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Sources of Errors in Estimating Community Health Center Physicians

This study assesses coverage errors and estimates bias and reliability in percentage of Community Health Centers (CHCs) using electronic medical records in the National Ambulatory Medical Care Survey (NAMCS). The research methodology involved a national probability sample survey of office-based physicians, with a focus on CHC physicians. Results showed moderate reliability and little bias in traditional NAMCS data compared to a separate stratum of CHC physicians. The study highlights the importance of separate strata for more accurate data collection and analysis in healthcare surveys.

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Sources of Errors in Estimating Community Health Center Physicians

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  1. Sources of Errors in Estimating Community Health Center Physicians Catharine W. Burt , Ed.D. Esther Hing, M.P.H. Division of Health Care Statistics June 3, 2008 Centers for Disease Control and Prevention National Center for Health Statistics

  2. Objectives • To assess coverage error among CHC physicians in the National Ambulatory Medical Care Survey (NAMCS) • To estimate bias and reliability in percentage of CHCs using electronic medical records

  3. NAMCS

  4. NAMCS Methodology • National probability sample survey of office-based physicians • Complex sample design • 112 geographic PSUs • Physicians stratified by specialty • Sample of visits within physicians • Sample frame: AMA and AOA masterfiles • Data collected by Census Bureau

  5. Scope of the NAMCS • Physicians must be: • Primarily engaged in office-based, patient care • Nonfederally employed • Not in anesthesiology, radiology, or pathology

  6. In-Scope NAMCS Locations • Freestanding private solo or group practice • Freestanding clinic/urgicenter • Neighborhood medical and mental health centers • Privately operated clinics • Non-Federal government clinic • Health maintenance organization • Community health center • Faculty practice plan

  7. Methods • In 2006, dual sample of physicians: traditional + separate stratum of 104 CHCs • Sampling frame: NACHC and IHS • Random selection of 3 providers within each CHC • Physicians and midlevel providers • After selection of providers, normal NAMCS procedures are followed • In-person induction interview • Sample of ~30 visits during sample week

  8. Coverage error • Compare the traditional sample of CHC physicians with the separate stratum of CHC physicians on physician characteristics Separate Stratum Traditional

  9. Content bias and consistency • Use separate stratum to estimate EMR use • We have multiple providers in the sampled CHCs to answer the EMR questions • Measure the reliability of the item response with Cohen’s kappa statistic

  10. Results Traditional sample (n=1,311) Separate Stratum (n=156) 6,775 Traditional sample MDs who work in CHCs (n=31) 8,596 (non-office-based) 39.4% 60.6%

  11. Comparison of percent distributions

  12. EMR use among CHC physicians No significant difference @ p=.05

  13. Response consistency of physicians reporting use of electronic health record systems in their CHC n=62 CHCs with multiple providers who answered the EMR items

  14. The test-retest counts yield an I =“Index of inconsistency” =0.214It can be shown that Cohen’s kappa statistic=1-I =0.786indicating moderate reliability.

  15. Summary • Separate stratum of CHCs • increases sheer volume of CHC providers (reduces RSE by 23.8%) • Indicates little bias in key characteristics in the traditional NAMCS • Allows for a consistency measure of item response for EMR use

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