Frequently Asked Questions

Learn more about participating in NHCS:

What is the National Hospital Care Survey?

The National Hospital Care Survey provides nationally representative data on inpatient hospital care, as well as care delivered in emergency departments (ED) and outpatient departments (OPD). For more information, please see the site About NHCS.

Why participate in NHCS?

Objective and timely data are essential to assess the health and well-being of the population and the performance and functioning of the health care system. Your participation in NHCS is important because without your involvement, your hospital and others like yours will not be represented in the national description of care provided by hospitals. Your hospital was randomly chosen to provide representative data not only for your hospital, but also for similar hospitals of the same service type, bed size, and geographic location. For more information about your participation, please see our webpage Why Participate in NHCS.

What does participation in NHCS entail?

For the electronic data component, we are asking all participating hospitals to:

1. Participate in a one-time eligibility interview to determine your hospital’s eligibility and the eligibility of your hospital’s emergency department (ED) and/or outpatient departments (OPDs).
2. Complete an Annual Hospital Interview on hospital characteristics, total admissions, total births, total number of beds, total ED visits, and total OPD visits.
3. Submit electronic health records (EHR) or Uniform Bill (UB)-04 administrative claims data for all inpatient discharges and ED and OPD visits. We will also accept an electronic file in the same format submitted to the state. See our Electronic Health Record Fact Sheet and Claims Data Fact Sheet. You can also access a list of the variables we collect here. NHCS Variable List

For hospitals sending UB-04 claims only or hospitals not providing all the required EHR data elements, we ask that you:

4. Permit our staff to visit your hospital to abstract additional clinical information from a sample of your ambulatory visits. For 2016, there are no plans for abstraction. Your hospital might be requested permission for subsequent years but not necessarily on an annual basis.

Each of these activities will occur on separate time tables. The submission of your electronic data will be continuous while the completion of questionnaires and the abstraction of medical records will be less frequent.

You may be asked to participate in voluntary special studies on occasion.

What are the benefits of participation?

Better Health Care Data: The National Hospital Care Survey (NHCS) has the potential to capture the continuum of patient health care both across and beyond hospital settings. By linking visits across inpatient and outpatient settings as well as with external data sources such as the National Death Index, NHCS can provide better information about resource utilization and post-discharge mortality. Your hospital’s voluntary participation is critical to this data collection effort!

Make a Difference: Your hospital will be part of a health care research effort that will lay the groundwork for analysis of health care cost, utilization, and integration of services across a broad spectrum of settings. The important data your hospital provides will inform policies to improve the state of health care in the nation.

Meaningful Data for Your Hospital: Your hospital data will be collected, analyzed, and shared with you! Selected summaries of your inpatient discharges and ambulatory visit data showing health care utilization statistics such as patient demographics, diagnoses/procedures, and length of stay will be provided. Your participation is not only useful to the nation, it will be useful to you!

Additional Benefits: In addition to the summary data provided, your hospital will be compensated for set up and for each year of participation. Health information professionals at your hospital have the opportunity to receive continuing education credits. We are here to help! Our survey staff is available to provide technical assistance to facilitate setting up data transmission mechanisms and schedules, as well as to furnish ongoing support.

How did you select our hospital to participate?

Your health care facility was randomly chosen to provide representative data not only for your hospital, but also for similar hospitals of the same service type, bed size, and geographic location. Selections were made to obtain enough facilities of different sizes, service types, and geographical locations to ensure that the hospitals in our study are able to produce national estimates of hospital care.

What type of information is collected?

The following information will be collected:

• Hospital-level data – Hospital characteristics (e.g., ownership status, trauma level rating, teaching hospital status, total admissions, and total births) are collected through administration of the Initial Intake Questionnaire and the Annual Hospital Interview.
• Electronic data – All inpatient discharges and visits to your hospital’s ED and OPD through collection of electronic health records, UB-04 administrative claims, or state files.
• Abstracted data –Clinical information such as lab tests and medications are abstracted from a sample of ambulatory visits to your hospital’s ED and OPD.

Who is conducting NHCS and how much hospital staff time will participation require?

NCHS has contracted with Westat for recruitment and data collection activities of NHCS. Westat is an agent of NCHS. More information about Westat can be found at: http://www.westat.com.

Once your hospital decides to participate in the survey, you will be contacted to arrange the following:

• Eligibility Interview: A one-time interview to determine eligibility and obtain general information about your hospital. This may take up to one hour, including answering any questions you may have.
• Annual Hospital Interview: An annual questionnaire conducted either by telephone, email, or web portal to obtain specific information about hospital characteristics, total admissions, total births and total number of beds. This will take up to two hours to complete.
• Electronic Data Submission: The time to set up or complete the submission process will vary by hospital but can take up to four hours.

If your hospital sends UB-04 claims, a state file, or incomplete EHR data, then you may be asked to participate in the following:

• Ambulatory Hospital Interview: Every 15 months, in-person and telephone interviews will be conducted with hospital administrators and staff in eligible EDs and OPDs. These may take approximately 1.5 hours to complete.
• Medical Record Abstraction: Abstraction of a sample of medical records from the ED and OPD. These data collection activities will be conducted by NCHS and their agents. All protected health information will be kept confidential and will be used only by NCHS staff, contractors, and its agents when required and with necessary controls. Abstraction will not be necessary in hospitals submitting all the necessary elements via their EHR data.

Not all activities will occur concurrently. Throughout the survey NCHS and its agents will remain respectful of your hospital’s priorities and work closely with you to arrange for work to be completed on a schedule that best accommodates your hospital.

Will patient privacy and confidentiality be maintained?

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

In addition, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015. This law requires the federal government to protect federal computer networks by using computer security programs to identify cybersecurity risks like hacking, internet attacks, and other security weaknesses. If any cybersecurity risk is detected, the information system may be reviewed for specific threats by computer network experts working for the government (or contractors or agents who have governmental authority to do so).

The National Hospital Care Survey has been approved by the NCHS Institutional Review Board (IRB). 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. Please leave a brief message with your name and phone number, and say that you are calling about Protocol 2015–13.

For more information about your confidentiality, please see our Confidentiality page.

Who will see my answers?

We take your privacy very seriously. The answers you give us are used for statistical research only. This means that your answers will be combined with other people's answers in a way that protects everyone's identity. As required by federal law, only those NCHS employees, our specially designated agents (such as the U.S. Census Bureau), and our full research partners who must use your personal information for a specific reason will do so. Anyone else is allowed to use your data only after all information that could identify you has been removed.

Strict laws prevent us from releasing information that could identify you or your family to anyone else without your consent. A number of federal laws require that all information NCHS collects be held in strict confidence: Section 308(d) of the Public Health Service Act (42 United States Code 242m), the Confidential Information Protection and Statistical Efficiency Act {CIPSEA, Title 5 of Public Law 107-347), and the Privacy Act of 1974, 5 U.S.C. § 552a.

Any NCHS employee, agent or contractor who willfully discloses ANY identifiable information could get a jail term of up to five years, a fine of up to $250,000, or both. In addition, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015. This law requires the federal government to protect federal computer networks by using computer security programs to identify cybersecurity risks like hacking, internet attacks, and other security weaknesses.

What do my answers have to do with cybersecurity?

The purpose of the Federal Cybersecurity Enhancement Act of 2015 is NOT to read patient personal health information. The Act allows software programs to scan information that is sent, stored on, or processed by government networks in order to protect the networks from hacking, denial of service attacks, and other security threats. If any information is suspicious, it may be reviewed for specific threats by computer network experts working for the government (or contractors or agents who have governmental authority to do so). Only information directly related to government network security is monitored. The Act requires any personal information that identifies you, your family, or your answers to health questions to be removed from suspicious files before they are shared.

Does HIPAA permit health care facilities to provide this patient information?

Yes. NHCS is being conducted under the auspices of CDC/NCHS, a federal statistical agency. Special provisions within HIPAA 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 in identifying 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 hospitals such as yours to participate in studies of this nature, such as NHCS, 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 IRB or privacy board. In this case, the hospital may rely on the approval of the NCHS’ IRB.

Does my hospital’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 we can send you a copy of the materials submitted to the IRB.

How will NHCS data be used?

NHCS data will be used by the U.S. Congress and other public health policy makers, government agencies, academic institutions, professional associations, health services researchers, and the media to describe and understand the changes that occur in health care delivery. The data are disseminated in the form of public health reports, journal articles, and microdata files.

In addition to providing a national description of health care delivery in hospital-based settings, NHCS will allow for the linkage of encounters of care both within the same hospital and with outside data sources such as the National Death Index and Medicare and Medicaid data sets. Linking to other government data will allow for more comprehensive analyses, such as measurement of post-discharge mortality and re-admission rates. Please see our Data Uses page for more examples of the reports that are produced with NCHS data.

I’m interested in participating in NHCS. What’s the next step?

Please call Ms. Carolyn Almen, NHCS Recruitment Manager, at our toll-free number, 888-377-7161 ext. 4744, to talk about your participation in the National Hospital Care Survey.

You may also contact Dr. Carol DeFrances, Chief, Ambulatory and Hospital Care Statistics Branch, NCHS, at 301–458–4440.