COVID19_OMB_Memo

National Ambulatory Medical Care Survey (OMB No. 0920-0234):

Proposal Summary for Adding COVID-19 Survey Questions

June 26, 2020

Proposed Plan:

• We plan to add five survey questions (with a few of these containing sub-questions) related to COVID-19 to the NAMCS Physician Induction Interview, and Community Health Center (CHC) Induction Interview. These questions will be added as soon as possible to the 2020 NAMCS, and will continue to be included in future years of NAMCS, if data collection on COVID-19 remains applicable.

• These questions will ask about: (1) availability of personal protective equipment, (2) shortages of COVID-19 testing, (3) need to turn away COVID-19 patients or refer them elsewhere, (4) health care providers testing positive for COVID-19, and (5) use of telemedicine/telehealth.

• These questions have now undergone the process of expert review by a small group of physicians and advanced practice providers (less than 9) to ensure they will perform optimally in the field. Based on the results of this review, edits/wording changes to these questions have been made.

• No change in burden is anticipated with the addition of these few questions.

Current OMB Approval Status:

• NAMCS data collection is currently approved through 05/31/2022 (OMB No. 0920-0234).

• Approval for the inclusion of these questions will be submitted through a nonsubstantive change package.

• The 2020 NAMCS entered the field in mid-May 2020. NCHS would update the 2020 data collection to include these items as soon as possible, during the fielding of the 2020 NAMCS. Without this approval, the new items will not be added to NAMCS until 2021, resulting in a missed opportunity to collect vital information on office-based physicians and CHCs during the pandemic.

Purpose, Goal and Added Value:

• The purpose of including these survey questions related to COVID-19 to the NAMCS Physician and CHC Induction Interviews is that they will yield unique, nationally-representative data on the experiences of office-based physicians and CHCs related to COVID-19.

• Upon a review of recent literature, we could not find surveys that collect similar COVID-19 data at the national level, and in an on-going basis, among office-based physicians or CHC settings. The inclusion of these questions will allow NAMCS to fill these gaps and offer unique, national-level estimates.

• These NAMCS COVID-19 items are granular, and the methodological rigor of NAMCS and its large sample size is expected to result in enough statistical power to yield more reliable data than these other surveys, which are more unclear on their methodology.

• Furthermore, combining the data related to COVID-19 with other physician and CHC characteristic data already collected will increase NAMCS research capability to examine the impact of COVID-19 on health care and service utilization according to physician and CHC characteristics.

Individual Survey Questions and Use:

• The survey questions for the NAMCS Physician Induction Interview and CHC Induction Interview are listed below. The questions proposed for both induction interviews mirror each other.

• As noted above, these questions will ask about: (1) availability of personal protective equipment, (2) shortages of COVID-19 testing, (3) need to turn away COVID-19 patients or refer them elsewhere, (4) health care providers testing positive for COVID-19, and (3) use of telemedicine/telehealth.

• Once collected, data from each survey question will be used in two specific manners:

1. The resulting data will be used to generate nationally representative estimates of the impact of COVID-19 on health care and service utilization among office-based physicians and CHCs. Furthermore, differences in these estimates according to physician characteristics (e.g., primary specialty, sex) and/or facility (e.g., office or CHC) will also be examined in order to identify significant patterns and differences in the effects of COVID-19. For example, these data could be used to answer research questions such as: did experiences providing care during the COVID-19 pandemic differ by physician specialty type and practice type? These results will be made available to the public through an NCHS published report and/or web tables.

2. The data from these survey questions themselves will also be made available to the public through the CDC Research Data Centers in the form of microdata files. These files can then be accessed and analyzed by external researchers who are interested, furthering the utility of these data.

NAMCS: Physician Induction Interview – Proposed Survey Questions Related to COVID-19

1. During the past THREE months, how often did your office experience shortages of any of the following personal protective equipment due to the onset of the coronavirus disease (COVID-19) pandemic?

1. N95 respirators or other approved facemasks

   1. Never

   2. Some of the time

   3. Most of the time

   4. All of the time

   5. Don’t know

2. Eye protection, isolation gowns, or gloves

   1. Never

   2. Some of the time

   3. Most of the time

   4. All of the time

   5. Don’t know

2. During the past THREE months, did your office have the ability to test patients for coronavirus disease (COVID-19) infection?

• Yes

• No [SKIP TO #2b]

• Not applicable – did not need to do any COVID-19 testing [SKIP TO #3]

• Don’t know [SKIP TO #2b]

1. [IF ANSWERED ‘YES’ TO #2]: During the past THREE months, how often did your office experience shortages of coronavirus disease (COVID-19) tests for any patients who needed testing?

   • Never

   • Some of the time

   • Most of the time

   • All of the time

   • Don’t know

2. During the past THREE months, how often did your office have a location where patients could be referred to for coronavirus disease (COVID-19) testing?

   • Never

   • Some of the time

   • Most of the time

   • All of the time

   • Don’t know

3. During the past THREE months, did your office need to turn away or refer elsewhere any patients with confirmed or presumptive positive coronavirus disease (COVID-19) infection?

• No, COVID-19 patients were not turned away or referred elsewhere

• Yes, some COVID-19 patients were turned away or referred elsewhere

• Yes, most COVID-19 patients were turned away or referred elsewhere

• Yes, all COVID-19 patients were turned away or referred elsewhere

• Not applicable – the office did not have any COVID-19 patients

• Don’t know

4. During the past THREE months, did any of the following clinical care providers in your office test positive for coronavirus disease (COVID-19) infection?

1. Physicians

   1. Yes

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

2. Physician assistants

   1. Yes

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

3. Nurse practitioners

   1. Yes

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

4. Certified nurse-midwives

   1. Yes

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

5. Registered nurses/licensed practical nurses

   1. Yes

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

6. Other clinical care providers

   1. Yes (please specify: ________________________________)

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

5. During January and February 2020, was your office using telemedicine or telehealth technologies (for example, audio with video, web videoconference) to assess, diagnose, monitor, or treat patients?

• Yes

• No

• Don’t know

1. [IF ANSWERED ‘ YES’ to #5]: After February 2020, did your office’s use of telemedicine or telehealth technologies to conduct patient visits increase?

   • Yes

   • No

   • Don’t know

2. [IF ANSWERED ‘YES’ to #5a]: After February 2020, how much has your office’s use of telemedicine or telehealth technologies to conduct patient visits increased?

   • Less than 25%

   • 25% to 49%

   • 50% to 74%

   • 75% or more

   • Don’t know

3. [IF ANSWERED ‘NO’ to #5]: After February 2020, has your office started using telemedicine or telehealth technologies?

   • Yes

   • No

   • Don’t know

4. [IF ANSWERED ‘YES’ to #5c]: Since your office started using these technologies, how many of your patient visits have been conducted using telemedicine or telehealth technologies?

   • Less than 25%

   • 25% to 49%

   • 50% to 74%

   • 75% or more

   • Don’t know

NAMCS: Community Health Center (CHC) Induction Interview – Proposed Survey Questions Related to COVID-19

(Same questions as Physician Induction Interview, with “Office” changed to “Center”)

1. During the past THREE months, how often did your center experience shortages of any of the following personal protective equipment due to the onset of the coronavirus disease (COVID-19) pandemic?

1. N95 respirators or other approved facemasks

   1. Never

   2. Some of the time

   3. Most of the time

   4. All of the time

   5. Don’t know

2. Eye protection, isolation gowns, or gloves

   1. Never

   2. Some of the time

   3. Most of the time

   4. All of the time

   5. Don’t know

2. During the past THREE months, did your center have the ability to test patients for coronavirus disease (COVID-19) infection?

• Yes

• No [SKIP TO #2b]

• Not applicable – did not need to do any COVID-19 testing [SKIP TO #3]

• Don’t know [SKIP TO #2b]

1. [IF ANSWERED ‘YES’ TO #2]: During the past THREE months, how often did your center experience shortages of coronavirus disease (COVID-19) tests for any patients who needed testing?

   • Never

   • Some of the time

   • Most of the time

   • All of the time

   • Don’t know

2. During the past THREE months, how often did your center have a location where patients could be referred to for coronavirus disease (COVID-19) testing?

   • Never

   • Some of the time

   • Most of the time

   • All of the time

   • Don’t know

3. During the past THREE months, did your center need to turn away or refer elsewhere any patients with confirmed or presumptive positive coronavirus disease (COVID-19) infection?

• No, COVID-19 patients were not turned away or referred elsewhere

• Yes, some COVID-19 patients were turned away or referred elsewhere

• Yes, most COVID-19 patients were turned away or referred elsewhere

• Yes, all COVID-19 patients were turned away or referred elsewhere

• Not applicable – the center did not have any COVID-19 patients

• Don’t know

4. During the past THREE months, did any of the following clinical care providers in your center test positive for coronavirus disease (COVID-19) infection?

1. Physicians

   1. Yes

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

2. Physician assistants

   1. Yes

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

3. Nurse practitioners

   1. Yes

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

4. Certified nurse-midwives

   1. Yes

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

5. Registered nurses/licensed practical nurses

   1. Yes

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

6. Other clinical care providers

   1. Yes (please specify: ________________________________)

   2. No

   3. Not applicable – did not have such provider type onsite

   4. Don’t know

5. During January and February 2020, was your center using telemedicine or telehealth technologies (for example, audio with video, web videoconference) to assess, diagnose, monitor, or treat patients?

• Yes

• No

• Don’t know

1. [IF ANSWERED ‘ YES’ to #5]: After February 2020, did your center’s use of telemedicine or telehealth technologies to conduct patient visits increase?

   • Yes

   • No

   • Don’t know

2. [IF ANSWERED ‘YES’ to #5a]: After February 2020, how much has your center’s use of telemedicine or telehealth technologies to conduct patient visits increased?

   • Less than 25%

   • 25% to 49%

   • 50% to 74%

   • 75% or more

   • Don’t know

3. [IF ANSWERED ‘NO’ to #5]: After February 2020, has your center started using telemedicine or telehealth technologies?

   • Yes

   • No

   • Don’t know

4. [IF ANSWERED ‘YES’ to #5c]: Since your center started using these technologies, how many of your patient visits have been conducted using telemedicine or telehealth technologies?

   • Less than 25%

   • 25% to 49%

   • 50% to 74%

   • 75% or more

   • Don’t know