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Esther Hing

Publications and source records attributed to Esther Hing.

11 recordsLinked to original sources
PubMed2007

Making patient-level estimates from medical encounter records using a multiplicity estimator.

The National Ambulatory Medical Care Survey (NAMCS) is a nationally representative survey of medical encounters in physician offices in the United States. Data from this survey and its counterpart in hospitals, the National Hospital Ambulatory Medical Care Survey (NHAMCS), have been used to investigate physician treatment and prescribing patterns. A limitation of these data, however, is that they represent visits rather than patients. Starting in 2001, the survey questionnaires began collecting information on the number of past visits the patient had to the sample provider during the one-year period prior to the sampled visit. This information was used to estimate number of patients from the NAMCS and NHAMCS visit data using a multiplicity estimator. The resulting distribution of patients by the number of annual visits is similar to the distribution of persons in the U.S. making ambulatory care visits from a population-based survey. This estimation technique may be useful in estimating patients with clinical characteristics that are difficult to collect from a population-based survey. Published in 2007 by John Wiley & Sons, Ltd.

Adolescent↗
PubMed2006

National Ambulatory Medical Care Survey: 2004 summary.

OBJECTIVES: This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. Selected trends in office visits are also presented. METHODS: The data presented in this report were collected in the 2004 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates using an estimator that uses a revised nonresponse adjustment. RESULTS: During 2004, an estimated 910.9 million visits were made to physician offices in the United States, an overall rate of 315.9 visits per 100 persons. Overall, 58.9 percent of visits were to physicians in the specialties of general and family practice, internal medicine, pediatrics, and obstetrics and gynecology. In 2004, primary care specialists provided 87.2 percent of all preventive care visits. The percentage of visits relying on Medicaid or the State Children's Health Insurance Program increased by 36% between 2001 and 2004. Essential hypertension, malignant neoplasms, acute upper respiratory infection, and diabetes mellitus were the leading illness-related primary diagnoses. There were an estimated 105.3 million injury-related visits in 2004, or 36.5 visits per 100 persons. Diagnostic or screening services were ordered or provided at 85.9 percent of visits, and counseling, education, therapeutic, or preventative services were ordered or provided at 42.0 percent of visits. Medications were prescribed or provided at 64.2 percent of visits.

Adolescent↗
PubMed2006

National Hospital Ambulatory Medical Care Survey: 2004 outpatient department summary.

OBJECTIVES: This report describes ambulatory care visits to hospital OPDs in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1994 through 2004 are also presented. METHODS: The data presented in this report were collected in the 2004 NHAMCS, a national probability sample survey of visits to emergency and outpatient departments of nonfederal, short-stay, and general hospitals in the United States. Selected comparisons are also made with data from the 2004 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. RESULTS: During 2004, an estimated 85.0 million visits were made to hospital OPDs in the United States, about 29.5 visits per 100 persons. Females (35.1 per 100 persons) had higher OPD visit rates than males (23.6 per 100 persons), and black or African American persons (50.3 per 100 persons) had higher OPD visit rates than white persons (27.0 visits per 100 persons). The overwhelming majority of visits to hospital OPDs were made by established patients (85.4 percent). Females made 75.5 percent of preventive care visits. The preventive care visit rate by Hispanic or Latino patients was twice the rate of non-Hispanic patients. Diagnostic and screening services were ordered at 90.3 percent of visits, therapeutic and preventive services were ordered at 50.0 percent of visits, and medications were ordered at 67.4 percent of visits. The proportion of visits involving only midlevel providers increased from 5.9 in 1993-94 to 11.4 percent of visits in 2003-04.

Adolescent↗
PubMed2006

Changes in U.S. prescribing patterns of menopausal hormone therapy, 2001-2003.

OBJECTIVE: In 2002, the combination estrogen-progestin hormone therapy (HT) treatment arm of the Women's Health Initiative was terminated early because cardiovascular and cancer risks were identified, while the estrogen-only therapy (ET) arm of this trial continued. We investigated hormone therapy prescription practice changes between 2001 and 2003 to explore the effects of the clinical trial results. METHODS: Data were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey for the years 2001 through 2003. These nationally representative surveys sample medical encounters in nonfederally employed physician's offices and outpatient departments of nonfederal short-stay and general hospitals. The proportion and rate of visits with ET and HT prescriptions were calculated. Logistic regression was used to estimate change over time accounting for patient and provider characteristics. RESULTS: Between 2001 and 2003, the number of visits with menopausal hormone prescriptions fell from 26.5 million to 16.9 million. Almost three-quarters of hormone visits were for ET prescriptions. The decrease in the rate of visits was slightly larger for HT prescription visits (44%) than ET prescription visits (35%). The rate of decline was highest among women 50 years of age and over. After controlling for covariates, there was no significant difference in the decline by hormone type. CONCLUSION: These nationally representative data indicate substantial declines in menopausal hormone prescriptions coinciding with clinical trial results on HT. These declines occurred among all types of therapy and patient characteristics. LEVEL OF EVIDENCE: II-3.

Adult↗
PubMed2005

National Hospital Ambulatory Medical Care Survey: 2003 outpatient department summary.

OBJECTIVES: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are shown on selected hospital, clinic, patient, and visit characteristics, as well as selected trends in OPD visits since 1993. The report highlights variation in use across the major types of OPD clinics surveyed. METHODS: The data shown in this report were collected from the 2003 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. RESULTS: During 2003, an estimated 94.6 million visits were made to hospital OPDs in the United States, about 33.1 visits per 100 persons. This rate represents a 35-percent increase since 1993, although rates have been stable since 1999. Infants under 12 months of age had a visit rate of 88.7 visits per 100 persons, a rate that increased by 23 percent since 1993. Increasing trends in OPD visit rates were found for persons 50-64 years of age (up by 30 percent), 13-21 years of age (up by 32 percent), 22-49 years of age (up by 34 percent), and 1-12 years of age (up by 71 percent). Females had higher OPD visit rates than males (39.6 compared with 26.4 visits per 100 persons), and black or African American persons had higher OPD visit rates than white persons (59.7 compared with 29.9 visits per 100 persons). Medicaid and State Children's Health Insurance Program patients used OPDs for preventive care services more frequently than private pay patients. The preventive care visit rate by Hispanic and Latino patients was twice the rate by non-Hispanic patients. Diphtheria, tetanus, and acellular pertussis (DTaP) was the most frequently provided vaccine to children under age 18 years. Between 1993-94 and 2003, the proportion of visits involving only mid-level providers increased from 5.9 to 12.6 percent of visits.

Adolescent↗
PubMed2005

Use of computerized clinical support systems in medical settings: United States, 2001-03.

OBJECTIVES: This report presents information on the use of electronic clinical systems to support patient care in physician offices and hospital emergency and outpatient settings. Percentages of hospital emergency and outpatient departments with electronic patient medical records and automated drug dispensing systems are presented by selected hospital characteristics for 2001-02. Percentages of physicians using electronic patient billing records, electronic patient medical records, and computerized prescription order entry systems are presented by selected physician characteristics for 2003. METHODS: Data are from provider induction interviews from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), the ambulatory care component of the National Health Care Survey (NHCS). The NHCS is a family of provider-based surveys that collect information on the care provided in various medical care settings. RESULTS: During 2001-03, electronic medical records were used less often in physician offices (17 percent) than in hospital emergency (31 percent) and outpatient departments (29 percent). In physician offices, information technology was more frequently used for billing patients (73 percent) than for maintaining medical records electronically (17 percent) or ordering prescriptions electronically (8 percent). Automated drug dispensing systems were available in hospital emergency departments (40 percent) more frequently than in outpatient departments (18 percent).

Ambulatory Care↗
PubMed2005

Effects of form length and item format on response patterns and estimates of physician office and hospital outpatient department visits. National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2001.

OBJECTIVES: This report describes effects due to form length and/or item formats on respondent cooperation and survey estimates. METHODS: Two formats were used for the Patient Record form for the 2001 NAMCS and OPD component of the NHAMCS: a short form with 70 subitems and a long form with 140 subitems. The short form also contained many write-in items and fit on a one-sided page. The long form contained more check boxes and other unique items and required a two-sided page. The NAMCS sample of physicians and NHAMCS sample of hospitals were randomly divided into two half samples and randomly assigned to either the short or long form. Unit and item nonresponse rates, as well as survey estimates from the two forms, were compared using SUDAAN software, which takes into account the complex sample design of the surveys. RESULTS: Physician unit response was lower for the long form overall and in certain geographic regions. Overall OPD unit response was not affected by form length, although there were some differences in favor of the long form for some types of hospitals. Despite having twice the number of check boxes on the long form as the short form, there was no difference in the percentage of visits with any diagnostic or screening services ordered or provided. However, visit estimates were usually higher for services collected with long form check-boxes than with (recoded) short form write-in entries. Finally, the study confirmed the feasibility of collecting certain items found only on the long form. CONCLUSION: Overall, physician cooperation was more sensitive to form length than was OPD cooperation. The quality of the data was not affected by form length. Visit estimates were influenced by both content and item format.

Ambulatory Care↗
PubMed2003

National Hospital Ambulatory Medical Care Survey: 2001 outpatient department summary.

OBJECTIVES: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics. The report highlights new items on continuity of care of OPD visits, including: whether the visit was the first or a followup for a problem, number of visits to the clinic during the past 12 months for established patients, and whether other physicians shared care for the patient's problem. The report also highlights variation in utilization across the major types of OPD clinics surveyed. METHODS: The data presented in this report were collected from the 2001 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. RESULTS: During 2001, about 83.7 million visits were made to hospital OPDs in the United States. The 2001 rate (29.9 per 100 persons) represents a 33 percent increase since 1992. Females had higher OPD visit rates than males (35.2 versus 24.3 visits per 100 persons) and black or African-American persons had higher OPD visit rates than white persons (48.8 versus 27.9 visits per 100 persons). The majority of visits to hospital OPDs were made by patients with previous visits to the clinic (84.2 percent); 70.0 percent had visited the clinic one or more times during the past 12 months. Preventive care visits comprised 15.5 percent of all OPD visits; nearly three out of four preventive care visits were made by females (72.8 percent). Diagnostic and screening services were ordered or provided at 85.0 percent of visits, therapeutic and preventive services were ordered or provided at 45.6 percent of visits, and medications were prescribed at 64.6 percent of visits. Most patients were given an appointment to return to the clinic (60.1 percent).

Adolescent↗
PubMed2003

Guide to using masked design variables to estimate standard errors in public use files of the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.

Until recently, sample design information needed to correctly estimate standard errors from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) public use files was not released for confidentiality reasons. In 2002, masked sample design variables were released for the first time with the 1995-2000 NAMCS and NHAMCS public use files. This paper shows how to use masked design variables to compute standard errors in three software applications. It also discusses when masking overstates or understates "in-house" standard errors, and how masking affects the significance levels of point estimates and logistic regression parameters.

Adolescent↗
PubMedDate not supplied

Combining estimates from complementary surveys: a case study using prevalence estimates from national health surveys of households and nursing homes.

OBJECTIVES: When a single survey does not cover a domain of interest, estimates from two or more complementary surveys can be combined to extend coverage. The purposes of this article are to discuss and demonstrate the benefits of combining estimates from complementary surveys and to provide a catalog of the analytic issues involved. METHODS: The authors present a case study in which data from the National Health Interview Survey and the National Nursing Home Survey were combined to obtain prevalence estimates for several chronic health conditions for the years 1985, 1995, and 1997. The combined prevalences were estimated by ratio estimation, and the associated variances were estimated by Taylor linearization. The survey weights, stratification, and clustering were reflected in the estimation procedures. RESULTS: In the case study, for the age group of 65 and older, the combined prevalence estimates for households and nursing homes are close to those for households alone. For the age group of 85 and older, however, the combined estimates are sometimes substantially different from the household estimates. Such differences are seen both for estimates within a single year and for estimates of trends across years. CONCLUSIONS: Several general issues regarding comparability arise when there is a goal of combining complementary survey data. As illustrated by this case study, combining estimates can be very useful for improving coverage and avoiding misleading conclusions.

Aged↗