three NHEFS surveys,

         4)   Health   Care   Facility   Stay   tape  --  contains
              information  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 tape is described in  detail  in  the
              following pages.

 Stay Reports

 The  1987  NHEFS  Health Care Facility Stay (HCFS) file  contains
 information on all  overnight  health  care  facility  stays  for
 members  of  the  1987 Followup cohort.  The 1987 Followup cohort
 consisted of the 11,750 subjects who were between 25 and 74 years
 old at their NHANES  I  examination  and  were  not  known  to be
 deceased  at the time of the 1986 NHEFS.  Followup cohort members
 who have either  an  interview or a death certificate on the 1987
 NHEFS data files were  eligible  for  the  health  care  facility
 records  component.   The aim of this component was to develop  a
 complete set of health  care facility (i.e., hospital and nursing
 home) records for each 1987  Followup  cohort  member.   This was
 accomplished  by  identifying all facility stays through a series
 of reporting mechanisms.   Facilities  were  contacted  to obtain
 copies of medical records.  Reports and medical records were then
 linked  and  the  1987  NHEFS Health Care Facility Stay file  was
 constructed.  The procedures for obtaining reports and collecting
 abstracts are described briefly, below.

 The  1987  NHEFS Health Care  Facility  Stay  file  contains  all
 information  on  overnight  stays  that are in-scope for the 1987
 NHEFS period.  The in-scope period depends upon the timing of the
 subject's last interview and his/her  vital status.  For subjects
 who have not been interviewed since the  NHANES  I exam, the 1987
 in-scope period is from the date of the NHANES I exam to the date
 of  the 1987 interview for surviving subjects and from  the  exam
 date  to  the  date of death for deceased subjects.  For subjects
 who have had at  least  one  followup interview prior to the 1987
 followup, the in-scope period  is  from  the  date  of  the  last
 interview  (either  1982-84  or  1986)  to  the  date of the 1987
 interview for surviving subjects and from the date  of  the  last
 interview to the date of death for deceased subjects.  Stays that
 were  reported  prior  to  the  in-scope  period  were defined as
 out-of-scope for the 1987 survey.
 Identification of Stay Reports:

 Reports of overnight hospital or nursing home facility  stays  were
 obtained from  various  sources. Most  reports were elicited  through
 a series of detailed  questions  in  sections B of the interview.
 Generally, respondents were asked to report all overnight facility stays
 since 1985 if the subject was last interviewed in the 1986 NHEFS, since
 1980 if the subject was last interviewed in the 1982-84 NHEFS, or since
 1970 if the subject was last interviewed at NHANES I examination. In
 addition to interview information, data on facility stays were gathered
 from other reporting sources: from the death certificate, tracing
 sources, and other hospital abstracts. At the conclusion of the interview,
 authorization was obtained for permission to contact facilities.

 Facility Data Collection

 For each stay reported during the interview, the name and address of the
 facility, the reported dates of the stay, and the reason for the stay were
 recorded on the hospital and health care facility chart (HHCF). A separate
 log book was kept containing similar data for reports gathered from the
 death certificates, tracing sources, and other hospital abstracts. All
 reports of facility stays were compiled & entered into a computerized
 tracking system. All reported facilities were contacted by mail and asked
 to review the subject's medical records & to abstract information on exact
 dates of admission, discharge & diagnoses onto standard abstract forms. In
 addition to completing abstract forms, facilities were requested to submit
 photocopies of selected sections of the subject's inpatient record i.e.,
 the "facesheet", the discharge summary, the third day EKG (for myocardial
 infarction diagnoses, 410 in the International Classification of Diseases,
 9th Revision, Clinical Modification (ICD-9-CM)) and of pathology reports
 (for any admission where a new malignancy was diagnosed).

 Matching Records

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

 Each record on the file represents an overnight facility stay. Therefore,
 one or more records will exist for some 1987 Followup cohort subjects, while
 other subjects will have no records on the file. The structure of the data
 file reflects the system used to obtain and process stay information. The
 record is divided into four major sections: 1) the report section, 2) the
 record status section, 3) the abstract section and, 4) the related stay
 section. An example of the record layout is provided in figure 1.

 The subject identification number (i.e. the sample sequence number) is in
 positions 1-5 on each record. This number is unique for each subject and is
 used when linking the Health Care Facility Stay tape to all other NHEFS and
 NHANES I Public Use Data Tapes. The total number of records per subject is
 found in positions 6-7 on the file.  The first section of the record is the
 report section (positions 29-59 and 63-204) which contains information from
 the reporting source as well as stay identification numbers assigned by NCHS.
 Each stay entered into the report section is assigned a health care facility
 stay id number (positions 29-33). When used in conjunction with the sample
 sequence number, this number uniquely identifies each record on the file.
 The reported date of admission is found in positions 47-54. This date is
 used in conjunction with the last interview date to determine whether
 reported stays were in-scope for the NHEFS 1987 survey (position 199)

 The record status section (positions 60-62) contains a code for the result of
 the abstract request, i.e. match or non-match status. If a facility returned
 an abstract that matched a report then a record status code of MAT (match)
 was applied. A returned abstract that did not match a report but was
 in-scope for the 1987 survey period was assigned the record status code of
 ASF (additional stay found). A record status code of CRM (cross-referenced
 match) was applied to a stay that was the continuation of a stay begun
 prior to the 1987 NHEFS survey period. If an abstract was not returned,
 the appropriate non-match code was assigned.

 The abstract section (positions  205-379) contains the information obtained
 from the facility records including actual dates of admission, discharge
 & diagnoses. The diagnoses on the abstracts were coded using the ICD-9-CM
 according to the medical coding specifications detailed in the following
 section of this codebook. The abstract section is similar to the original
 1982-84 NHEFS Health Care Facility record file released in August 1987. The
 other three sections were added when the 1986 version of the Health Care
 Facility Stay file was designed. A revised 1982-84 HCFS data tape which is
 structured in the same format as the 1986 and 1987 HCFS tapes has also
 been released.

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

 Due to the procedures we instituted for maximizing the collection of reports
 of hospital or nursing home stays, i.e., deliberately requesting out-of-scope
 report information, it was necessary to devise  rules  for  removing  the
 "correctly reported" out-of-scope reports from the final version of the file.
 This was only possible after the facilities returned abstract information to
 us. Reports of stays with a reported  date of admission more than one year
 prior to the last interview in health care facilities which had  not  been
 contacted previously were flagged with a Type D in position 199.  If an
 in-scope abstract was received from the facility it was added onto the file
 with a record status code of ASF, & the Type D report was deleted from the
 final version of the file.  If the facility responded to the request for
 information but no in-scope abstracts were received from the facility, the
 Type D report was deleted from the file based on the presumption that the
 date had been correctly reported & the stay was out-of-scope. In 12 cases,
 the Type D reports remain on the final version of the file. This occurred
 when it was impossible to contact the facility. These records for un-
 confirmed reports of out-of-scope stays can be eliminated from analyses
 at the analysts' discretion. A Type C flag was assigned in position 199 when
 a reported date of admission was within one year of the previous interview.
 If an in-scope abstract was returned which matched the Type C report, it
 was assigned a record status code of MAT (n=142). (The matching rules
 permitted an admission date of up to one year before or after the reported
 date of admission). If the facility responded but no in-scope abstracts
 were received the Type C reports were removed from the file again on the
 assumption that the correct date had been reported and the stay was truly
 out-of-scope. There are 15 non-matched Type C cases remaining on the file.
 In seven of these cases it was not possible to contact the facility (non-
 match code of FNC in positions 60-62); in five cases the subject did not
 provide authorization to write the facility (ANO in positions 60-62); two
 cases were facility non-response (ONR): & in one case the facility refused
 to send an abstract (REF). 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, the related stay codes (positions 380-429),
 are used to identify stays which are contained within other stays. This
 occurred most often when nursing home residents had a brief hospital stay
 but returned to the nursing home. A detailed example of the related stay
 section is presented below. In panel A, a chronologic history of a subject's
 hospital and nursing home stays is presented in order to facilitate the
 discussion of the related stay codes. This subject was admitted to the
 nursing home on March 1, 1985, and discharged to the hospital on April 1,
 1985. He returned to the original nursing home on April 8 and stayed until
 April 22 when he required readmission to the hospital. He returned from the
 hospital to the nursing home on April 25, 1985 where he remained until
 April 30, 1985.

 Panel A:  Chronologic profile of hospital and nursing home stays

 Location          Admission      Discharge

 Nursing home      03/01/85       04/01/85
 Hospital          04/01/85       04/08/85
 Nursing home      04/08/85       04/22/85
 Hospital          04/22/85       04/25/85
 Nursing home      04/25/85       04/30/85

 Panel B

 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 demon-
 strate 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

 30201   N. Home       03/01/85  04/30/85   30101     30102
 30101   Hosp          04/01/85  04/08/85   30201
 30102   Hosp          04/22/85  04/25/85   30201


Coding Procedures and Guide to Tape Layout

 Medical Coding Specifications

 Medical coding for the NHEFS 1987 data tape was based on the International
 Classification of Diseases-9th  Revision-Clinical Modification (ICD-9-CM).
 The  health  care  facility  was  asked  to  abstract  all  diagnoses  and
 procedures onto a special form.  In  most  cases,  a  copy of the hospital
 discharge  summary and/or medical records facesheet was  attached  to  the
 abstract.  The diagnoses and procedures listed on the discharge summary or
 facesheet were  then  compared  with  those provided on the abstract form.
 In most instances, discrepancies were resolved  by coding the diagnoses or
 procedures as provided on the discharge summary or the facesheet.

 All  diagnoses  were coded to the highest level of  specificity  possible.
 The fourth-digit  subcategory  for  diagnosis and procedure codes was used
 whenever  possible.   The  fifth-digit subclassification  of  disease  for
 diagnosis codes was also used  when  appropriate.   A three-digit ICD code
 was used only if it could not be further subdivided.   The following rules
 were used to code diagnoses and procedures.
4Rules Governing Medical Coding of Diagnoses

 All medical diagnoses listed on the health care facility  abstract form or
 the  discharge summary are coded in the order in which the diagnoses  were
 listed.   The principal diagnosis is the condition established after study
 to be chiefly  responsible for occasioning the admission of the patient to
 the health care  facility.   The  admitting  diagnosis  is not used as the
 principal diagnosis unless the admitting and discharge diagnoses  are  the
 same.
          Ex:  Patient admitted with a diagnosis of bronchopneumonia. After
          workup  and  treatment,  x-ray  findings,  etc.,  the patient was
          discharged  with  a  final  diagnosis  of  bronchopneumonia.  The
          principal diagnosis is coded 485 for bronchopneumonia.

 Note that the facility was asked to select the principal  diagnosis and no
 review of the records was made to determine if the correct  diagnosis  was
 selected.

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

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

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

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

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

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

 Hospital acquired infections, such as a "staph"  infection,  if documented
 on the facesheet and/or discharge summary are coded.  Documentation may be
 in the form of a note by the infections committee, stamped notation,  or a
 checkmark, depending on the record format.

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

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

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

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

          Old  myocardial  infarction   (more   than  8  weeks  since  last
          occurrence)

          Status post bypass surgery

          Malignant neoplasm (cancer in remission or under treatment)

          Old cerebrovascular accident

          Sterilization

          Normal pregnancy undelivered

          Manipulation of an IUD

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

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

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

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


     2.   When a symptom is listed that is unrelated to any of the
          diagnoses listed, the symptom is coded.

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


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

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

 Rules Governing Medical Codes for Procedures

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

 The principal procedure is the primary procedure most related to the
 principal diagnosis and is performed for definitive treatment as opposed
 to diagnostic and/or exploratory purposes.

          Ex:  Diagnosis  = uterine fibroids.
               Procedures = biopsy of uterus, total abdominal
                            hysterectomy, 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 other listed diagnoses)

          Surgical procedures

          Cardiac catheterizations

          D and C (following delivery or abortion only)

 The following procedures are not coded:

          Surgical approach

          Operative cholangiogram

          Lumbar puncture

          CT scan

          Endoscopy

          Diagnostic D and C

          Diagnostic radiology
          Examination (under anesthesia, physical exam, etc.)

          Manipulations

          Physical therapy

          Application or removal of casts, splints, etc.

Medical Coding Conventions

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

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

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

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

             Ex. 1:  _ 4 2 2 9 0    Code is 422.90
             Ex. 2:  _ V 7 1 1 _    Code is V71.1
             Ex. 3:  _ 4 3 6 _ _    Code is 436
             Ex. 4:  P 1 8 0 0 _    Code is P180.0
             Ex. 5:  R 1 7 4 9 _    Code is R174.9

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

               Ex. 1:  E 9 0 6 1      Code is E906.1
               Ex. 2:  E 8 5 1 _      Code is E851

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

               Ex. 1:  4 2 9 2      Code is 42.92
               Ex. 2:  0 3 1 _      Code is 03.1


RECORD LAYOUT

 Tape
 Position    Frequencies    Variable Description and Codes

                            SUBJECT INFORMATION

 1-5         7361           NHANES I Sample Sequence Number

 6-7                        Record Count

             7361           01-26 = Total number of records

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

 8-28        7361           Blank

 Tape Positions 29-46

 Tape
 Position    Frequencies    Variable Description and Codes

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

                   Note:  The report section of the record (positions
                   29-59  and  63-204) contains  the  information  on
                   health care facility  stays  that  was reported on
                   the  questionnaire,  on  a  death certificate,  on
                   another hospital/nursing home  abstract  form,  or
                   obtained from other sources.
 (29-33)           Health Care Facility Stay ID Number

                   Note:   When  used  in conjunction with the sample
                   sequence number this  number  uniquely  identifies
                   each record on the tape.  It is composed  of three
                   variables:   Survey  Period  Identifier,  Facility
                   Number  and  Stay  Number  Within  Facility.   For
                   example:  a  Stay  Number  of  30102  refers  to a
                   facility  stay reported during the NHEFS 1987 wave
                   (3)  in  the  first  facility  reported  for  that
                   subject (01)  but  the  second  admission  to that
                   facility (02).

 29                         Survey Period Identifier

             7361           3 = NHEFS 1987

                   Note:   This variable identifies the survey period
                   in which the stay data were collected.  A facility
                   stay reported  during  the NHEFS 1987 wave will be
                   identified with a code number "3".  All records on
                   this file are coded "3" in this field.

 30-31                      Facility Number

             7361           01-11-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

             7349           01-23 =   Stay number
               12           00 = D stay record

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

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

 34-35                      Facility ID Prefix

             6845           01 = Hospital
             405            02 = Nursing home
             111            03 = Out of country, don't know, not ascertained

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

 36-46       7361           Blank

 Tape
 Position    Frequencies    Variable Description and Codes

 (47-54)                    Reported Admission Date/Range

                   The date of admission to a facility is reported by
                   month, day and year.  A range of years  was  coded
                   when the respondent was unable to recall the exact
                   year of admission.  When the year of admission was
                   reported  as  a  range,  the beginning year of the
                   range is found in positions  51-52  and the ending
                   year  of  the  range is found in positions  53-54.
                   Except  for type  D  (position  199)  records  the
                   reported  date  of  admission  is  present for all
                   source  code  2 and 4 records (see position  200),
                   and CRM and CRX records (positions 60-62).

 47-48                      Reported Month of Admission

             4457           01-12 = Month of admission
             1321              98 = Don't know
               80              99 = Not ascertained

             1503           Blank =

                            Type D  (position 199), record status code
                            ASF (positions  60-62), source code 1 or 3
                            (position  200)  and  record  status  code
                            (positions 60-62)  not  a cross-referenced
                                 stay (CRM, CRX)

 49-50                      Reported Day of Admission

             2572           01-31 = Day of admission
             3201              98 = Don't know
               85              99 = Not ascertained

             1503           Blank =

                            Type D (position 199), record  status code
                            ASF (positions 60-62), source code  1 or 3
                            (position  200)  and  record  status  code
                            (positions  60-62)  not a cross-referenced
                            stay (CRM, CRX)

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

             5465           70-87 = Year of admission or beginning year
                                    of range (1970-1987)

              375              98 = Don't know
               18              99 = Not ascertained
             1503

                            Blank = Type  D (position 199), or record  status
                                    code SF (positions 60-62), or source code
                                    (position  200)  1  or 3 and record status
                                    code (positions 60-62) not a
                                    cross-referenced stay (CRM, CRX)

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

              183           73-87 = Ending year of range (1973-1987)
             7178           Blank = No range given for reported year of
                                    admission, type D (position 199), or
                                    record status code ASF (positions 60-62),
                                    or source code (position 200) 1 or 3 and
                                    record status code (positions 60-62) not a
                                    cross-referenced stay (CRM, CRX)

 Tape
 Position    Frequencies    Variable Description and Codes

 (55-59)                    ID Number of Cross Referenced Facility Status
                            Stay

                   Note:  The ID number on the 1982-84  or 1986 NHEFS
                   Facility   Tape  (positions  29-33)  is  used   to
                   reference stays in a hospital or nursing home that
                   began during  the 1982-84 or 1986 NHEFS period and
                   which continue  into the 1987 survey period.  This
                   variable is coded  only  for records with a CRM or
                   CRX in positions 60-62 on the 1987 file.

 55                         Survey Period Identifier of Cross-referenced
                            Facility Stay

               23           1 = NHEFS 1982-84
              181           2 = NHEFS 1986
             7157           Blank = Stay not cross-referenced

 56-57                      Facility Number of Cross-referenced Stay

              204           01-04 = Stay number

             7157           Blank = Stay not cross-referenced

 58-59                      Stay Number Within Facility of Cross-
                            reference Stay

              204           00-14 = Stay number

             7157           Blank = Stay not cross-referenced

                            RECORD STATUS

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

 60-62                      Record Status Code

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

             7361           ANO - XRD = Record status code

 Tape
 Position    Frequencies    Variable Description and Codes

 (63-198)                   Reported Conditions and Codes

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

                            A numeric code was assigned to each text
                            description to aid the researcher in the use of
                            this  information  (see  positions  63-64,  97-98,
                            131-132, 165-166).  These variables should be used
                            in conjunction  with  information in the abstract
                            section, i.e, ICD-9-CM diagnosis codes, present on
                            records with a record status  code  of MAT, ASF or
                            CRM.  Appendix B contains a complete  description
                            of these  fields  along  with guidelines for their
                            use.

 (63-96)                    First Reported Condition

 63-66                      Condition Code

             5717           01-37 = Condition code (See Appendix B)
             1644           Blank = Source Code equal  to  2  or  3  or D stay
                                    record or Record Status Code ASF or source
                                    code equal to 1 and record status code not
                                    CRM.

 67-96                      Condition Text

             5717           Description of reason for facility stay
             1644           Blank =  Source Code equal to 2 or 3 or D stay
                                     record or Record Status Code ASF or
                                     source code equal to 1 and record
                                     status code not CRM.

 Tape
 Position    Frequencies    Variable Description and Codes

 (97-130)                   Second Reported Condition

 97-100                     Condition Code

             1096           01-37 = Condition code (See Appendix B)
             6265           Blank = Source Code equal to 2 or 3 or D stay
                            record or Record Status Code ASF or source
                            code equal to 1 and record status code not
                            CRM or only one condition reported

 101-130                    Condition Text

             1096           Description of reason for facility stay
             6265           Blank = Source Code equal to 2 or 3 or D stay
                            record or Record Status Code ASF or source
                            code equal to 1 and record status code not
                            CRM or only one condition reported

 Tape
 Position    Frequencies    Variable Description and Codes

 (131-164)                  Third Reported Condition

 131-134                    Condition Code

              217           01-37 = Condition code (See Appendix B)
             7144           Blank = Source Code equal to 2 or 3 or D stay
                            record or Record Status Code ASF or source
                            code equal to 1 and record status code not
                            CRM or less than three conditions reported

 135-164                    Condition Text

              217           Description of reason for facility stay
             7144           Blank =  Source Code equal to 2 or 3 or D stay
                            record or Record Status Code ASF or source
                            code equal to 1 and record status code not
                            CRM or less than three conditions reported

 Tape
 Position    Frequencies    Variable Description and Codes

 (165-198)                  Fourth Reported Condition

 165-168                    Condition Code

               30           01-37 = Condition code (See Appendix B)
             7331           Blank = Source Code equal to 2 or 3 or D stay
                            record or Record Status Code ASF or source
                            code equal to 1 and record status code not
                            CRM or less than four conditions reported

 169-198                    Condition Text

               30           Description of reason for facility stay
             7331           Blank = Source Code equal to 2 or 3 or D stay
                            record or Record Status Code ASF or source
                            code equal to 1 and record status code not
                            CRM or less than four conditions reported

 199                        Type of Stay Flag

              157      C =     A reported stay with admission date  up to one
                               year prior to the date of last interview (i.e.
                               the  NHEFS  1982-84 or 1986 if interviewed  at
                               either  followup   or   date   of   NHANES   I
                               Examination if not interviewed since exam.

               12      D =     A reprted stay with admission date more than
                               one year prior to date of last interview and
                               the   facility    had   not   been   contacted
                               previously.  If there  were  multiple reported
                               stays in the same facility that  were all type
                               D (more than one year prior to last interview)
                               these stays were consolidated into  one  entry
                               in   the  tracking  system.   If  an  in-scope
                               abstract  was received in response to a type D
                               report, the  abstract  was  never matched, but
                               assigned   a   record  status  code   of   ASF
                               (positions 60-62).  The type D report was then
                               removed from the  file.  The 12 type D reports
                               remaining   on   the  final   file   are   all
                               non-responses from  the facility and thus were
                               not able to be resolved.

   7192            Blank =     In-scope stay; a reported  date  of  admission
                               after the last interview date.  This field  is
                               also blank for record status codes of ASF, CRM
                               or CRX (positions 60-62).

                   Note:   This   variable   identifies  reported
                   facility stays as in-scope or out-of-scope for
                   the  NHEFS  1987  interview period.   Reported
                   dates of admission  of  don't know (989898) or
                   not ascertained (999999)  in  positios  47-52
                   were considered in-scope.

 200                        Source of Report of Stay that Initiated
                            Request for Abstract

               46               1 =     Information from death certificate
              126               2 =     Information from hospital abstract
                                        report
               49               3 =     Information from other source
             5728               4 =     Information from NHEFS 1987 interview
             1412           Blank =     Not  a requested  stay.   Additional
                                        stay information obtained from
                                        facility (record status code ASF
                                        positions 60-62).  ASF may also be
                                        coded as source code 3.

 201-204     7361           Blank

                            ABSTRACT DATA

                   Note:  The abstract  data  portion  of  the record
                   (positions 205-380) contains information  obtained
                   from  an  abstract  form returned by the facility.
                   This  section  of  the  stay   record   (excluding
                   positions  207-208)  will be blank when a facility
                   did  not  return  an  abstract  form  for  a  stay
                   (n=1597).

 205-206                    Abstract Number

             5764           01-26 = Number of abstract
             1597           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

   7361                     00-26 = 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

             5431               1 = Hospital
              333               2 = Nursing home
             1597           Blank = Stay reported, no abstract form
                                    received

 Tape
 Position    Frequencies    Variable Description and Codes

 (210-215)                  Date of Admission

 210-211                    Month of Admission

             5764           01-12 = Month of admission
             1597           Blank = Stay reported, no abstract form received

 212-213                    Day of Admission

             5764           01-31 = Day of admission
             1597           Blank = Stay reported, no abstract form received

 214-215                    Year of Admission

             5764           71-87 = Year of admission (1971-1987)
             1597           Blank = Stay reported, no abstract form received

 Tape
 Position    Frequencies    Variable Description and Codes

 (216-221)                  Date of Discharge

                   Note:  When a subject  had  a  brief  break  in  a
                   nursing  home  stay  not due to a hospitalization,
                   the nursing home stays were combined into one long
                   stay with the latest discharge  date  assigned  to
                   the stay.  The information contained in the report
                   and  abstract  sections  of  the  stay is from the
                   earliest abstract.  For example:  subject A was in
                   a  nursing  home  from 10-31-86 to 12-22-86.   The
                   subject was readmitted  to  the  same nursing home
                   1-3-87  and stayed until their death  3-5-87.   No
                   information  is  available for 12-22-86 to 1-3-87.
                   These 2 stays would  appear  on the file as 1 stay
                   from 10-31-86 to 3-5-87.  Length  of stay would be
                   calculated  on  the  entire  stay  (see  positions
                   222-225).   If the break in the nursing  home  was
                   due  to  an  interspersed   hospitalization,   the
                   nursing  homes  stays  were collasped as described
                   above and a code was entered  in  the related stay
                   section (see positions 380-429).


 216-217                    Month of Discharge

             5565           01-12 = Month of discharge
              199              97 = Inapplicable (still at facility on
                                    date of 1987 interview)
             1597           Blank = Stay reported, no abstract form
                                    received

 218-219                    Day of Discharge

             5565           01-31 = Day of discharge
              199              97 = Inapplicable (still at facility on
                                    date of 1987 interview)
             1597           Blank = Stay reported, no abstract form
                                    received

 220-221                    Year of Discharge

             5565           72-87 = Year of discharge (1972-1986)
              199             97  = Inapplicable (still at facility on
                                    date of 1987 interview)
             1597           Blank = Stay reported, no abstract form
                                    received

 Tape
 Position    Frequencies    Variable Description and Codes

 222-225                    Length of Record Stay

               17           0000      = Died on day of admission
             5548           0001-2564 = Total number of days in facility
              199           9997      = Inapplicable (still at  facility
                                        on date of 1987 interview)
             1597           Blank     = Stay reported, no abstract form
                                        received

                   Note:  Length of stay is calculated by subtracting
                   the date of admission  from the date of discharge.
                   For subjects with nursing home stays, brief breaks
                   were collapsed into one  continuous  nursing  home
                   stay   (see positions 216-221).  For subjects with
                   information  coded  in  the  related stays section
                   (see  positions  380-429)  length   of  stay  will
                   include time spent in other facilities.

 226                     Was the Patient in Cardiac Intensive Care
                         Unit?

              485              1 = Yes
             4575              2 = No
              333              7 = Inapplicable (facility is a nursing
                                   home)
              371              9 = Not ascertained
             1597          Blank = Stay reported, no abstract form
                                   received

 227-229                    Number of Days in Cardiac Intensive Care Unit

              445           000-070 = Number of days
             5279               997 = Inapplicable (position 226 = 2,7,9)
               40               999 = Not ascertained
             1597             Blank = Stay reported, no abstract form
                                      received

                   Note:  A length of  stay of 0 days occurred when a
                   subject was admitted  to  the facility and died on
                   the day of admission.

 230                        Was the Patient In Other Intensive Care Unit?

              381               1 = Yes
             4359               2 = No
              333               7 = Inapplicable (facility is a nursing
                                    home)
              691               9 = Not ascertained
             1597           Blank = Stay reported, no abstract form
                                    received

 231-233                    Number of Days in Other Intensive Care Unit

              364           000-066 = Number of days
             5383               997 = Inapplicable (Position 230 = 2,7,9)
               17               999 = Not ascertained
   1597                       Blank = Stay reported, no abstract form
                                      received

                   Note:  A length of stay  of 0 days occurred when a
                   subject was admitted to the  facility  and died on
                   the day of admission.

 234                        Patient Admitted to Nursing Home From:

              113               1 = Private residence
              160               2 = Acute care hospital
               12               3 = Chronic disease hospital
               46               4 = Other nursing home
             5431               7 = Inapplicable (facility is a hospital)
                2               9 = Not ascertained
             1597           Blank = Stay reported, no abstract form
                                    received

 235                        Disposition of Hospital Patient

             4623               1 = Routine discharge/discharged home
               27               2 = Left against medical advice
              427               3 = Discharged/transferred to another
                                    facility or organization
              119               4 = Discharged/referred to organized home
                                    care service
              212               5 = Died
               12               6 = Not discharged/still in hospital on
                                    the date of 1987 interview
              333               7 = Inapplicable (facility is a nursing
                                    home)
               11               9 = Subject discharged, disposition not
                                    ascertained
             1597           Blank = Stay reported, no abstract form
                                    received

 236                        Disposition of Nursing Home Patient

              187               1 = Not discharged/still in a nursing home on
                                    date of 1987 interview
               16               2 = Discharged to private residence/referral
                                    to organized home care services
               72               3 = Died
               26               4 = Discharged to private residence/no
                                    referral
               32               5 = Transferred to another facility
             5431               7 = Inapplicable (facility is a hospital)
             1597           Blank = Stay reported, no abstract form received

 237                        Transferred to Another Health Care Facility

               22               1 = Acute care hospital
                6               2 = Other nursing home
                3               3 = Chronic disease hospital
                1               4 = Other
             5732               7 = Inapplicable (Position 236 = 1,2,3,4 or 7)
             1597           Blank = Stay reported, no abstract form received

 Tape
 Position    Frequencies    Variable Description and Codes

 238-239                    Number of Diagnoses

             5763           01-22 = Number of diagnoses
                1              99 = Not ascertained
             1597           Blank = Stay reported, no abstract form received

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

 240-245                    Principal Diagnosis

             5763           ICD-9-CM Code
                1           999999= Not ascertained
             1597           Blank = Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 246-250                    Principal Diagnosis E Code

              463           ICD-9-CM Code
             6898           Blank =  Stay  reported,  no abstract
                            form received or principal diagnosis
                            does not require E code

                   Note:  See medical coding specifications.

 251-256                    Second Diagnosis

             4577           ICD-9-CM Code
             1187           999997 = Inapplicable (only one diagnosis coded)
             1597           Blank = Stay reported, no abstract form received

                   Note:   See medical coding specifications.

 257-261                    Second Diagnosis E Code

              131           ICD-9-CM Code
             1187           99997 = Inapplicable (only one diagnosis coded)
             6043           Blank = Stay reported, no abstract form received
                            or second diagnosis does not require E code

                   Note:  See medical coding specifications.

 262-267                    Third Diagnosis

             3374           ICD-9-CM Code
             2390           999997 = Inapplicable (less than three
                            diagnoses coded)

             1597           Blank = Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 268-272                    Third Diagnosis E Code

               88           ICD-9-CM Code
             2390           99997  =  Inapplicable (less than three
                            diagnoses coded)
             4883           Blank =  Stay reported, no abstract form
                            received or third diagnosis does not require
                            E code

                   Note:  See medical coding specifications.

 273-278                    Fourth Diagnosis

             2333           ICD-9-CM Code
             3431           999997 = Inapplicable (less than four
                            diagnoses coded)
             1597           Blank = Stay reported, no abstract form
                            received

                   Note:  See medical coding specifications.

 279-283                    Fourth Diagnosis E Code

               70           ICD-9-CM Code
             3431           99997 =  Inapplicable (less than four
                            diagnoses coded)
             3860           Blank =  Stay reported, no abstract form
                            received or fourth diagnosis does not
                            require E code

                   Note:  See medical coding specifications.

 284-289                    Fifth Diagnosis

             1526           ICD-9-CM Code
             4238           999997 =  Inapplicable (less  than  five
                            diagnoses coded)
             1597           Blank = Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 290-294                    Fifth Diagnosis E Code

               28           ICD-9-CM Code
             4238           99997 =  Inapplicable  (less  than  five
                            diagnoses coded)
             3095           Blank =  Stay  reported,  no abstract form
                            received or fifth diagnosis does not require E code

                   Note:  See medical coding specifications.

 295-300                    Sixth Diagnosis

              965           ICD-9-CM Code
             4799           999997 = Inapplicable  (less  than  six
                            diagnoses coded)
             1597           Blank = Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 301-305                    Sixth Diagnosis E Code
               29           ICD-9-CM Code

             4799           99997 =  Inapplicable  (less   than  six
                            diagnoses coded)
             2533           Blank =  Stay reported, no abstract  form
                            received or sixth diagnosis does not require
                            E code

                   Note:  See medical coding specifications.

 306-311                    Seventh Diagnosis

              597           ICD-9-CM Code
             5167           999997 = Inapplicable  (less  than seven
                            diagnoses coded)
             1597           Blank = Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 312-316                    Seventh Diagnosis E Code

               17           ICD-9-CM Code
             5167           99997 = Inapplicable  (less than seven
                            diagnoses coded)
             2177           Blank =  Stay reported,  no  abstract form
                            received or seventh diagnosis does not require
                            E code

                   Note:  See medical coding specifications.

 317-322                    Eighth Diagnosis

              376           ICD-9-CM Code
             5388           999997 =  Inapplicable (less than  eight
                            diagnoses coded)
             1597           Blank = Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 323-327                    Eighth Diagnosis E Code

                6           ICD-9-CM Code
             5388           99997 =  Inapplicable  (less  than  eight
                            diagnoses coded)
             1967           Blank =  Stay  reported, no abstract form
                            received or eighth diagnosis does not require
                            E code

                   Note:  See medical coding specifications.

 328-333                    Ninth Diagnosis

              238           ICD-9-CM Code
             5526           999997 =  Inapplicable  (less  than
                            nine diagnoses coded)
             1597           Blank = Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 334-338                    Ninth Diagnosis E Code

                 7          ICD-9-CM Code
              5526          99997 =  Inapplicable  (less  than  nine
                            diagnoses coded)
              1828          Blank =  Stay  reported, no abstract form
                            received or ninth diagnosis does not require
                            E code

                   Note:  See medical coding specifications

 339-344                    Tenth Diagnosis

              161           ICD-9-CM Code
             5603           999997 =  Inapplicable  (less  than  ten
                            diagnoses coded)
             1597           Blank = Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 345-349                    Tenth Diagnosis E Code

                8           ICD-9-CM Code
             5603           99997 =  Inapplicable   (less  than  ten
                            diagnoses coded)
             1750           Blank =  Stay reported, no abstract form
                            received or tenth diagnosis does not require
                            E code

                   Note:  See medical coding specifications.

 Tape
 Position    Frequencies    Variable Description and Codes

 350-351                    Number of Procedures

             5431           00-08 = Number of procedures
              333              97 = Inapplicable (facility is a nursing
                                    home)
             1597           Blank = Stay reported, no abstract form received

                   Note:   This variable identifies the total  number
                   of procedures coded on the facility abstract.  The
                   number of  reported procedures from a hospital may
                   exceed the maximum  number  of  five coded on this
                   data tape.

 352-355                    First Procedure

             2239           ICD-9-CM Code
             3525           9997 = Inapplicable (facility is  a  nursing
                            home or no procedures coded)
             1597           Blank =  Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 356-359                    Second Procedure

              950           ICD-9-CM Code
             4814           9997  =  Inapplicable  (facility is a nursing
                            home or only one procedure coded)
             1597           Blank =   Stay reported, no abstract form
                            received

                   Note:  See medical coding specifications.

 360-363                    Third Procedure

              354           ICD-9-CM Code
             5410           9997 = Inapplicable (facility  is  a nursing home
                            or less than three procedures coded)
             1597           Blank = Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 364-367                    Fourth Procedure

              119           ICD-9-CM Code
             5645           9997 = Inapplicable  (facility is a nursing  home
                            or less than four procedures coded)
             1597           Blank = Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 368-371                    Fifth Procedure

               31           ICD-9-CM Code
             5733           9997  = Inapplicable (facility is a nursing
                                    home or less than five procedures
                                    coded)
             1597           Blank = Stay reported, no abstract form received

                   Note:  See medical coding specifications.

 (372-373)                  Presence of Documents

 372                        Pathology Report

              190               1 = Required and present
               76               2 = Required and not present
             5165               6 = Not required
              333               7 = Inapplicable (facility is a nursing home)
             1597           Blank = Stay reported, no abstract form received

 373                        Third Day EKG Report

              142               1 = Required and present
               40               2 = Required and not present
             5249               6 = Not required
              333               7 = Inapplcable (facility is a nursing home)
             1597           Blank = Stay reported, no abstract form received

 374-379     7361           Blank

 Tape
 Position    Frequencies    Variable Description and Codes

 (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 occurred
                   during the nursing  home  stay.   Up to 10 related
                   stays can be listed.

                   In  the  case  of  hospital records, this  set  of
                   variables identifies  the nursing home stay within
                   which  the  hospital  stay   occurred.   Only  one
                   related stay is identified for hospital records.

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

                   An example of the usage of the related stay section is
                   found in the introduction to this codebook.

 (380-429)                  ID Number(s) of Related Stay(s)

 (380-384)                  ID of First Related Stay

 380                        Survey Period Identifier

              238               3 = NHEFS 1987
             7123           Blank = No related stays

 381-382                    Facility Number

              238           01-10 = Hospital/nursing home number
             7123           Blank = No related stays

 383-384                    Stay Number Within Facility

              238           01-09 = Stay number
             7123           Blank = No related stays

 (385-389)                  ID of Second Related Stay

 385                        Survey Period Identifier

               34               3 = NHEFS 1987
             7327           Blank = No second related stay

 386-387                    Facility Number

               34           01-04 = Hospital/nursing home number
             7327           Blank = No second related stay

 388-389                    Stay Number Within Facility

               34           01-11 = Stay number
             7327           Blank = No second related stay

 (390-394)                  ID of Third Related Stay

 390                        Survey Period Identifier

               19               3 = NHEFS 1987
             7342           Blank = No third related stay

 391-392                    Facility Number

               19           01-04 = Hospital/nursing home number
             7342           Blank = No third related stay

 393-394                    Stay Number Within Facility

               19           01-12 = Stay number
             7342           Blank = No third related stay

 (395-399)                  ID of Fourth Related Stay

 395                        Survey Period Identifier

                8               3 = NHEFS 1987
             7353           Blank = No fourth related stay

 396-397                    Facility Number

                8           01-04 = Hospital/nursing home number
             7353           Blank = No fourth related stay

 398-399                    Stay Number Within Facility

                8           02-06 = Stay number
             7353           Blank = No fourth related stay

 (400-404)                  ID of Fifth Related Stay

 400                        Survey Period Identifier

                4               3 = NHEFS 1987
             7357           Blank = No fifth related stay

 401-402                    Facility Number

                4           02-03 = Hospital/nursing home number
             7357           Blank = No fifth related stay

 403-404                    Stay Number Within Facility

                4           01-03 = Stay number
             7357           Blank = No fifth related stay

 (405-409)                  ID of Sixth Related Stay

 405                        Survey Period Identifier

                2               3 = NHEFS 1987
             7359           Blank = No sixth related stay

 406-407                    Facility Number

                2           02-03 = Hospital/nursing home number
             7359           Blank = No sixth related stay

 408-409                    Stay Number Within Facility

                2           02-04 = Stay number
             7359           Blank = No sixth related stay

 (410-414)                  ID of Seventh Related Stay

 410                        Survey Period Identifier

                1               3 = NHEFS 1987
             7360           Blank = No seventh related stay

 411-412                    Facility Number

                1              03 = Hospital/nursing home number
             7360           Blank = No seventh related stay

 413-414                    Stay Number Within Facility

                1              05 = Stay number
             7360           Blank = No seventh related stay

 (415-419)                  ID of Eighth Related Stay

 415                        Survey Period Identifier

             7361           Blank = No eighth related stay

 416-417                    Facility Number

             7361           Blank = No eighth related stay

 418-419                    Stay Number Within Facility

             7361           Blank = No eighth related stay

 (420-424)                  ID of Ninth Related Stay

 420                        Survey Period Identifier

             7361           Blank = No ninth related stay

 421-422                    Facility Number

             7361           Blank = No ninth related stay

 423-424                    Stay Number Within Facility

             7361           Blank = No ninth related stay

 (425-429)                  ID of Tenth Related Stay

 425                        Survey Period Identifier

             7361           Blank = No tenth related stay

 426-427                    Facility Number

             7361           Blank = No tenth related stay

 428-429                    Stay Number Within Facility

             7361           Blank = No tenth related stay



APPENDIX A 1987

 RECORD STATUS CODES

 Code   Frequency  Description

 ANO -   57       "Authorization Not Obtained." This code indicates that
                  the subject or proxy refused to sign the Medical
                  Authorization Form (MAF). These stays are not requested
                  from the reported facilities.

 ASF - 1446       "Additional Stay Found." This code was assigned when a
                  received stay could not be matched to a reported stay
                  and the received stay is in-scope. This code was also
                  assigned to in-scope stays that were received as a result
                  of an inquiry generated by a type D report (Position 199).
                  The type D report was deleted from the final file.

 CRM -  183       "Cross-Referenced Match." This code indicates a stay
                  that was begun prior to the NHEFS 1987 survey period &
                  continues into the 1986 survey period. For this type of
                  stay, the abstract is brought forward from the previous
                  wave. The discharge date and discharge status information
                  are the only positions that are updated. The admission
                  date is prior to the most recent interview because this
                  is a continuing stay.  Thus, it appears but is not out-
                  of-scope for 1987.

 CRX -   21       "Cross-Referenced Non-Match." A code assigned by NCHS
                  staff to close out a stay that was begun in a previous
                  wave and was reported to have continued into the 1987
                  Survey period, yet no in-scope stay was received for
                  the 1987 survey period.

 FNC -  110       "Facility Never Contacted." This code was assigned when
                  the facility was not contacted for the following reasons:
                  the respondent could not recall the name of the facility;
                  the facility was closed; the facility could not be located;
                  and facility located outside the United States.

 MAT -  4135      "Record Match." This code was assigned when a received
                  stay matches a reported stay. This code was assigned to
                  in-scope & type C (position 199) reports, but never to
                  type D reports. In-scope stays that were received as the
                  result of a type D report were assigned an ASF code. See
                  ASF.

 ONR -  101       "Other Non-Response." This code is assigned to a stay
                  when no response for the stay request has been received
                  from the facility by the end of the study period.

 REF -  158       "Refused." This code is assigned after a facility
                  refuses to send back the stay record requested. It is
                  record, not subject specific. For example, a facility
                  may send some records for a subject but refused to send
                  others.

 XNH -  367       "Subject Never at Facility." This code is used when the
                  facility indicates that the patient was never admitted to
                  that facility.

 XNS -  755       "Other - No Stay Found." This code is assigned when a
                  facility responds it is unable to send records because
                  an in-scope stay was not found at this facility, or when
                  the facility returns the request form without records and
                  provides no explanation for the failure to provide records.

 XRD -   28       "Record Destroyed or No Longer Available." This code is
                  assigned if the facility attempts to locate the record
                  and states it no longer exists, i.e., destroyed, lost.

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


APPENDIX B 1987

 Numeric Codes

 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
      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
      15       Surgery
      16       Don't know
      17       Not ascertained
      18       Tests/observation/x-rays/physical exam
      19       Digestive/endocrine condition
      20       Respiratory condition (including influenza and pneumonia)
      21       Infection
      22       Kidney/bladder/urinary condition
      23       Debility/pain
      24       Male reproductive condition
      25       Musculoskeletal problem or injury other than a fracture
      26       Circulatory condition
      27       Female reproductive condition
      28       Mental illness
      29       Neurologic condition
      30       Nutritional condition or dehydration
      31       Bleeding or blood disorder
      32       Skin condition
      33       Condition not elsewhere coded
      34       Admission to a facility other than an acute care hospital
      35       In a facility at time of death
      36       Cataracts
      3603     Eye problem other than cataracts, detached retina or glaucoma
      37       A fall

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

 Note that codes "07" and "14" are not included in the coding structure for
 the 1987 file.  These codes had been assigned to conditions in the 1982-84
 and  1986  followups.   The  1987 followup questionnaire differs from  the
 previous two versions and sufficient  information  was  not  collected  to
 assign these codes.

 Reported  conditions  and  their  associated codes can be divided into six
 types depending on where in the interview  the  stay  was reported and the
 amount of information obtained:  specific conditions included in Section B
 of the interview (Type A); conditions which are well-defined but for which
 no  question  exists  in  Section  B  of the interview (Type  B);  unknown
 conditions (Type C); conditions about which  there is no specific question
 in  Section  B  but  for  which  sufficient information  is  available  to
 attribute them to disorders of a major  body  system  (Type D); conditions
 that  are broadly defined and/or cannot be attributed to  a  single  major
 body system (Type E); and conditions that cannot be classified into any of
 the above  categories (Type F).  Each condition type, the associated codes
 and the rules  for  assigning the reported conditions to the categories of
 the coding structure are described in detail below.

 Type A

 Type A - Conditions about  which  the respondent was asked in section B of
 the interview.  For example, if a respondent  answered  "yes"  to question
 B-17 ("Were you hospitalized for your arthritis?"), then a condition  code
 of  "01"  and a text field containing "arthritis" would be included on the
 facility stay record.  Type A conditions are:

       01   Arthritis (B-17)
       02   Gout (B-17)
       03   Heart attack (B-23)
       04   Other heart conditions (B-24)
       05   Coronary bypass surgery (B-27)
       06   Procedures for pacemakers (B-29)
       08   Stroke (B-35)
       09   Diabetes (B-42)
       10   High blood pressure (B-48)
       11   Cancer (B-52)
       12   Fractured hip (B-61)
       20   Pneumonia, bronchitis and influenza (B-71)
            Note: this code is also found under Type D because other
            respiratory conditions are also coded to category 20
       22   Kidney, bladder or urinary problem (B-74)
       34   Care in non-acute care facility (B-86)
       35   In a facility at death (B-93)
       36   Cataracts (B-79)
       37   A fall (B-70)

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

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

 Second,  data  may be inconsistent between the interview and the HCFS file
 if the respondent  remembered and reported a condition after responding to
 the corresponding question  in Section B of the interview.  This tended to
 occur at the time the interviewer  was  recording  information on the HHCF
 chart.  For example, while recording information on  a stay for high blood
 pressure, the respondent may add that he/she was also hospitalized at that
 time  for  a  heart condition.  The respondent may not have  reported  the
 hospitalization when asked about heart conditions in question B-24 and the
 Section B information may not have been updated to reflect this additional
 condition.  However, heart condition would appear on the HCFS file.

 Type B

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

       13   Bone fracture
       18   Tests and observation

 Type C

 Type C - Unknown conditions:

       16    Don't know
       17    Not ascertained

 Type D

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

       19   The digestive/endocrine system
       20   The respiratory system
            Note: this code is also found under Type A because the specific
            question  about  pneumonia,  bronchitis and influenza (B-71) is
            coded to the general category
       24   The male reproductive system
       25   The musculoskeletal system
       26   The circulatory system (except strokes)
       27   The female reproductive system
       29   Neurologic disorders
       31   Blood disorder/bleeding
       32   Skin problem
       3603 Eye problem (except cataracts, detached retina or glaucoma)

 Type E

 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
       28   Mental illness
       30   Nutrition and dehydration

 Type F

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

       33   Other conditions

 Additional information 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 abstrat.  Both flexibility and caution  should  be
 exercised when selecting stays based on these codes.  In order to help the
 analyst use these  condition  codes effectively, a description of the code
 assignment procedure along with an example is provided.

 Rules for Assignment

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

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

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

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

 Rule 4:    General  descriptions,  symptoms  and  conditions not coded  by
            rules 1 through 3 were coded at the discretion  of  the medical
            coder, again with emphasis on as much specificity as  possible.
            For example, "HEADACHES, BRAIN TUMOR" would be coded to  "29  -
            Neurologic  disorders", not to "23 - Debility and pain".  (Type
            D or Type E conditions)

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

Considerations for the data user

 These precedence rules were used for all three followups.   However, since
 the questionnaires used in each followup differed slightly, the assignment
 of  codes  also  differed.  Questions about specific conditions  were  not
 always included in  all  three questionnaires.  For example, Question B-63
 in the 1986 interview asked  about  overnight  stays  for  surgery  making
 condition  code  "15  -Surgery"  a  Type A condition in the 1986 followup.
 There is no similar question in the 1982-84  or 1987 interview, therefore,
 surgery is a Type E condition in the 1982-84 and  1987  files.   In  other
 cases,  groups  of  conditions  are  combined  into  one  question  on one
 questionnaire but asked separately on another.  For example, T.I.A.'s  and
 other  strokes  are  combined  in  one question in 1987.  Since it was not
 possible to separate reports of T.I.A.'s  from  other  strokes in the 1987
 file, there are no conditions assigned to codes "07" in  this file.  There
 are reports assigned to "07" in the 1982-84 and 1986 files  since separate
 T.I.A. and stroke questions were asked.  An attempt was made to include as
 much  detail  in  the code as possible.  The questionnaire in the  1982-84
 followup included enough detail to separate specific digestive conditions,
 such as colitis and  gallbladder  problems,  from  the general category of
 digestive  disorders.   Therefore,  the 1982-84 HCFS data  file,  includes
 sub-codes  under  "19  -  Digestive/endocrine   system".   Thus,  analysts
 interested  in  colitis  can  identify cases from the  reported  condition
 section of the 1982-94 file but not from the 1986 or 1987 files.  However,
 all files can be used to identify  cases of the digestive/endocrine system
 in  general.   The  analyst should refer  to  the  questionnaire  and  the
 condition coding structure  in  the HCFS data tape codebook for the period
 of  interest  in  order  to  obtain  the  maximal  amount  of  information
 available.

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

 To illustrate the first situation,  consider  a  search  for  all reported
 stays with breast biopsies.   A respondent might report a breast biopsy in
 response to the question relating to cancer and cancer treatment.  In this
 case  the  textual  field  would contain a description such as "BIOPSY  OF
 RIGHT BREAST" and the numeric  code  assigned  would  be  11 (indicating a
 response  to  the  cancer stay question).  Breast biopsies could  also  be
 reported in response  to  the surgery question in the 1986 followup and be
 assigned the code of 15.  If  the  biopsy  was  reported  in  response  to
 question  B-83  on  the 1987 questionnaire, "Have you stayed in a hospital
 for any other reason...?",  it  would  be  assigned to code 18 - Tests and
 observation".  To identify breast biopsy cases  it  would  be necessary to
 search  the  alphabetic fields for codes 11, 15 and 18.  In addition,  the
 reports  of  breast  biopsies  include  several  wording  variations,  for
 example, "BREAST  BIOPSY",  "BIOPSY  OF  BREAST".   The  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.




This page last reviewed: Thursday, January 28, 2016
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