Welcome NAMCS Participants

The intent of the Lookback module is to improve the nation’s ability to monitor and evaluate the quality of clinical care to prevent diseases such as heart disease and stroke. Sampled visits which indicate patients with elevated risk for heart disease or stroke will have additional information collected from all prior visits to the provider during the past 12 months. Combining data from the current visit as well as the prior visits will permit evaluation and monitoring of appropriateness of clinical management and the relationship to intermediate outcomes. Furthermore, information on the clinical management of such diseases could identify shortfalls in the quality of care and opportunities for improvement.

The National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Complementary medicine refers to useof CAM together with conventional medicine, such as using acupuncture in addition to usual care to help lessen pain. Alternative medicine refers to use of CAM in place of conventional medicine.

The 2012 NAMCS includes a CAM supplement. The questions included in this supplement are sponsored by NCCAM and will provide information on the frequency of referrals and extent to which conventional providers integrate CAM into their patient treatment plans.

This supplement will be administered to physicians who are likely to see asthma patients. The study is expected to aid research in several areas: 1) to understand barriers to implementation of asthma management strategies; 2) to determine overall acceptance of the National Heart, Lung and Blood Institute’s Guidelines for the Diagnosis and Management of Asthma; and 3) to describe how identification of these barriers can inform ongoing strategies to increase the uptake of these guidelines.

In addition to the standard in-person NAMCS, a mail survey examining adoption of electronic medical records (EMRs)/electronic health records (EHRs) is being conducted again in 2012. The survey is being mailed to physicians who are otherwise eligible for NAMCS, but have not been selected in the regular NAMCS sample. The mail survey has been fielded continuously since 2008. The sample size was increased starting in 2010 so that state-level EMR/EHR estimates could be created.

The mail survey was funded by the Office of the National Coordinator for Health Information Technology (ONC) and will assist in measuring the progress of the goal for most Americans to have access to an interoperable EHR by 2014. A report detailing findings from the 2011 mail survey is available as an NCHS Data Brief: Electronic Health Record Systems and Intent to Apply for Meaningful Use Incentives Among Office-based Physician Practices: United States, 2001–2011.

Added in 2011, the Physician Workflow Supplement is a follow-up data collection initiative sponsored by ONC to provide a better understanding of physician experiences with adoption and use of EHRs. The base sample for the survey comprises respondents to the 2011 EHR supplement. Respondents are being followed annually for a three-year period, beginning in 2011 and running through 2013. The main purpose of the survey is to obtain information on costs, benefits, and barriers related to the use of EHR systems at various stages of adoption. This information will help ONC understand the experiences of adopters and measure progress towards Health Information Technology for Economic and Clinical Health Act (HITECH) program goals. Data will also help guide policymaking surrounding meaningful use criteria of EHR that have been established to help create a private and secure 21st century electronic health information system. Together with data from the EHR supplement, responses will help to develop criteria for successive stages of meaningful use.

2011 Highlights

Community Health Centers

The 2011 NAMCS once again includes a sample of Community Health Centers. These were surveyed by NAMCS for the first time in 2006 and have been included in each annual survey since then.

What are Community Health Centers?

Community Health Centers (CHCs) are local, non-profit, community-owned health care providers that serve low-income and medically underserved areas. Health centers serve as the medical home and family physician to over 20 million people nationally - a number that is quickly growing. Health center patients are among the nation's most vulnerable populations - people who even if insured would nonetheless remain isolated from traditional forms of medical care because of where they live, who they are, the language they speak, and their higher levels of complex health care needs. As a result, patients are disproportionately low income, uninsured or publicly insured, and minority.

Why include CHCs in the NAMCS?

Although general information is known about CHCs through the Uniform Data System (a mandatory reporting system within the Bureau of Primary Health Care, Health Resources and Services Administration), details of patient/physician encounters are not known.

Visits made to CHCs, although in-scope for the NAMCS, have been underrepresented in the survey because the normal sample of physicians is simply not large enough to capture many of the physicians who work at these important locations.

How does the NAMCS sample CHCs?

NAMCS includes three different types of CHCs in the sample: (1) CHCs that receive grant funds from the federal government through section 330 of the Public Service Act (PHSA), (2) Look-alike CHCs that meet all the requirements to receive 330 grant funding, but do not actually receive a grant, and (3) Urban Indian Federally Qualified Health Centers (FQHC).

Up to three providers at each of the 104 CHCs in the sample will be asked to participate. The resulting visits that are sampled from the approximately 312 providers will enable NCHS to provide separate statistics on the visits made to CHCs.

Additionally, mid-level providers--nurse practitioners, physicians assistants, and nurse midwives--who work in CHCs are eligible to participate in the NAMCS.

Continuing Stratum of Oncologists

As in 2010, a separate stratum of oncologists has been included in the 2011 NAMCS. This initiative is being funded by the Division of Cancer Control and Population Sciences of the National Cancer Institute (NCI), National Institutes of Health (NIH) and is intended to improve estimates of physician services related to cancer care. This information is needed by clinical and public policymakers in order to assess and monitor the quality of cancer care. With funding from NCI in 2006 and 2007, NAMCS produced the first nationally representative data from patients’ medical records on the management of ambulatory cancer care. With the new data, many research questions can be explored in greater depth, such as whether cancer treatment varies by physician specialty, physician practice characteristics, geographic region, insurance status, and patient demographics. Funding for this stratum is expected to continue in 2012.

Collection of Laboratory Values

To better understand the extent to which ambulatory health care providers identify and control abnormal values of lipoproteins, blood sugar, and glycohemoglobin before and after diagnoses of cardiovascular disease, lab value items will continue to be collected on the Patient Record form (PRF).  However, unlike 2010, only one PRF is being used.  There are additional items on the back of the form with space to record up to six laboratory values (total cholesterol, HDL, LDL, triglycerides, HgbA1c, and FBG). Physician specialty or type of setting will determine if these items should be completed. The addition of these items represents a partnership between the CDC’s National Center for Health Statistics and the Division for Heart Disease and Stroke Prevention of the National Center for Chronic Disease Prevention and Health Promotion.

Electronic Medical Records/Electronic Health Records Mail Survey

In addition to the standard in-person NAMCS, a supplementary mail survey examining adoption of electronic medical records (EMRs)/electronic health records (EHRs) is being conducted again in 2011 conducted.  The survey is being mailed to physicians who are otherwise eligible for NAMCS, but have not been selected in the regular NAMCS sample.  The mail survey has been fielded continuously since 2008. The sample size was increased starting in 2010 so that state-level EMR/EHR estimates could be created.

The mail survey was funded by the Office of the National Coordinator for Health Information Technology (ONC) and will assist in measuring the progress of the goal for most Americans to have access to an interoperable EHR by 2014.  A report detailing findings from the 2008 and 2009 standard NAMCS EMR questions, as well as from the mail surveys, is available as an NCHS Health E-Stat: “Electronic Medical Record/Electronic Health Record Use by Office-based Physicians: United States, 2008 and Preliminary 2009”.

Confidentiality and Privacy

Confidentiality of NAMCS data

The NAMCS is conducted under the authority of Sec. 306 of the Public Health Service Act (42 USC 242k) which requires NCHS to collect statistics on a variety of health indicators. Information collected in this survey is used to study overall patterns of health care use by the population and for other similar statistical purposes. NCHS has a long history of protecting the privacy of information that we collect, and Sec. 308(d) of the Public Health Service Act (42 USC 242m) assures the confidentiality of data collected in the NAMCS. We strictly observe this confidentiality statute, which prohibits the release of identifiable information that we obtain unless we are given consent to do so by the subject.

HIPAA Privacy Rule and NAMCS

This section contains an overview of the Privacy Rule and how it affects your NAMCS participation.  For more comprehensive information on the Privacy Rule and the NAMCS, please go to HIPAA Privacy Rule Questions and Answers for NAMCS.

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 you 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 [PDF - 1.1 MB] with NCHS.  If you have questions about your 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 [PDF - 534 KB] for NAMCS.

We have included all the information you need to be assured that you are allowed to disclose protected health information for the NAMCS in our introductory letter to physicians [PDF - 18 KB], CHC directors [PDF - 18 KB], and CHC providers [PDF - 18 KB], 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 you generally provide to your patients must indicate that patient information may be disclosed for either research or public health purposes.  And secondly, you may need to keep a record of the disclosure [PDF - 69 KB] (which we will provide) that shows that some data from the patient’s medical record were disclosed to CDC for the NAMCS. Of course, if you do not transmit health information electronically (such as claims data), then you are not subject to the Privacy Rule or the requirements described above.

The Privacy Rule applies to data collected for the NAMCS because we are asking you to provide certain information about patients without their authorization.  For public health and research purposes, the NAMCS 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 providers like you by upholding the highest confidentiality standards and practices.

For additional information on the confidentiality of NAMCS data, please go to NCHS’s Privacy Protection page and Frequently Asked Questions (FAQ’s) about the NAMCS.

Your assurance of privacy

NCHS is legally bound to assure confidentiality of all responses, including any information that might result in a physician’s practice or hospital being identified. The data files that are released for research do not include any provider or patient identifying information.

The NAMCS does not collect any personally identifiable data about patients such as patient's name or address. The top section of the NAMCS 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).

To view a copy of the NAMCS Patient Record form, see NAMCS Survey Instruments.

Data Utilization

• How are NAMCS data used?
  NAMCS data are used to provide statistics that describe the characteristics of office visits to physicians. 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 public health policy makers, health services researchers, medical schools, physician associations, epidemiologists, and the print and broadcast media to describe and understand the changes that occur in medical care requirements and practices. The data are disseminated in the form of public health reports, journal articles, and microdata files.
• NAMCS data in the news
  • Docs Still Give Antibiotics for Ear Infection: The guidelines set forth by the American Academy of Pediatrics and the American Academy of Family Physicians on the management of acute otitis media have not appreciably altered antibiotic prescribing. MedPage, accessed (12/9/11).
  • More physicians applying for meaningful use incentives: A majority of physicians who responded to the National Ambulatory Medical Care Survey (NAMCS) reported that they potentially qualify for financial incentives attached to meeting Stage 1 meaningful use criteria. CMIO, accessed (12/9/11).
  • Physician use of EMR/EHR Statistics: Despite the federal push for healthcare organizations to adopt effective, meaningful use EMRs/EHRs by 2014 to replace paper records, the latest statistics from the National Ambulatory Medical Care Survey (NAMCS) show that physicians are lagging in implementing a viable system at their practices. SmartDataCollective, accessed (12/9/11).
  • 57% of Office-Based Physicians Used EMRs, EHRs in 2011: Fifty-seven percent of office-based physicians used electronic medical record/electronic health record systems in 2011, a huge jump from the 18 percent in 2001, according to a report by the Centers for Disease Control and Prevention. Becker’s Orthopedic, Spine and Pain Management, Becker's Orthopedic, Spine and pain Management, accessed (12/9/11).
  • Data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey indicate that antipsychotic prescribing increased from 8.6 cases per 1000 in US children (2 to 18 years of age) in 1995-1996 to 39.4 cases per 1000 US children in 2001-2002. Medscape Today. Medscape, accessed (12/9/11).
  • NAMCS Charts and Tables
  • Publications using NAMCS data

   

  Professional Endorsements

  This is truly a national resource. Without it, we would not have any reliable estimates of what happens at all the visits that Americans have with their doctors. -- Jim Rodgers, American Medical Association Vice president for Health Policy.

  NAMCS is endorsed by many professional organizations. Here is a list of organizational endorsements:

  • American Academy of Ambulatory Care Nursing
  • American Academy of Dermatology
  • American Academy of Family Physicians
  • American Academy of Neurology
  • American Academy of Ophthalmology
  • American Academy of Orthopedic Surgeons
  • American Academy of Otolaryngology – Head and Neck Surgery, Inc
  • American Academy of Pediatrics
  • American Academy of Physical Medicine and Rehabilitation
  • American College of Cardiology
  • American College of Obstetricians and Gynecologists
  • American College of Physicians
  • American College of Preventive Medicine
  • American College of Surgeons
  • American Osteopathic Association
  • American Psychiatric Association
  • American Society of Clinical Oncology
  • American Society of Plastic Surgeons
  • American Urological Association
  • Association of American Medical Colleges
  • National Association of Community Health Centers

   

  Continuing Medical Education for Health Care Providers

  Notice: This course is currently unavailable. It should be available again in early August. Please watch for an announcement on the ACLIST or continue to check this website for further information. We apologize for any inconvenience. (6/2012)

  The course entitled National Ambulatory Medical Care Survey Methods: What Clinicians Need to Know is now eligible for 1.25 hours of Category 1 continuing medical education (CME), 1.4 hours of continuing nursing education (CNE) and 0.1 continuing education (CEU) credits.

  More Information

   

  Audio-Visual Presentation

  • Watch an Audio-Visual Presentation on the NAMCS (requires Flash 4 player or higher)
  • Download Flash Player

   

  Contact Information

  If you have any further questions or comments related to participation, please contact Don Cherry at:

  National Center for Health Statistics
  Ambulatory Care Statistics Branch
  3311 Toledo Road, Room 3409
  Hyattsville, Maryland 20782
  Phone: 800-392-2862
  Fax: 301-458-4032

  Ambulatory Health Care Data home page