An NCHS Update with a Few Challenges An NCHS Update with a Few Challenges Charles J. Rothwell Centers for Disease Control and Prevention National Center for Health Statistics

Topics NCHS Staffing A brief look at NCHS activities supporting CDC and Public Health NCHS Budget Challenges for the Future

Thank You to Ed Sondik 17 years as Director of NCHS Best wishes for “re-prioritizing”!

NCHS Staff Updates New NHANES Director: Dr. Kathryn Porter Acting NCHS Director: Charlie Rothwell Acting DVS Director: Delton Atkinson Stephanie Ventura is retiring Marjorie Greenberg is retiring

NCHS Staff Updates Director, NCHS: announcement closes at the end of this Friday Chief, Reproductive Statistics Branch: announcement closed and candidates being reviewed Associate Director for Science DVS: announcement closed 2 weeks ago

NCHS BSC Updates NCHS BSC Updates New Chair: Dr. Raynard Kington Welcome to New Members Michael Davern, Ph.D. (University of Chicago) Ana Victoria Diez-Roux, M.D., M.P.H., Ph.D. (University of Michigan) Genevieve M. Kenney, Ph.D. (The Urban Institute) Thomas A. LaVeist, Ph.D. (The Johns Hopkins University) F. Javier Nieto, M.D., M.P.H., Ph.D. (University of Wisconsin) Linette T. Scott, M.D., M.P.H. (California Department of Health Care Services)

CDC/Public Health of the Future How does NCHS Help?

Improving health security at home and around the world Improvements in data timeliness will allow the use of mortality data for real time surveillance -- pilots will be underway to develop this capability Improvements in data timeliness for natality data to track high risk births Emergency Department sample expansion for the NHAMCS in 5 large states to better understand ED capacity Vital Registration in underdeveloped countries

Information for preventing the leading causes of illness, injury, disability, and death NCHS data provide the backbone for the Million Hearts campaign Recently published reports on declines in infant mortality, trends in allergic conditions in children, consumption of sugars, trends in LDL cholesterol, health behaviors in adults and declines in teenage birth rates in states

Information for preventing the leading causes of illness, injury, disability, and death Testing methods to collect bio- measures in the NHIS that would provide timely critical information about hypertension, obesity, diabetes, and high cholesterol Nutrition data shows consumption of fast food, sugar-sweetened beverages, sodium

Strengthening public health- health care collaboration Expanding the sample for Community Health Care Centers in the NAMCS and monitoring change in utilization as ACA provisions are implemented Provides data to asses quality of care. NCHS data cited frequently in AHRQ’s National Healthcare Quality Report Provides data on resources in the health care field - recent NCHS report on supply of and access to generalist and specialty physicians

Strengthening public health- health care collaboration Healthcare surveys provide data on provider EHR adoption and use Health, United States 2012 special feature: Emergency Care in the United States NHIS providing data on use of and access to care

NCHS Budget Update

FY 2013 Budget Continuing Resolution for FY 2013 Funding for FY 2013 is level with FY 2012 ($ M) NCHS base budget comes from PHS Evaluation Funds – they were not subject to sequester!!!! An additional $30-$40 million comes from other agencies – some of this may be in jeopardy Funds for Vital Statistics – you need to wait and hear from Delton!

FY 2013 ACA Activities Although we did not get as much as last year... We also receive ACA funding. Proposed activities include: NHIS Additional questions to monitor ACA Continue expanded sample size; more state estimates Testing to add biomarkers (height, weight, BP, dried blood spots NAMCS/NHAMCS Continue expanded sample size to permit state-specific estimates of clinical care provided in physician offices and Community Health Centers, including primary prevention and clinical management of risk factors for heart disease and stroke Fund states to implement electronic birth record systems and transition to 2003 birth certificate and EDR expansion.

Challenges DoD and NCHS: A New Challenge to Solve - the Out-of-Country Deaths.

Background 2012 Media reports on military suicides Congressional inquiries into military suicides DoD/VA lengthy history of successful matches with the NDI – but only for specific research groups and medical centers National Death Index comprehensive IAA with the Dept. of Defense and the Veterans Administration.

DoD/VA IAA with NDI

Status 2013 Over 26 million records successfully matched to the NDI MOU with DoD for out-of-country deaths successfully finalized NCHS will be receiving DoD out-of- country deaths back to 1979, and maybe back to 1950 DoD will update us monthly going forward

The Challenge The MOU permits NCHS to return death information to the state of birth to flag birth records with decedent status. How will NCHS provide the correct death information to the correct state of birth – when the DoD data files DO NOT contain state of birth? How will NCHS provide the correct death information to the correct state of birth – when the DoD data files DO NOT contain state of birth?

DoD Death Record Contents Name SSN DOB Age at death Gender Race Ethnicity Marital Status Home of record Incident type code

Constraints Security and confidentiality Sending out 57 copies of complete DoD files to all the jurisdictions increases risk of a breach Magnitude of effort To have 57 jurisdictions send in birth records for NCHS to do the match would be absurd

So what to do? DoD outreach is major change for them and us Benefit to NCHS and the states is significant How to successfully implement DoD death and state birth record match, AND reassure DoD that their data are secure and confidentiality guaranteed

Next Challenge: EDRs and EHRs Unsure how EDRs and EHRs will relate at this point One pilot study underway More to follow At least it would be nice for the certifier to see the EHR when certifying death

Next Challenge: EDRs and EHRs Goal: faster and better quality data for surveillance and for vital statistics For surveillance... Why can’t for deaths due to reportable diseases, preventable deaths, etc. the EHR record along with the EDR record be provided to the State Health Department for state public health intervention and monitoring health care outcomes?