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EXPLORING DIFFERENCES IN ESTIMATES OF VISITS TO EMERGENCY ROOMS FOR INJURIES FROM ASSAULTS

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EXPLORING DIFFERENCES IN ESTIMATES OF VISITS TO EMERGENCY ROOMS FOR INJURIES FROM ASSAULTS USING THE NCVS AND NHAMCS Jaqueline Cohen a James Patrick Lynch b a H. John Heinz III School of Public Policy and Management Carnegie Mellon University b John Jay College of Criminal Justice1 Introduction Researchers seeking to provide a better understanding of crime statistics tend to compare survey-based statistics such as the NCVS with data from police administrative series like the UCR. Because these two types of data collections systems are so different, simple direct comparisons are of little value regarding limitations inherent to a particular data collection system. This chapter explores the NCVS data using a different perspective that compares data from the national crime survey of population with those from a national survey of establishments—the National Hospital Ambulatory Care Survey (NHAMCS). This comparison provides an understanding of how the design, instrumentation and procedures of the NCVS may influence estimates of interpersonal violence, particularly that component of violence resulting in injuries treated in hospital emergency rooms. The estimates of emergency room visits for injuries due to violence obtained from the NCVS are considerably smaller than those from the NHAMCS. The analyses include a series of adjustments to these estimates that explore the role of features specific to each survey in the observed differences. The household sampling frame employed in the NCVS receives special attention as a potential source of the observed differences. Investigating this source of divergence is particularly important, since many of our major social indicators on the economy and participation in government programs depend upon household surveys. If some population groups are under-represented in the household sampling frame used in Census surveys, and this under-coverage results in underestimates of violence, this finding could have implications for the use of the household frame to estimate the magnitude of other problems that disproportionately affect marginal populations, such as unemployment, poverty, drug abuse and poor health status. The first section that follows describes the two surveys, but principally the NHAMCS, since the NCVS is described extensively in Chapter 2. The second section presents the unadjusted estimates of the rate of emergency room visits due to violent crime from the two surveys. The third section outlines a series of potential explanations for the observed rate differences and the last section includes a series of adjustments to the rates designed to test the plausibility of the various explanations.2The NHAMCS and the NCVS The National Center for Health Statistics (NCHS) annually fields a family of surveys designed to measure utilization of health care services in a variety of provider settings. The NHAMCS estimates the level and type of outpatient medical services provided in hospital emergency departments (EDs) and outpatient departments (OPDs) nationally. Fielded for the first time in 1992, the NHAMCS supplements data on ambulatory medical care services provided in physicians’ offices collected since 1973 in the National Ambulatory Medical Care Survey (NAMCS). Patients treated in hospital-based ambulatory care settings differ in certain demographic and medical characteristics from patients treated in physicians’ offices, and the NHAMCS provides data on this important segment of ambulatory care services (http://www.cdc.gov/nchs/about/major/ahcd/nhamcsds.htm). NHAMCS relies on a national probability sample of visits to EDs and OPDs in general (medical and surgical), short-stay (average length of stay less than 30 days) hospitals (excluding federal, military and Veterans Administration hospitals) located in the 50 states and the District of Columbia. A four-stage probability design samples in the following order from: (1) geographic-based primary sampling units (PSUs consisting of counties, county equivalents or MSAs), (2) hospitals in the selected PSUs, (3) EDs and OPDs in these hospitals, and (4) patient visits to these departments. The NHAMCS PSUs are the probability subsample of PSUs used in the 1985-94 National Health Interview Surveys. A total of about 1,900 PSUs were stratified by socioeconomic and demographic variables within four geographic regions by MSA or non-MSA status. The selection probability was proportional to PSU size. The final sample includes a fixed panel of 600 hospitals (drawn from about 5,600 hospitals nationally) located in 112 PSUs across the country. A target number of 50 visits to each sampled ED were selected systematically—every nth visit based on the expected number of patients who will be seen in each ED—over a randomly selected 4-week reporting period during the survey year. The data used here include the samples of about 23,000 visits to hospital EDs in each year from 1995 to 1998. Specially trained hospital staff members implement the visit sampling process and extract the information from the sampled records onto data collection forms. Census field3representatives collect these forms, check them for completeness, and perform various edit checks on the forms and keyed data. Sampling weights and non-response adjustments are applied to produce population estimates of total ED visits in the nation. The ED data include variables to identify injury visits, whether the injury was unintentional, intentionally inflicted in an assault or self-inflicted, and mechanism (weapon type) producing the injury. These variables are the basis for estimating total ED visits for assault injuries. In contrast, the NCVS is based upon a probability sample of households residing in housing units contained in the address lists emerging from the United States decennial census. Addresses are selected from the list in a multi-stage process described in detail in Chapter 2. The households selected from the lists are visited by Census interviewers and all members of the household twelve years of age and older are interviewed about their violence and theft crime victimization experiences. Interviews are highly structured; all respondents answer the same screener questions and computer-assisted interviewing is employed in some circumstances. Respondents who mention that they were actually attacked in an incident of interpersonal violence are asked about any injuries they sustained and


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