Scientific Data Documentation
Epidemiologic Followup Study, 1982-84 Health Care Facility Stay
DSN: CC37.HANES1FU.FCLY824
NHANES EPIDEMIOLOGIC FOLLOWUP STUDY
HEALTH CARE FACILITY STAY 1982-84
Abstract 1982-84
Sandra T. Rothwell
Enclosure Date: September 10, 1990
From: NHEFS Statistical Staff
Division of Analysis, NCHS
Subject: 1982-84 NHANES I Epidemiologic Followup Study
Revised Health Care Facility Stay Public Use Data Tape
To: Project Officers and Investigators
See Addressees Below
The revision of the 1982-84 Health Care Facility Stay (HCFS) file has been
completed. The original file, the 1982-84 Health Care Facility Record file,
only contained information from the medical records obtained from health care
facilities. The 1986, the 1987 and the revised 1982-84 Health Care Facility
Stay data files include both descriptive information reported by the
respondent and the medical information returned from the health care
facility. This new format, then, includes information about all possible
stays in health care facilities whether or not an actual health care facility
record was obtained.
At the time the 1986 and 1987 Health Care Facility Stay files were
constructed, a comparable 1982-84 file did not exist. However, it was
possible to construct a comparable file for 1982-84 because the respondent's
descriptive information needed to replicate the content of the 1986 and 1987
files was available in the 1982-84 interview. This information was linked
with the medical information on the original file to create the revised file.
In addition, during data collection for the 1986 and 1987 files, more medical
records for the 1982-84 followup period were obtained. These have been
included in the revised file. The resulting data set is more complete than
the original and can be used in conjunction with the Health Care Facility
Stay files for later followup periods.
This Revised 1982-84 Health Care Facility Stay Data File has been finalized
and is being released to all collaborators. It replaces the 1982-84 Health
Care Facility Record Data file released in 1987. A memo has been sent to
your contact person which describes the tape characteristics for this file.
Please contact that person for information about accessing your tape.
Use of NHEFS Data
With the goal of mutual benefit, NCHS requests the cooperation of recipients
of data tapes in certain actions related to their use:
A. Any published material derived from the data should acknowledge the
National Center for Health Statistics (NCHS) as the original source. It
should also include a disclaimer which credits any analyses,
interpretations, or conclusions reached to the author (recipient of the
tape) and not to NCHS, which is responsible only for the initial data.
B. Consumers who wish to publish a technical description of the data will
make a reasonable effort to insure that the description is not
inconsistent with that published by NCHS. This does not mean, however,
that NCHS will review such descriptions.
C. Authors should provide NCHS with a reprint of published articles which
utilize the 1982-84 NHEFS data. Please send reprints to:
NHEFS Data Management Staff
Division of Analysis
National Center for Health Statistics
Presidential Building, Room 1080
6525 Belcrest Road
Hyattsville, MD 20782
Errors in the Data Tapes
The NHEFS Public Use data tapes have been subjected to a great deal of
careful editing. However, due to the large volume of data in the series, it
is likely that a small number of errors or discrepancies remain undetected.
Some continuous data items have extremely high or low values and we have
verified that the values have not been incorrectly keyed.
In general, the NHEFS data management team has not attempted to resolve
substantive data discrepancies that may exist 1) within the 1982-84 NHEFS
data tapes, or 2) between the 1982-84 NHEFS data tapes and the data tapes of
the original National Health and Nutrition Examination Survey (NHANES I) and
other NHEFS followup waves.
BACKGROUND
Background 1982-84
The first National Health and Nutrition Examination Survey (NHANES I)
collected data from a national probability sample of the civilian
noninstitutionalized population. The survey, which included a standardized
medical examination and questionnaires that covered various topics, took
place from 1971 through 1974 and was augmented by an additional national
sample in 1974-75. The NHANES I sample included 20,729 persons 25 to 74
years of age, 14,407 (70 percent) of whom underwent the medical examination.
Although NHANES I provides a wealth of information on the prevalence of
health conditions and risk factors, the cross-sectional nature of the
original survey limits its usefulness in studying the effects of clinical,
environmental, and behavioral factors and in tracing the natural history of
disease. Therefore, the NHANES I Epidemiologic Followup Study (NHEFS) was
designed to investigate the association between factors measured at the base-
line with the development of specific health conditions.
The followup study originated as a joint project between the National Center
for Health Statistics (NCHS) and the National Institute on Aging (NIA). The
1982-84 initial followup of the cohort was funded primarily by NIA, with
additional financial support from the following components of the National
Institutes of Health (NIH) and Public Health Service agencies: National
Cancer Institute; National Institute of Mental Health; National Institute on
Alcohol Abuse and Alcoholism; National Heart, Lung, and Blood Institute;
National Institute of Neurologic and Communicative Disorders and Stroke;
National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases;
National Institute of Allergy and Infectious Diseases; and the National
Institute of Child Health and Human Development. All of these agencies were
involved in both developing topics of import in their specialty areas and
designing procedures to collect data that would address these issues.
The size and scope of the population in the NHEFS provides a unique
opportunity to examine causal relationships in a large, heterogeneous,
nationally representative population. The followup study population included
the 14,407 participants who were 25 to 74 years of age when they were
examined in NHANES I (1971-75). Tracing of subjects began in 1981. Data
collection for the followup was conducted from 1982 to 1984, with all data
collection completed in August 1984.
Copies of all pertinent study materials (tracing materials, questionnaires,
authorization forms, and health facility data collection forms) can be found
in Appendix VI of the Plan and Operation of the NHANES I Epidemiologic
Followup Study 1982-84. (Vital and Health Statistics), Series 1, No. 22.
The design of NHEFS consisted of five steps:
tracing the subjects or their proxies to a current address;
acquiring death certificates;
performing in-depth interviews with the subjects or with their proxies;
taking pulse, blood pressure, and weight measurements of surviving
subjects;
obtaining hospital and nursing home records, including pathology
reports and electrocardiograms.
The first phase of the project was to trace and locate all subjects in the
cohort and to determine their vital status. All persons who could not be
traced were considered lost to followup. The fact of death had to be
confirmed by a death certificate or a proxy interview. In some cases,
information about the death of a subject was obtained from neighbors or other
tracing contacts. Although this information was noted in the record, these
persons were considered lost to followup unless the information was verified
by a proxy interview or a death certificate.
For subjects who had died, date and place of death were obtained through the
tracing process. This information was used to obtain a copy of the death
certificate from the appropriate State Vital Statistics office. The tracing
process was also used to obtain the current address of surviving subjects as
well as to identify a knowledgeable proxy respondent for deceased subjects.
Respondents who were identified and located through the tracing procedure
were then contacted and asked to participate in a personal interview. In a
few cases, respondents who had been traced successfully could not be
relocated for the interview. Only vital status as of tracing was available
for those subjects.
Attempts were made to interview all subjects identified during tracing.
Interviews were conducted wherever the respondent resided, including in
nursing homes, prisons, mental health facilities, or occasionally at some
other convenient location (for example, a parent's home). For surviving
subjects, attempts were made to measure the subject's pulse rate, blood
pressure (three consecutive readings), and weight. After the physical
measurements were completed, the subjects were given written reports of the
measurements.
The interview was designed to gather information on selected aspects of the
subject's health history since the time of the NHANES I exam. This
information included a history of the occurrence or recurrence of selected
medical conditions, an assessment of behavioral, social, nutritional, and
medical risk factors believed to be associated with these conditions, and an
assessment of various aspects of functional status. Whenever possible, the
questionnaire was designed to retain item comparability between NHANES I and
NHEFS in order to measure change over time. However, questionnaire items
were modified, added, or deleted when necessary to take advantage of current
improvements in questionnaire methodology.
Parts D, E, and G of the questionnaire contain items to determine whether or
not the subject had an overnight stay in a health care facility after 1970.
If a stay was reported, information on the name and address of the facility,
the date of the stay, and the reason for the stay was recorded on a special
Hospital and Health Care Facility (HHCF) chart on the back cover of the self-
administration booklet. The hospitals and nursing homes in which study
subjects had reported stays were later contacted and asked to review the
subject's medical records for all stays occurring between January 1 of the
year of the NHANES I exam up to the date of the 1982-84 interview and to
return information abstracted from their records. Limited data were
requested on the hospital and nursing home abstract forms. The major items
requested were the dates of admission and discharge, the discharge diagnoses
and any procedures that may have been performed. For nursing homes the
admission diagnoses were reported. In addition to completing abstract forms,
facilities were requested to submit photocopies of the "face sheet," and
"discharge summary," the third day EKG for myocardial infarction diagnoses,
(410 in the International Classification of Diseases, 9th Revision, Clinical
Modification (ICD-9-CM) and of pathology reports for any admission where a
new malignancy was diagnosed. Respondents who reported facility stays were
asked to sign a Medical Authorization Form that would be used to request the
release of hospital record information. These authorization forms were
retained on file and a photocopy was sent to each hospital that the respon-
dent had identified during the interview. This data collection was conducted
between April 1983 and August 1984. The resulting facility abstract records
were released in 1987 as the Health Care Facility Record file.
As of August 1984, 13,383 (93 percent) of the 14,407 members of the 1982-84
NHEFS cohort had been successfully traced. Interviews were conducted for
12,220 subjects (91 percent of those successfully traced). In addition,
17,127 facility stay records were collected for 6,477 subjects using
information obtained from the interview, death certificate, or some other
source. Death certificates were obtained for 1,935 (96 percent) of the 2,022
subjects who were known to have died since the NHANES I examination.
The data collected from the 1982-84 NHEFS are stored on four separate tapes,
the first three of which have been available since 1987.
1) Vital and Tracing Status tape -- contains summary information
about the status of the cohort.
2) Interview tape -- contains the data collected from the 1982-84
NHEFS subject and proxy interviews.
3) Mortality Data tape -- contains data abstracted from the death
certificates for 1982-84 decedents.
4) Revised Health Care Facility Stay tape -- contains information
collected on reports of stays in hospitals and non-hospital
health care facilities (e.g., nursing home, mental health care
facility) as well as information abstracted from facility
medical records. This fourth file, originally titled the Health
Care Facility Record Data Tape and released in 1987, has been
substantially revised. The revised tape contains 25,436 health
care facility stay records for 8,270 subjects. The tape is
described in detail in the following pages.
Description of Tape Revision
The 1982-84 Health Care Facility Record tape has been restructured to produce
the Revised 1982-84 Health Care Facility Stay Data Tape. The original file
contained only the coded medical abstracts obtained from health care
facilities. However, the Health Care Facility Stay data files produced for
the 1986 and 1987 followups include both the descriptive information reported
by the respondent and the medical information returned from the health care
facility. This new format includes information about all possible stays in
health care facilities whether or not an actual health care facility record
was obtained. It was created to facilitate the use of the health care
facility data.
At the time that the 1986 and 1987 Health Care Facility Stay files were
constructed, a comparable 1982-84 Health Care Facility Stay file did not
exist. However, it has been possible to reconstruct such a file for 1982-84
because most of the information needed to replicate the content and proces-
sing of the 1986 and 1987 files was available. The 1982-84 interview con-
tained detailed reports of the conditions leading to each stay in a health
care facility, the dates of each stay and the names of the facilities where
the stays occurred. This information could be linked to the medical records
that were obtained from the facilities and which appeared on the 1982-84
Health Care Facility Record file as it was originally released.
In addition, during data collection for the 1986 and 1987 files, additional
medical records for the 1982-84 followup period were obtained. These have
been included in the revised file. The resulting data set is more complete
than the original; it can be used in conjunction with Facility Stay files for
later followup periods; and it provides information on stays in health care
facilities that were reported but not confirmed by the receipt of a facility
abstract.
The Revised 1982-84 NHEFS Health Care Facility Stay (HCFS) file contains
information on all overnight health care facility stays for members of the
1982-84 followup cohort. The 1982-84 Followup cohort consisted of the 14,407
subjects who were between 25 and 74 years old at their NHANES I examination.
Followup cohort members who have either an interview or a death certificate
on the 1982-84 NHEFS data files or who returned a mail questionnaire were
eligible for the health care facility records component. The aim of this
component was to present a complete set of health care facility (i.e.,
hospital and nursing home) records for each 1982-84 Followup cohort member.
These records are intended to cover the period from the NHANES I examination
to the date of the 1982-84 interview for surviving subjects and the period
from exam to the date of death for deceased subjects. This is referred to as
the "in-scope" period. Stays that were reported prior to or after the in-
scope period were defined as out-of-scope for the 1982-84 followup. The
procedures for constructing this file are briefly described below.
Restructuring the 1982-84 Health Care Facility Record File:
When the 1986 NHANES I Epidemiologic Followup was designed, it was decided to
combine the information which respondents reported concerning overnight
health care facility stays with the abstracted information received from the
facilities. The resulting file was built using a computerized tracking
system. In order to reprocess the 1982-84 data file and make it comparable
with the 1986 format, it was necessary to review the 1982-84 interviews and
enter the data into the tracking system developed for the 1986 wave.
Abstracts that had been received during the 1982-84 followup were matched to
the interview information that had been entered into the tracking system in
the same manner as the 1986 and 1987 abstracts were being matched to inter-
view information. The results of the matching process were then used to
build the revised 1982-84 file. Occasionally, facilities which were being
contacted as part of the 1986 or 1987 followups would send abstracts for
stays that had been reported in the 1982-84 followup, but for which an
abstract had not been received during the appropriate collection period.
These abstracts were also entered into the tracking system. The resulting
restructured file was renamed the Revised 1982-84 Health Care Facility Stay
file and is comparable in format to the 1986 to 1987 Health Care Facility
Stay files.
Matching Records:
When the abstracts were reviewed, they were checked against report informa-
tion in the tracking system to determine if the abstract "matched" any of the
reported stays. Date of admission and diagnosis were used as matching
criteria but exact matches on date or diagnosis were not required for a stay
to be considered matched. Abstracts were matched to reports if the reported
date of admission was within a year of the actual date of admission and if
the reported reason for admission involved the same body system as at least
one of the diagnoses present on the abstract. Cases that did not meet these
specific criteria were reviewed by NCHS staff and matched when appropriate.
Since the matching rules allowed for an admission date of up to one year
before or after the reported date of admission, some stay records are present
on the file with an out-of-scope report date, but an in-scope date on the
matched abstract. These records are identified by a Type C flag in position
199 of the record (see further explanation of the Type C flag below).
Each record on the file represents an overnight facility stay. Therefore, one
or more records will exist for some 1982-84 Followup cohort subjects, while
other subjects will have no records on the file. The structure of the data
file reflects the system used to obtain and process stay information. The
record is divided into four major sections: 1) the report section, 2) the
record status section, 3) the abstract section, and, 4) the related stay
section. An example of the record layout is provided in figure 1.
The subject identification number (i.e., the sample sequence number) is in
positions 1-5 on each record. This number is unique for each subject and is
used when linking the Health Care Facility Stay tape to all other NHEFS and
NHANES I Public Use Data Tapes. The total number of records per subject is
found in positions 6-7 on the file. The first section of the record is the
report section (positions 29-59 and 63-204) which contains information from
the reporting source as well as stay identification numbers assigned by NCHS.
Each stay entered into the report section is assigned a health care facility
stay id number (positions 29-33). When used in conjunction with the sample
sequence number, this number uniquely identifies each record on the file. The
reported date of admission is found in positions 47-54. This date is used in
conjunction with the date of exam to determine whether reported stays were
in-scope for the NHEFS 1982-84 survey (position 199).
The record status section (positions 60-62) contains a code for the result of
the abstract review i.e., match or non-match status. If there existed an
abstract that matched a report then a record status code of MAT (match) was
assigned. An abstract that did not match any report but was in-scope for the
1982-84 survey period was assigned the record status code of ASF (additional
stay found). If no matching abstract was found, the appropriate non-match
code was assigned.
The abstract section (positions 205-379) contains the information obtained
from the facility records including actual dates of admission, discharge and
diagnoses. The diagnoses on the abstracts were coded using the ICD-9-CM
according to the medical coding specifications detailed in the following
section of this codebook. The abstract section of each record is similar to
the original 1982-84 NHEFS Health Care Facility record file released in
August 1987. The other three sections are those that were added for compar-
ability with the 1986 and 1987 HCFS files.
Information will be present in one or more sections of the record depending
on whether a report was obtained, and whether an abstract was received. The
presence or absence of information in the first three sections results in
three different record profiles. Figure 2 illustrates these three profiles.
The first is the successfully matched stay record, where an abstract was
received which matched a report. Abstract information is added to the
report and the code of MAT was entered into the record status section.
Complete information is available in the first three sections of the record
for these stays. The second type occurs when an abstract was not matched to
a report and, therefore, no data is contained in the abstract section. The
appropriate non-match code was entered in the record status section. The
third type of record is one which was generated solely by the existence of a
facility abstract. This type of record resulted from an existing in-scope
abstract that did not match with any report on the tracking system. When
this occurred, the abstract was entered on the file, and stay identifiers
were assigned in the report section of the record but no other information
in the report section is present. An ASF (additional stay found) code was
entered in the record status section.
In some cases requests were made to facilities for information about stays
with reported admission dates that preceded the date of the NHANES I exam
(i.e., were out-of-scope). This was done to maximize the collection of
reports of hospital or nursing home stays. Reports of stays with a reported
date of admission more than one year prior to the exam were retained on the
file when they represented the only mention of visits to a specific health
care facility for a given subject. These were flagged with a Type D in
position 199. All stays with reported dates within the year immediately
preceding the exam were kept and flagged with a Type C in position 199.
After the receipt of information from the health care facility, it was
necessary to remove stays from the tracking system that had been out-of-scope
and to incorporate information on in-scope stays that was generated from the
"out-of-scope" reports. If an in-scope abstract was received from a facility
named on a Type D report, the in-scope abstract was added to the file with a
record status code of ASF and the Type D report was deleted from the file.
The Type D report was also deleted from the file if the facility responded to
the Type D request, but sent no in-scope abstracts. In this case it was
presumed that the respondent had correctly reported the date as out-of-scope.
In 47 cases the Type D reports remain on the final version of the file. This
occurred when it had been impossible to contact the facility or when
authorization to obtain hospital records had not been granted. These records
for unconfirmed reports of out-of-scope stays can be eliminated from analyses
at the analysts' discretion. In the case of Type C reports, if an in-scope
abstract was returned which matched the Type C report, the report was
assigned a record status code of MAT (n=144). (Recall the matching rules
permitted an admission date of up to one year before or after the reported
date of admission.) If the facility responded but no in-scope abstract was
received, the Type C report was removed from the file. Again it was assumed
that the correct date had been reported and the stay was truly out-of-scope.
There are 42 Type C reports that remain on the file. These reports were
given by respondents who did not grant permission to obtain abstracts or they
involved facilities that could not be contacted, refused to participate or
did not respond. These unconfirmed reports of out-of-scope stays are
identified by the non-match status in positions 60-62 and a Type C flag in
position 199.
The final section of the record contains related stay codes (positions 380-
429). These related stay codes are used to identify stays which are
contained within other stays. This occurred most often when nursing home
residents had a brief hospital stay but then returned to the nursing home.
A detailed example of the related stay section is presented below. In panel
A, a chronologic history of a subject's hospital and nursing home stays is
presented in order to facilitate the discussion of the related stay codes.
This subject was admitted to the nursing home on March 1, 1981, and
discharged to the hospital on April 1, 1981. He returned to the original
nursing home on April 8 and stayed until April 22 when he required readmis-
sion to the hospital. He returned from the hospital to the nursing home on
April 25, 1981 where he remained until April 30, 1981.
Panel A: Chronologic profile of hospital and nursing home stays:
Location Admission Discharge
Nursing home 03/01/81 04/01/81
Hospital 04/01/81 04/08/81
Nursing home 04/08/81 04/22/81
Hospital 04/22/81 04/25/81
Nursing home 04/25/81 04/30/81
Panel B illustrates how these stays are present in the final file. The three
nursing home stays were collapsed into one long stay with two related
hospitalizations. The related stay codes were added to demonstrate the
relationship between the hospital and nursing home stays.
Panel B: Final file layout
Variable Position:
29-33 209 210-215 216-221 380-384 385-389
Variable Name:
Stay Dis- First Second
Number Type Admit charge Related Related
10201 N. Home 03/01/81 04/30/81 10101 10102
10101 Hosp. 04/01/81 04/08/81 10201
10102 Hosp. 04/22/81 04/25/81 10201
Medical Coding Specifications
Medical coding for the NHEFS 1982-84 data tape was based on the International
Classification of Diseases-9th Revision-Clinical Modification (ICD-9-CM). The
health care facility was asked to abstract all diagnoses and procedures onto
a special form. In most cases, a copy of the hospital discharge summary and/
or medical records facesheet was attached to the abstract. The diagnoses and
procedures listed on the discharge summary or facesheet were then compared
with those provided by coding the diagnoses or procedures as provided on the
discharge summary or the facesheet.
All diagnoses were coded to the highest level of specificity possible. The
fourth-digit subcategory for diagnosis and procedure codes was used whenever
possible. The fifth-digit subclassification of disease for diagnosis codes
was also used when appropriate. A three-digit ICD code was used only if it
could not be further subdivided. The following rules were used to code
diagnoses and procedures.
Rules Governing Medical Coding of Diagnoses:
All medical diagnoses listed on the health care facility abstract form or the
discharge summary are coded in the order in which the diagnoses were listed.
The principal diagnosis is the condition established after study to be
chiefly responsible for occasioning the admission of the patient to the
health care facility. The admitting diagnosis is not used as the principal
diagnosis unless the admitting and discharge diagnoses are the same.
Ex: Patient admitted with a diagnosis of bronchopneumonia. After
workup and treatment, x-ray findings, etc., the patient was discharged
with a final diagnosis of bronchopneumonia. The principal diagnosis is
coded 485 for bronchopneumonia.
Note that the facility was asked to select the principal diagnosis and not
review of the records was made to determine if the current diagnosis was
selected.
All other diagnoses or conditions existing at the time of admission or that
developed subsequently during the stay are coded.
Ex: Patient was admitted with a diagnosis of uncontrolled diabetes
mellitus, and during the course of examination and treatment, phlebitis
was discovered. The diabetes and the phlebitis are coded.
Diagnoses documented as probable, possible, suspected, question of, sug-
gestive of, compatible with, or questionable are coded and prefixed with a
"P".
Ex: If the diagnosis is stated possible myocardial infarction, the
diagnosis code is P410.9.
If a diagnosis is stated as "rule out" or "R/O", the condition is coded as if
it exists and the "P" prefix is not used. If a diagnosis is stated as "ruled
out", the condition is not coded.
Ex: If "R/O M.I." appears on the facesheet, the code is 410.9. If
"M.I. ruled out" appears, the condition is not coded.
When the abstract included an infarction as one of the discharge diagnoses
and it was clear from other information in the abstract or the final
diagnoses sections of the facesheet and discharge summary that the infection
was a result of a hospital procedure, the appropriate external cause of
injury code was added.
Malignant neoplasms are coded according to ICD-9-CM coding specifications
which indicate primary site of origin.
Injuries and poisonings are coded, where applicable, using both the nature of
the injury and the external cause of injury code (E800-E999).
Ex: Patient sustained comminuted fracture of the femur due to a fall
down stairs. Nature of injury code is 821.00 and external cause of
injury code is E880.9.
"History of" conditions are not coded with the following exceptions:
Old myocardial infarction (more than 8 weeks since last occurrence)
Status post bypass surgery
Malignant neoplasm (cancer in remission or under treatment)
Old cerebrovascular accident
Sterilization
Normal pregnancy undelivered
Manipulation of an IUD
These diagnoses are coded using "V" codes and were used on a limited basis.
Recurrent malignancy codes are prefixed with an "R".
Symptoms (ICD-9-CM) codes 7800-7999) were coded using the following
guidelines:
1. When the only diagnosis listed on the abstract form, facesheet,
and/or discharge summary is a symptom, the symptom is coded.
Ex: The only discharge diagnosis listed is "chest pain". The
code number 786.50 (chest pain, unspecified) is assigned.
2. When a symptom is listed that is unrelated to any of the diag-
noses listed, the symptom is coded.
Ex: The discharge diagnoses listed are acute myocardial
infarction, diabetes mellitus, and hepatomegaly. The hepato-
megaly is also coded.
3. When a symptom is listed and is related to a listed discharge
diagnosis the symptom is not coded.
Ex: The discharge diagnoses listed are diabetes mellitus,
acute appendicitis, severe abdominal pain. Only the diabetes and
the appendicitis are coded. The abdominal pain is not coded.
Rules Governing Medical Codes for Procedures:
The same general rules apply to coding procedures as to coding diagnoses.
Medical procedures are coded and sequenced in accordance with the principal
and secondary procedures described on the health care facility abstract form
or the discharge summary/facesheet.
The principal procedure is the primary procedure most related to the princi-
pal diagnosis and is performed for definitive treatment as opposed to diag-
nostic and/or exploratory purposes.
Ex: Diagnosis = uterine fibroids.
Procedures = biopsy of uterus, total abdominal hysterectomy,
incidental appendectomy.
The hysterectomy is coded as the principal procedure and the
appendectomy and the biopsy are coded as secondary procedures.
All procedures documented on the discharge summary and/or facesheet are coded
if they fall into the following categories:
Biopsies (if related to the principal diagnosis and procedure or if
related to the other listed diagnoses)
Surgical procedures
Cardiac catheterizations
D and C (following delivery or abortion only)
The following procedures are not coded:
Surgical approach
Operative cholangiogram
Lumbar puncture
CT scan
Endoscopy
Diagnostic D and C
Diagnostic radiology
Examination (under anesthesia, physical exam, etc.)
Manipulations
Physical therapy
Application or removal of casts, splints, etc.
Medical Coding Conventions:
Diagnostic codes--Up to ten diagnoses are coded for each hospital and nursing
home stay. The format for each diagnosis code is six positions. The
following conventions were used when entering diagnostic codes on the data
tape:
1. ICD-9-CM diagnostic codes (including "V" codes) were entered
beginning with the second position of the variable field
continuing through the sixth position. There is an implied
decimal point between the fourth and fifth positions of the
variable field.
2. If the diagnoses codes required less than five digits the
remaining tape positions are blank.
3. Prefix codes "P" and "R" are coded in the first tape position. If
the diagnosis code has no prefix the first position is blank.
Ex. 1: _ 4 2 2 9 0 Code is 422.90
Ex. 2: V 7 1 1 Code is V71.1
Ex. 3: 4 3 6 Code is 436
Ex. 4: P 1 8 0 0 Code is P180.0
Ex. 5: R 1 7 4 9 Code is R174.9
4. E codes - External cause of injury codes
An external cause of injury code is provided, when applicable,
immediately after the medical diagnosis code which describes the
nature of the injury. E codes were entered on the data tape
beginning in the first position of the variable field and
continuing through the fifth position. There is an implied
decimal point between the fourth and fifth positions of the
variable field. If an E code required less than five positions
the remaining positions are blank. If an E code is not applica-
ble (i.e., the medical diagnosis code is not a nature of injury
code) or could not be coded, the variable field is blank.
Ex. 1: E 9 0 6 1 Code is E906.1
Ex. 2: E 8 5 1 Code is E851
Procedure codes--Up to five procedures are coded for each health care facili-
ty record. Each procedure code is formatted in a field containing four
positions. Procedure codes were entered beginning with the first positions.
Procedure codes were entered beginning with the first position of the varia-
ble field continuing through the fourth position. There is an implied deci-
mal point between the second and third positions of the variable field. If a
procedure code required less than four positions the remaining positions are
blank.
Ex. 1: 4 2 9 2 Code is 42.92
Ex. 2: 0 3 1 Code is 03.1
RECORD LAYOUT
Stay Tape Codebook
Tape
Position Frequencies Variable Description and Codes
(1-28) SUBJECT INFORMATION
1-5 25,436 NHANES I Sample Sequence Number
6-7 Record Count
25,436 01-55 = Total number of records
Note: Each record on the file represents an
overnight stay in a health care facility (hospi-
tal or nursing home). This variable identifies
for each subject the total number of records on
the file. It will be the same for each record
the subject has on the file.
8-28 25,436 Blank
(29-59, STAY IDENTIFIERS AND REPORTED
63-204) INFORMATION ON FACILITY STAYS
Note: The report section of the record (posi-
tions 29-59 and 63-204) contains the information
on health care facility stays that was reported
on the questionnaire, on a death certificate, on
another hospital/nursing home abstract form, or
obtained from other sources.
(29-33) Health Care Facility Stay ID Number
Note: When used in conjunction with the sample
sequence number this number uniquely identifies
each record on the tape. It is composed of
three variables: Survey Period Identifier,
Facility Number and Stay Number Within Facility.
For example: a Stay Number of 10102 refers to a
facility stay reported during the NHEFS 1982-84
wave (1) in the first facility reported for that
subject (01) but the second admission to that
facility (02).
29 Survey Period Identifier
25,436 1 = NHEFS 1982-84
Note: For each NHEFS subject, a two digit num-
ber was assigned to each facility in which a
stay occurred. Thus, if a subject had multiple
stays at the same facility, all stays will have
the same facility number.
Facility numbers were assigned consecutively.
However, due to tape editing, there are missing
numbers in the sequence of facility numbers.
30-31 Facility Number
25,436 01-09 = Hospital/nursing home number
Note: For each NHEFS subject, a two digit
number was assigned to each facility in which a
stay occurred. Thus, if a subject had multiple
stays at the same facility, all stays will have
the same facility number.
Facility numbers were assigned consecutively.
However, due to tape editing, there are missing
numbers in the sequence of facility numbers.
32-33 Stay Number Within Facility
25,436 01-45 = Stay number
00 = D stay record
Note: The two digit stay numbers were assigned
to identify different stays in the same facili-
ty. Type D stay records were assigned a stay
number of "00". A type D stay record is defined
as a stay with a reported admission date more
than one year prior to the date of the NHANES I
Examination (see position 199).
Stay numbers within facilities were assigned
consecutively. However, due to tape editing,
three are missing numbers in the sequence of
stay numbers within facilities.
34-35 Facility ID Profile
24,457 01 = Hospital
664 02 = Nursing home
315 03 = Out of country, don't know, or not
ascertained
Note: This variable identifies the type of
facility to which the request for a stay record
was mailed.
36-46 25,436 Blank
(47-54) Reported Admission Date/Range
Respondents were asked to provide information on
the month, day and year of admission for each
stay to a facility. A range of years was coded
when the respondent was unable to recall the
exact year of admission. When the year of
admission was reported as a range, the beginning
year of the range is found in positions 51-52
and the ending year of the range is found in
positions 53-54. Except for type D (position
199) records the reported date of admission is
present for all source code 2 and 4 records (see
position 200).
47-48 Reported Month of Admission
1,136 01-12 = Month of admission
4 98 = Don't know
18,453 99 = Not ascertained
5,843 Blank = Type D (position 199), record status
code
ASF (positions 60-62), or source code 1
or 3 (positions 200)
49-50 Reported Day of Admission
188 01-31 = Day of admission
3 98 = Don't know
19,402 99 = Not ascertained
5,843 Blank = Type D (position 199), record status
code
ASF (positions 60-62), or source code 1
or 3 (position 200)
Tape
Position Frequencies Variable Description and Codes
51-52 Reported Year of Admission or Beginning Year of
Range
18,973 68-84 = Year of admission or beginning year of
range (1968-1984)
505 98 = Don't know
115 99 = Not ascertained
5,845 Blank = Type D (position 199), record status
code ASF (positions 60-62), or
source code (position 200) 1 or 3
53-54 Reported Year of Admission - Ending Year of
Range
1,452 70-84 = Ending year of range (1970-1984)
23,984 Blank = No range given for reported year of
admission, type D (position 199), record status
code ASF (positions 60-62), or source code
(position 200) 1 or 3
55-59 25,436 Blank
(60-62) RECORD STATUS
Note: The record status section of the record
(positions 60-62) contains information on the
outcome of the request for a health care facili-
ty stay.
60-62 Record Status Code
Note: See Appendix A for an explanation of the
record status codes.
25,436 ANO - XRD = Record status code
(63-198) Reported Conditions and Codes
During the process of completing the Hospital
and Health Care Facility Chart (HHCF) respon-
dents described the conditions that led to their
overnight facility stays. This information is
included as a text field on the stay record.
Space is allotted for the recording of up to
four reasons for the hospital or nursing home
stay (see positions 67-96, 101-130, 135-164 and
169-198).
A numeric code was assigned to each text
description to aid the researcher in the use of
this information (see positions 63-66, 97-100,
131-134, 165-168). These variables should be
used in conjunction with information in the
abstract section, i.e., ICD-9-CM diagnosis
codes, present on records with a record status
code of MAT or ASF. Appendix B contains a com-
plete description of these fields along with
guidelines for their use.
(63-96) First Reported Condition
63-66 Condition Code
19,388 01-37 = Condition code (See Appendix B)
6,048 Blank = Source Code not equal to 4, D stay
record, or Record Status Code ASF.
67-96 Condition Text
19,388 Description of reason for facility stay
6,048 Blank = Source Code not equal to 4, D stay
record, or Record Status Code ASF
(97-130) Second Reported Condition
97-100 Condition Code
5,748 01-37 = Condition code (See Appendix B)
19,688 Blank = Source Code not equal to 4, D stay
record, or Record Status Code ASF,
or only one condition reported.
Tape
Position Frequencies Variable Description and Codes
101-130 Condition Text
5,748 Description of reason for facility stay
19,688 Blank = Source Code not equal to 4, D stay
record or Record Status Code ASF,
or only one condition reported.
(131-164) Third Reported Condition
131-134 Condition Code
1,346 01-37 = Condition code (See Appendix B)
24,090 Blank = Source Code not equal to 4, D stay
record or Record Status Code ASF,
or less than three conditions
reported.
135-164 Condition Text
1,346 Description of reason for facility stay
24,090 Blank = Source Cod not equal to 4, D stay
record or Record Status Code ASF,
or less than three conditions
reported. Tape
Tape
Position Frequencies Variable Description and Codes
(165-198) Fourth Reported Condition
165-168 Condition Code
288 01-37 = Condition code (See Appendix B)
25,148 Blank = Source code not equal to 4, D stay
record or Record Status Code ASF,
or less than four conditions reported.
199 Type of Stay Flag
186 C = A reported stay with admission date up to
one year prior to the date of NHANES I
Examination.
47 D = A reported stay with admission date more
than one year prior to date of NHANES I
exam. If there were multiple reported
stays in the same facility that were all
type D (more than one year prior to exam)
these stays were consolidated into one
entry in the tracking system. If an in-
scope abstract was received in response to
a type D report, the abstract was never
matched to the type D report, but was
assigned a record status code of ASF
(positions 60-62). The type D report was
then removed from the file. The 47 type D
reports that remain on the file were unable
to be resolved either because the facility
could not be contacted (status of FNC) or
because authorization to collect facility
data was not obtained (status of ANO).
25,203 Blank = In-scope stay; a reported date of
admission after the exam date. This
field is also blank for records with
status codes of ASF.
Note: This variable identifies reported
facility stays as in-scope or out-of-scope
for the NHEFS 1982-84 interview period.
Reported dates of admission of don't know
(989898) or not ascertained (999999) in
positions 47-52 were considered in-scope.
200 Source of Report of Stay that Initiated Request
for Abstract
126 1 = Information from death certificate
205 2 = Information from hospital abstract
report
141 3 = Information from other source
19,435 4 = Information from NHEFS 1982-84
interview
5,529 Blank = Not a requested stay. Additional stay
information obtained from facility
(record status code ASF positions 60
-62). ASF may also be coded as
source code 3.
Tape
Position Frequencies Variable Description and Codes
201-204 25,436 Blank
(205-379) ABSTRACT DATA
Note: The abstract data portion of the record
(positions 205-379) contains information ob-
tained from an abstract form returned by the
facility. This section of the stay record
(excluding positions 207-208) will be blank when
a facility did not return an abstract form for a
stay (n=6933).
205-206 Abstract Number
18,503 01-53 = Number of abstract
6,933 Blank = Stay reported, no abstract form received
Note: For each subject, a two digit number was
assigned consecutively to each abstract form
received.
207-208 Total Number of Abstracts Received
25,436 00-53 = Total number of abstracts received
Note: This number represents the total number
of abstracts received for each subject. The
total number is repeated on each subject record.
209 Facility Record Type
18,085 1 = Hospital
418 2 = Nursing home
6,933 Blank = Stay reported, no abstract form received
(210-215) Date of Admission
210-211 Month of Admission
18,501 01-31 = Day of admission
6 99 = Not ascertained
6,933 Blank = Stay reported, no abstract form received
212-213 Day of Admission
18,497 01-31 = Day of admission
6 99 = Not ascertained
6,933 Blank = Stay reported, no abstract form
received
214-215 Year of Admission
18,503 71-84 = Year of admission (1971-1984)
6,933 Blank = Stay reported, no abstract form received
(216-221) Date of Discharge
Note: When a subject had a brief break in a
nursing home stay, the nursing home stays were
combined into one long stay with the latest
discharge date assigned to the stay. The
information contained in the report and abstract
sections of the stay is from the earliest
abstract.
For example: subject A was in a nursing home
from 10-31-81 to 12-22-81. The subject was
readmitted to the same nursing home 1-3-82.
These 2 stays would appear on the file as 1 stay
from 10-31-81 to 3-5-82. Length of stay would
be calculated on the entire stay (see positions
222-225). If the break in the nursing home was
due to an interspersed hospitalization, the
nursing home stays were collapsed as described
above and a code was entered in the related stay
section (see positions 380-429).
216-217 Month of Discharge
18,350 01-12 = Month of discharge
145 97 = Inapplicable (still at facility on date
of 1982-84 interview)
8 99 = Not ascertained
6,933 Blank = Stay reported, no abstract from received
218-219 Day of Discharge
18,346 01-31 = Day of discharge
145 97 = Inapplicable (still at facility on date
of 1982-84 interview)
12 99 = Not ascertained
6,933 Blank = Stay reported, no abstract form received
220-221 Year of Discharge
18,353 71-84 = Year of discharge (1971-1984)
145 97 = Inapplicable (still at facility on date
of 1982-84 interview)
5 99 = Not ascertained
6,933 Blank = Stay reported, no abstract form received
222-225 Length of Record Stay
80 0000 = Died on day of admission
18,243 0001-3380 = Total number of days in facility
145 9997 = Inapplicable (still at facility on
date of 1982-84 interview)
15 9999 = Not ascertained
6,933 Blank = Stay reported, no abstract form
received
Note: Length of stay is calculated by subtract-
ing the date of admission from the date of dis-
charge. For subjects with nursing home stays,
brief breaks were collapsed into one continuous
nursing home stay (see positions 216-221). For
subjects with information coded in the related
stays section (see positions 380-429) length of
stay will include time spent in other facili-
ties. Length of stay is not ascertained if
either the admission or discharge date contains
a code of 99.
226 Was the Patient in Cardiac Intensive Care Unit?
1,124 1 = Yes
15,811 2 = No
418 7 = Inapplicable (facility is a nursing
home)
1,150 9 = Not ascertained
6,933 Blank = Stay reported, no abstract form received
227-229 Number of Days in Cardiac Intensive Care Unit
1,053 000-076 = Number of days
17,379 997 = Inapplicable (position 226 = 2,7,or 9)
71 999 = Not ascertained
6,933 Blank = Stay reported, no abstract form re-
ceived
Note: A length of stay of 0 days occurred when
a subject was admitted to the CCU and was dis-
charged on the day of admission.
230 Was the Patient In Other Intensive Care Unit?
877 1 = Yes
14,979 2 = No
418 7 = Inapplicable (facility is a nursing
home)
2,229 9 = Not ascertained
6,933 Blank = Stay reported, no abstract form received
231-233 Number of Days in Other Intensive Care Unit
832 000-129 = Number of days
17,626 997 = Inapplicable (Position 230 = 2,7,or 9)
45 999 = Not ascertained
6,933 Blank = Stay reported, no abstract form
received
Note: A length of stay of 0 days occurred when
a subject was admitted to the ICU and was dis-
charged on the day of admission.
234 Patient Admitted to Nursing Home From:
99 1 = Private residence
235 2 = Acute care hospital
8 3 = Chronic disease hospital
58 4 = Other nursing home
18,085 7 = Inapplicable (facility is a hospital)
18 9 = Not ascertained
6,933 Blank = Stay reported, no abstract form received
235 Disposition of Hospital Patient
15,819 1 = Routine discharge/discharged home
70 2 = Left against medical advice
883 3 = Discharged/transferred to another faci-
lity or organization
215 4 = Discharged/referred to organized home
care service
729 5 = Died
15 6 = Not discharged/still in hospital on the
date of 1982-84 interview
418 7 = Inapplicable (facility is a nursing
home)
354 9 = Subject discharged, disposition not
ascertained
6,933 Blank = Stay reported, no abstract form received
236 Disposition of Nursing Home Patient
130 1 = Not discharged/still in a nursing home
on date of 1982-84 interview
23 2 = Discharged to private residence/referral
to organized home care services
122 3 = Died
59 4 = Discharged to private residence/no re-
ferral
81 5 = Transferred to another facility
18,085 7 = Inapplicable (facility is a hospital)
3 9 = Not ascertained
6,933 Blank = Stay reported, no abstract form received
237 Transferred to Another Health Care Facility
41 1 = Acute care hospital
32 2 = Another nursing home
0 3 = Chronic disease hospital
5 4 = Other
18,422 7 = Inapplicable (Position 236 = 1, 2, 3, 4,
7, or 9)
3 9 = Not ascertained
6,933 Blank = Stay reported, no abstract form received
238-239 Number of Diagnoses
18,493 01-21 = Number of diagnoses
10 99 = Not ascertained
6,933 Blank = Stay reported, no abstract form received
Note: This variable identifies the total number
of diagnoses entered on the abstract. The num-
ber of coded diagnoses may exceed the maximum
number (10) allowed on the data tape.
240-245 Principal Diagnosis
18,493 ICD-9-CM Code
10 999999 = Not ascertained
6,933 Blank = Stay reported, no abstract form re-
ceived
Note: See medical coding specifications.
246-250 Principal Diagnosis E Code
1,380 ICD-9-CM Code
24,056 Blank = Stay reported, no abstract form received
or principal diagnosis does not require
E code
Note: See medical coding specifications
Tape
Position Frequencies Variable Description and Codes
251-256 Second Diagnosis
13,083 ICD-9-CM Code
5,420 999997 = Inapplicable (only one diagnosis coded)
6,933 Blank = Stay reported, no abstract form re-
ceived
Note: See medical coding specifications.
257-261 Second Diagnosis E Code
376 ICD-9-CM Code
5,420 99997 = Inapplicable (only one diagnosis coded)
19,640 Blank = Stay reported, no abstract form received
or second diagnosis does not require E
code
Note: See medical coding specifications.
262-267 Third Diagnosis
8,552 ICD-9-CM Code
9,951 999997 = Inapplicable (less than three diagnoses
coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
268-272 Third Diagnosis E Code
214 ICD-9-CM Code
9,951 99997 = Inapplicable (less than three diagnoses
coded)
15,271 Blank = Stay reported, no abstract form received
or third diagnosis does not require E
code
Note: See medical coding specifications.
273-278 Fourth Diagnosis
5,420 ICD-9-CM Code
13,083 999997 = Inapplicable (less than four diagnoses
coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
279-283 Fourth Diagnosis E Code
163 ICD-9-CM Code
13,083 99997 = Inapplicable (less than four diagnoses
coded)
15,271 Blank = Stay reported, no abstract form received
or fourth diagnosis does not require E
code
Note: See medical coding specifications.
284-289 Fifth Diagnosis
3,300 ICD-9-CM Code
15,203 999997 = Inapplicable (less than five diagnoses
coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
290-294 Fifth Diagnosis E Code
100 ICD-9-CM Code
15,203 99997 = Inapplicable (less than five diagnoses
coded)
10,133 Blank = Stay reported, no abstract form received
or fifth diagnosis does not require E
code
Note: See medical coding specifications.
295-300 Sixth Diagnosis
1,956 ICD-9-CM Code
16,547 999997 = Inapplicable (less than six diagnoses
coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
Tape
Position Frequencies Variable Description and Codes
301-305 Sixth Diagnosis E Code
72 ICD-9-CM Code
16,547 99997 = Inapplicable (less than six diagnoses
coded)
8,817 Blank = Stay reported, no abstract form received
or sixth diagnosis does not require E
code
Note: See medical coding specifications.
306-311 Seventh Diagnosis
1,039 ICD-9-CM Code
17,464 999997 = Inapplicable (less than seven diagnoses
coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
312-316 Seventh Diagnosis E Code
37 ICD-9-CM Code
17,464 99997 = Inapplicable (less than seven diagnoses
coded)
8,817 Blank = Stay reported, no abstract form received
or seventh diagnosis does not require E
code
Note: See medical coding specifications.
317-322 Eighth Diagnosis
568 ICD-9-CM Code
17,935 999997 = Inapplicable (less than eight diagnoses
coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
323-327 Eighth Diagnosis E Code
12 ICD-9-CM Code
17,935 99997 = Inapplicable (less than eight diagnoses
coded)
8,817 Blank = Stay reported, no abstract form received
or eighth diagnosis does not require E
code
Note: See medical coding specifications.
328-333 Ninth Diagnosis
310 ICD-9-CM Code
18,193 999997 = Inapplicable (less than nine diagnoses
coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
334-338 Ninth Diagnosis E Code
9 ICD-9-CM Code
18,193 99997 = Inapplicable (less than nine diagnoses
coded)
7,234 Blank = Stay reported, no abstract form received
or ninth diagnosis does not require E
code
Note: See medical coding specifications.
339-344 Tenth Diagnosis
165 ICD-9-CM Code
18,338 999997 = Inapplicable (less than ten diagnoses
coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
345-349 Tenth Diagnosis E Code
2 ICD-9-CM Code
18,338 99997 = Inapplicable (less than ten diagnoses
coded)
7,096 Blank = Stay reported, no abstract form received
or tenth diagnosis does not require E
code
Note: See medical coding specifications.
350-351 Number of Procedures
18,085 00-05 = Number of procedures
418 97 = Inapplicable (facility is a nursing
home)
6,933 Blank = Stay reported, no abstract form received
Note: This variable identifies the total number
of procedures coded on the facility
abstract.
Tape
Position Frequencies Variable Description and Codes
352-355 First Procedure
7,264 ICD-9-CM Code
11,239 9997 = Inapplicable (facility is a nursing home
or no procedures coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
356-359 Second Procedure
2,635 ICD-9-CM Code
15,868 9997 = Inapplicable (facility is a nursing home
or only one procedure coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
360-363 Third Procedure
774 ICD-9-CM Code
17,729 9997 = Inapplicable (facility is a nursing home
or less than three procedures coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
364-367 Fourth Procedure
234 ICD-9-CM Code
18,269 9997 = Inapplicable (facility is a nursing home
or less than four procedures coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
368-371 Fifth Procedure
55 ICD-9-CM Code
18,448 9997 = Inapplicable (facility is a nursing home
or less than five procedures coded)
6,933 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
(372-373) Presence of Documents
372 Pathology Report
560 1 = Required and present
119 2 = Required and not present
17,406 6 = Not required
418 7 = Inapplicable (facility is a nursing
home)
6,933 Blank = Stay reported, no abstract form received
373 Third Day EKG Report
377 1 = Required and present
151 2 = Required and not present
17,557 6 = Not required
418 7 = Inapplicable (facility is a nursing
home)
6,933 Blank = Stay reported, no abstract form received
374-379 25,436 Blank Tape
(380-429) RELATED STAY CODES
Note: Residents in nursing homes are often
admitted to hospitals during the course of their
stays in the nursing home. The related stay
section of the record cross-links nursing home
stays with interspersed hospital stays.
In the case of nursing home records, this set of
variables identifies hospital stays that occur-
red during the nursing home stay. Up to 10 rel-
ated stays can be listed.
In the case of hospital records, this set of
variables identifies the nursing home stay with-
in which the hospital stay occurred.
The Related Stay is identified by the Health
Care Facility Stay ID Number (positions 29-33)
of that stay.
An example of the usage of the related stay sec-
tion is found in the introduction to this code-
book.
(380-384) ID of First Related Stay
380 Survey Period Identifier
231 1 = NHEFS 1982-84
25,205 Blank = No related stays
381-382 Facility Number
231 01-07 = Hospital/nursing home number
25,205 Blank = No related stays
383-384 Stay Number Within Facility
231 01-20 = Stay number
25,205 Blank = No related stays
(385-389) ID of Second Related Stay
385 Survey Period Identifier
34 1 = NHEFS 1982-84
25,402 Blank = No second related stay
386-387 Facility Number
34 01-07 = Hospital/nursing home number
25,402 Blank = No second related stay
388-389 Stay Number Within Facility
34 01-18 = Stay number
25,402 Blank = No second related stay
(390-394) ID of Third Related Stay
390 Survey Period Identifier
15 1 = NHEFS 1982-84
25,421 Blank = No third related stay
391-392 Facility Number
15 02-07 = Hospital/nursing home number
25,421 Blank = No third related stay
393-394 Stay Number Within Facility
15 01-11 = Stay number
25,421 Blank = No third related stay
(395-399) ID of Fourth Related Stay
395 Survey Period Identifier
6 1 = NHEFS 1982-84
25,430 Blank = No fourth related stay
396-397 Facility Number
6 02-03 = Hospital/nursing home number
25,430 Blank = No fourth related stay
398-399 Stay Number Within Facility
6 01-07 = Stay number
25,430 Blank = No fourth related stay
(400-404) ID of Fifth Related Stay
400 Survey Period Identifier
25,436 Blank = No fifth related stay
Tape
Position Frequencies Variable Description and Codes
401-402 Facility Number
25,436 Blank = No fifth related stay
403-404 Stay Number Within Facility
25,436 Blank = No fifth related stay
(405-409) ID of Sixth Related Stay
405 Survey Period Identifier
25,436 Blank = No sixth related stay
406-407 Facility Number
25,436 Blank = No sixth related stay
408-409 Stay Number Within Facility
25,436 Blank = No sixth related stay
(410-414) ID of Seventh Related Stay
410 Survey Period Identifier
25,436 Blank = No seventh related stay
411-412 Facility Number
25,436 Blank = No seventh related stay
413-414 Stay Number Within Facility
25,436 Blank = No seventh related stay
(415-419) ID of Eighth Related Stay
415 Survey Period Identifier
25,436 Blank = No eighth related stay
419-417 Facility Number
25,436 Blank = No eighth related stay
418-419 Stay Number Within Facility
25,436 Blank = No eighth related stay
(420-424) ID of Ninth Related Stay
420 Survey Period Identifier
25,436 Blank = No ninth related stay
421-422 Facility Number
25,436 Blank = No ninth related stay
423-424 Stay Number Within Facility
25,436 Blank = No ninth related stay
(425-429) ID of Tenth Related Stay
425 Survey Period Identifier
25,436 Blank = No tenth related stay
426-427 Facility Number
25,436 Blank = No tenth related stay
428-429 Stay Number Within Facility
25,436 Blank = No tenth related stay
Figure 1
Health Care Facility Record Layout
Figure 1
NHANES I Epidemiologic Followup Study (NHEFS)
Health care facility record layout
Facility identifiers . Actual dates . Codes assigned by
Reported date of Match admission and NCHS to identify
admission or discharge stays contained
Reported cause of reason for . ICD-9-CM diagnoses within other stays
admission non-match . Discharge status
Source of report from hospitals and
nursing homes
Record Related
Report Section Status Section Abstract Section Stay section
Figure 2
Examples of Matching Process and Record Status Codes
Figure 2
NHANES I Epidemiologic Followup Study (NHEFS)
Examples of matching process and record status codes
Record status code
Match Report Section Mat Abstract Section
non-
Non-match Report Section match No Abstract
code received
Additional abstract No report ASF Abstract Section
found section
APPENDIX A 1982-84
RECORD STATUS CODES
Code Frequency Description
ANO- 268 "Authorization Not Obtained." This code indicates that
the subject or proxy refused to sign the Medical Authori-
zation Form (MAF). Information on these stays were not
requested from the reported facilities.
ASF- 5668 "Additional Stay Found." This code was assigned when a
returned in-scope abstract could not be matched to a
reported stay. This code was also assigned to in-scope
abstracts that were received as a result of an inquiry
generated by a type D report (Position 199). The type D
report was deleted from the final file.
FNC- 407 "Facility Never Contacted." This code was assigned when
the facility was not contacted for the following reasons:
the respondent could not recall the name of the facility;
the facility was closed; the facility could not be lo-
cated; and facility was located outside the United States.
MAT- 12,835 "Record Match." This code was assigned when a received
abstract matched a reported stay. This code was assigned
to in-scope and type C (position 199) reports, but never
to type D reports. In-scope abstracts that were received
as the result of a type D report were assigned an ASF
code. (See ASF.)
ONR- 1196 "Other Non-Response." This code was assigned to a stay
when no response for the stay request had been received
from the facility by the end of the study period.
REF- 184 "Refused." This code was assigned if a facility refused
to send back the abstract requested. It is record, not
subject specific. For example, a facility may have sent
some abstracts for a subject but refused to send others.
XNH- 587 "Subject Never at Facility." This code was used when the
facility indicated that the patient was never admitted to
that facility.
XNS- 4194 "Other - No Stay Found." This code was assigned when a
facility responded it was unable to send abstracts because
no in-scope stay was found at the facility, or when the
facility returned the request form without abstracts and
provided no explanation for the failure to do so.
Code Frequency Description
XRD- 97 "Record Destroyed or No Longer Available." This code was
assigned if the facility attempted to locate the abstract
but stated that it no longer existed, i.e., was destroyed,
or lost.
NOTE: Additional information concerning the assignment of the record status
codes is found in the introduction to this section.
APPENDIX B 1982-84
Codes for Health Care Facility Stay Records
NUMERIC CODES FOR REPORTED CONDITIONS ON
HEALTH CARE FACILITY STAY RECORDS
Code for reported Condition
Condition Description
01 Arthritis
02 Gout
03 Heart attack
04 Another heart condition besides heart attack
05 Coronary bypass surgery
06 Pacemaker repair, insertion and/or replacement
07 T.I.A. small stroke
08 Stroke or CVA (cerebrovascular accident)
09 Diabetes
10 High blood pressure
11 Cancer and/or cancer treatment
12 Fractured hip
13 Another type of bone fracture besides a hip
fracture
14 Pneumonia or influenza
15 Surgery
16 Don't know
17 Not ascertained
18 Tests/observation/x-rays/physical exam
Code for reported Condition
Condition Description
19 Digestive/endocrine condition
1901 Colon condition
1902 Ulcers
1903 Liver condition
1904 Colitis or enteritis
1905 Diverticulitis
1907 Gallbladder disease
20 Respiratory condition (other than influenza
and pneumonia)
2001 Asthma
2002 Chronic bronchitis or emphysema
21 Infection
22 Kidney/bladder/urinary condition
23 Debility/pain
2301 Headache
24 Male reproductive condition
25 Musculoskeletal problem or injury other than a
fracture
2501 Neck pain
2502 Back pain
2503 Hip pain
2504 Dislocated hip
2505 Other joint pain
26 Circulatory condition
27 Female reproductive condition
28 Mental illness
2801 Nervous breakdown
29 Neurologic condition
2901 Parkinson's disease
2902 Multiple sclerosis
2903 Epilepsy
30 Nutritional condition or dehydration
31 Bleeding or blood disorder
32 Skin condition
33 Condition not elsewhere coded
Code for reported Condition
Condition Description
34 Admission to a facility other than an acute care
hospital
35 In a facility at time of death
36 Cataracts
3601 Glaucoma
3602 Detached retina
3603 Eye problem other than cataracts, detached
retina or glaucoma
37 A fall
Background
During the process of completing the Hospital and Health Care Facility
(HHCF) chart respondents were asked to describe the conditions that led to
their facility stays and this information is included as a text field on the
stay record. The text portion of the reported condition contains standard
nomenclature words. If necessary the respondent's description was edited to
fit into the 30 positions available in the record. A numeric code was also
assigned to each description. This was done so that users would not have to
deal with alphabetic description fields when investigating reasons for
facility stays. Space is allotted on the report section of the facility stay
record for recording of up to four reasons for the hospitalization or nursing
home stay (positions 63-198 of the HCFS record).
Note that code 1906 is not included in the coding structure for the
1982-84 file. This code had been designated for reports of overnight hospi-
tal stays for thyroid disease. No such stays were reported.
Reported conditions and their associated codes can be divided into six
types depending on where in the interview the was reported and the amount of
information obtained: specific conditions included in either the subject or
proxy interview (Type A); conditions which are well-defined but for which no
question exists in the interview (Type B); unknown conditions (Type C);
conditions about which there is no specific question in the interview but for
which sufficient information is available to attribute them to disorders of a
major body system (Type D); conditions that are broadly defined and/or cannot
be attributed to a single major body system (Type E); and conditions that
cannot be classified into any of the above categories (Type F). Each
condition type, the associated codes and the rules for assigning the reported
conditions to the categories of the coding structure are described in detail
below.
Type A - Conditions about which the respondent was asked in the
interview. For example, if a respondent answered "yes" to question G-26
("Since 1970, had (he/she) ever stayed overnight in a hospital for
arthritis?"), then a condition code of "01" and a test field containing
"arthritis" would be included on the facility stay record. Type A conditions
are listed below with the corresponding interview question number in
parentheses. Unless otherwise indicated, the question is found in both the
subject and proxy questionnaires.
01 Arthritis (G-26 of the proxy questionnaire)
03 Heart attack (G-17)
04 Other heart conditions (G-15 and G-16)
07 T.I.A., small stroke (G-21)
08 Stroke (G-22)
09 Diabetes (G-40 on the subject questionnaire and D-22 on the proxy
questionnaire)
10 High blood pressure (D-5)
11 Cancer (D-65 and D-54 on the subject questionnaire and D-22 on
the proxy questionnaire)
12 Fractured hip (E-94 on the subject questionnaire)
1901 Colon problem (G-8)
1902 Ulcers (G-5)
1903 Cirrhosis of the liver (G-9)
1904 Colitis or enteritis (G-14)
1905 Diverticulitis (G-19)
1907 Gallbladder disease (D-47 on the subject questionnaire and D-14
on the proxy questionnaire)
2001 Asthma (G-1)
2002 Chronic bronchitis and emphysema (G-2)
22 Kidney, bladder or urinary problem (G-6 and G-7)
2301 Headache (G-3)
2501 Neck pain (E-26 on the subject questionnaire)
2502 Back pain (E-46 on the subject questionnaire)
2503 Hip pain (E-59 on the subject questionnaire)
2504 Dislocated hip (E-99 on the subject questionnaire)
2505 Other joint problem (E-99 on the subject questionnaire)
2801 Nervous breakdown (G-12)
2901 Parkinson's disease (G-10)
2902 Multiple sclerosis (G-11)
2903 Epilepsy (G-50 on the subject questionnaire G-25 on the proxy
questionnaire)
34 Care in non-acute care facility (G-62 on the subject question-
naire and G-31 on the proxy questionnaire)
35 In a facility at death (V-3 on the proxy questionnaire)
36 Cataracts (G-18)
3601 Glaucoma (G-19)
3602 Detached retina (G-20)
Complete agreement between responses to the questions in the interview
and Type A condition codes on the facility stay file should not be expected.
There are several reasons for a lack of agreement between these two data
sources.
First, the respondent may report a facility stay for a given condition
in the interview and yet no facility stay record containing the condition may
appear on the NCFS file. This would result if: (1) it was determined that
the hospitalization did not last overnight causing the stay to be deleted
from the HCFS file; or (2) the reported stay was found to be "out-of-scope".
(See the introduction to this codebook and the Plan and Operation for defini-
tions of out-of-scope stays.)
Second, data may be inconsistent between the interview and the HCFS
file of the respondent remembered and reported a condition after responding
to the corresponding question in the interview. This tended to occur at the
time the interviewer was recording information on the HHCF chart. For ex-
ample, while recording information on a stay for high blood pressure, the
respondent may add that he/she was also hospitalized at that time for a heart
condition. The respondent may not have reported the hospitalization when
asked about heart conditions in question G-15 and the Section G information
may not have been updated to reflect this additional condition. However,
heart condition would appear on the HCFS file.
Type B - Conditions which do not have a corresponding question in the
interview but for which sufficient descriptive information is available to
allow them to be easily coded:
02 Gout
05 Coronary bypass surgery
06 Procedures for pacemakers
13 Bone fracture
14 Pneumonia and influenza
18 Test and observation
37 A fall
Type C - Unknown conditions:
16 Don't know
17 Not ascertained
Type D - Conditions for which there is not a specific question in the
interview but which can be attributed to disorders of a major body system:
19 A condition of the digestive/endocrine system not found in the
detailed conditions of the 1990 series codes (see Type A)
20 Respiratory conditions other than pneumonia, influenza, chronic
bronchitis, emphysema or asthma
24 The male reproductive system
25 A condition of the musculoskeletal system not found in the
detailed conditions of the 2500 series codes (see Type A)
26 The circulatory system (except strokes)
27 The female reproductive system
29 A neurologic disorder not found in the detailed conditions of the
2900 series codes (see Type A)
31 Blood disorders and bleeding
32 Skin problem
3603 Eye problem other than cataracts, detached retina or glaucoma
Type E - Conditions which are broadly defined or are attributed to
problems of more than one major body system:
15 Surgery
21 Infections
23 Debility and pain other than headache
28 Mental illness other than nervous breakdown
30 Nutrition and dehydration
Type F - All conditions that cannot be assigned to one of the above
codes:
33 Other conditions
Additional information on reasons for a facility stay is available in
the abstract section of the record (positions 205-379) if an abstract has
been matched to the report. In general, information from the abstract is
considered a more accurate determination of the conditions associated with
the stay than are the reported conditions. The condition codes in the report
section of stay records do provide useful information in the absence of a
medical abstract. Both flexibility and caution should be exercised when
selecting stays based on these codes. In order to help the analyst use these
condition codes effectively, a description of the code assignment procedure
along with an example is provided.
Rules for Assignment
The numeric codes were assigned to the respondent's non-technical
descriptions by trained medical coders. In order to minimize variation among
the coders assigning these codes, precedence rules were defined. Generally,
a condition was coded to the most specific category in which it could be
placed. The assignment rules are described below in primary order, e.g. Rule
2 was used only if Rule 1 did not apply and so forth.
Rule 1: If a condition was one about which there was a specific question
in either the subject or proxy interview, the code appropriate
for that question was assigned. (Type A conditions)
Rule 2: If the textual description could be coded to a narrowly defined
condition not referenced in the interview or to the unknown
category, the appropriate Type B or Type C code was assigned.
Rule 3: Conditions that could not be coded to a specific question but
could be coded to a major body system were assigned the
appropriate Type D code.
Rule 4: General descriptions, symptoms and conditions not coded by rules
1 through 3 were coded at the discretion of the medical coders,
again with emphasis on as much specificity as possible. For
example, "PAIN IN THE KNEES" would be coded to "25 - Debility and
pain". (Type D or Type E conditions)
Rule 5: Everything that could not be assigned a code after applying the
above rules was coded to "33 - Other conditions". (Type F
conditions)
Considerations for the Data User
These precedence rules were used for all three followups. However,
since the questionnaires used in each followup differed slightly, the
assignment of codes also differed. Questions about specific conditions were
not always included in all three questionnaires. For example, Question B-63
in the 1986 interview asked about overnight stays for surgery making condi-
tion code "15-Surgery" a Type A condition in the 1986 followup. There is no
similar question in the 1982-84 or 1987 interview, therefore, surgery is a
Type E condition in the 1982-84 and the 1987 files. In other cases, groups
of conditions are combined into one question on one questionnaire but asked
separately on another. For example, T.I.A.'s and other strokes are combined
in one question in 1987. Since it was not possible to separate reports of
T.I.A.'s from other strokes in the 1987 file, there are no conditions assign-
ed to codes "07" in this file. There are reports assigned to "07" in the
1982-84 and 1986 files since separate T.I.A. and stroke questions were asked.
An attempt was made to include as much detail in the code as possible.
The questionnaire in the 1982-84 followup included enough detail to
separate specific digestive conditions, such as colitis and gallbladder
problems, from the general category of digestive disorders. Therefore, the
1982-84 HCFS data file, includes sub-codes under "19 - Digestive/endocrine
system". Thus, analysts interested in colitis can identify cases from the
reported condition section of the 1982-84 file but not from the 1986 or 1987
files. However, all files can be used to identify cases of the
digestive/endocrine system in general. The analyst should refer to the
questionnaire and the condition coding structure in the HCFS data tape
codebook for the period of interest in order to obtain the maximal amount of
information available.
In using the condition codes to select records of interest, two
characteristics of the coding structure should be considered: (1) the
condition of interest may be found under more than one numeric code and (2)
each numeric code covers more than one condition.
To illustrate the first situation, consider a search for all reported
stays with breast biopsies. A respondent might report a breast biopsy in
response to the question relating to cancer and cancer treatment. In this
case the textual field would contain a description such as "BIOPSY OF RIGHT
BREAST" and the numeric code assigned would be 11 (indicating a response to
the cancer stay question). Breast biopsies could also be reported in re-
sponse to the surgery question in the 1986 followup and be assigned the code
of 15. If the biopsy was reported in response to question G-61 on the 1982-84
questionnaire, "Have you stayed in a hospital for any other reason...?", it
would be assigned to code 18 - Tests and observation". To identify breast
biopsy cases it would be necessary to search the alphabetic fields for codes
11, 15 and 18. In addition, the reports of breast biopsies include several
wording variations, for example, "BREAST BIOPSY", "BIOPSY OF BREAST". The
analysts needs to investigate all possible wordings.
To illustrate the second situation, consider code 18 - "Tests and
observation". Over 250 different verbal descriptions have been coded to this
category including a variety of radiological procedures, surgeries and
physical examinations. Selecting just on code 18 will result in a wide
variety of procedures. Those of a specific interest need to be identified by
the textual description.
Analysts who wish to use these reports, should print and review all the
reported condition codes and alphabetic descriptions from the Health Care
Facility Stay data files. Such a review will aid in (1) finding all the
numeric condition codes under which the condition of interest will be found
and (2) insuring that, within any numeric condition code, only the reports of
interest will be selected.
Finally, the condition codes in the report section should be used in
conjunction with the information in the abstract section if it is available.
Returned abstracts were matched to reports if one of the reported conditions
matched one of the discharge diagnoses on the abstract. Other conditions
reported for the same stay may or may not be confirmed in the matched medical
abstract. If the condition of interest is not indicated as a discharge
diagnosis on the medical record, the analyst may not want to accept the
reported condition as a reason for the stay. Similarly, conditions may be
listed as discharge diagnoses that do not appear on the report section. See
the introduction to this codebook for a description of the match criteria.