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., Former Director, Centers for Disease Control and Prevention Cervical Cancer Screening Supplement Hospital-based Ambulatory Surgery Centers 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. Beginning in 2009, hospital-based ambulatory surgeries will be included in the study. 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? 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 crowding, the introduction of new medical technologies, and the shift from hospital inpatient to outpatient surgery. 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 has been included annually since then. Background 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 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! Hospital-based Ambulatory Surgery Centers The National Survey of Ambulatory Surgery (NSAS) was conducted by the
National Center for Health Statistics in 1994-96 and again in 2006. Because
of the shift from hospital inpatient to outpatient surgery for many
procedures, it is important to collect these data annually; therefore, the
NSAS will be incorporated into the NHAMCS. Beginning in 2009, hospital-based
ambulatory surgery centers will be included in the study and in 2010, there
are plans to add free-standing ambulatory surgery centers. Confidentiality
of NHAMCS data HIPAA
Privacy Rule and 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 maybe 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 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 Data Supplements from Previous Years The following supplement was used in 2008. Pandemic
and Emergency Response Preparedness Supplement
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) remained the same in order to be able to establish trends over time. Other elements were 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 included questions about evacuation plans and the set-up of temporary facilities should the hospital not be able to operate. Supplement data will be used to 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 also provides nationally representative benchmarks that can serve as one quality control mechanism for other projects that are designed to detect emerging health threats within a shorter time period.
The following supplement was used in 2002, 2003, and 2006.
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. The following four supplements were used in 2003 and 2004. Hospital
Capacity Card 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. 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 Preparedness
There
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. 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 Academy of Ophthalmology American College of Emergency Physicians American College of Surgeons American College of Osteopathic Emergency Physicians American Health Information Management Association Emergency Nurses Association Federation of American Hospitals Society for Academic Emergency Medicine Society for Ambulatory Anesthesia If you have any further questions or comments related to participation, please contact Linda McCaig at:
National Center for Health Statistics
This page last reviewed February 12, 2009
This page last reviewed
February 12, 2009
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