National Hospital Ambulatory Medical Care Survey
OMB 0920-0278 (exp. 08/31/2009)
Change Request
Addition of Pandemic and Emergency Response Preparedness Questions to the
2008 National Hospital Ambulatory Medical Care Survey
Contact:
Catharine Burt, Ed.D.
Chief, Ambulatory Care Statistics Branch
NCHS
(301) 458-4126
August 9, 2007
Title: Addition of Pandemic and Emergency Response Preparedness Questions to the 2008 National Hospital Ambulatory Medical Care Survey
A. Justification
1. Circumstances of Making the Collection of Information Necessary
If approval is received, pandemic and emergency response preparedness questions will be added to the 2008 National Hospital Ambulatory Medical Care Survey (NHAMCS) at the request of the Office of the Assistant Secretary for Planning and Evaluation (OASPE) of the Department of Health and Human Services (DHHS). A self-administered questionnaire will be completed for each sample hospital by the person responsible for the hospital’s emergency response plan. Information will be obtained on the content of the hospital’s emergency response plan, staff training, participation in mass casualty drills, and the hospital’s resources and capabilities. The pandemic and emergency response preparedness questions were adapted from the previously approved “Bioterrorism and Mass Casualty Preparedness Supplement” (NHAMCS-905) that was fielded in 2003 and 2004. Proposed questions are delineated in Section B2. The current NHAMCS is approved as OMB number 0920-0278 (expires August 31, 2009).
2. Purpose and Use of Information Collection
In 2003 and 2004, with OASPE funding, the National Center for Health Statistics (NCHS) fielded Bioterrorism and Mass Casualty Preparedness Supplements to the NHAMCS that evaluated various dimensions of hospital emergency preparedness, including the training of clinicians for smallpox, anthrax and several other weaponizable biological agents, as well as chemical and radiological exposures. The supplement also evaluated the level of planning and implementation in several other areas, the level of collaboration with outside organizations, and quantified the resources available to hospitals such as mechanical ventilators and negative pressure isolation rooms. The results of the survey showed in general that while hospitals were prepared in most of these areas, much work remained to be done as Federal funding for hospital preparedness became more available. Details of the 2003 survey results are available at http://www.cdc.gov/nchs/data/ad/ad364.pdf. Combined data from 2003 and 2004 are available at http://www.cdc.gov/nchs/data/ad/ad380.pdf.
This new agreement with OASPE involves revising and updating the previously approved NHAMCS Bioterrorism and Mass Casualty Preparedness Supplements. Certain elements (such as the existence of updated emergency response plans) will remain the same in order to be able to establish trends over time. Other elements will be revised to answer questions generated by the previous surveys and newer public health priorities. Examples include adding specificity on some resources such as decontamination showers, to include numbers of patients able to be accommodated, and including questions about evacuation plans and the set-up of temporary facilities should the hospital not be able to operate. The elements will assess progress towards hospital preparedness for dealing with bioterrorism and mass casualty incidents, and in so doing evaluate the ability of hospitals to deal with naturally occurring diseases, epidemics and pandemics, such as SARS or influenza.
This project supports the DHHS goal to prepare for emerging health threats. The project will also provide nationally representative benchmarks that could serve as one quality control mechanism for other projects that are designed to detect emerging health threats within a shorter time period.
The DHHS requested that data be collected on the state of preparedness of the nation’s hospitals to respond to a terrorist attack, so that the Department may identify policy strategies for addressing this issue.
4. Efforts to Identify Duplication and Use of Similar Information
The NHAMCS-905 Bioterrorism and Mass Casualty Preparedness Supplement was conducted in 2003 and 2004. The literature review from subsequent publications coming out of that data revealed no other nationally representative surveys of this type. The proposed pandemic and emergency response preparedness questions will follow up on some of the old questions, in addition to asking new questions. Thus, it is not duplication but an update on hospital preparedness.
6. Consequences of Collecting the Information Less Frequently
This information from the pandemic and emergency response preparedness questions will only be collected during the 2008 panel of the NHAMCS.
8. Comments in Response to Efforts to Consult Outside the Agency
The following people commented on the contents of the new questionnaire:
CDR Brad Austin, MPH, USPHS
Former Project Officer, National Bioterrorism Hospital Preparedness Program
Office of the Secretary, DHHS, 200 Independence Avenue SW, Washington, D.C. 20201
(202) 401-2267
Douglas A. Boenning, M.D.
Associate Medical Director, Emergency Medicine and Trauma Center
Children's National Medical Center, Washington, D.C.
Medical Advisor, Office of Science and Data Policy, OASPE, DHHS
200 Independence Avenue SW, Washington, D.C. 20201
Phone: (202) 260-0287
Email: Douglas.Boenning@HHS.GOV
Leon L. Haley, Jr., MD, MHSA, CPE
Chief of Emergency Medicine, Grady Health System
Associate Professor, Department of Emergency Medicine, Emory University
80 Jesse Hill Jr. Drive, SE, Atlanta, Georgia 30303
Phone : (404) 616-6419
E-mail : LHaley@emory.edu
John L. Hick, MD
Department of Emergency Medicine, Hennepin County Medical Center
701 Park Avenue South, MC825, Minneapolis, MN 55415
E-mail: John.Hick@co.hennepin.mn.us
Dale Hitchcock
Director, Division of Data Policy, Office of Science and Data Policy
Office of the Assistant Secretary for Planning and Evaluation, DHHS
200 Independence Avenue SW, Washington, D.C. 20201
Phone: (202) 690-7100
E-mail: Dale.Hitchcock@HHS.GOV
Michael J. Hopmeier
President, Unconventional Concepts, Inc.
311 North Fairfax, Suite 720, Arlington, Virginia 22203
Phone : (703) 797-4562
E-mail : hopmeier@gnt.net
Kathi C. Huddleston, RN, MSN
Doctoral Student, College of Nursing and Health Science, George Mason University
9507 Claychin Court, Burke, Virginia 22015
E-mail: KathiHuddleston@cox.net
Arthur J. Kellermann, MD, MPH
Health Policy Fellow, Majority Staff
Committee on Oversight and Government Reform
Phone : (202) 226-2803
E-mail : Art.Kellermann@mail.house.gov
Ann Knebel
Deputy Director, Office of the Secretary, DHHS
200 Independence Avenue SW, Washington, D.C. 20201
Phone: (202) 205-5129
E-mail: Ann.Knebel@hhs.gov
Arnauld Nicogossian, MD, FACPM, FACP
Director, Office of International Medical Policy, George Mason University
4400 University Drive, MS 3C6, Fairfax, VA 22030
Phone: (703) 993-8217
CDR Melissa Sanders, USPHS
Team Leader, Hospital Preparedness Program
Office of the Assistant Secretary for Preparedness and Response, DHHS
330 C Street SW, Room 5616, Washington, D.C. 20201
(202) 205-2865
Deputy Assistant Secretary for Planning and Evaluation, OASPE, DHHS
200 Independence Avenue SW, Washington, D.C. 20201
Phone: 202-690-5874
Email: Jim.Scanlon@HHS.GOV
11. Justification for Sensitive Questions
There are no questions of a sensitive nature.
12. Estimates of Annualized Burden Hours and Cost
Table A. Annual Burden
The respondents are those facilities currently in the sample. The currently approved annual burden is 7,313 hours. The addition of 190 hours to complete the pandemic and emergency response preparedness questions will result in the same burden as is currently approved because OPD response rates have decreased since the last submission.
Type of Respondent |
Form Name |
No. of Respondents |
No. of Responses per Respondent |
Average Burden per Response (in hours) |
Total Response Burden
(in hours) |
Ancillary Service Executive |
Hospital induction (NHAMCS-101) -pandemic and emergency response preparedness questions |
455 |
1 |
25/60 |
190 |
Hospital Chief Medical Officer |
Hospital Induction (NHAMCS-101) Ineligible Eligible |
50 420 |
1 1 |
15/60 1 |
13 420 |
Ancillary Service Executive |
Ambulatory Unit Induction (ED) (NHAMCS-101/U) |
400 |
1 |
1 |
400 |
Ancillary Service Executive |
Ambulatory Unit Induction (OPD) (NHAMCS-101/U) |
239 |
4 |
1 |
956 |
Physician/ Registered Nurse/Medical Record Clerk |
ED Patient Record form [NHAMCS-100 (ED)] |
220 |
100 |
6/60 |
2,200 |
Medical Record Clerk |
Pulling and re-filing ED Patient Record |
180 |
100 |
1/60 |
300 |
Physician/ Registered Nurse/Medical Record Clerk |
OPD Patient Record form [NHAMCS-100 (OPD)] |
125 |
190 |
6/60 |
2,375 |
Medical Record Clerk |
Pulling and re-filing OPD Patient Record |
125 |
190 |
1/60 |
396 |
Physician |
Cervical Cancer Screening Supplement (CCSS) (NHAMCS-906) |
200 |
1 |
15/60 |
50 |
Physician Assistant/Nurse Practitioner/ Nurse Midwife |
Cervical Cancer Screening Supplement (CCSS) (NHAMCS-906) |
50 |
1 |
15/60 |
13 |
TOTAL |
7,313 |
||||
It is estimated that 400 hospitals will have an eligible ED and will complete the required induction form for the ED (NHAMCS-101/U). The average number of Patient Record forms (PRFs) completed by the hospital per ED will be 100 (see NHAMCS-100(ED)). Approximately 220 of the 400 hospitals will complete the PRFs without assistance from a Census Bureau representative. Burden to hospital staff who complete the NHAMCS-100(ED) is estimated to be 6 minutes per form. However, in approximately 180 hospitals, the NHAMCS-100(ED) form will be completed by a Census Bureau representative. In these cases, the only burden to hospital staff is the burden associated with pulling and re-filing the patient record, which is estimated to be one minute per form. Table A.12-A does not include the Census Bureau representative’s effort for completing NHAMCS-100(ED) forms.
It is estimated that 239 hospitals will have eligible OPDs. Each clinic within the OPD completes a separate induction form; the average number of clinics per OPD is four (see NHAMCS-101/U). The average number of Patient Record forms (PRFs) completed by the hospital per OPD will be 190 (see NHAMCS-100(OPD)). Approximately half of the hospitals (125 out of the 250) will complete the PRF without assistance from a Census Bureau representative. Burden to hospital staff who complete the NHAMCS-100(OPD) is estimated to be 6 minutes per form. For the remaining 125 hospitals, the NHAMCS-100(OPD) form will be completed by a Census Bureau representative, and the only burden to hospital staff is the burden associated with pulling and re-filing the patient record, which is estimated to be one minute per form. Table A.12-A does not include the Census Bureau representative’s effort for completing NHAMCS-100(OPD) forms. The CCSS forms are also completed in the OPD.
The total number of annual responses (90,031) was calculated by multiplying the number of respondents by the number of responses per respondent, then adding those values. The hour burden estimates were based on previous years’ experience in administering the survey.
Table B. Annual Cost to Respondents
The hourly wage estimate for the pandemic and emergency response preparedness questions for hospital ancillary service executives was based on the 2005 Hay Group’s Hospital Compensation Survey. The average annual response burden cost for the NHAMCS is estimated to be $292,608 for each survey year (i.e., 2007 and 2008). The hourly wage estimate for the Hospital Induction interview and the Patient Record form for hospital executives was based on the 2005 Hay Group’s Hospital Compensation Survey, for other hospital employees it was based on information from the mean hourly rate for physicians (general medicine/obstetricians/gynecologists/internists), physician assistants/nurse practitioners, registered nurses, and medical secretaries for 2004 published by the Bureau of Labor Statistics. The average annual hourly wage was determined by assuming that 10% of the Patient Record forms will be completed by physicians, 30% by nurses, and 60% by clerks. The following table shows how the respondent cost was calculated:
A. 12-B. Annualized Cost to Respondents:
Type of Respondent |
Form
|
Response burden hours |
Hourly wage rate |
Respondent cost |
Ancillary Service Executive |
Hospital Induction (NHAMCS-101) - pandemic and emergency response preparedness questions |
190 |
$54.00 |
$10,260 |
Hospital Chief Medical Officer |
Hospital Induction (NHAMCS-101) - Ineligible Eligible |
13 420 |
$125.00 $125.00 |
$ 1,625 $ 52,500 |
Ancillary Service Executive |
Ambulatory Unit Induction -ED (NHAMCS-101/U) |
400 |
$61.00 |
$ 24,400 |
Ancillary Service Executive |
Ambulatory Unit Induction - OPD (NHAMCS-101/U) |
1,000 |
$61.00 |
$ 61,000 |
Physician/ Registered Nurse/Medical Record Clerk |
Emergency Dept. Patient Record (NHAMCS-100) |
2,200 |
$28.24 |
$ 62,128 |
Medical Record Clerk |
Emergency Dept. Patient Record (NHAMCS-100) |
300 |
$16.31 |
$ 4,893 |
Physician/ Registered Nurse/Medical Record Clerk |
Outpatient Dept. Patient Record (NHAMCS-100) |
2,500 |
$28.24 |
$ 70,600 |
Medical Record Clerk |
Outpatient Dept. Patient Record (NHAMCS-100) |
417 |
$16.31 |
$ 6,801 |
Physician |
Cervical Cancer Screening Supplement (CCSS)(NHAMCS-906) |
50 |
$89.00 |
$ 4,450 |
Physician Assistant/Nurse Practitioner/ Nurse Midwife |
Cervical Cancer Screening Supplement (CCSS) (NHAMCS-906) |
13 |
$39.00 |
$ 507 |
|
TOTAL |
|
|
$292,608 |
14. Annualized Cost to the Government
The estimate of average annual cost for the NHAMCS pandemic and emergency response preparedness questions is as follows:
$ 50,250 Survey support
$ 2,819 Overhead
$281,931 Interagency Agreement – Data Collection, Keying, and Printing (Census Bureau)
$335,000 Total
15. Explanation for Program Changes or Adjustments
The current approved burden is 7,313 hours. The new pandemic and emergency response preparedness questions will add 190 hours; however, 190 hours were subtracted due to a decrease in the OPD response rate. The total of 7,313 hours is the same as the currently approved burden.
16. Plans for Tabulation and Publication and Project Time Schedule
The duration of the 2008 pandemic and emergency response preparedness questions will be 20 months. The timetable for key activities for the 2008 survey is as follows:
01/2008 Begin data collection
12/2008 End data collection
02/2009 Close out field work
05/2009 End data processing
09/2009 End weighting and begin data analysis
12/2009 Provide report of full year of data to DHHS
B. Collection of Information Employing Statistical Methods
1. Respondent Universe and Sampling Methods
The target sample for the 2008 NHAMCS and the pandemic and emergency response preparedness questions pandemic questionnaire consists of 556 hospitals. We estimate that about 445 hospitals will be both eligible and willing to participate.
2. Procedures for Collection of Information
Training on the pandemic and emergency response preparedness questions will be provided to Census Bureau field representatives (FRs). In addition, information on the purpose and background of the questions as well as specific instructions will be in the FR manual.
During the administration of the NHAMCS-101 hospital induction questionnaire which is conducted with the hospital administrator, the FR will obtain the name and telephone number of the person responsible for the hospital’s emergency response plan. The FR will then contact this person, explain the purpose of the questions, and schedule an appointment to deliver the form. Census Bureau Headquarters staff, Demographic Surveys Division, Housing Surveys Branch, is responsible for overseeing the data collection. Census Bureau Headquarters staff, Field Division, is responsible for the supervision of staff in the Bureau’s 12 Regional Offices who in turn supervise the FRs.
Proposed Questions
The following 2008 pandemic and emergency response preparedness questions are proposed to track trends in hospital preparedness from the baselines established in the 2003 and 2004 Bioterrorism and Mass Casualty Preparedness Supplements. Modifications are based on experience with the data from these prior surveys, and on an effort to provide unique data not being asked in other surveys being fielded.
Does your emergency response plan specifically address each of these types of incidents?
Epidemics/pandemics
Biological accidents or attacks
Chemical accidents or attacks
Nuclear/radiological accidents or attacks
Explosive accidents or attacks
Natural disasters
Does your emergency response plan specifically address these special populations?
Pediatric
Elderly
Medically fragile
Deaf
Blind
Since September 11, 2001, with which of the following entities has your hospital engaged in cooperative planning in developing or updating an emergency response plan for public health emergencies (e.g. terrorism, mass casualties, epidemics, disasters)?
Other hospitals
Emergency medical services (EMS)
Fire department
Hazardous materials (HAZMAT) teams
State or local law enforcement
Federal Bureau of Investigation (FBI)
State or local public health department
State or local office of emergency management
With which of the following actions has your hospital implemented during a hospital overcrowding incident or a public health emergency (e.g. disasters, mass casualties, disease outbreaks, terrorism)? (Choices will include yes, no, and not in emergency response plan.)
Collaboration with outside entities
A memorandum of understanding (MOU) with one or more other hospitals to accept adult patients in transfer from the emergency department when no beds are available at your hospital
MOU with one or more children’s hospitals to accept pediatric patients in transfer from the emergency department when no beds are available at your hospital
MOU with a regional burn center to accept patients in transfer in the aftermath of an explosive or incendiary mass casualty incident
Regional communication systems to track:
emergency department closures or diversions
available intensive care unit beds
available hospital beds
specialty coverage
Mutual aid agreements with other agencies to share supplies and equipment
Expansion of on-site surge capacity
Cancellation of elective procedures and admissions
Expansion of isolation capacity for airborne diseases (e.g. cohorting in designated units with negative airflow)
Conversion of inpatient units to augment ICU capacity (e.g. post-anesthesia care unit, same-day surgery)
Establishment of alternate care areas on site (with beds, staffing and equipment)
inpatient unit hallways
decommissioned ward space
non-clinical space (e.g. offices, storage areas, conference rooms)
Setting up temporary facilities when the hospital is unusable (without power or flooded, etc.)
Agreements with other outpatient facilities to augment outpatient services during a public health emergency
Priority setting for limited resources
Methods to deliver potassium iodide in response to radioactive release
Regional multi-hospital coordination of standards of care during a pandemic or other mass casualty incident
Process to be followed when adjusted standards of care are necessary for use and withdrawal of mechanical ventilation
Triage processes for other limited intensive care resources
Expanding on-site health care work force
Staff absenteeism from personal or family repercussions from the emergency
Advance registration of volunteer health professionals
Mutual aid agreements with other agencies to share health care providers
Continuity of operations
Mass casualty management
Fatality management
Establishing an on-site large capacity morgue during a mass casualty incident
Hospital evacuations
Pediatric
Guidelines on increasing pediatric surge capacity
Protocol to identify and protect displaced children rapidly
Tracking system for accompanied and unaccompanied children
Reunification of children with families
Special populations
Mechanisms to minimize communication difficulties in dealing with handicapped or vulnerable populations
Sheltering of pregnant women
Sheltering of patients with special health care needs
Communications
Notification of alerts from your state/local health department
Participation with local public health in public influenza education, vaccination or awareness campaigns
In how many mass casualty drills, simulations or exercises has your hospital participated in the last year?
Internal drills
Full scale simulation
How many victims?
How long did the drill last?
Table-top exercises
Drills in collaboration with other organizations (e.g. law enforcement, health department, emergency management, fire department, emergency medical services, hazardous materials teams, decontamination teams)
Full scale simulation
How many victims?
How long did the drill last?
Table-top exercises
What scenarios did the drills, simulations or exercises address?
General disaster and emergency response
Biologic accidents or attacks
Severe epidemic or pandemic
Mass vaccinations
Mass medication distribution to hospital personnel
Mass medication distribution to community
Chemical accidents or attacks
Nuclear or radiological accidents or attacks
Decontamination procedures
Explosive or incendiary accidents or attacks
With which organizations were the drills or exercises performed? (Choices will be yes, no, not present in community)
State or local law enforcement
State or local public health department
State or local office of emergency management
Fire department
Emergency medical services (EMS) – fire department based
Emergency medical services – not based in fire department
Hazardous materials (HAZMAT) teams
Decontamination teams
School systems
Day care organizations
Long-term care facilities
Industrial or commercial organizations
What resources and capabilities does your hospital have available in-house in the event of a mass casualty incident (total numbers)?
Mechanical ventilators
N95 masks to supply all patient care providers for at least one week
Personal protective suits with powered air-purifying respirators (PAPR)
Emergency department treatment spaces
Critical care beds (e.g. intensive care, pediatric intensive care, coronary care, post-anesthesia care)
Negative pressure isolation rooms
Regular inpatient staffed beds
Decontamination showers
How many ambulatory patients can be handled per hour?
How many stretcher patients can the shower handle per hour?
Designated cache of antibiotics for hospital employees
What is the total number of hours that your hospital’s emergency department was on ambulance diversion in 2007?
What is the total number of hours that your hospital was on trauma diversion in 2007?
What is the total number of hours that your hospital was on diversion for critical care cases in 2007?
Title of person completing the questions
3. Test of Procedures or Methods to Be Undertaken
A pilot test of the earlier supplement was conducted by the Census Bureau in October 2002 in three hospitals in each of three Regional Offices. All of the respondents were cooperative. Some provided suggestions for improving the form and minor revisions were made. This survey was fielded in 2003 and 2004, with no major issues related to questionnaire design. The current survey has minor modifications that are not anticipated to lead to major procedural problems.
4. Individuals Consulted on Statistical Aspects and Individuals Collecting and/or Analyzing the Data
Statistical and methodological consultation was provided by:
Catharine W. Burt, EdD
Chief, Ambulatory Care Statistics Branch, NCHS, CDC
3311 Toledo Road, Hyattsville, MD 20782
Phone: (301) 458-4126
E-mail: CBurt@cdc.gov
The data will be analyzed under the direction of:
Richard W. Niska, MD, MPH
Senior Medical Epidemiologist
Ambulatory Care Statistics Branch/Division of Health Care Statistics
National Center for Health Statistics, CDC
Phone: (301) 458-4340
E-mail: RNiska@cdc.gov
| File Type | application/msword |
| File Title | National Hospital Ambulatory Medical Care Survey |
| Author | rdn4 |
| Last Modified By | ziy6 |
| File Modified | 2007-08-16 |
| File Created | 2007-08-16 |