Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010

February 28, 2017

Questions for Margaret J. Hall, Health Statistician and Lead Author of “Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010.”

Q: Why did you decide to do a report on national estimates of surgical and nonsurgical ambulatory procedures performed in hospitals and ambulatory surgery centers?

MH: The National Center for Health Statistics (NCHS), Division of Health Care Statistics, gathers national data on health care utilization. Included are surveys of inpatient care, physicians’ office care, and emergency department and outpatient department care. From 1994 to 1996, and again in 2006, NCHS gathered ambulatory surgery data through the National Survey of Ambulatory Surgery. Ambulatory surgery, also called outpatient surgery, refers to surgical and nonsurgical procedures that are nonemergency, scheduled in advance, and generally do not result in an overnight hospital stay. The nationally representative data from our inpatient and ambulatory surgery surveys showed that ambulatory surgery procedures made up a large part of the total surgery performed in the United States. In 2010, we were able to expand the National Hospital Ambulatory Medical Care Survey (NHAMCS), which has gathered data on hospital emergency and outpatient department utilization since 1992, to also gather data on ambulatory surgery in hospitals and in ambulatory surgery centers. This meant that we could provide more recent estimates of this important component of health care utilization.

Data were gathered on patient characteristics including age, sex, expected payment source, duration of surgery, and discharge disposition, as well as on the number and types of procedures performed in these settings. As is the case in our other health care surveys, sample data are collected and are then weighted to produce nationally representative estimates.


Q: Is the first time NCHS has published a report on this topic? Is there trend data?

MH: NCHS has published ambulatory surgery data for 1994 through 1996 and again for 2006. This report primarily contains 2010 data but it does note that the estimated number of ambulatory surgery visits decreased from 34.7 million to 28.6 million from 2006 to 2010. This 18% drop was statistically significant. But the 48.3 million ambulatory surgery procedures estimated using 2010 NHAMCS data was not significantly different from the 53.3 million ambulatory surgery procedures estimated using 2006 NSAS data.


Q: How do ambulatory surgery procedures by sex and age break down?

MH: For both males and females, 39% of procedures were performed on those aged 45–64. For females, about 24% of procedures were performed on those aged 15–44 compared with 18% for males, whereas the percentage of procedures performed on those under 15 was lower for females than for males (4% compared with 9%). About 19% of procedures were performed on those aged 65–74, with about 14% performed on those aged 75 and over. For the latter two age groups, there was no significant difference between males and females.


Q: What types of ambulatory surgery procedures are most patients getting?

MH: Seventy percent of the 48.3 million ambulatory surgery procedures were in the following clinical categories: operations on the digestive system (10 million or 21%), operations on the eye (7.9 million or 16%), operations on the musculoskeletal system (7.1 million or 15%), operations on the integumentary system (4.3 million or 9%), and operations on the nervous system (4.2 million or 9%). These procedure categories made up 72% of procedures performed on females and 67% of those performed on males.

  • Examples of operations on the digestive system include endoscopy of large intestine—which included colonoscopies—which was performed 4.0 million times; endoscopy of small intestine which was performed 2.2 million times; and endoscopic polypectomy of large intestine which was performed an estimated 1.1 million times.
  • Eye operations included extraction of lens, performed 2.9 million times, and insertion of lens, performed 2.6 million times, both for cataracts; and operations on eyelids, performed 1.0 million times.
  • Musculoskeletal procedures included operations on muscle, tendon, fascia, and bursa, performed 1.3 million times.
  • Operations on the integumentary system included excision or destruction of lesion or tissue of skin and subcutaneous tissue, performed 1.2 million times.
  • Operations on the nervous system included injection of agent into spinal canal, performed 2.9 million times, including injections for pain relief.

Q: Were there any findings that surprised you?

MH: It was surprising that the number of ambulatory surgery visits and procedures performed did not increase from 2006 to 2010. Instead our 2010 data showed that there was a significant decrease of 18% in the number of ambulatory surgery visits since 2006. The number of procedures performed during 2010 did not differ significantly from the number performed in 2006.

One reason for these findings could be an under count in the survey in 2010. There were some problems in hospitals identifying in-scope ambulatory surgery visits since they were more dispersed throughout the hospitals in 2010 than they had been in 2006. Another reason that ambulatory surgery visit estimates could have decreased could be the deep economic recession that began in 2007. By 2010, when our survey began gathering ambulatory surgery data in both hospitals and Ambulatory Service Centers, the economy had not fully recovered and, due to this, some patients may have decided not to schedule ambulatory surgery. Some ambulatory surgery procedures are elective.

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QuickStats: Age-Adjusted Percentage of Adults Aged 65 Years or Older by Number of 10 Selected Diagnosed Chronic Conditions and Poverty Status

February 27, 2017

For the period 2013–2015, 13% of adults aged 65 years or older reported having none of 10 selected diagnosed chronic conditions; 25% had one, 46% had two or three, and 16% had four or more of the conditions.

No differences by poverty status were observed among those who reported having two or three conditions, but those in the lowest income group (100% or less of the poverty threshold) were less likely to have none or only one of the chronic conditions compared with those in the highest income group (400% or more of the poverty threshold).

Those in the lowest income group also were more likely to have four or more conditions when compared with those in the highest income group (21% compared with 12%).

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6607a6.htm


Has the death rate from drug overdoses in the U.S. increased most rapidly among young people over the last decade and a half?

February 24, 2017

Source: National Vital Statistics System

https://www.cdc.gov/nchs/data/databriefs/db273.pdf


Early Release of Selected Estimates Based on Data From the January–September 2016 National Health Interview Survey

February 23, 2017
Tainya C. Clarke, Ph.D., M.P.H., Health Statistician

Tainya C. Clarke, Ph.D., M.P.H., Health Statistician

Questions for Tainya C. Clarke, Ph.D., M.P.H., Health Statistician and Lead Author on the “Early Release of Selected Estimates Based on Data From the January–September 2016 National Health Interview Survey.”

Q: What health measures does this report look at?

TC: The measures covered in this report are lack of health insurance coverage and type of coverage, having a usual place to go for medical care, obtaining needed medical care, receipt of influenza vaccination, receipt of pneumococcal vaccination, obesity, leisure–time physical activity, current cigarette smoking, alcohol consumption, human immunodeficiency virus (HIV) testing, general health status, personal care needs, serious psychological distress, diagnosed diabetes, and asthma episodes and current asthma. Three of these measures (lack of health insurance coverage, leisure-time physical activity, and current cigarette smoking) are directly related to Healthy People 2020 Leading Health Indicators.


Q: How do you collect your data for these surveys?

TC: The data is collected by household interview surveys that are fielded continuously throughout the year by the National Center for Health Statistics (NCHS). Interviews are conducted in respondents’ homes. Health and socio-demographic information is collected on each member of all families residing within a sampled household. Within each family, additional information is collected from one randomly selected adult (the “sample adult”) aged 18 years or older and one randomly selected child (the “sample child”) aged 17 years or younger. NHIS data is collected at one point in time so we cannot determine causation. Data presented in this report are quarterly data and are preliminary.


Q: What are some of the findings that you would highlight in this early release report?

TC: Here are some findings from the early release report:

• The percentage of persons of all ages who had a usual place to go for medical care decreased, from 87.9% in 2003 to 85.4% in 2010, and then increased to 88.3% in January–September 2016.

• The percentage of persons who failed to obtain needed medical care due to cost increased, from 4.3% in 1999 to 6.9% in 2009 and 2010, and then decreased to 4.4% in January–September 2016.

• The percentage of adults aged 65 and over who had ever received a pneumococcal vaccination increased from 63.5% in 2015 to 67.3% in January–September 2016.

• The prevalence of obesity among U.S. adults aged 20 and over increased, from 19.4% in 1997 to 30.6% in January–September 2016.

• In the third quarter of 2016, 52.8% of U.S. adults aged 18 and over met the 2008 federal physical activity guidelines for aerobic activity (based on leisure-time activity). This was higher than the third quarter of 2015 estimate of 49.5%.

• The prevalence of current cigarette smoking among U.S. adults declined, from 24.7% in 1997 to 15.3% in 2015 and remained low through the third quarter of 2016 (15.9%).
• During January–September 2016, men were more likely to have had at least 1 heavy alcohol drinking day (31.6%) in the past year compared with women (18.6%).

• The prevalence of diagnosed diabetes among adults aged 18 and over increased, from 5.1% in 1997 to 9.2% in 2010, and has since remained stable through January–September 2016.


Q: What do the findings in this report tell us about the health of the country overall?

TC: Since 2010, the percentage of uninsured persons has decreased by almost 50% (16.0% vs 8.8%) and the percentage of persons who failed to obtain needed medical care due to cost has also shown a significant decline during the same time period (6.9% to 4.4%). These two indicators demonstrate increased access to healthcare from 2010 to September 2016.


Q: Are there any trends in this report that Americans should be concerned about?

TC: Although in the 3rd quarter of 2016, 52.8% of U.S. adults met the 2008 federal physical activity guidelines for aerobic activity; obesity is an epidemic that has seen a steady increase since 1997 and now affects just under one third (30.6%) of U.S. adults.


Trends and Variations in Reproduction and Instrinsic Rates: United States, 1990-2014

February 22, 2017

Questions for Brady E. Hamilton, Ph.D., Demographer, Statistician, and Lead Author on “Trends and Variations in Reproduction and Intrinsic Rates: United States, 1990-2014

Q: Why did you conduct this study?

BH: We produced this report because we wanted to provide an updated analysis of fertility patterns in the United States. This report provides current detailed information on the fertility patterns for the United States, as measured by reproduction and intrinsic rates, which have not been available since the release of an earlier report more than a decade ago (https://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_17.pdf). The new report focuses on the recent trends in these rates and also presents, for the first time, reproduction and intrinsic rates for the three largest population groups — non-Hispanic white, non-Hispanic black, and Hispanic.


Q: What is the difference between reproduction rates and intrinsic rates, and what can they tell us about population growth and change in the United States?

BH: The reproduction and intrinsic rates are important to understanding population growth and change in the United States and are useful additions to the annual birth and fertility rates (such as the crude birth rate and general fertility rate) published by NCHS. Unlike the annual birth and fertility rates which measure the fertility of women in a given year, the reproduction rates summarize the number of births expected for a (hypothetical) group of 1,000 women over their lifetime given their particular fertility and mortality rates. The reproduction rates can measure, for example, whether the number of births is at “replacement,” that is, the level at which a given group of women can exactly replace themselves. For example, the net reproduction rate in 2014 was 897 which means that given their fertility and mortality rates in 2014, we would expect to see 897 daughters born per 1,000 of these women, which is below replacement level (1,000 daughters). The reproduction rates can be used to compare populations over time or among different groups. The intrinsic rates summarize the birth, death, and rate of change of a population, which would be expected to prevail given particular fertility and mortality rates. These rates measure the change of a population, either growth or decline, and can be used to compare populations over time or among different groups. For example, the intrinsic rate of natural increase in 2014 was -3.7, which means that given the fertility and mortality rates in 2014, the population for the United States was declining. This measure excludes migration.


Q: Was there a result in your study’s analysis of reproduction and intrinsic rates in the United States that you hadn’t expected and that really surprised you?

BH: The pervasive and large declines in the rates among the race and Hispanic origin groups was quite striking. For the three largest groups — non-Hispanic white, non-Hispanic black, and Hispanic– the total fertility, gross reproduction, and net reproduction rates declined by at least 7% from 2006 through 2014. The Intrinsic rate of natural increase declined by at least 78% from 2006 through 2014 for the three groups.


Q: What differences, if any, did you see among race and ethnic groups?

BH: While the total fertility, gross reproduction, and net reproduction rates and intrinsic rate of natural increase declined for the three race and Hispanic origin groups, there were differences among the groups in the rate of decline and among the rates themselves. In general, the reproduction rates declined the least for non-Hispanic white women and the most for Hispanic women from 2006 through 2014. Similarly, in 2014, the reproduction rates were lowest for non-Hispanic white women and highest for Hispanic women. The intrinsic rates of natural increase differed, too, with the rate being negative for both the non-Hispanic white and non-Hispanic black population groups in 2014, but positive for the Hispanic population group.


Q: What is the take home message of this report?

BH: The take home message from the report is that reproduction rates and intrinsic rate of natural increase have declined overall from 1990 through 2014 and for the three largest race and Hispanic origin groups from 2006 through 2014. However, differences in the reproductive and intrinsic rates for the groups exist.


QuickStats: Percentage of Total Daily Kilocalories Consumed from Sugar-Sweetened Beverages Among Children and Adults, by Sex and Income Level

February 21, 2017

During 2011–2014, on average, 7.3% of boys’ and 7.2% of girls’ total daily calories were obtained from Sugar Sweetened Beverages (SSB) compared with 6.9% for men and 6.1% for women.

For men, women, and girls, the percentage of total daily kilocalories from SSBs declined as income level increased.

For boys, the percentage of total daily kilocalories was lower for those in the highest income group than in the other income groups. Compared with women, a larger proportion of men’s total daily kilocalorie intake came from SSBs.

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6606a8.htm


Characteristics of Primary Care Physicians in Patient-centered Medical Home Practices: United States, 2013

February 17, 2017

Questions for Esther Hing, Survey Statistician and Lead Author on “Characteristics of Primary Care Physicians in Patient-Centered Medical Home Practices: United States, 2013

Q: Can you define what a patient-centered medical home (PCMH) practice is?

EH: One of several PCMH definitions is that PCMHs provide care that is: comprehensive care provided by a team of providers, patient-centered care, coordinated care, has accessible services, and care focused on quality and safety.


Q: Why did you decide to do a report on PCMH practices?

EH: Although the PCMH has been advocated by the “primary care community” for more than a decade, there are no national estimates that describe characteristics of this model of care delivery. “Primary care community” includes primary care physicians as well as other primary care providers and associated professional societies. The report, based on questions funded by the Assistant Secretary for Planning and Evaluation (ASPE), will inform policy makers of the prevalence of certified PCMH practices in the United States, as well as care attributes of these practices (compared with non-PCMH practices).

Estimates not only serve as benchmark estimates for this model of primary care, but adds to the knowledge base about this type of practice. Payers and the federal government have increasingly funded PCMH demonstrations, and certain payers and states have also increased funding to practitioners in PCMH practices.


Q: Is the first time NCHS has published a report on this topic?

EH: Yes, this is the first year that the PCMH questions have been reported.


Q: What did your report find on primary care physicians in PCMH practices?

EH: The report found that primary care physicians in PCMH practices tended to be in larger practices, and located in urban areas. These findings may be attributed to infrastructure requirements needed for PCMH care delivery. It may also reflect that in 2013, the Centers for Medicare and Medicaid Service (CMS) demonstrations and payment policy supporting chronic care was not yet implemented or was in early stages of development.


Q: Were there any findings that surprised you?

EH: The finding that a substantial percentage of non-PCMH practices have non- physician clinicians and Electronic Health Records suggests that there is untapped potential for a greater number of primary care practices to become PCMHs.

However, the relatively lower participation by solo and small practices as PCMHs suggests the need for assistance or coaching to make this transformation. The ongoing implementation of payment incentives from CMS and elsewhere has encouraged growth of PCMHs. This is a trend that the National Ambulatory Medical Care Survey (NAMCS) can be used to examine for the next few years and beyond.