Scientific Data Documentation
Epidemiologic Followup Study, 1987 Health Care Facility Stay
DSN: CC37.HANES1FU.FCLTY87
NHANES EPIDEMIOLOGIC FOLLOWUP STUDY
HEALTH CARE FACILITY STAY 1987
Acknowledgments
The NHANES I Epidemiologic Followup Study (NHEFS), 1987 Health
Care Facility Stay Public Use tape was prepared by Sandra T.
Rothwell under the direction of Jennifer H. Madans. Assistance
was provided by other members of the NHEFS data management team:
Joel C. Kleinman, Fanchon F. Finucane, Christine S. Cox, Virginia
M. Freid, Brian A. Kissel, Cynthia A. Reuben, Michael E.
Mussolino, Helen E. Barbano, Madelyn A. Lane, and Jacob J.
Feldman. Virginia M. Freid, Sandra T. Rothwell, and Dawn M.
Scott were in charge of data set management. La-Tonya D. Curl
and Carole J. Hunt were in charge of manuscript preparation.
Special thanks are extended to Joan Cornoni-Huntley of the
National Institute on Aging (NIA) who played an important role in
the development and continuation of the NHEFS. The contribution
of Westat, the contractor who collected the data for this
longitudinal study, is also gratefully acknowledged.
The NHEFS originated as a joint project between the National
Center for Health Statistics (NCHS) and NIA. It has been funded
primarily by NIA, with additional financial support from the
following components of the National Institutes of Health (NIH)
and other Public Health Service agencies: the National Cancer
Institute; the National Institute of Child Health and Human
Development; the National Heart, Lung, and Blood Institute; the
National Institute on Alcohol Abuse and Alcoholism; the National
Institute of Mental Health; the National Institute of Diabetes
and Digestive and Kidney Diseases; the National Institute of
Arthritis and Musculoskeletal and Skin Diseases; the National
Institute of Allergy and Infectious Diseases; and, the National
Institute of Neurological and Communicative Disorders and Stroke.
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 1987 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
Note: New address effective May 1990.
Errors in the Data Tapes and Survey Differences
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.
In general, the NHEFS data management team has not attempted to
resolve substantive data discrepancies that may exist 1) within
the 1987 NHEFS data tapes, or 2) between the 1987 NHEFS data
tapes and the data tapes of the original National Health and
Nutrition Examination Survey (NHANES I) and other NHEFS followup
waves.
Tape Characteristics
Title: 1987 NHEFS Health Care Facility Stay Data Tape
Record Length: 429
Blocksize: 31746
Number of Records: 7,361
Number of Reels: 1
Recording Mode: FIXED BLOCK, EBCDIC
Density: 6250 bpi
Channel: 9 TRACK
Created by: Office of Analysis and Epidemiology
Division of Analysis
National Center for Health Statistics
Presidential Building, Room 1080
6525 Belcrest Road
Hyattsville, Maryland 20782
Background 1987
The NHANES I Epidemiologic Followup Study (NHEFS) is a
longitudinal study which uses as its baseline those adult persons
ages 25 to 74 years who were examined in the first National
Health and Nutrition Survey (NHANES I). The NHEFS is comprised
of a series of followup surveys, three of which have been
conducted to date. The first wave of data collection, the
1982-84 NHEFS, was conducted from 1982 to 1984 and included all
persons who were between 25 and 74 years at their NHANES I
examination (n=14,407). The second wave of data collection, the
1986 NHEFS, was conducted for members of the NHEFS cohort who
were 55-74 years at their baseline examination and not known to
be deceased at the 1982-84 NHEFS (n=3,980). The third wave of
data collection, the 1987 NHEFS, was conducted for the entire
non-deceased NHEFS cohort (n=11,750). This series of tape
documentation describes data collected in the 1987 NHEFS. A plan
to re-contact the entire non-deceased NHEFS cohort in 1991 is
currently under review.
Methods
General Information
NHANES I collected data from a national probability sample of the
United States civilian noninstitutionalized population between
the ages of 1 and 74 years. The survey, which included a
standardized medical examination and questionnaires that covered
various health-related 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, of whom 14,407 (70 percent) completed a medical examination.
The design, content and operation of NHANES I has been described
elsewhere (Vital and Health Statistics, Series 1, Nos. 10a, 10b,
and 14).
Although NHANES I provided a wealth of information on the
prevalence of health conditions and risk factors, the
cross-sectional nature of the original survey limits its
usefulness for studying the effects of clinical, environmental,
and behavioral factors and in tracing the natural history of
disease. Therefore, the NHEFS was designed to investigate the
association between factors measured at the baseline and the
development of specific health conditions. It originated as a
joint project between the National Center for Health Statistics
(NCHS) and the National Institute on Aging with collaboration
from components of the National Institutes of Health and other
Public Health Service agencies. The 14,407 participants who were
25 to 74 years of age when they were examined in NHANES I
(1971-75) were included in the followup study population.
In the first wave, the 1982-84 NHEFS, data were collected on all
14,407 subjects (i.e., individuals examined at NHANES I) in the
cohort. Tracing of subjects began in 1981 and data collection
was conducted from 1982 to 1984. Approximately 93 percent
(n=13,383) of the cohort was successfully traced by the end of
the survey period. Detailed information on the design, content,
and operation of the 1982-84 NHEFS may be found in the Plan and
Operation of the NHANES I Epidemiologic Followup Study 1982-84,
Vital and Health Statistics, Series 1, No. 22. The basic design
of the 1982-84 NHEFS consisted of the following components:
-- tracing subjects or their proxies to a current
address;
-- acquiring death certificates for deceased subjects;
-- performing in-depth interviews with the subjects or
with their proxies including, for surviving
subjects, taking pulse, blood pressure, and weight
measurements of subjects; and,
-- obtaining hospital and nursing home records,
including pathology reports and electrocardiograms.
The second wave of the NHEFS, the 1986 NHEFS, collected
information on changes in the health and functional status since
the last contact with the older members of the NHEFS cohort. It
was restricted to those subjects who were at least 55 years old
at their NHANES I examination (n=5,677), which is almost 40
percent of the entire NHEFS cohort. The group includes 1,697
subjects who were deceased at the time of the 1982-84 NHEFS and
3,980 subjects who were not known to be deceased at the time of
the 1982-84 NHEFS. Tracing and data collection in the 1986 NHEFS
was undertaken only for the 3,980 subjects in the latter group,
regardless of their tracing or interview status in 1982-84. The
remaining 1,697 subjects who were deceased at the time of the
1982-84 NHEFS were excluded from additional data collection in
the 1986 NHEFS. Detailed information on the design, content, and
operation of the 1986 NHEFS may be found in the Plan and
Operation of the NHANES I Epidemiologic Followup Study 1986,
Vital and Health Statistics, Series 1, No. 25.
The 1987 NHEFS, the third wave of the NHEFS, collected
information on changes in the health and functional status of the
NHEFS cohort since the last contact. The 1987 NHEFS cohort
includes 2,657 subjects who were deceased at the time of the
1982-84 and 1986 NHEFS and 11,750 subjects who were not known to
be deceased prior to the 1987 NHEFS data collection period.
Tracing and data collection in the 1987 NHEFS was undertaken only
for the non-deceased subjects, regardless of their tracing or
interview status in previous NHEFS surveys. The 2,657 previously
deceased subjects were excluded from additional data collection
in the 1987 NHEFS.
The design and data collection procedures adopted in the 1987
NHEFS were very similar to the ones developed in the previous
surveys: subjects were traced; subject and proxy interviews were
conducted; and, health care facility abstracts and death
certificates were collected. All subjects whose vital status was
not obtained through tracing procedures were considered
lost-to-followup in the 1987 NHEFS. In some cases, information
about the death of a subject was obtained from a former neighbor,
a relative or another tracing source. Although this information
was noted in the subject's tracing record, he or she was
considered lost-to-followup unless the information was verified
by means of a death certificate or proxy interview. A subject's
death had to be confirmed by either a death certificate or proxy
interview.
In addition to verifying the subject's vital status, the tracing
process also was 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 telephone interview. In a few cases,
subjects who had been traced successfully could not be relocated
for the interview. Only their vital status and the date when
they were last traced in the 1987 survey are available.
A major difference between the 1982-84 and 1987 NHEFS waves was
the manner in which the interviews were conducted. In the
1982-84 NHEFS, the two-hour subject interview usually was
conducted in-person while, in the 1986 and 1987 NHEFS, the
interview was shortened to 30 minutes in length and was conducted
primarily by telephone. In addition, since the questionnaire was
not administered in-person, no physical measurements were made in
the 1986 or the 1987 NHEFS.
The 1987 NHEFS interviews were conducted over the telephone using
a Computer Assisted Telephone Interviewing (CATI) system. CATI
is a telephone interviewing technique that allows the interviewer
to enter the answers supplied by the respondent directly into the
computer. Thus, editing and coding time is reduced and
keypunching from a hard copy questionnaire is eliminated. A
computer program drives the questionnaire so that the correct
skip patterns are followed and the appropriate questions are
displayed on the computer monitor. The skip patterns are based
on information gathered from previous data collection waves or on
responses provided during the interview. For example, certain
questions on pregnancy and menstrual history in the 1987
interview were programmed to be skipped automatically if the
subject was male or if the female subject was interviewed
previously and was 45 years of age or older at the time of that
interview. Edit and logic checks are incorporated into the data
collection system itself, thus improving the quality of the data.
As of January 25, 1988, the end of the 1987 NHEFS data collection
period, 11,018 (93.8 percent) of the 11,750 members of the 1987
NHEFS cohort had been successfully traced. Interviews were
conducted for 9,998 subjects (90.7 percent of those successfully
traced). In addition, 7,361 facility stay records were collected
for 3,472 subjects using information obtained from the interview,
death certificate, or some other source. Death certificates were
obtained for 524 (94.4 percent) of the 555 subjects who were
known to have died since last contact.
The data collected from the 1987 NHEFS are stored on four
separate tapes:
1) Vital and Tracing Status tape -- contains summary
information about the status of the cohort,
2) Interview tape -- contains the data collected from
the 1987 NHEFS subject and proxy interviews,
3) Mortality Data tape -- contains data abstracted
from the death certificates from all three NHEFS surveys,
4) Health Care Facility Stay tape -- contains
information 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 tape is described in detail in the
following pages.
Stay Reports
The 1987 NHEFS Health Care Facility Stay (HCFS) file contains
information on all overnight health care facility stays for
members of the 1987 Followup cohort. The 1987 Followup cohort
consisted of the 11,750 subjects who were between 25 and 74 years
old at their NHANES I examination and were not known to be
deceased at the time of the 1986 NHEFS. Followup cohort members
who have either an interview or a death certificate on the 1987
NHEFS data files were eligible for the health care facility
records component. The aim of this component was to develop a
complete set of health care facility (i.e., hospital and nursing
home) records for each 1987 Followup cohort member. This was
accomplished by identifying all facility stays through a series
of reporting mechanisms. Facilities were contacted to obtain
copies of medical records. Reports and medical records were then
linked and the 1987 NHEFS Health Care Facility Stay file was
constructed. The procedures for obtaining reports and collecting
abstracts are described briefly, below.
The 1987 NHEFS Health Care Facility Stay file contains all
information on overnight stays that are in-scope for the 1987
NHEFS period. The in-scope period depends upon the timing of the
subject's last interview and his/her vital status. For subjects
who have not been interviewed since the NHANES I exam, the 1987
in-scope period is from the date of the NHANES I exam to the date
of the 1987 interview for surviving subjects and from the exam
date to the date of death for deceased subjects. For subjects
who have had at least one followup interview prior to the 1987
followup, the in-scope period is from the date of the last
interview (either 1982-84 or 1986) to the date of the 1987
interview for surviving subjects and from the date of the last
interview to the date of death for deceased subjects. Stays that
were reported prior to the in-scope period were defined as
out-of-scope for the 1987 survey.
Identification of Stay Reports:
Reports of overnight hospital or nursing home facility stays were
obtained from various sources. Most reports were elicited through
a series of detailed questions in sections B of the interview.
Generally, respondents were asked to report all overnight facility stays
since 1985 if the subject was last interviewed in the 1986 NHEFS, since
1980 if the subject was last interviewed in the 1982-84 NHEFS, or since
1970 if the subject was last interviewed at NHANES I examination. In
addition to interview information, data on facility stays were gathered
from other reporting sources: from the death certificate, tracing
sources, and other hospital abstracts. At the conclusion of the interview,
authorization was obtained for permission to contact facilities.
Facility Data Collection
For each stay reported during the interview, the name and address of the
facility, the reported dates of the stay, and the reason for the stay were
recorded on the hospital and health care facility chart (HHCF). A separate
log book was kept containing similar data for reports gathered from the
death certificates, tracing sources, and other hospital abstracts. All
reports of facility stays were compiled & entered into a computerized
tracking system. All reported facilities were contacted by mail and asked
to review the subject's medical records & to abstract information on exact
dates of admission, discharge & diagnoses onto standard abstract forms. In
addition to completing abstract forms, facilities were requested to submit
photocopies of selected sections of the subject's inpatient record i.e.,
the "facesheet", the 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).
Matching Records
As the abstracts were received, they were checked against report infor-
mation 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 a match record status, an out-of-scope
report date, but an in-scope date on the abstract. These records are
identified by a Type C flag in position 199 of the file.
Each record on the file represents an overnight facility stay. Therefore,
one or more records will exist for some 1987 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 last interview date to determine whether
reported stays were in-scope for the NHEFS 1987 survey (position 199)
The record status section (positions 60-62) contains a code for the result of
the abstract request, i.e. match or non-match status. If a facility returned
an abstract that matched a report then a record status code of MAT (match)
was applied. A returned abstract that did not match a report but was
in-scope for the 1987 survey period was assigned the record status code of
ASF (additional stay found). A record status code of CRM (cross-referenced
match) was applied to a stay that was the continuation of a stay begun
prior to the 1987 NHEFS survey period. If an abstract was not returned,
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
& 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 is similar to the original
1982-84 NHEFS Health Care Facility record file released in August 1987. The
other three sections were added when the 1986 version of the Health Care
Facility Stay file was designed. A revised 1982-84 HCFS data tape which is
structured in the same format as the 1986 and 1987 HCFS tapes has also
been released.
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 receipt of a
facility abstract. This type of record resulted when the facility returned
an 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.
Due to the procedures we instituted for maximizing the collection of reports
of hospital or nursing home stays, i.e., deliberately requesting out-of-scope
report information, it was necessary to devise rules for removing the
"correctly reported" out-of-scope reports from the final version of the file.
This was only possible after the facilities returned abstract information to
us. Reports of stays with a reported date of admission more than one year
prior to the last interview in health care facilities which had not been
contacted previously were flagged with a Type D in position 199. If an
in-scope abstract was received from the facility it was added onto the file
with a record status code of ASF, & the Type D report was deleted from the
final version of the file. If the facility responded to the request for
information but no in-scope abstracts were received from the facility, the
Type D report was deleted from the file based on the presumption that the
date had been correctly reported & the stay was out-of-scope. In 12 cases,
the Type D reports remain on the final version of the file. This occurred
when it was impossible to contact the facility. These records for un-
confirmed reports of out-of-scope stays can be eliminated from analyses
at the analysts' discretion. A Type C flag was assigned in position 199 when
a reported date of admission was within one year of the previous interview.
If an in-scope abstract was returned which matched the Type C report, it
was assigned a record status code of MAT (n=142). (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 abstracts
were received the Type C reports were removed from the file again on the
assumption that the correct date had been reported and the stay was truly
out-of-scope. There are 15 non-matched Type C cases remaining on the file.
In seven of these cases it was not possible to contact the facility (non-
match code of FNC in positions 60-62); in five cases the subject did not
provide authorization to write the facility (ANO in positions 60-62); two
cases were facility non-response (ONR): & in one case the facility refused
to send an abstract (REF). 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, the related stay codes (positions 380-429),
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 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, 1985, and discharged to the hospital on April 1,
1985. He returned to the original nursing home on April 8 and stayed until
April 22 when he required readmission to the hospital. He returned from the
hospital to the nursing home on April 25, 1985 where he remained until
April 30, 1985.
Panel A: Chronologic profile of hospital and nursing home stays
Location Admission Discharge
Nursing home 03/01/85 04/01/85
Hospital 04/01/85 04/08/85
Nursing home 04/08/85 04/22/85
Hospital 04/22/85 04/25/85
Nursing home 04/25/85 04/30/85
Panel B
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 demon-
strate 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
30201 N. Home 03/01/85 04/30/85 30101 30102
30101 Hosp 04/01/85 04/08/85 30201
30102 Hosp 04/22/85 04/25/85 30201
Coding Procedures and Guide to Tape Layout
Medical Coding Specifications
Medical coding for the NHEFS 1987 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 on the abstract form.
In most instances, discrepancies were resolved 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.
4Rules 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 no
review of the records was made to determine if the correct 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,
suggestive 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.
Hospital acquired infections, such as a "staph" infection, if documented
on the facesheet and/or discharge summary are coded. Documentation may be
in the form of a note by the infections committee, stamped notation, or a
checkmark, depending on the record format.
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
diagnoses listed, the symptom is coded.
Ex: The discharge diagnoses listed are acute myocardial
infarction, diabetes mellitus, and hepatomegaly. The
hepatomegaly 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
principal diagnosis and is performed for definitive treatment as opposed
to diagnostic 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 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 code 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
applicable (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
facility record. Each procedure code is formatted in a field containing
four positions. Procedure codes were entered beginning with the first
position of the variable field continuing through the fourth position.
There is an implied decimal 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
Tape
Position Frequencies Variable Description and Codes
SUBJECT INFORMATION
1-5 7361 NHANES I Sample Sequence Number
6-7 Record Count
7361 01-26 = Total number of records
Note: Each record on the file represents an
overnight stay in a health care facility (hospital
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 7361 Blank
Tape Positions 29-46
Tape
Position Frequencies Variable Description and Codes
(29-59 STAY IDENTIFIERS AND REPORTED INFORMATION
63-204) ON FACILITY STAYS
Note: The report section of the record (positions
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 30102 refers to a
facility stay reported during the NHEFS 1987 wave
(3) in the first facility reported for that
subject (01) but the second admission to that
facility (02).
29 Survey Period Identifier
7361 3 = NHEFS 1987
Note: This variable identifies the survey period
in which the stay data were collected. A facility
stay reported during the NHEFS 1987 wave will be
identified with a code number "3". All records on
this file are coded "3" in this field.
30-31 Facility Number
7361 01-11-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
7349 01-23 = Stay number
12 00 = D stay record
Note: The two digit stay numbers were assigned to
identify different stays in the same facility.
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 last interview (see position
199).
Stay numbers within facilities were assigned
consecutively. However, due to tape editing,
there are missing numbers in the sequence of stay
numbers within facilities.
34-35 Facility ID Prefix
6845 01 = Hospital
405 02 = Nursing home
111 03 = Out of country, don't know, not ascertained
Note: This variable identifies the type of facility
to which he request for a stay record was mailed.
36-46 7361 Blank
Tape
Position Frequencies Variable Description and Codes
(47-54) Reported Admission Date/Range
The date of admission to a facility is reported by
month, day and year. 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),
and CRM and CRX records (positions 60-62).
47-48 Reported Month of Admission
4457 01-12 = Month of admission
1321 98 = Don't know
80 99 = Not ascertained
1503 Blank =
Type D (position 199), record status code
ASF (positions 60-62), source code 1 or 3
(position 200) and record status code
(positions 60-62) not a cross-referenced
stay (CRM, CRX)
49-50 Reported Day of Admission
2572 01-31 = Day of admission
3201 98 = Don't know
85 99 = Not ascertained
1503 Blank =
Type D (position 199), record status code
ASF (positions 60-62), source code 1 or 3
(position 200) and record status code
(positions 60-62) not a cross-referenced
stay (CRM, CRX)
51-52 Reported Year of Admission or Beginning Year
of Range
5465 70-87 = Year of admission or beginning year
of range (1970-1987)
375 98 = Don't know
18 99 = Not ascertained
1503
Blank = Type D (position 199), or record status
code SF (positions 60-62), or source code
(position 200) 1 or 3 and record status
code (positions 60-62) not a
cross-referenced stay (CRM, CRX)
53-54 Reported Year of Admission - Ending Year of
Range
183 73-87 = Ending year of range (1973-1987)
7178 Blank = No range given for reported year of
admission, type D (position 199), or
record status code ASF (positions 60-62),
or source code (position 200) 1 or 3 and
record status code (positions 60-62) not a
cross-referenced stay (CRM, CRX)
Tape
Position Frequencies Variable Description and Codes
(55-59) ID Number of Cross Referenced Facility Status
Stay
Note: The ID number on the 1982-84 or 1986 NHEFS
Facility Tape (positions 29-33) is used to
reference stays in a hospital or nursing home that
began during the 1982-84 or 1986 NHEFS period and
which continue into the 1987 survey period. This
variable is coded only for records with a CRM or
CRX in positions 60-62 on the 1987 file.
55 Survey Period Identifier of Cross-referenced
Facility Stay
23 1 = NHEFS 1982-84
181 2 = NHEFS 1986
7157 Blank = Stay not cross-referenced
56-57 Facility Number of Cross-referenced Stay
204 01-04 = Stay number
7157 Blank = Stay not cross-referenced
58-59 Stay Number Within Facility of Cross-
reference Stay
204 00-14 = Stay number
7157 Blank = Stay not cross-referenced
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 facility
stay.
60-62 Record Status Code
Note: See Appendix A for an explanation of the record
status codes.
7361 ANO - XRD = Record status code
Tape
Position Frequencies Variable Description and Codes
(63-198) Reported Conditions and Codes
During the process of completing the Hospital and
Health Care Facility Chart (HHCF) respondents
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 63-64, 97-98,
131-132, 165-166). 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, ASF or
CRM. Appendix B contains a complete description
of these fields along with guidelines for their
use.
(63-96) First Reported Condition
63-66 Condition Code
5717 01-37 = Condition code (See Appendix B)
1644 Blank = Source Code equal to 2 or 3 or D stay
record or Record Status Code ASF or source
code equal to 1 and record status code not
CRM.
67-96 Condition Text
5717 Description of reason for facility stay
1644 Blank = Source Code equal to 2 or 3 or D stay
record or Record Status Code ASF or
source code equal to 1 and record
status code not CRM.
Tape
Position Frequencies Variable Description and Codes
(97-130) Second Reported Condition
97-100 Condition Code
1096 01-37 = Condition code (See Appendix B)
6265 Blank = Source Code equal to 2 or 3 or D stay
record or Record Status Code ASF or source
code equal to 1 and record status code not
CRM or only one condition reported
101-130 Condition Text
1096 Description of reason for facility stay
6265 Blank = Source Code equal to 2 or 3 or D stay
record or Record Status Code ASF or source
code equal to 1 and record status code not
CRM or only one condition reported
Tape
Position Frequencies Variable Description and Codes
(131-164) Third Reported Condition
131-134 Condition Code
217 01-37 = Condition code (See Appendix B)
7144 Blank = Source Code equal to 2 or 3 or D stay
record or Record Status Code ASF or source
code equal to 1 and record status code not
CRM or less than three conditions reported
135-164 Condition Text
217 Description of reason for facility stay
7144 Blank = Source Code equal to 2 or 3 or D stay
record or Record Status Code ASF or source
code equal to 1 and record status code not
CRM or less than three conditions reported
Tape
Position Frequencies Variable Description and Codes
(165-198) Fourth Reported Condition
165-168 Condition Code
30 01-37 = Condition code (See Appendix B)
7331 Blank = Source Code equal to 2 or 3 or D stay
record or Record Status Code ASF or source
code equal to 1 and record status code not
CRM or less than four conditions reported
169-198 Condition Text
30 Description of reason for facility stay
7331 Blank = Source Code equal to 2 or 3 or D stay
record or Record Status Code ASF or source
code equal to 1 and record status code not
CRM or less than four conditions reported
199 Type of Stay Flag
157 C = A reported stay with admission date up to one
year prior to the date of last interview (i.e.
the NHEFS 1982-84 or 1986 if interviewed at
either followup or date of NHANES I
Examination if not interviewed since exam.
12 D = A reprted stay with admission date more than
one year prior to date of last interview and
the facility had not been contacted
previously. If there were multiple reported
stays in the same facility that were all type
D (more than one year prior to last interview)
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, but
assigned a record status code of ASF
(positions 60-62). The type D report was then
removed from the file. The 12 type D reports
remaining on the final file are all
non-responses from the facility and thus were
not able to be resolved.
7192 Blank = In-scope stay; a reported date of admission
after the last interview date. This field is
also blank for record status codes of ASF, CRM
or CRX (positions 60-62).
Note: This variable identifies reported
facility stays as in-scope or out-of-scope for
the NHEFS 1987 interview period. Reported
dates of admission of don't know (989898) or
not ascertained (999999) in positios 47-52
were considered in-scope.
200 Source of Report of Stay that Initiated
Request for Abstract
46 1 = Information from death certificate
126 2 = Information from hospital abstract
report
49 3 = Information from other source
5728 4 = Information from NHEFS 1987 interview
1412 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.
201-204 7361 Blank
ABSTRACT DATA
Note: The abstract data portion of the record
(positions 205-380) contains information obtained
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=1597).
205-206 Abstract Number
5764 01-26 = Number of abstract
1597 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
7361 00-26 = 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
5431 1 = Hospital
333 2 = Nursing home
1597 Blank = Stay reported, no abstract form
received
Tape
Position Frequencies Variable Description and Codes
(210-215) Date of Admission
210-211 Month of Admission
5764 01-12 = Month of admission
1597 Blank = Stay reported, no abstract form received
212-213 Day of Admission
5764 01-31 = Day of admission
1597 Blank = Stay reported, no abstract form received
214-215 Year of Admission
5764 71-87 = Year of admission (1971-1987)
1597 Blank = Stay reported, no abstract form received
Tape
Position Frequencies Variable Description and Codes
(216-221) Date of Discharge
Note: When a subject had a brief break in a
nursing home stay not due to a hospitalization,
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 10-31-86 to 12-22-86. The
subject was readmitted to the same nursing home
1-3-87 and stayed until their death 3-5-87. No
information is available for 12-22-86 to 1-3-87.
These 2 stays would appear on the file as 1 stay
from 10-31-86 to 3-5-87. 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 homes stays were collasped as described
above and a code was entered in the related stay
section (see positions 380-429).
216-217 Month of Discharge
5565 01-12 = Month of discharge
199 97 = Inapplicable (still at facility on
date of 1987 interview)
1597 Blank = Stay reported, no abstract form
received
218-219 Day of Discharge
5565 01-31 = Day of discharge
199 97 = Inapplicable (still at facility on
date of 1987 interview)
1597 Blank = Stay reported, no abstract form
received
220-221 Year of Discharge
5565 72-87 = Year of discharge (1972-1986)
199 97 = Inapplicable (still at facility on
date of 1987 interview)
1597 Blank = Stay reported, no abstract form
received
Tape
Position Frequencies Variable Description and Codes
222-225 Length of Record Stay
17 0000 = Died on day of admission
5548 0001-2564 = Total number of days in facility
199 9997 = Inapplicable (still at facility
on date of 1987 interview)
1597 Blank = Stay reported, no abstract form
received
Note: Length of stay is calculated by subtracting
the date of admission from the date of discharge.
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 facilities.
226 Was the Patient in Cardiac Intensive Care
Unit?
485 1 = Yes
4575 2 = No
333 7 = Inapplicable (facility is a nursing
home)
371 9 = Not ascertained
1597 Blank = Stay reported, no abstract form
received
227-229 Number of Days in Cardiac Intensive Care Unit
445 000-070 = Number of days
5279 997 = Inapplicable (position 226 = 2,7,9)
40 999 = Not ascertained
1597 Blank = Stay reported, no abstract form
received
Note: A length of stay of 0 days occurred when a
subject was admitted to the facility and died on
the day of admission.
230 Was the Patient In Other Intensive Care Unit?
381 1 = Yes
4359 2 = No
333 7 = Inapplicable (facility is a nursing
home)
691 9 = Not ascertained
1597 Blank = Stay reported, no abstract form
received
231-233 Number of Days in Other Intensive Care Unit
364 000-066 = Number of days
5383 997 = Inapplicable (Position 230 = 2,7,9)
17 999 = Not ascertained
1597 Blank = Stay reported, no abstract form
received
Note: A length of stay of 0 days occurred when a
subject was admitted to the facility and died on
the day of admission.
234 Patient Admitted to Nursing Home From:
113 1 = Private residence
160 2 = Acute care hospital
12 3 = Chronic disease hospital
46 4 = Other nursing home
5431 7 = Inapplicable (facility is a hospital)
2 9 = Not ascertained
1597 Blank = Stay reported, no abstract form
received
235 Disposition of Hospital Patient
4623 1 = Routine discharge/discharged home
27 2 = Left against medical advice
427 3 = Discharged/transferred to another
facility or organization
119 4 = Discharged/referred to organized home
care service
212 5 = Died
12 6 = Not discharged/still in hospital on
the date of 1987 interview
333 7 = Inapplicable (facility is a nursing
home)
11 9 = Subject discharged, disposition not
ascertained
1597 Blank = Stay reported, no abstract form
received
236 Disposition of Nursing Home Patient
187 1 = Not discharged/still in a nursing home on
date of 1987 interview
16 2 = Discharged to private residence/referral
to organized home care services
72 3 = Died
26 4 = Discharged to private residence/no
referral
32 5 = Transferred to another facility
5431 7 = Inapplicable (facility is a hospital)
1597 Blank = Stay reported, no abstract form received
237 Transferred to Another Health Care Facility
22 1 = Acute care hospital
6 2 = Other nursing home
3 3 = Chronic disease hospital
1 4 = Other
5732 7 = Inapplicable (Position 236 = 1,2,3,4 or 7)
1597 Blank = Stay reported, no abstract form received
Tape
Position Frequencies Variable Description and Codes
238-239 Number of Diagnoses
5763 01-22 = Number of diagnoses
1 99 = Not ascertained
1597 Blank = Stay reported, no abstract form received
Note: This variable identifies the total number
of diagnoses entered on the abstract. The number
of coded diagnoses may exceed the maximum number
allowed on the data tape (10).
240-245 Principal Diagnosis
5763 ICD-9-CM Code
1 999999= Not ascertained
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
246-250 Principal Diagnosis E Code
463 ICD-9-CM Code
6898 Blank = Stay reported, no abstract
form received or principal diagnosis
does not require E code
Note: See medical coding specifications.
251-256 Second Diagnosis
4577 ICD-9-CM Code
1187 999997 = Inapplicable (only one diagnosis coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
257-261 Second Diagnosis E Code
131 ICD-9-CM Code
1187 99997 = Inapplicable (only one diagnosis coded)
6043 Blank = Stay reported, no abstract form received
or second diagnosis does not require E code
Note: See medical coding specifications.
262-267 Third Diagnosis
3374 ICD-9-CM Code
2390 999997 = Inapplicable (less than three
diagnoses coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
268-272 Third Diagnosis E Code
88 ICD-9-CM Code
2390 99997 = Inapplicable (less than three
diagnoses coded)
4883 Blank = Stay reported, no abstract form
received or third diagnosis does not require
E code
Note: See medical coding specifications.
273-278 Fourth Diagnosis
2333 ICD-9-CM Code
3431 999997 = Inapplicable (less than four
diagnoses coded)
1597 Blank = Stay reported, no abstract form
received
Note: See medical coding specifications.
279-283 Fourth Diagnosis E Code
70 ICD-9-CM Code
3431 99997 = Inapplicable (less than four
diagnoses coded)
3860 Blank = Stay reported, no abstract form
received or fourth diagnosis does not
require E code
Note: See medical coding specifications.
284-289 Fifth Diagnosis
1526 ICD-9-CM Code
4238 999997 = Inapplicable (less than five
diagnoses coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
290-294 Fifth Diagnosis E Code
28 ICD-9-CM Code
4238 99997 = Inapplicable (less than five
diagnoses coded)
3095 Blank = Stay reported, no abstract form
received or fifth diagnosis does not require E code
Note: See medical coding specifications.
295-300 Sixth Diagnosis
965 ICD-9-CM Code
4799 999997 = Inapplicable (less than six
diagnoses coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
301-305 Sixth Diagnosis E Code
29 ICD-9-CM Code
4799 99997 = Inapplicable (less than six
diagnoses coded)
2533 Blank = Stay reported, no abstract form
received or sixth diagnosis does not require
E code
Note: See medical coding specifications.
306-311 Seventh Diagnosis
597 ICD-9-CM Code
5167 999997 = Inapplicable (less than seven
diagnoses coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
312-316 Seventh Diagnosis E Code
17 ICD-9-CM Code
5167 99997 = Inapplicable (less than seven
diagnoses coded)
2177 Blank = Stay reported, no abstract form
received or seventh diagnosis does not require
E code
Note: See medical coding specifications.
317-322 Eighth Diagnosis
376 ICD-9-CM Code
5388 999997 = Inapplicable (less than eight
diagnoses coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
323-327 Eighth Diagnosis E Code
6 ICD-9-CM Code
5388 99997 = Inapplicable (less than eight
diagnoses coded)
1967 Blank = Stay reported, no abstract form
received or eighth diagnosis does not require
E code
Note: See medical coding specifications.
328-333 Ninth Diagnosis
238 ICD-9-CM Code
5526 999997 = Inapplicable (less than
nine diagnoses coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
334-338 Ninth Diagnosis E Code
7 ICD-9-CM Code
5526 99997 = Inapplicable (less than nine
diagnoses coded)
1828 Blank = Stay reported, no abstract form
received or ninth diagnosis does not require
E code
Note: See medical coding specifications
339-344 Tenth Diagnosis
161 ICD-9-CM Code
5603 999997 = Inapplicable (less than ten
diagnoses coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
345-349 Tenth Diagnosis E Code
8 ICD-9-CM Code
5603 99997 = Inapplicable (less than ten
diagnoses coded)
1750 Blank = Stay reported, no abstract form
received or tenth diagnosis does not require
E code
Note: See medical coding specifications.
Tape
Position Frequencies Variable Description and Codes
350-351 Number of Procedures
5431 00-08 = Number of procedures
333 97 = Inapplicable (facility is a nursing
home)
1597 Blank = Stay reported, no abstract form received
Note: This variable identifies the total number
of procedures coded on the facility abstract. The
number of reported procedures from a hospital may
exceed the maximum number of five coded on this
data tape.
352-355 First Procedure
2239 ICD-9-CM Code
3525 9997 = Inapplicable (facility is a nursing
home or no procedures coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
356-359 Second Procedure
950 ICD-9-CM Code
4814 9997 = Inapplicable (facility is a nursing
home or only one procedure coded)
1597 Blank = Stay reported, no abstract form
received
Note: See medical coding specifications.
360-363 Third Procedure
354 ICD-9-CM Code
5410 9997 = Inapplicable (facility is a nursing home
or less than three procedures coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
364-367 Fourth Procedure
119 ICD-9-CM Code
5645 9997 = Inapplicable (facility is a nursing home
or less than four procedures coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
368-371 Fifth Procedure
31 ICD-9-CM Code
5733 9997 = Inapplicable (facility is a nursing
home or less than five procedures
coded)
1597 Blank = Stay reported, no abstract form received
Note: See medical coding specifications.
(372-373) Presence of Documents
372 Pathology Report
190 1 = Required and present
76 2 = Required and not present
5165 6 = Not required
333 7 = Inapplicable (facility is a nursing home)
1597 Blank = Stay reported, no abstract form received
373 Third Day EKG Report
142 1 = Required and present
40 2 = Required and not present
5249 6 = Not required
333 7 = Inapplcable (facility is a nursing home)
1597 Blank = Stay reported, no abstract form received
374-379 7361 Blank
Tape
Position Frequencies Variable Description and Codes
(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 occurred
during the nursing home stay. Up to 10 related
stays can be listed.
In the case of hospital records, this set of
variables identifies the nursing home stay within
which the hospital stay occurred. Only one
related stay is identified for hospital records.
The Related Stay is identified by its Health Care
Facility Stay ID Number (positions 29-33) of the
record for that stay.
An example of the usage of the related stay section is
found in the introduction to this codebook.
(380-429) ID Number(s) of Related Stay(s)
(380-384) ID of First Related Stay
380 Survey Period Identifier
238 3 = NHEFS 1987
7123 Blank = No related stays
381-382 Facility Number
238 01-10 = Hospital/nursing home number
7123 Blank = No related stays
383-384 Stay Number Within Facility
238 01-09 = Stay number
7123 Blank = No related stays
(385-389) ID of Second Related Stay
385 Survey Period Identifier
34 3 = NHEFS 1987
7327 Blank = No second related stay
386-387 Facility Number
34 01-04 = Hospital/nursing home number
7327 Blank = No second related stay
388-389 Stay Number Within Facility
34 01-11 = Stay number
7327 Blank = No second related stay
(390-394) ID of Third Related Stay
390 Survey Period Identifier
19 3 = NHEFS 1987
7342 Blank = No third related stay
391-392 Facility Number
19 01-04 = Hospital/nursing home number
7342 Blank = No third related stay
393-394 Stay Number Within Facility
19 01-12 = Stay number
7342 Blank = No third related stay
(395-399) ID of Fourth Related Stay
395 Survey Period Identifier
8 3 = NHEFS 1987
7353 Blank = No fourth related stay
396-397 Facility Number
8 01-04 = Hospital/nursing home number
7353 Blank = No fourth related stay
398-399 Stay Number Within Facility
8 02-06 = Stay number
7353 Blank = No fourth related stay
(400-404) ID of Fifth Related Stay
400 Survey Period Identifier
4 3 = NHEFS 1987
7357 Blank = No fifth related stay
401-402 Facility Number
4 02-03 = Hospital/nursing home number
7357 Blank = No fifth related stay
403-404 Stay Number Within Facility
4 01-03 = Stay number
7357 Blank = No fifth related stay
(405-409) ID of Sixth Related Stay
405 Survey Period Identifier
2 3 = NHEFS 1987
7359 Blank = No sixth related stay
406-407 Facility Number
2 02-03 = Hospital/nursing home number
7359 Blank = No sixth related stay
408-409 Stay Number Within Facility
2 02-04 = Stay number
7359 Blank = No sixth related stay
(410-414) ID of Seventh Related Stay
410 Survey Period Identifier
1 3 = NHEFS 1987
7360 Blank = No seventh related stay
411-412 Facility Number
1 03 = Hospital/nursing home number
7360 Blank = No seventh related stay
413-414 Stay Number Within Facility
1 05 = Stay number
7360 Blank = No seventh related stay
(415-419) ID of Eighth Related Stay
415 Survey Period Identifier
7361 Blank = No eighth related stay
416-417 Facility Number
7361 Blank = No eighth related stay
418-419 Stay Number Within Facility
7361 Blank = No eighth related stay
(420-424) ID of Ninth Related Stay
420 Survey Period Identifier
7361 Blank = No ninth related stay
421-422 Facility Number
7361 Blank = No ninth related stay
423-424 Stay Number Within Facility
7361 Blank = No ninth related stay
(425-429) ID of Tenth Related Stay
425 Survey Period Identifier
7361 Blank = No tenth related stay
426-427 Facility Number
7361 Blank = No tenth related stay
428-429 Stay Number Within Facility
7361 Blank = No tenth related stay
APPENDIX A 1987
RECORD STATUS CODES
Code Frequency Description
ANO - 57 "Authorization Not Obtained." This code indicates that
the subject or proxy refused to sign the Medical
Authorization Form (MAF). These stays are not requested
from the reported facilities.
ASF - 1446 "Additional Stay Found." This code was assigned when a
received stay could not be matched to a reported stay
and the received stay is in-scope. This code was also
assigned to in-scope stays 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.
CRM - 183 "Cross-Referenced Match." This code indicates a stay
that was begun prior to the NHEFS 1987 survey period &
continues into the 1986 survey period. For this type of
stay, the abstract is brought forward from the previous
wave. The discharge date and discharge status information
are the only positions that are updated. The admission
date is prior to the most recent interview because this
is a continuing stay. Thus, it appears but is not out-
of-scope for 1987.
CRX - 21 "Cross-Referenced Non-Match." A code assigned by NCHS
staff to close out a stay that was begun in a previous
wave and was reported to have continued into the 1987
Survey period, yet no in-scope stay was received for
the 1987 survey period.
FNC - 110 "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 located;
and facility located outside the United States.
MAT - 4135 "Record Match." This code was assigned when a received
stay matches a reported stay. This code was assigned to
in-scope & type C (position 199) reports, but never to
type D reports. In-scope stays that were received as the
result of a type D report were assigned an ASF code. See
ASF.
ONR - 101 "Other Non-Response." This code is assigned to a stay
when no response for the stay request has been received
from the facility by the end of the study period.
REF - 158 "Refused." This code is assigned after a facility
refuses to send back the stay record requested. It is
record, not subject specific. For example, a facility
may send some records for a subject but refused to send
others.
XNH - 367 "Subject Never at Facility." This code is used when the
facility indicates that the patient was never admitted to
that facility.
XNS - 755 "Other - No Stay Found." This code is assigned when a
facility responds it is unable to send records because
an in-scope stay was not found at this facility, or when
the facility returns the request form without records and
provides no explanation for the failure to provide records.
XRD - 28 "Record Destroyed or No Longer Available." This code is
assigned if the facility attempts to locate the record
and states it no longer exists, i.e., destroyed, lost.
NOTE: Additional information concerning the assignment of the record
status codes is found in the introduction to this codebook.
APPENDIX B 1987
Numeric Codes
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
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
15 Surgery
16 Don't know
17 Not ascertained
18 Tests/observation/x-rays/physical exam
19 Digestive/endocrine condition
20 Respiratory condition (including influenza and pneumonia)
21 Infection
22 Kidney/bladder/urinary condition
23 Debility/pain
24 Male reproductive condition
25 Musculoskeletal problem or injury other than a fracture
26 Circulatory condition
27 Female reproductive condition
28 Mental illness
29 Neurologic condition
30 Nutritional condition or dehydration
31 Bleeding or blood disorder
32 Skin condition
33 Condition not elsewhere coded
34 Admission to a facility other than an acute care hospital
35 In a facility at time of death
36 Cataracts
3603 Eye problem other than cataracts, detached retina or glaucoma
37 A fall
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 the
respondent's own words if possible or a summary of the respondent's
description which was edited to fit into the 30 positions. 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 codes "07" and "14" are not included in the coding structure for
the 1987 file. These codes had been assigned to conditions in the 1982-84
and 1986 followups. The 1987 followup questionnaire differs from the
previous two versions and sufficient information was not collected to
assign these codes.
Reported conditions and their associated codes can be divided into six
types depending on where in the interview the stay was reported and the
amount of information obtained: specific conditions included in Section B
of the interview (Type A); conditions which are well-defined but for which
no question exists in Section B of the interview (Type B); unknown
conditions (Type C); conditions about which there is no specific question
in Section B 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
Type A - Conditions about which the respondent was asked in section B of
the interview. For example, if a respondent answered "yes" to question
B-17 ("Were you hospitalized for your arthritis?"), then a condition code
of "01" and a text field containing "arthritis" would be included on the
facility stay record. Type A conditions are:
01 Arthritis (B-17)
02 Gout (B-17)
03 Heart attack (B-23)
04 Other heart conditions (B-24)
05 Coronary bypass surgery (B-27)
06 Procedures for pacemakers (B-29)
08 Stroke (B-35)
09 Diabetes (B-42)
10 High blood pressure (B-48)
11 Cancer (B-52)
12 Fractured hip (B-61)
20 Pneumonia, bronchitis and influenza (B-71)
Note: this code is also found under Type D because other
respiratory conditions are also coded to category 20
22 Kidney, bladder or urinary problem (B-74)
34 Care in non-acute care facility (B-86)
35 In a facility at death (B-93)
36 Cataracts (B-79)
37 A fall (B-70)
Complete agreement between responses to the questions in section B 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 HCFS 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 definitions of out-of-scope stays.)
Second, data may be inconsistent between the interview and the HCFS file
if the respondent remembered and reported a condition after responding to
the corresponding question in Section B of the interview. This tended to
occur at the time the interviewer was recording information on the HHCF
chart. For example, 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 B-24 and the
Section B information may not have been updated to reflect this additional
condition. However, heart condition would appear on the HCFS file.
Type B
Type B - Conditions which do not have a corresponding question in Section
B of the interview but for which sufficient descriptive information is
available to allow them to be easily coded:
13 Bone fracture
18 Tests and observation
Type C
Type C - Unknown conditions:
16 Don't know
17 Not ascertained
Type D
Type D - Conditions for which there is not a specific question in Section
B of the interview but which can be attributed to disorders of a major
body system:
19 The digestive/endocrine system
20 The respiratory system
Note: this code is also found under Type A because the specific
question about pneumonia, bronchitis and influenza (B-71) is
coded to the general category
24 The male reproductive system
25 The musculoskeletal system
26 The circulatory system (except strokes)
27 The female reproductive system
29 Neurologic disorders
31 Blood disorder/bleeding
32 Skin problem
3603 Eye problem (except cataracts, detached retina or glaucoma)
Type E
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
28 Mental illness
30 Nutrition and dehydration
Type F
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 abstrat. 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 priority
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 Section B of the 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 Section B or to the unknown
category, the appropriate Type B or Type C code was assigned.
Rule 3: Conditions that could 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
coder, again with emphasis on as much specificity as possible.
For example, "HEADACHES, BRAIN TUMOR" would be coded to "29 -
Neurologic disorders", not to "23 - 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
condition 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 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 assigned 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 1982-94 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 response to the surgery question in the 1986 followup and be
assigned the code of 15. If the biopsy was reported in response to
question B-83 on the 1987 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.