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Welcome NHAMCS Participants!
"We learn a great deal about the health of Americans by studying what happens in hospital emergency and outpatient departments. We are grateful to the hospitals who take the time to provide this important information for monitoring and improving our Nation's health." -- Julie L. Gerberding, M.D., M.P.H., Director, Centers for Disease Control and Prevention
Cervical
Cancer Screening Supplement
Pandemic
and Emergency Response Planning Supplement
Data
Supplements from Previous Years
The National Hospital Ambulatory Medical Care Survey (NHAMCS) is the Nation’s foremost study of ambulatory medical care in hospital emergency and outpatient departments and has been conducted annually since 1992.
Each year, approximately 500 nationally representative hospitals provide data on a sample of patient visits to selected outpatient clinics and emergency service areas over a 4-week reporting period.
These data are widely used by health care researchers, policy analysts, congressional staff, the news media, and many others to improve our knowledge of medical practice patterns.
Reliable NHAMCS data depend on complete reports from all sampled hospitals. Data from all sample cases are needed to ensure that policy decisions are based on the most accurate data possible.
Who is eligible to
participate?
Randomly selected sample
of non-Federal
general and short-stay hospitals, located in the 50 States and the
District of Columbia, that have a 24-hour ED or an OPD with physician
services clinics are eligible for participation in the NHAMCS.
Why
participate?
NHAMCS
participation is important because without it, neither your hospital
nor others like yours can benefit from being represented in the national
description of visits to hospital-based outpatient departments and
emergency departments. Your hospital was randomly chosen to provide
representative data not only for its own outpatient clinics and emergency
service areas, but also for similar hospitals in the same geographic
region.
Furthermore, the September 11, 2001, attack on our nation and subsequent bioterrorism incidents have highlighted the unique role of the emergency department within the health care system. In addition to being a "safety net" provider, the emergency department must be able to respond to bioterrorism and mass casualty incidents, natural disasters, and pandemics; therefore, it is important to collect data from this setting.
What
are the benefits of participating?
By
participating in the NHAMCS, you will be able to contribute to the
national description of hospital-based ambulatory care. The
need for more complete ambulatory medical care data has been accentuated
by increasing efforts at cost containment, the rapidly aging population,
the growing number of persons without health insurance, emergency
department overcrowding, and the introduction of new medical technologies.
Your hospital's participation will result in more reliable statistics
and will enable researchers to better measure the utilization
and provision of ambulatory health services. Failure to participate
lessens the accuracy of the data used by researchers.
If you would like more information on participation, please contact Linda McCaig at lmccaig@cdc.gov or (800) 223-3815, or visit our Ambulatory Health Care Data home page.
Cervical
Cancer Screening Supplement
The supplement was included for the first time in the 2006 NHAMCS. It
was continued for 2007 and has been included again for 2008.
Background
CDC's
National Center for Health Statistics and National Center for Chronic
Disease Prevention and Health Promotion have joined forces to collect
information on the screening of cervical cancer at hospital-based
outpatient departments in the United States.
Genital human papillomavirus (HPV) infection is common among sexually active populations. There is considerable new information about HPV infection, transmission, and methods of prevention. In addition, a new DNA test to detect HPV as well as newly approved indications for HPV testing have important implications for clinicians in both their cervical cancer screening practices and their management of positive HPV diagnoses among female patients and their sex partners. There is recognition that this new information may require different approaches to cervical cancer screening in primary care practice, as well as new information that needs to be conveyed when counseling and educating patients and their sex partners.
How to Participate
If your hospital has been asked to
be part of the NHAMCS, it may also have been asked to complete
the Cervical Cancer Screening Supplement (CCSS). The supplement applies only to
general medicine clinics and obstetrics and
gynecology clinics. We hope you will choose to
help us in this endeavor. The supplement does not request any confidential
information.
If you have not yet been given the form, please contact your Census Representative who will be glad to assist you and answer any questions you may have. Thank you for being part of this important research study!
Pandemic
and Emergency Response Planning Supplement
The Pandemic and Emergency
Response Preparedness Supplement has been added to the 2008 NHAMCS at the
request of the Office of the Assistant Secretary for Planning and Evaluation
(OASPE) of the Department of Health and Human Services (DHHS). Information
is being obtained on the content of the hospital’s emergency response plan,
staff training, participation in mass casualty drills, and the hospital’s
resources and capabilities.
The questionnaire was adapted from a previous NHAMCS supplement on Bioterrorism and Mass Casualty Preparedness that was fielded in 2003 and 2004. Certain elements (such as existence of updated emergency response plans) will remain the same in order to be able to establish trends over time. Other elements will be revised to answer questions generated by the previous surveys and newer public health priorities. Examples include adding infectious diseases such as influenza and severe acute respiratory syndrome (SARS), expanding the categories for chemical and radiological exposures to include specific agents targeted in the hospital preparedness grant guidances; and adding specificity on some resources such as decontamination showers, to include numbers of patients able to be accommodated.
The content will include questions about evacuation plans and the set-up of temporary facilities should the hospital not be able to operate. The supplement will assess progress towards hospital preparedness for dealing with bioterrorism and mass casualty incidents, and in so doing evaluate the ability of hospitals to deal with naturally occurring diseases, epidemics and pandemics, such as SARS or influenza. This project supports the DHHS goal to prepare for emerging health threats. The project will also provide nationally representative benchmarks that could serve as one quality control mechanism for other projects that are designed to detect emerging health threats within a shorter time period.
Confidentiality
of NHAMCS data
The
NHAMCS is conducted under the authority of Sec. 306 of the Public Health
Service Act (42 USC 242k), which requires NCHS to collect statistics on a
variety of health indicators. Information collected in this survey is used
to study overall patterns of health care use by the population and for
other similar statistical purposes. NCHS has a long history of protecting
the privacy of information that we collect, and Sec. 308(d) of the Public
Health Service Act (42 USC 242m) assures the confidentiality of data
collected in the NHAMCS. We strictly observe this confidentiality statute,
which prohibits the release of identifiable information that we obtain
unless we are given consent to do so by the subject.
HIPAA
Privacy Rule and NHAMCS
This section contains an
overview of the Privacy Rule and how it affects your NHAMCS participation.
For more comprehensive information on the Privacy Rule and the
NHAMCS, please go to HIPAA Privacy Rule Q’s and A’s for
NHAMCS.
The final Privacy Rule has been published as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Health care providers who transmit financial and administrative health information electronically must comply with the Rule as of April 14, 2003.
The Privacy Rule permits your hospital to make disclosures of protected health information without patient authorization for public health purposes or for research that has been approved by an Institutional Review Board (IRB). This survey meets both of these criteria. Additionally, disclosures may be made under a data use agreement with NCHS. If you have questions about your hospital’s rights as a respondent, you may call the IRB at 1-800-223-8118. The IRB is an independent board that protects the interests of people who take part in studies. Click here to see the IRB approval letter for NHAMCS.
We have included all the information you need to be assured that your hospital is allowed to disclose protected health information for the NHAMCS in our introductory letter to hospitals and also here at our website. However, there are several things that you must do to assure compliance with the Rule when participating in the survey. First, the privacy notice that your hospital generally provides to patients must indicate that patient information may be disclosed for either research or public health purposes. And, secondly, your hospital may need to keep a record of the disclosure (which we will provide) that shows that some data from the patient’s medical record were disclosed to CDC for the NHAMCS. Of course, if your hospital does not transmit health information electronically (such as claims data), then it is not subject to the Privacy Rule or the requirements described above.
The Privacy Rule applies to data collected for the NHAMCS because we are asking you to provide certain information about patients without their authorization. For public health and research purposes, the NHAMCS collects information from the patient's medical record such as visit date, birth date, and residential ZIP code. While not directly identifiable, these data are considered protected health information as defined by the Privacy Rule. As described above, the Rule allows you to disclose this information for public health and research purposes.
Please be assured that we fully intend to continue our long history of gaining the voluntary participation of hospitals like yours by upholding the highest confidentiality standards and practices.
For additional information on the confidentiality of NHAMCS data, please go to NCHS's Privacy Protection page and "Frequently Asked Questions (FAQ's)" about the NHAMCS.
Your
assurance of privacy
NCHS is legally bound to assure
confidentiality of all responses, including any information that might result in
a physician's practice or hospital being identified. The data files
that are released for research do not include any provider or patient
identifying information.
The NHAMCS does not collect any personally identifiable data about patients such as patient's name or address. The top section of the NHAMCS Patient Record form, the survey instrument, contains a detachable section where hospital staff can record the patient's name for reference purposes. This section is detached prior to submission of the forms, and is kept by hospital staff for several weeks, in case it is necessary to retrieve missing information or clarify recorded information. Other information that may permit identification of an individual, a practice, or an establishment will be held confidential, will be used only by persons engaged in and for the purpose of the survey, and will not be disclosed or released to other persons or used for any other purpose without consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m).
Patient
Record Forms
To see a copy of the
NHAMCS Emergency Department and Outpatient Department Patient Record
forms, click
here.
Data Supplements from Previous Years
The following four supplements were used in 2003 and 2004.
Hospital
Capacity Card
Because
hospital personnel frequently report that the chief reason for ED crowding
is the lack of inpatient beds, it is important to obtain inpatient bed
counts. Comparing the number
of licensed and staffed beds on the Hospital Capacity Card will provide an
indication of untapped capacity. NCHS
would like to do a comparison of the daily inpatient occupancy rate with
the frequency of ambulance diversion.
ED
Staffing and Capacity and Ambulance Diversion (SCAD) Supplement
The purpose of this supplement is to obtain data on issues related to ED crowding. It is important to know if the ED performs triage, how many treatment spaces there are, specific information about physician staffing, and the availability of on-all specialists. NCHS would like to know the training level of physicians working in the ED in order to assess how it accounts for variation across EDs in observed treatment patterns.
ESA
Ambulance Diversion Log
The
purpose of the Ambulance Diversion Log is to obtain data on ambulance
diversion. There are no
national estimates available on diversion frequency and no information
comparing types of cases seen in EDs while they are on diversion.
In order to help policymakers, NCHS would like to know in what
proportion of hospitals diversion occurs and with what frequency; the
reasons for the diversion; and who in the hospital ordered the diversion.
Bioterrorism and Mass Casualty
PreparednessThere is a growing appreciation of the unique role of the ED within the US health care system and of its expanding role as a “safety net” provider. The attacks on September 11, 2001, and the subsequent cases of anthrax spotlight the quintessential role of EDs in the immediate response to mass casualty incidents and in the detection and surveillance of bioterror-related diseases. To improve their preparedness for biological and chemical attacks, hospitals face clinical and communications challenges. One of the biggest obstacles to a hospital’s readiness is recognizing the early signs of a terrorism-related condition, because many biochemical agents trigger routine symptoms in patients. This is a self-administered two-page questionnaire pertaining to the hospital’s preparedness for events involving bioterrorism and mass casualties. It includes questions on additional training received on this topic since September 11, 2001.
Emergency
Pediatric Services and Equipment Supplement (EPSES)
The Emergency Pediatric Services and Equipment Supplement (EPSES) was first used in 2002 and 2003 and reintroduced in 2006. It was sponsored by the Health Resources and Services Administration (HRSA) and assessed how well hospitals were prepared to provide emergency pediatric services. NCHS is using the data collected to evaluate emergency pediatric preparedness at a national level. This is NOT an assessment or evaluation of individual hospitals. This is a study to produce data for national statistics on pediatric preparedness in hospital ED settings.
How are NHAMCS data
used?
NHAMCS
data are used to provide statistics that describe the characteristics of visits
to hospital emergency departments and outpatient departments. These
include patient demographic characteristics; the conditions most often
treated; and the diagnostic and therapeutic services rendered, including
medication prescribed. These data are used by the U.S. Congress
and other public health policy makers, government agencies,
universities and medical schools, professional associations, health
services researchers and epidemiologists, as well as the print
and broadcast media, to describe and understand the changes that occur in
medical practice. The data are disseminated in the form of public
health reports, journal articles, and microdata files.
NHAMCS data
in the news
"ER
Care in Critical Condition", NBC Nightly News with Brian Williams--
8/6/2008.
"Emergency
Care Waits Found to Be on Rise: Patients are waiting longer for
care in the nation's emergency rooms, a potentially deadly result of the
shrinking number of emergency departments and rising demand for
emergency services, according to a new study by researchers at Harvard
Medical School."--Washington Post, 1/15/08
NHAMCS
Charts and Tables
Outpatient
Department Visit Data
Emergency
Department Visit Data
Sports
Injuries for Children and Young Adults
Publications
using NHAMCS data
"NHAMCS is an invaluable resource for anyone who wants to understand critical issues about access to care, utilization of hospital emergency departments, and other matters of fundamental importance to the health of Americans." -- Art Kellermann, MD, MPH, FACEP, Professor and Chairman, Department of Emergency Medicine, Emory School of Medicine; Co-Chair, Committee on the Consequences of Uninsurance, Institute of Medicine
NHAMCS is endorsed by the following professional organizations:
American
College of Emergency Physicians
American
College of Osteopathic Emergency Physicians
Emergency
Nurses Association
Federation
of American Hospitals
Society
for Academic Emergency Medicine
If you have any further questions or comments related to participation, please contact Linda McCaig at:
National Center for Health Statistics
Ambulatory Care Statistics Branch
3311 Toledo Road, Room 3409
Hyattsville, Maryland 20782
Phone: 800-223-3815
Fax: 301-458-4032
Ambulatory
Health Care Data home page
This
page last reviewed
October 02, 2008
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October 02, 2008
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