Welcome NHCS Participants!

Your facility has been selected to participate in the National Hospital Care Survey (NHCS), a new survey starting in 2011.  The purpose of NHCS is to describe national patterns of health care delivery in hospital-based settings and in freestanding ambulatory surgery centers (ASCs).  Data will be collected on hospitals and ASCs, their patients, and their care, providing national estimates of service use and allowing policy-makers and researchers to study relationships between the organization and delivery of health care.  This survey integrates inpatient data collected from the National Hospital Discharge Survey (NHDS) and emergency and outpatient department (ED and OPD) and (ASC) data from the National Hospital Ambulatory Medical Care Survey (NHAMCS).  For many years the NHDS and NHAMCS were conducted annually to meet the need for information on hospital inpatients, emergency and outpatient departments, and ambulatory surgery centers.  The new survey will continue to provide nationally representative health care statistics that NHDS and NHAMCS currently provide but will have some distinct advantages.  This survey will collect more information at the hospital level, such as your hospital’s infrastructure for health information technology and volume of care provided by a particular facility.  Also, this survey will allow for the linkage of encounters of care within the same facility and with outside data sources such as the National Death Index and Medicare and Medicaid data.  We look forward to having your facility be a part of the new NHCS!

 

A Message from the CDC Director

Running Time: 2 minutes, 7 seconds
Release Date: 5/3/2012

A message from CDC Director Thomas Frieden on the importance of participation in the National Hospital Care Survey

Read the script [PDF - 13 KB]

 

Health Information Management (HIM) Professionals

Learn more about how Health Information Management (HIM) Professionals can earn Continuing Education Credits.

 

Participation Materials

• NHCS Secure Transfer System:
  • Westat Secure Transfer System (WSTS) NEW
  • Quick Reference Guide for the WSTS [PDF - 262 KB]
  • Detailed Instructions for the WSTS [PDF - 955 KB]
  • Data security plan  [ PDF - 45 KB]
• UB-04/837 Data File Specifications
  • File Transfer Specifications [PDF - 47 KB]
• Facility Questionnaire
• Facility Questionnaire, Part C [PDF - 73 KB]
• Facility Questionnaire, Part D [PDF - 369 KB]
• Introductory packet materials:
  • Letter from NCHS Director [PDF - 29 KB]
  • Hospital FAQ's [PDF - 840 KB]
  • NHCS brochure [PDF - 402 KB]
  • Strictly confidential brochure [PDF - 468 KB]
  • IRB approval letter [PDF - 54 KB]
• Professional Endorsements
  • American Health Information Management Association [PDF - 126 KB]
  • Federation of American Hospitals [PDF - 32 KB]
  • National Association of Public Hospitals and Health Systems [PDF - 57 KB]
• Other materials
  • HIPAA Privacy Rule and NHCS operations [PDF -113 KB]
  • Meaningful use information [PDF - 70 KB]

 

 

What is the National Hospital Care Survey?

The National Hospital Care Survey provides nationally representative data on utilization of inpatient hospital care as well as care delivered in emergency departments, outpatient departments, and hospital-based and free-standing ambulatory surgery centers. For more information see the NHCS website. 

 

Why participate in the NHCS?

NHCS is a national survey that, because of its size and design, provides information representative of all non-federal, noninstitutional hospitals and freestanding ambulatory surgery centers in the United States. Your participation in NHCS is important because without your involvement, your health care facility and others like yours will not be represented in the national description of care provided by hospitals and freestanding ambulatory surgery centers.  Your health care facility was randomly chosen to provide representative data not only for your hospital or freestanding surgery center, but also for similar hospitals or freestanding ambulatory surgery centers of the same service type, bed size and geographic location.

 

What does participation in the NHCS entail?

Starting in 2011, participation in the NHCS will include the following: 

• Contact by NHCS project staff to hear about the study and answer questions to confirm that your hospital is eligible to participate in the survey.
• Identification of a primary contact within the hospital that will be responsible for enrolling the hospital in NHCS, answering questions about the hospital and electronically transmitting the UB-04 data on a quarterly basis for all inpatients from the hospital.
• Completion of a short self-administered facility questionnaire that provides additional information about the characteristics of the hospital.

You may be asked to participate in special studies on occasion, but participation in these studies will be voluntary.

In 2013, participation in the NHCS will include the following:

• Continued submission of UB-04 data on a quarterly basis for all inpatients from the hospital.
• Determination of your hospital’s emergency department and/or outpatient departments and/or ambulatory surgery centers eligibility.
• Identification of contacts within the hospital who will enroll the ambulatory units in NHCS.
• Abstraction of medical records data from sampled visits to the ambulatory units.

All NHCS activities will be conducted either at participating health care facilities or by telephone.  No travel will be required of hospital staff.

 

What are the benefits of participation?

Hospitals that participate in the NHCS will receive $500 to offset the costs of setting up the processes and procedures to electronically transmit the Uniform Bill (UB)-04 (administrative claims data) to a secure site maintained by Westat, an agent of NCHS. Also at the end of each year of data collection your hospital will receive an additional $500 for participation.  In addition, hospital health information management (HIM) staff are eligible to receive continuing education credits for completing an online training focused on participation in NHCS.

Further, NHCS will collect data that will be used to make national estimates of hospital discharges and ambulatory care visits.  NHCS data will provide health care facilities with national benchmarks, which allow facilities to compare themselves to the nation.  By participating, your health care facility contributes to the national description of hospital and ambulatory surgery center utilization. Also, NHCS research findings may help health care facilities to better care for patients.  Your facility’s participation will result in more reliable statistics and will enable researchers to better measure the provision and utilization of health care in hospitals and ambulatory care facilities. The collection of this data will help to provide a more complete picture of hospital and ambulatory medical care.  Failure to participate lessens the accuracy of the data.

 

What type of information is collected?

We will collect all information available on the UB-04.  For more information, see the listing of UB-04 variables [PDF - 55 KB].

Also, the following hospital information will be collected:

• Hospital demographics (e.g., total number of discharges for the year and hospital ownership type)
• Clinical capabilities and services (e.g., Does the hospital have an ED? What is the trauma level rating of the ED?)
• Types of revenue sources
• Health information technology (HIT) (e.g., In which areas of the hospital does HIT function?)
• Electronic Medical Records (EMR) use (e.g., Are EMRs used in direct patient care settings?)

For more information, see the 2011 facility level questionnaire.

 

Who will be collecting information and how long will it take?

RTI, Social and Scientific Systems (SSS) and Westat are independent, nonprofit research organizations that are agents of NCHS.  These organizations will be assisting NCHS with recruitment and data collection activities.  They are designated agents of NCHS and are under contract to conduct the NHCS. Once your hospital decides to participate in the survey, you will be contacted to arrange the following:  

• Completion of an Induction Interview to be conducted one time in order to obtain general information needed to facilitate the data transmission from your hospital.  This is estimated to take 1 hour, including answering any questions you may have.
• Completion of a Facility Questionnaire which gathers more specific information about hospital characteristics, financial information, staffing, and health information technology.  This is a self-administered questionnaire, and it is estimated to take approximately 2 hours to complete.
• Creation of an electronic file of all inpatients in a specified format and transmission to a secure site on a quarterly basis. We estimate that this would require approximately 1 hour each time.  However, we recognize that the actual time required may vary across hospitals.

In 2013, you will be contacted to arrange the following: 

• Completion of Ambulatory Induction Interviews to identify ambulatory unit contacts for the survey and obtain general information needed to facilitate the data abstraction from these units.  This is estimated to take 1 hour, including answering any questions you may have.
• Completion of Ambulatory Unit Questionnaires which obtain more specific information about unit characteristics, patient volume, staffing, and services offered.  This is estimated to take approximately 1 hour to complete.
• Availability of medical records for abstraction from sampled visits to selected ambulatory units.

 

Is the information provided by my hospital kept confidential?

Yes.  All information collected will be the property of NCHS and kept strictly confidential.  The identity of specific health care facilities and individual patients will not be released in any manner, except to NCHS staff, contractors, and agents when required and with necessary controls.  Results of the study will be published only in an aggregated manner that will not allow identification of any individual hospital or patient.

  
NCHS has a long history of protecting the privacy of information we collect. NHCS is authorized by Congress in Section 306 of the Public Health Service Act (42 USC 242K), which requires NCHS to collect statistics on a variety of health indicators. Furthermore, in accordance with Section 308(d) of the Public Health Service Act (42 USC 242m), no information collected in this survey may be used for any purpose other than the purpose for which it is collected. Such information may not be published or released in any form if the individual or establishment is identifiable unless the individual or establishment has consented to such release. If any federal employee or contractor gives out confidential information not authorized by law, he or she can be fired, fined, and/or imprisoned.

The information you and your staff supply will be used solely for statistical research and reporting purposes. All information, publications, and data files will be released in such a way that no individual hospital or inpatient can be identified. For more information, please see the NCHS Confidentiality webpage or contact Eve Powell-Griner, NCHS Confidentiality Officer at 301 458-4257 or E-mail: EPowell-Griner@cdc.gov.

NCHS is required by law to keep all data regarding patients and facilities strictly confidential and to use these data only for research and statistical purposes as stated by Section 308(d) of the Public Health Service Act [42 United States Code 242m (d) and Section 513 of the Confidential Information Protection and Statistical Efficiency Act or CIPSEA (PL-107-347). All protected health information will be kept confidential and will be used only by NCHS staff, contractors, and agents when required and with necessary controls.  CIPSEA also includes provisions for a felony conviction and/or fine of up to $250,000 if NCHS staff or contractors violate the confidentiality provisions.

The national survey has been approved by the Institutional Review Board (IRB) of NCHS.  If you have questions about your rights as a participant in this research study, please call the Research Ethics Review Board at NCHS, toll-free, at 1-800-223-8118. 

 

Can my hospital participate and still comply with the HIPAA Privacy Rule?

Yes. This study conforms to the Privacy Rule as mandated by HIPAA, where disclosure of patient data is permitted for public health purposes. The Privacy Rule also specifies that in providing information to public health agencies, such as CDC, your hospital may rely on our assurance that the request constitutes the minimum necessary information required. The Privacy Rule permits your hospital to make disclosures without patient authorization for public health purposes and for research that has been approved by an IRB. This survey meets both of those criteria.

NCHS' Privacy and Data Release Policies and Current Legislative Authorities [PDF - 235 KB] web sites provide information for you to verify that your hospital is allowed to disclose to NCHS the information requested by the survey. The web sites include information on the authority under which NCHS is collecting these data and that the data being collected are the minimum information necessary.

NHCS is being conducted under the auspices of CDC/NCHS (federal government).   Special provisions within HIPAA exist to permit health care facilities to provide data to public health entities such as CDC/NCHS for purposes such as NHCS. 

The HIPAA Privacy Rule recognizes 1) the legitimate need for public health authorities and others responsible for ensuring the public's health and safety to have access to protected health information to conduct their missions, and 2) the importance of public health reporting by covered entities to identify threats to the public and individuals.  The Privacy Rule permits 1) protected health information disclosures without a written patient authorization for specified public health purposes to public health authorities legally authorized to collect and receive the information for such purposes, and 2) disclosures that are required by state and local public health or other laws (HIPAA Regulations (45 CFR§164.501)).  Thus, HIPAA permits health care facilities such as yours to participate in studies of this nature for public health purposes.  Because our contractors are serving as authorized agents of NCHS, it is permissible to disclose data to them for the purposes of this project.  HIPAA also permits covered entities to obtain the documentation and rely on the approval of one Institutional Review Board (IRB) or privacy board.  In this case, the hospital may rely on the approval of the NCHS’ IRB. 

 

Does my health care facility’s Institutional Review Board need to review this research project?

No. For research projects, only one IRB must review the project and NCHS’ IRB (which has the authority to review such projects under the Regulations for the Protection of Human Subjects) has done so.  We have the IRB approval letter [PDF - 54 KB] that indicates that three waivers have been approved for this survey, and contains the documentation that is required by the Privacy Rule.  If you desire, your hospital’s IRB may review the project as well.  Your IRB can verify that the IRB approval letter we have provided adheres to the requirements of the Privacy Rule, and NHCS can send you a copy of the materials submitted to the IRB. 

 

How will NHCS data be used?

NHCS is a new survey designed to provide information and offer opportunities for data linkage that its precursors, the National Hospital Discharge Survey (NHDS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), could not provide.

Historically, NHDS and NHAMCS data have been used to provide national and regional statistics of hospital and ambulatory care utilization in nonfederal short-stay health care facilities in the United States. NHDS provides information on inpatient characteristics such as age, sex, and source of payment, hospital characteristics such as size, ownership and geographic region, lengths of hospital stays, diagnoses, surgical and diagnostic procedures performed during hospitalization, and trends in health care for inpatients.  The NHAMCS provides the same type of information as NHDS on ambulatory care patient characteristics, along with information on patient complaints, procedures, medication therapy, disposition, types of providers seen, and causes of injury (emergency department and ambulatory surgery center only).

NHDS and NHAMCS 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 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.

The new NHCS will continue to provide nationally representative data on utilization of hospital and ambulatory care and nationally representative health care statistics on inpatient care, as well as care delivered in emergency departments (ED), outpatient departments (OPD), and hospital-based and free-standing ambulatory surgery centers (ASC).  The collection of personal identifiers (protected health information) will allow the linkages of encounters of care provided to the same patient in ED, OPD, ASC, and inpatient departments.  This new survey will also allow for linkages to be made to the National Death Index to measure post-discharge mortality and Medicare and Medicaid data, if applicable.  Obtaining all the UB-04 data from a hospital will also allow for the sampling of hospital discharges with specific diagnoses and procedures for special studies that will use medical record abstraction to collect more specific clinical data. 

Here are several examples of NHDS and NHAMCS data uses:

Selected Reports

• Inpatient Care for Septicemia or Sepsis: A Challenge for Patients and Hospitals [PDF - 609 KB]
• Factors Influencing Rural Residents’ Utilization of Urban Hospitals [PDF - 190 KB]
• Visits to Primary Care Delivery Sites: United States, 2008 [PDF - 654 KB]
• Emergency Department Visits for Chest Pain and Abdominal Pain: United States, 1999-2008 [PDF - 731 KB]
• National Hospital Discharge Survey: 2007 Summary [PDF - 402 KB]
• National Hospital Ambulatory Medical Care Survey: 2007 Outpatient Department Summary [PDF - 608 KB]
• National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary [PDF - 624 KB]
• Electronic Medical Records by Ambulatory Care Providers: United States, 2006 [PDF - 307 KB]
• For more reports and data, see:
  • NHDS “Survey Results and Products”
  • NHAMCS “Survey Results and Products”

NHAMCS and NHDS data in the news

• “Chickenpox Vaccine Cuts Hospitalization Rates: Study”
  Bloomberg Businessweek (01/2011)
• “ER visits for abdominal pain up, chest pain down”
  USA Today (09/08/2010)
• “Health Care Wastefulness Is Detailed in Studies”
  New York Times (09/07/2010)
• “Total Knee Replacement Surgery a National Trend Among Young Patients”
  Topnews (03/2010)
•  “Study Questions Need for Emergency Appendectomies”
  Bloomberg Businessweek (01/2010)
• "Wide Majority of EDs Board Patients"
  American College of Emergency Physician News (07/2009)
• "U.S. Emergency Rooms Find Ways to Fix What Ails Them"
  USA Today (12/14/2008)

Extensive compendiums of journal articles using NHDS and NHAMCS

• Selected articles using National Hospital Discharge Survey (NHDS) or National Survey of Ambulatory Surgery (NSAS) data [PDF - 318 KB]
• National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) List of Publications [PDF - 327 KB]

 

I’m ready to participate, what should I do?

Please call our toll-free number, 1-877-321-6437, to talk with someone about your participation in the National Hospital Care Survey.