Tuesday: Scientific Sessions

Health Disparities and Health Equity

Greetings and Introduction:

Irma E. Arispe, Ph.D.
Division Director, Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention

Welcome and Opening Remarks:

Charles J. Rothwell
Director, National Center for Health Statistics, Centers for Disease Control and Prevention

Keynote speaker:

J. Nadine Gracia, M.D., M.S.C.E.
Deputy Assistant Secretary for Minority Health and the Director of the Office of Minority Health at the U.S. Department of Health and Human Services (HHS)

Room: Grand Ballroom (Salons D-E)

AA1. Improving Understanding of Race and Ethnicity: 30 Years After the Heckler Report

In 1985, then Department of Health and Human Services Secretary Margaret Heckler released the “Report of the Secretary’s Task Force on Black & Minority Health” (AKA The Heckler Report) that documented large racial and ethnic differences in health and mortality in the United States. This report led to the establishment of the Office of Minority Health and a general increased awareness of racial and ethnic health disparities in the national conversation on health. This session will examine advances and challenges in measuring and understanding health disparities through the lens of the issues raised in the Heckler Report. The focus is on the state of research on racial and ethnic disparities in health and mortality, issues related to data quality in studying health disparities, racial and ethnic differences in health care quality, and developments surrounding the potential mechanisms driving racial and ethnic disparities in health in the decades following the release of the Heckler Report. The session serves to commemorate what has been achieved in reducing racial and ethnic inequalities in health and to demonstrate what remains to be done. [SS-18]

Room: Salon D

AA2. Leveraging Meaningful Use for Enhanced Data Reporting in the National Health Care Surveys

This session will describe NCHS’ activities to leverage the collection of electronic health record (EHR) data to enhance reporting for its provider-based surveys. It will begin with a brief overview of the National Health Care Surveys and their transition to EHR data collection, followed by a description of the development of an HL7 CDA Implementation Guide (IG). The HL7 CDA IG is used to standardize electronic submission of survey data elements to achieve consistent and efficient acquisition of these data. Additionally, we will discuss research initiatives undertaken to advance EHR data collection for the National Ambulatory Medical Care Survey, including a pilot project that compares the completeness and comparability of data captured using three modes of data collection: manual abstraction from the medical record, extraction from an EHR system, and a continuity of care document. Work with leading EHR vendors to extract data for the National Hospital Care Survey according to the HL7 IG standards will also be presented. Finally, the session will conclude with an overview of Stage 3 Meaningful Use and its potential impact on data collection for the National Health Care Surveys, as the surveys have been included in the proposed rule under public health reporting. [SS-03]

Room: Brookside A-B

AA3. Assessing and Improving the Quality of the New Birth Data: The Good, the Bad, and the Underreported

This session will focus on recent efforts to evaluate and improve the quality of medical and health data based on the 2003 revision of the birth certificate and will present some key highlights from these data. The session will present 1) results of recent studies in several states comparing birth certificate data with data abstracted from hospital medical records, 2) data highlights and quality reviews for several data items new to the birth certificate, such as the results of a study comparing assisted reproductive technology (ART) data from the birth certificate with data from the National ART Surveillance System, and also source of payment for the delivery and pregnancy interval; 3) current federal and state collaborative efforts to improve data quality, including the decisions to remove several items from the national birth file and the development of e-training for hospital staff to assist in accurately and thoroughly completing the birth certificate. [SS-11]

Room: White Oak A-B

AA4. Data Suppression: If, What, When, Why, How

In 2013, NCHS assembled a workgroup with representatives from its different programs to evaluate the current practice for data suppression and presentation, particularly how these practices are applied to large publications like Health, United States. The workgroup has developed some proposed guidelines for proportions, the most commonly produced estimate. This session will describe and illustrate the proposed NCHS data presentation standards for proportions and discuss them in the context of other standards within the federal statistical system and from the perspective of users. There will be sufficient time for audience questions and comments. [SS-16]

Room: Salon E

AA5. Who Provides Primary Care in the United States? Going Beyond Physician-based Care

While the need for primary care services has increased during the last 15 years, the proportion of medical school graduates planning to practice in primary care has declined from 60% in 1997 to about 25% in 2012. One proposal to address physician shortage in primary care is to increase services delivered by advanced care practitioners including nurse practitioners (NPs), physician assistants (PAs), and nurse midwives (NMs). This session examines the changes in and growth of primary care services provided by NPs, PAs, and NMs nationwide. In addition, major data sources—including provider data from the American Association of Physician Assistants, the 2012 National Sample Survey of Nurse Practitioners, and the in-person and mail surveys of the National Ambulatory Medical Care Survey (NAMCS)—that are available to examine primary care workforce and service utilization will be discussed. Recent survey work and pilot studies in NAMCS will also be presented to identify major gaps in what is known about services delivered by these professionals. This session informs the ongoing discussion about how the landscape of primary care delivery is changing and what national data sources are still needed to capture this information in the United States. [SS-04]

Room: White Flint Amphitheatre

AA6. The Role of the Web in National Health Surveys

Rising nonresponse and increasing costs continue to threaten traditional methods of collecting national health survey data, especially telephone and face-to-face interviewing. Web surveys have become an increasingly popular mode of data collection, because of their relatively low cost and speed of implementation, but suffer from a number of known limitations, including concerns about coverage error due to uneven access to the Internet, high rates of nonresponse relative to other modes, and difficulties in drawing samples of the general population using the Internet. Researchers continue to evaluate ways that the Internet can be used to supplement or replace existing methods of data collection. This includes both probability-based and non-probability-based (e.g., opt-in or access) Web panels, as well as the use of Web surveys in a mixed-mode design. This presentation will include a broad overview of the inferential challenges and opportunities of including Web data collection—whether as a standalone mode or in combination with some other method—in large-scale national heath surveys. The speaker will present a review of the existing research as well as examples from his own recent research exploring ways to integrate Web data collection into large-scale surveys. The presentation will identify opportunities for the inclusion of Web surveys in national health surveys, and the challenges of doing so, along with identifying gaps in research knowledge to permit fuller use of this mode. The session will end with a summary of findings from multi-mode data collection studies conducted for NCHS surveys. [SS-26]

Room: Salons F-G

How to Find and Apply for Employment Opportunities at NCHS (12:00—1:30 p.m.)

Demystify the federal job search by hearing from those who’ve successfully navigated it. The first portion of this session will consist of an overview of where and how to apply for employment opportunities at NCHS. This overview will include a description of the application process for internships, fellowships, and permanent federal positions. Attendees will then hear from a panel of current NCHS employees who will discuss their career paths and answer questions from the audience about their experiences at NCHS.

Room: Glen Echo

Meet NCHS Leadership (12:30—1:30 p.m.)

Share your thoughts with NCHS leaders in a casual lunchtime Q&A. Bring your lunch and share ideas about NCHS products and services. We look forward to hearing your questions about NCHS’ survey programs, data products, future directions, the Conference, or any other related topics.

Room: Salons H

Community Health Data, Data Stewardship, and Data Access and Use: Tools and Resources (12:30—1:30 p.m.)

Hear about the latest work by the National Committee on Vital Health Statistics (NCVHS), including a number of useful tools and guidance in the areas of population health, community health, and data stewardship. NCVHS Leadership will discuss the committee’s efforts and products, such as supporting community data engagement, developing a toolkit for communities using health data, and providing guidance principles on access to and use of federal health data systems.

Room: Forest Glen

BB1. Examining Disparities in Urban and Rural Health: Where Are We?

Identifying differences in urban-rural health and health care utilization is important now and will be even more important as the effects of the Affordable Care Act are assessed. The first talk in this session will present an overview of urban-rural classification schemes, including the Office of Management and Budget’s metropolitan-nonmetropolitan classification, NCHS’ Urban-Rural Classification Scheme for Counties, USDA’s Economic Research Service Urban-Rural Continuum Code scheme, and the Census Bureau’s urban-rural classification. Data using the NCHS scheme will be presented in this and other talks in this session. Using data from the National Hospital Discharge Survey, the second presentation will include trend data on care delivered in rural and urban hospitals over time, along with data showing when residents remain in rural areas for their hospitalization or inpatient surgery and when they go to urban areas for this care. The third talk will use birth data from the National Vital Statistics System to examine differences in selected birth characteristics by urban or rural status. The last talk will include findings from an Urban Rural Chartbook that updates the one prepared by NCHS for Health, United States, 2001. [SS-06]

Room: Salon D

BB2. Impending Changes to the National Health Interview Survey

In the next few years, the National Health Interview Survey (NHIS) will undergo several changes. In 2016, the next periodic NHIS sample redesign will be implemented. The primary NHIS sample address source for 2016 and beyond will change from a list created by field canvassing to a purchased vendor list. In 2018, a redesigned questionnaire will be introduced for the first time since 1997. The first half of this session will feature two presentations. One will describe the 2016 NHIS sample redesign, and the other will describe the process to redesign the NHIS questionnaire and its content. The second half of the session will be open for audience questions, comments, and suggestions for the questionnaire redesign. [SS-09]

Room: Salon E

BB3. Small Area Estimation

Small Area Estimation (SAE) methods are powerful tools for the examination of spatial variations of statistical estimates in geographic localities. In many localities, sample sizes are either small, leading to high variability of direct estimates, or data are not available altogether. SAE methods allow model assumptions to be used for “borrowing strength” between different geographic localities and different years of data collection, resulting in a substantial reduction of variability of estimates and allowing for prediction when data are not available. In this session, we will present several applications of SAE methods for different purposes. If reasons for “borrowing strength” can be successfully argued based on the nature of the studied data, the precision of model-based SAE may be substantially improved over direct estimates. Such improved estimates may be provided to policy makers and used for planning and efficient allocation of government resources. In other cases, smoothed local estimates produced by SAE methods can be successfully used as research tools for better visualization and initial understanding of spatiotemporal patterns of the studied outcome. They can facilitate further detailed analysis of the broader social, economic, and environmental determinants of health and health disparities. [SS-25]

Room: White Flint Amphitheatre

BB4. Beyond EHR Adoption: Use of EHRs for Care Delivery Reform, Quality Improvement, and Care Coordination

Electronic health records (EHRs) and their use have led to different experiences in health care. Using nationally representative survey data about EHR use and Centers for Medicare & Medicaid Services Incentive Program information, more insight is provided on how physicians with meaningful use-enabled EHR systems are using their systems. This session will also provide information on how patient information is sent and received by office-based physicians and how this impacts care coordination. Mixed methods are used to provide more context around the role of EHRs and the sharing of patient information in improving care coordination. Additionally, the use of health IT and participation in new models of payment and delivery (e.g., patient centered medical homes and accountable care organizations) are evaluated for their impact on care delivery. [SS-05]

Room: Brookside A-B

BB5. Recent Advances in Survey Nonresponse and Measurement Error Methodology

This session presents several research projects that deal with survey and administrative data nonresponse and measurement error problems. Multiple imputation has been a popular approach to survey nonresponse problems. Applications include bridging different histology coding systems in cancer registry data, filling in missing values in linked data, and applying Bayesian model-based methods to surveys with complex designs. In another project, statistical matching has been used to handle measurement error in NHIS. [SS-24]

Room: White Oak A-B

BB6. Perspectives on Health: Special Topics From Health, United States

This session highlights special topic features from the congressionally-mandated annual report, Health, United States, beginning with a discussion of why a special topic is included and how special topics are selected. This session will present findings from the three most recent special features: “Socioeconomic Status and Health,” “Emergency Care,” and “Prescription Drugs.” The first session presents findings on associations between socioeconomic status (SES) and morbidity and mortality, prevention and risk factors, and access to care and health insurance, providing a broad picture of the relationship between Americans’ SES and their health. The second session on emergency care explores what persons use the emergency department, why they visit the emergency department, what happens there, and how much emergency visits cost. The 2013 special feature on prescription drugs examines the use of prescription drugs in the United States and presents data on the number and classes of drugs used by Americans, as well as the impact of specific groups of drugs used to control chronic disease. Quality issues such as the use of antibiotics for the common cold and spending on prescription drugs complete the picture of prescription drug use in the United States. This session illustrates how critical public health issues highlighted in special features in Health, United States can be used by policy analysts and researchers to inform their own research and program initiatives. [SS-21]

Room: Salons F-G

CC1. Teen and Young Adult Health Disparities: More Than Just Sex and Pregnancy

Much of what we hear about teen and young adult health focuses on sex and pregnancy. In what other outcomes do health disparities exist for teenagers and young adults in addition to sex and pregnancy? Possible topics include child and teen overweight and obesity, nutritional status, causes of death, immunization, contraception use, and birth rates. Further, what do we know about the causes and consequences of these disparities? [SS-13]

Room: White Flint Amphitheatre

CC2. Veteran’s Health: What We Know, What We Still Need to Know

The health of veterans is a topic of great public and scientific interest. Currently, there are an estimated 22.6 million community-dwelling veterans living in the United States, which represents about 9% of the total U.S. population. During military service, people can experience events or environments that can affect their health and their willingness to utilize healthcare services. Government data systems, including the National Health and Nutrition Examination Survey and the National Health Interview Survey, collect data on respondents' military service status, health, and their utilization of health care services. By analyzing these data, researchers can generate a detailed description of veteran's health and their utilization of health care services. This session provides an overview of studies currently underway that examine veteran's health and health care utilization and provides researchers interested in this topic a chance to share their research with interested parties. [SS-20]

Room: Brookside A-B

CC3. Medication Use in Health Care Settings

Medications are used to prevent, manage, and cure diseases; alleviate pain and distressing symptoms; and improve quality of life and life expectancy. In 2011, $263 billion was spent on prescription medications, representing more than 10% of all national health care expenditures and up from 5.6% in 1990. The National Health Care Surveys are a family of health care provider and establishment surveys that collect data on medication use in ambulatory and long-term care settings. Using these surveys, this session will provide a national snapshot of medication use in health care settings¾ including physician offices, hospital outpatient departments, and hospice agencies¾in the context of selected clinical recommendations. Specific topics include appropriate and inappropriate use of antibiotics, aspirin use for secondary prevention of cardiovascular diseases, and concomitant opioid-laxative use during the last week of life. This session aims to present key findings on opportunities to reduce unnecessary medication use and increase appropriate use. [SS-02]

Room: Salon F-G

CC4. Progress in Monitoring Sodium Intake in the U.S. Population

High sodium intake has been associated with the increased risk of cardiovascular diseases, the leading cause of death in the United States. The current interest in recommendations on sodium intake reduction emphasizes the importance of both research to improve measurement of sodium intake and the need for continued nutrition monitoring efforts. As the primary data system that provides objective information to monitor the health and nutritional status of the U.S. population, the National Health and Nutrition Examination Survey’s mission requires ongoing data collection to assess trends, complemented with research to improve measurement methods. This session will provide an overview of the complex issues related to the assessment of sodium intake, present research findings on measurement methods, and include discussions on future research and the application of methods to better assess population sodium intake. [SS-14]

Room: White Oak A-B

CC5. From Health to Harm: The Burden of Drug Poisoning in the United States

In 2008, poisoning became the leading cause of injury deaths in the United States, with nearly 44,000 deaths occurring in 2013. Drugs—both pharmaceutical and illicit—account for 90% of the poisoning deaths. Misuse or abuse of prescription drugs, including opioid analgesic pain relievers, is responsible for much of the recent increase in drug-poisoning deaths. From 1999 to 2013, the number of drug-poisoning deaths more than doubled, and opioid analgesic-related drug-poisoning deaths nearly quadrupled. This session will describe how NCHS data have been used to study trends in drug poisoning, the populations involved, and approaches to reduce this public health burden. [SS-17]

Room: Salon D

CC6. Health Care Quality and Disparities

Disparities in health are related to differences in social determinants, health care, lifestyle, and genetics. Since the release of the Heckler report, Americans have become healthier, in part due to improvements in health care and lifestyle. However, many disparities in health and health care persist. In this session, Agency for Healthcare Research & Quality (AHRQ) research on understanding, measuring, and reporting on disparities in health care quality is highlighted. [SS-28]

Room: Salon E