Data on Race and Ethnicity in the National Health Care Survey

Irma E. Arispe, Ph.D.

Associate Director for Science

Division of Health Care Statistics

National Center for Health Statistics

Data Users Conference, 2002

National Center for Health Statistics

The National Health Care Survey

• Family of establishment-based surveys• Data from health care providers and their

medical/administrative records• Information on characteristics of providers,

patients and visits• Purpose is to describe what is happening in the

health care system, utilization of services, the content of encounters

• Very useful for profiling trends over time

NHCS: Selected Components

Survey Type of encounter

Years fielded

Sample size (Approximate)

National Hospital Discharge Survey

Hospital discharges 1965 to present 500 hospitals 300,000 discharges

National Ambulatory Medical Care Survey

Visits to office based physicians

1973-1981, 1985, 1989-present

2,500-3,400 MDs 21,000-36,000 visits

National Hospital Ambulatory Medical Care Survey

Visits to hospital outpatients and emergency departments

1992-present 500 hospitals 21,000-36,000 ED visits 29,000-35,000 OPD

National Home and Hospice Care Survey

Agencies, current patients, discharges

1992-1994, 1996, 1998, 2000

1,100-1,800 agencies 3,500-5,400 patients 3,000-4,900 discharges

National Nursing Home Survey

Nursing homes with 3+ beds, current patients, discharges

1973-1974, 1977, 1985, 1995, 1997, 1999

1,100-1,900 facilities 5,200-8,200 residents 6,000-6,900 discharges

Data from providers and medical recordsare very useful for...

• Understanding how conditions present to and across the health care system

• Understanding the content of the encounter, including disposition of care

• Examining diffusion of innovations• Profiling practice, looking at quality of health care• Enhancing data from population-based surveys

...but they aren’t the best data sourcefor understanding access the patient’s sociodemographic characteristics or

perspective on the health encounter

Hospital Care: the National Hospital Discharge Survey (NHDS)

• Collecting– Manual abstraction (Majority of hospitals)

• Always permitted collection of multiple race• Since 2000, data from hospital records used the following categories:

White, Black or AA, AI/AN, Asian, NH/OPI, other, not stated

– Automated data (Majority of records)• Data obtained from states, abstracting services, hospitals• Data follow the UB 92 format which does not collect race or ethnicity

• Reporting– Race generally not reported in publications, but data are included in the

public use file– There were about 54 multiple race cases in 2000, grouped into other

category. – Single race denominators used in 2000 for US civilian population (multiple

race denominators from 2000 Census not available at time of publication)

Ambulatory Care: NAMCS & NHAMCS

• Collecting– Beginning in 1999: White, Black/AA, Asian, NH & OPI,

AI/AN

• Reporting– Multiple race cases reported as “multiple race” if there are 30

or more such cases (NAMCS & OPD in 2000)

– Multiple race cases coded as a separate category, included in public use file

– Single race denominators used for rate calculation in 2000 for US civilian noninstitutionalized population (Year 2000 multiple race data not available at time of publication)

Long term care: NNHS and NHHCS

• Collecting– Use minimum set for data on race for federal statistics …

• in NNHS since 1999• in NHHCS since 1998

– Data elements concordant with the MDS/OASIS

• Reporting– About 10 multiple race cases in 1999; coded as other– Denominators currently are for single race, US civilian

population, Year 2000 data not available– Data are missing more frequently for discharges than for

current patients

Hispanic/Latino EthnicityMissing/Unknown in 2000

Survey Name Percent Missing/Unknown

National Hospital DischargeSurvey

63%

National AmbulatoryMedical Care Survey

22%

National HospitalAmbulatory Medical CareSurvey

18% ED 24% OPD

National Home and HospiceCare Survey

19% HHC 16% Hospice

Issues in collecting race/ethnicity data in establishment based surveys

• Survey participation is voluntary; Providers are not mandated to collect or report data

• Confidentiality concerns discourage reporting of race and ethnicity

• State laws do not mandate collection of race/ethnicity data• Data not included in some administrative data sources

such as the UB 92, MDS or OASIS• Concerns exist about the quality of reported data• Small sample size precludes reporting• Increasing precision of categories decreases reporting

capability