Tuesday: Scientific Sessions
Plenary I: 8:30—10:00 a.m.
Health Statistics and the Economy
Greetings and Introduction:
Julia L. Kowaleski
Chief, Registration Methods Program in the Division of Vital Statistics, National Center for Health Statistics
Welcome and Opening Remarks:
- Edward J. Sondik, Ph.D.
Director, National Center for Health Statistics
National Conference on Health Statistics - Edward Sondik - August 7, 2012 [PDF - 2.6 MB]
- Katherine K. Wallman
Chief Statistician, U.S. Office of Management and Budget
The State of Our Federal Statiscal Union: Challenges Continue, but Opportunities Abound [PDF - 166 KB]
Edward J. Sondik, Ph.D., Director, National Center for Health Statistics
Dr. Sondik serves as Director of the National Center for Health Statistics (NCHS), the nation’s principal health statistics agency and one of the federal centers that make up the Centers for Disease Control and Prevention. NCHS monitors the nation’s health through research and analysis in health and vital statistics, epidemiology, and related health and statistical sciences. Under Dr. Sondik’s direction, NCHS also works to anticipate and plan for future data needs, and to develop the technologies and analytic tools necessary to meet the nation’s health statistics needs.
Katherine K. Wallman, Chief Statistician, U.S. Office of Management and Budget
Katherine Wallman currently serves as Chief Statistician at the United States Office of Management and Budget. In this capacity, she provides policy oversight, establishes priorities, advances longterm improvements, and sets standards for a Federal statistical establishment that comprises more than 70 agencies spread across every cabinet department and accounts for more than $5 billion in annual expenditures.
- Harold S. Luft, Ph.D.
Senior Investigator for the Department of Health Policy Research of the Palo Alto Medical Foundation Research Institute
Health Statistics and the Economy [PDF - 474 KB]
Harold Luft, Ph.D., Senior Investigator, Department of Health Policy Research, Palo Alto Medical Foundation Research Institute
Dr. Luft served as Director of the Palo Alto Medical Foundation ResearchInstitute from 1993 through 2007. He is also the Caldwell B. Esselstyn Professor Emeritus of Health Policy and Health Economics at the Philip R. Lee Institute for Health Policy Studies (IHPS) at the University of California, San Francisco (UCSF).
Concurrent Scientific Session I - 10:30 a.m.—12:00 p.m.
SS-04. Policy Challenges for the Medicaid Program
Four papers that use NCHS data to analyze current challenges for the Medicaid program will be presented. The first paper uses data from the National Health and Nutrition Examination Survey (NHANES) 2005–2010 to analyze health conditions among uninsured adults aged 19–64 who currently have family income at or below 138% of the federal poverty level and are expected to become newly Medicaid-eligible under the Affordable Care Act (ACA). The second paper uses data from the 2011 National Ambulatory Medical Care Survey (NAMCS) Electronic Medical Records Supplement to provide a current snapshot of physician capacity to provide care to those expected to become newly Medicaid-eligible, as measured by cross-state patterns in physician acceptance of new Medicaid patients. The third and fourth papers examine the effects on quality of care of two ongoing aspects of Medicaid programs that vary across states: the use of prescription drug copayments for adults, and the introduction of physician pay-for-performance (P4P) programs in Medicaid managed-care programs. The session will end with time for questions and answers.
- Physician Acceptance of New Medicaid Patients by State in 2011 [PDF - 399 KB]
- Preparing for an Expanded Medicaid Population under the ACA: Undiagnosed and Untreated Health Needs [PDF - 124 KB]
- Analysis of Pay-For-Performance (P4P) Program for Utilization of Preventive Care Services among Medicaid Population in United States [PDF - 215 KB]
SS-17 The Million Hearts Initiative—Monitoring Goals
Cardiovascular disease is the leading cause of death in the United States. Each year, Americans suffer more than 2 million heart attacks and strokes, and each day more than 2,000 people die from cardiovascular disease. Million Hearts is a national initiative to prevent 1 million heart attacks and strokes over 5 years. The initiative seeks to achieve its goal by improving access to effective care; improving the quality of care through Appropriate Aspirin Therapy, Blood Pressure Control, Cholesterol Management, and Smoking Cessation ("ABCS"); focusing clinical attention on the prevention of heart attack and stroke; activating the public to lead a heart-healthy lifestyle; and improving the prescription of and adherence to appropriate medications for the ABCS. This session will provide an overview of the Million Hearts Initiative, highlight new and existing data used to monitor risk factors and events at both the population and clinical levels, and provide the perspective of health care providers.
- Monitoring Million Hearts Campaign Using NCHS Ambulatory and Hospital Care Statistics [PDF - 396 KB]
- The Million Hearts Initiative – Monitoring Goals [PDF - 41 KB]
- Million Hearts Campaign: Clinical Perspective [PDF - 118 KB]
- Monitoring cardiovascular risk factors in the US population [PDF - 3.6 MB]
- Introduction to Million Hearts [PDF - 581 KB]
SS-20. Results of the 2010 Census: Impact on Trends and Variations in Population and Health Statistics
The results of Census 2010 have been released, and intercensal estimates for the 2000s that incorporate these results are now available. These new and revised data have important impacts on a myriad of population statistics—including estimates of immigration and birth and death rates—and on health statistics. Presentations will describe the underlying census data and discuss how key population-based rates of birth and death, as well as measures of the incidence and prevalence of health conditions, are impacted by the new estimates. The effect of the new data (including the American Community Survey) on key measures of population change such as immigration will be assessed.
- The U.S. Census Bureau’s Postcensal and Intercensal Population Estimates [PDF - 197 KB]
- Old Age Mortality and New Census Population Estimates [PDF - 213 KB]
- Effect of Population Counts on Cancer Rates and Trends [PDF - 959 KB]
- New Population Estimates and Revised Birth and Fertility Rates: 2001-2009 [PDF - 338 KB]
- Fertility and the 2010 Census [PDF - 272 KB]
- Results of the 2010 Census: Impact on Trends and Variations in Population and Health Statistics [PDF - 82 KB]
SS-25. Healthy People 2020: A New Era for the Nation’s Disease Prevention and Health Promotion Agenda—What’s New? What’s Different?
In the United States, the health of the population is monitored using a wide range of measures and indicators. For the past three decades, the Healthy People initiative has served as a data-driven, science-based national agenda for disease prevention and health promotion. The Healthy People blueprint establishes benchmarks and monitors progress over time in order to drive improvements in the health of all Americans. In the past decade, Healthy People 2010 mapped out two overarching goals and 969 measures divided into 28 topic areas. Launched in December 2010, Healthy People 2020 establishes four overarching goals and 1,200 objectives to be tracked and assessed for progress across 42 topic areas. The history, goals, and key features all contribute to the impact of Healthy People. This session will describe the history of the Healthy People initiative, highlight changes from Healthy People 2010 to 2020, outline challenges in tracking and assessing 1,200 measures, and identify the impact Healthy People has had in the field of public health. It will also demonstrate improvements set forth by Healthy People 2020 at the national and state levels and discuss implementation tools designed to further the use of Healthy People data at the state and local levels.
- Healthy People Data: Transitioning from 2010 to 2020 [PDF - 2.8 MB]
- MD’s State Health Improvement Process (SHIP) [PDF - 1 MB]
- Healthy People 2020: A Foundation for Health Promotion and Disease Prevention Throughout the Nation [PDF - 2.3 MB]
SS-28. Linked NCHS–CMS Data: Analytic Methods and Research Examples
NCHS has developed a record linkage program designed to maximize the scientific value of the Center's population-based surveys. Recently, several NCHS surveys have been linked with Medicare and Medicaid enrollment and claims data from Centers for Medicare & Medicaid Services CMS. The NCHS–CMS linked data files enable researchers to examine the factors that influence disability, chronic disease, health care utilization, morbidity, and mortality in low-income families with children and in the elderly and disabled U.S. populations. However, an analyst using these files needs to consider many factors, including the need for reweighting, program participation, and the correspondence between the survey and claims information. The goal of this session is to highlight methodological research being conducted on the linked NCHS–CMS data. Research topics will include an evaluation of reweighting strategies for incompletely linked data; an evaluation of how often self-reported conditions appear in Medicare summary files;- and approaches used to address issues encountered when using national survey data linked to a state-based administrative dataset using two examples: first, the association between Medicaid costs and obesity and, second, the percentage of children enrolled in Medicaid at any time during a 5-year period.
- Overview of NCHS Linked Data and Analytic Considerations [PDF - 540 KB]
- Analytical Issues: Using Linked MAX/NHANES Data to Study Obesity Costs [PDF - 144 KB]
- On dealing with “incompletely linked” data in linked survey/administrative databases: An empirical comparison of alternative methods [PDF - 200 KB]
- A Longitudinal View of Child Enrollment in Medicaid [PDF - 344 KB]
SS-37. Understanding Lesbian, Gay, Bisexual, and Transgender Health: Overview, Methodological Challenges, and Policy Implications
Recent reports have identified a range of disparities in health outcomes and health care access among sexual minority populations. This session will highlight current sexual and gender identity research at NCHS, and within the larger academic community. Specifically, health-related and measurement topics will be explored, and advancements, trends, and challenges in the field will be addressed.
- The Picture of LGBT Health [PDF - 207 KB]
- Developing a "Perfect" Sexual Identity Measure [PDF - 459 KB]
- HHS Update on LGBT Data and Policy [PDF - 200 KB]
- Transgender Health: Data Requirements/Policy Implications [PDF - 133 KB]
Concurrent Scientific Session II - 1:30—3:00 p.m.
SS-08. Electronic Health Records: How Will They Change the Way We Collect Data?
Electronic health record data hold the promise of providing multiple benefits for research, including access to more data elements, higher-quality data, and greater analytic power. This session will explore the ways that NCHS needs to adapt its approaches to data collection to realize these benefits. The panel will discuss the importance of data standards in ensuring data comparability across multiple sources; the stepwise transformation of manual data collection methods to take advantage of the increasing availability and standardization of electronic health record data; and the quality and completeness of data from electronic health records (preliminary results of a pilot study). The moderator will encourage dialog from the audience within and across these topics.
- Supporting Standards Development for HIT/EHR Adoption; Electronic Health Records [PDF - 1.2 MB]
- "Sourcing" Data for NAMCS [PDF - 136 KB]
SS-10. Autism, Autism Spectrum Disorder, and Other Developmental Delays: The Survey of Pathways to Diagnosis and Services
Data from the 2007 National Survey of Children’s Health (NSCH) revealed that approximately 1 in 100 children aged 3–17 years has an autism spectrum disorder (ASD) and that nearly 40% of those ever diagnosed with an ASD did not currently have the condition. To explore possible explanations of these findings, NCHS fielded the Survey of Pathways to Diagnosis and Services (“Pathways”), which was sponsored by NIH’s National Institute of Mental Health (NIMH). Pathways provides the largest-ever nationally representative survey data set on the health care and diagnostic history of children with special health care needs (CSHCN) identified as having (or having had) ASD, intellectual disability, or developmental delay. This survey is a follow-up to the 2009–2010 National Survey of Children With Special Health Care Needs and was conducted by NCHS using the State and Local Area Integrated Telephone Survey (SLAITS) mechanism. Pathways gathered additional information on how CSHCN with these conditions came to be diagnosed in the past, their current diagnostic status, the types of services the children have received for the conditions, and other parental concerns such as wandering. More than 4,000 parents of CSHCN with these relatively rare but increasingly identified conditions completed a telephone interview. A data brief that accompanied the public-use data release for Pathways gives a snapshot of children who currently have an ASD. This session will discuss key analytic findings from Pathways in greater detail and will describe the design and content of the survey.
- An Introduction to the Survey of Pathways to Diagnosis and Services, 2011 [PDF - 270 KB]
- Findings on Children’s Pathways To Diagnosis and Services [PDF - 134 KB]
SS-14. Using National Data to Understand the Health of the Asian American Population
The goal of this session is to describe the health of the Asian American population using national data from NCHS—specifically from the Division of Vital Statistics and the Division of Health Interview Statistics. The session will also review recent data collection by the National Health and Nutrition Examination Survey related to Asian American health. Future directions and needs, as well as challenges in obtaining data on this group (e.g., low participation rates and language barriers) will also be addressed.
- Ongoing Activities to Support the Asian Oversample in NHANES [PDF - 1.7 MB]
- Using National Data to Understand the Health of the Asian American Population [PDF - 535 KB]
- Examining disparities in Asian health: the National Health Interview Survey Experience [PDF - 148 KB]
SS-16. Understanding Diet and Nutrition in the U.S. Population Through Various Biochemical Indicators
This session will provide information on specific biochemical indicators of diet and nutrition from National Health and Nutrition Examination Survey (NHANES) data. Nutritional biochemistry has been an important component of NHANES for many years. New NHANES laboratory tests include trans, saturated, monounsaturated, and polyunsaturated fatty acids. The second National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population was released earlier in 2012. This session will discuss this report and additional analysis on the association of sociodemographic and lifestyle factors with nutritional indicators, specifically the B vitamins.
SS-21. Mortality Surveillance
Continuing improvements in the National Vital Statistics System’s ability to quickly collect death certificate data and to code the cause of death has made mortality surveillance possible. In this session, mortality surveillance will be defined and its dual role as both a partner in traditional public health surveillance and a method for improving statistical data file quality will be discussed. Presentations will provide an overview of traditional public health surveillance and offer a vision of the role mortality surveillance might play by highlighting a new partnership between NCHS’ Division of Vital Statistics (DVS) and the National Center for Immunization and Respiratory Diseases’ surveillance program to verify deaths due to rare vaccine-preventable diseases. Presentations will also look at other opportunities for mortality surveillance to make meaningful contributions to data quality and traditional public health surveillance. Ongoing projects within NCHS, including VIEWS and EZ–MMD, that promise to further enhance mortality data’s utility as a surveillance tool will also be discussed.
- EZ-Mortality Medical Data: A 21st Century Approach for Completing Death Certificates [PDF - 441 KB]
- Overview of Vaccine Preventable Disease (VPD) Surveillance in the United States [PDF - 242 KB]
- Mortality Surveillance: Real-Time Monitoring for Improved Data Quality and Public Health [PDF - 114 KB]
- Enhancing injury mortality surveillance using National Vital Statistics System [PDF - 1.3 MB]
SS-34. Data Standards in HHS Data Collection
Data standards allow for more uniform data collection and comparison across systems. Data standards are the common language that allows for sharing information, communication across disciplines, integration of disparate data systems, comparisons among datasets and across geographic areas, and linkage of data in a secure environment. Health data standards enable disease surveillance, monitoring the health and health care of the United States, performing outcomes research and providing information for decision making and policy development. This panel will provide an overview and examples of health data standards in HHS data collection at the survey and system levels. This panel will include presentations on electronic health record standards for vital statistics, the International Classification of Disease system, demographic data standards for HHS surveys, and socioeconomic status data collection in HHS surveys.
- HHS Data Standards for Race, Ethnicity, Sex, Primary Language and Disability Status [PDF - 70 KB]
- Data Standards in HHS Data Collection [PDF - 360 KB]
- ICD International Classification of Diseases [PDF - 1.8 MB]
- Developing Standards for Linking Electronic Health Records and Vital Records Systems [PDF - 650 KB]
- Assessing the Potential for Standardization of Socioeconomic Status in HHS Surveys [PDF - 731 KB]
Concurrent Scientific Session III - 3:30—5:00 p.m.
SS-01. The Community as a Learning System for Health: Using Local Data to Improve Local Health
Local initiatives could be powerful engines for improving population health on a national scale. Communities need access to relevant data; the methods and skills to analyze the data and address local priorities and needs; tools to make the data analysis usable and useful; and guidance on privacy and security. This session will present a vision for strengthening local data, capacities, and uses. It will also suggest ways to support the development and functioning of community-oriented learning systems in which people, actions, results, and knowledge are dynamically interconnected to improve local health.
SS-06. The 2010 National Survey of Residential Care Facilities: A New Resource for Researchers, Providers, and Policymakers to Inform Long-term Care Policy and Practice
This session will give an overview of the National Survey of Residential Care Facilities (NSRCF); presents selected findings using the newly available 2010 data on providers and residents; and highlights the relevance and value of NSRCF data from three key perspectives—provider, policymaker, and researcher—giving examples of how the data have been used. The aging of the U.S. population—particularly those aged 85 and over, which compose the fastest growing age segment—will lead to an increase in the number of people who need long-term care in the future. Assisted living and other residential care communities (RCCs) are an important component of the long-term care system. Conducted by HHS, NSRCF is the first nationally representative survey of assisted living and other RCCs as small as four beds serving older people and younger persons with physical disabilities. Using a probability-based sampling design to select RCCs and current residents, interviews were completed with 2,302 communities. Nationwide, 31,100 RCCs served 733,300 residents each day in 2010.
- 2010 National Survey of Residential Care Facilities (NSRCF): Overview and Selected Findings [PDF - 895 KB]
- Industry Perspective on the National Study of Residential Care Facilities [PDF - 240 KB]
- National Survey of Residential Care Facilities: A key resource for policymakers [PDF - 190 KB]
- Are Residential Care Facilities “Community Services”? [PDF - 1 MB]
SS-12. Paradata: Managing Surveys and Evaluating Data
Many federal surveys face the challenge of collecting and releasing high-quality data despite stagnant or shrinking budgets. Furthermore, these operational constraints occur within an increasingly difficult survey-taking climate that has witnessed a gradual but steady decline in the accessibility of sample units and in the willingness of householders to participate. To address these challenges, many survey agencies collect paradata—information about the data collection process—to guide ongoing data collection activities (with the goal of minimizing survey error) and to evaluate the quality of collected data. The papers in this session will describe similar uses of paradata within the National Health Interview Survey (NHIS), the National Health and Nutrition Examination Survey (NHANES), and the National Survey of Family Growth (NSFG).
- Exploring the association between question characteristics, respondent characteristics, interviewer characteristics and survey data quality [PDF - 101 KB]
- Paradata and Survey Management in the National Survey of Family Growth (NSFG), 2006-2012 [PDF - 725 KB]
- Incorporating Statistical Process Control and Statistical Quality Control Techniques into a Quality Assurance Program [PDF- 214 KB]
- Paradata on the NHANES Survey [PDF - 420 KB]
SS-23. How Measurement and Modeling of Social Determinants of Health Can Inform Actions to Reduce Disparities
While numerous indicators of health have shown improvement in the United States in recent decades, disparities persist among populations. One of four overarching goals of Healthy People 2020 remains to “achieve health equity, eliminate disparities, and improve the health of all groups.” CDC defines social determinants of health as the complex, integrated, and overlapping social structures and economic systems (for example, the social environment, physical environment, health services, and structural and societal factors) that are responsible for most health inequities. This scientific session will provide an in-depth discussion of approaches to leveraging social determinants of health in the measurement, tracking, and reduction of health disparities, while investigating related methodological and data issues. In particular, this session will examine how: social determinants of health have contributed to the differential development of obesity among the U.S. population; labor markets and welfare policies shape health across the life course; the built environment and neighborhood contexts offer opportunities for public health interventions; and improvements in record and geographic linkage efforts can better inform actions to reduce health disparities.
- How life history theory can be viewed as an organizing framework for understanding variation in birth outcomes, and how the built environment and neighborhood contexts offer an opportunities for public health interventions [PDF - 1.3 MB]
- Record and Geographic Linkages to Inform Health Disparities [PDF - 560 KB]
- Gender disparities in adult obesity: Investigating behavioral and social factors in childhood [PDF - 731 KB]
- How Labor Markets and Welfare Policies Shape Health Across the Life Course: The Potentials and Limitations of Natural Policy Experiments [PDF - 1 MB]
SS-35. Monitoring the Affordable Care Act Using Population-based National Surveys
Health care access and utilization is rapidly changing in light of the Affordable Care Act (ACA) of 2010. National population surveys can be a powerful tool to monitor the effect of ACA. This session will examine changes in health insurance, health care access, and utilization using the National Health Interview Survey and the Medical Expenditure Panel Survey. This session will examine rates and trends using questions that have long histories within the surveys as well as new questions specifically designed to pick up changes in health care access and utilization resulting from ACA.
- Financial burden of medical care: Looking at new data from the National Health Interview Survey [PDF - 182 KB]
- Monitoring Pediatric Emergency Room Use with the National Health Interview Survey [PDF - 314 KB]
- Individual Insurance Benefits to be Available under Health Reform Would Have Cut Out-Of-Pocket Spending in 2001-08 [PDF - 115 KB]