Joan F. Van Nostrand, National Center for Health Statistics
I will try to describe to you why this talk is called "in the Pipeline" and what it means. This presentation could have been called "A Preview of Coming Attractions."
It is a focus on data bases relevant to long term care that are being planned, collected or computerized, but not yet released.
It is an attempt to whet your data appetite and to alert you to the schedule for release, so that you can build the data into your long range analysis plans.
I have a broad definition of data bases. I am including data tapes, reports, and conferences. I have organized this preview according to schedule. I will begin with what is coming out first.
The first data base has just been released. It is a data tape for the Study of Secular Change and Aging. It is a concatenation of data tapes from the National Health Interview Survey (NHIS) covering the years 1969-1981. The tape includes the core data items from NHIS for any person who was age 30+ for each of those years, in a standard format. One of the strong points of it is that it can be used to examine changes over time. It is currently available from the National Center for Health Statistics (NCHS) or from the National Archive of Computerized Data on Aging in Michigan.
The second data base in the pipeline is a report that provides detailed data on the health of older persons. This report focuses on all the surveys of NCHS. It provides data in great age detail, often up to the category age 85+. It is an excellent reference report. If you have a question on activities of daily living (ADL's), intermediate activities of daily living (IADL's) or cognitive impairments, you can flip to the correct page and get basic data on a nationally representative population. It also has a special appendix that describes in detail the content of many NCHS data sets. This is useful because an analyst can pinpoint some of the data sets and data items that might be useful in an analysis. The report will be released in the middle of July. It is called Health Statistics on Older Persons, 1986. If you want a copy, you can come to the next item on my list, the Public Health Conference on Records and Statistics.
This year the topic of the conference is data on aging. It will address issues in health, in research and in public policy for now and into the 21st century. There are some sessions in this conference that focus on long term care.
It is a 3 day conference, from July 13-15 in Washington, D.C., and is open free to the public. The report Health Statistics on Older Persons will be in the registration package. One of the plenary sessions has Josh Wiener from Brookings talking about public policy and long term care. There are concurrent sessions that look at long term care in relation to issues of community-based care, mental health, and forecasting health and service use. In another plenary session, Ann Sommers will speak on Politics and Personal Preferences, A Consumer's View. I think she will be rather provocative and raise some interesting issues about long term care.
The third data base in the pipeline is a data tape from the 1986 National Mortality Follow-Back Survey (NMFBS). This is information about the last year of life for a sample of about 10,000 older persons who died in 1986. Data were collected by NCHS from the next-of-kin and from hospitals, nursing homes and hospices that were identified as having provided care to the sample in the last year of life. It should provide data on high users of health care services and their risk factors. It also has information on socioeconomic status and on net worth. This provides the opportunity to relate socioeconomic status to the use of institutional care in hospitals, nursing homes, and hospices.
The fourth data base is entering the pipeline, so to speak. It is the National Health and Nutrition Examination Survey (NHANES) III scheduled for fall 1988. It includes physical examinations, medical tests, and food intake. Cycles I and II had a limitation, a cut-off at age 74. For the 1988 cycle, NCHS is planning to eliminate the age cut-off, so that all elderly would be included. NCHS is developing an in-home examination to address the problems of limited mobility that often lead to a lower participation rate for the elderly, since it was difficult for them to get to the trailed examination centers. This in-home exam is structured to include basics like heights, weight, blood pressure, and measures of physical functioning. This survey will provide data for an in-depth analysis of the health of the aging.
The next data base is also one that is entering the pipeline. It will provide data on the use of community-based long term care.
There are some rich data sets, like the National Long Term Care Survey (NLTCS) and the Supplement on Aging (SOA), which look at the use of community-based long-term care from a population point of view. One problem with them is that when the analyst wishes to study subgroups of users, say women who are 85+ or persons who are part of the minority population, the number of cases is so small that the analysis is impossible to conduct.
NCHS plans to launch a National Health Care Survey in 1992 by collecting data from the providers of care. The long term care component will cover nursing homes, home health agencies, and hospices. Such data will be important for making comparisons among different providers in terms of clients, costs, and payment sources.
The last data base I want to bring to your attention is a report by the National Academy of Sciences due to be released in 1988. It is on the needs for data for health policy analysis for an aging society. It is a set of recommendations on how to fill data gaps to analyze health policy in relation to the geriatric revolution that is occurring. It has a chapter on long term care and another on the financing of care. It is going to focus more attention on the federal data system in relation to data for health policy analysis.
I think it will also serve to intensify debate on what the priority data gaps are and on how to fill them. It is important that you as a group of users with critical data needs, are aware of this report so that you will have a chance to provide input into this discussion of gaps, how to fill them, and what priorities to follow.