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Protocol - Access to Health Services

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Description

This protocol includes 10 interviewer-administered questions from the National Health Interview Survey (NHIS) Adult Access to Health Care & Utilization Module. Questions capture when medical care was last sought, usual place of care, frequency of getting medical care and reasons for not getting medical care.

Specific Instructions

None

Availability

Available

Protocol

1. About how long has it been since you last saw a doctor or other health care professional about your health?

0[ ]Never

1[ ]Within the past year (anytime less than 12 months ago)

2[ ]Within the last 2 years (1 year but less than 2 years ago)

3[ ]Within the last 3 years (2 years but less than 3 years ago)

4[ ]Within the last 5 years (3 years but less than 5 years ago)

5[ ]Within the last 10 years (5 years but less than 10 years ago)

6[ ]10 years ago or more

7[ ]Refused

9[ ]Don't know

If answer is “Within the past year (anytime less than 12 months ago)”, “Within the last 2 years (1 year but less than 2 years ago)”, “Within the last 3 years (2 years but less than 3 years ago)”, “Within the last 5 years (3 years but less than 5 years ago)”, “Within the last 10 years (5 years but less than 10 years ago)” or “10 years ago or more” go to question 2.

If answer is “Never”, “Refused”, or “Don’t know”, go to question 4.

2. Was this a wellness visit, physical, or general purpose check-up?

1[ ]Yes

2[ ]No

7[ ]Refused

9[ ]Don't know

If answer is “Yes” go to question 4.

If answer is “No”, “Refused”, or “Don’t know”, go to question 3.

3. About how long has it been since you last saw a doctor or other health professional for a wellness visit, physical, or general purpose check-up?

0[ ]Never

1[ ]Within the past year (anytime less than 12 months ago)

2[ ]Within the last 2 years (1 year but less than 2 years ago)

3[ ]Within the last 3 years (2 years but less than 3 years ago)

4[ ]Within the last 5 years (3 years but less than 5 years ago)

5[ ]Within the last 10 years (5 years but less than 10 years ago)

6[ ]10 years ago or more

7[ ]Refused

9[ ]Don't know

4. Is there a place that you USUALLY go to if you are sick and need health care?

1[ ]Yes

2[ ]There is NO place

3[ ]There is MORE THAN ONE place

7[ ]Refused

9[ ]Don't know

If answer is “Yes”, “There is MORE THAN ONE place”, “Refused”, or “Don’t know” go to question 5.

If answer is “There is NO place”, go to question 6.

5. What kind of place is it/do you go to most often - a doctor's office or health center; an urgent care center, a clinic in a drug store or grocery store; a hospital emergency room; a VA Medical Center or VA outpatient clinic; or some other place?

Read if necessary: A doctor's office or health center is a place where you see the same doctor or the same group of doctors every visit, where you usually need to make an appointment ahead of time, and where your medical records are on file.

Read if necessary: Urgent care centers and clinics in a drug store or grocery store are places where you do not need to make an appointment ahead of time, and do not usually see the same health care provider at each visit.

1[ ]A doctor's office or health center

2[ ]Walk-in clinic, urgent care center, or retail clinic in a pharmacy or grocery store

3[ ]Emergency room

4[ ]A VA Medical Center or VA outpatient clinic

5[ ]Some other place

6[ ]Does not go to one place most often

7[ ]Refused

9[ ]Don't know

          6. During the past 12 months, how many times have you gone to an urgent care center or a clinic in a drug store or grocery store about your health?

           Read if necessary: Urgent care centers and clinics in drug stores or grocery stores are places where you do not need to make an appointment ahead of time, and do not usually see the same health care provider at each visit.

           Read if necessary: This is different from a hospital emergency room.

Enter 96 if number of times is 96 or more.

[ ] ____ (00-96 Range of values)

97[ ]Refused

99[ ]Don't know

If answer is 0-39, “Refused” or “Don’t know”, go to question 7.

If answer is 40-96, repeat question 6 to verify.

7. During the past 12 months, how many times have you gone to a hospital emergency room about your health?

Read if necessary: This includes emergency room visits that resulted in a hospital admission.

Enter 96 if number of times is 96 or more.

[ ] ___ (00-96 Range of values)

97[ ]Refused

99[ ]Don't know

If answer is 0-39, “Refused” or “Don’t know”, go to question 8.

If answer is 40-96, repeat question 7 to verify.

8. During the past 12 months, have you been hospitalized overnight? (If Question 7 is 1-96 or “Refused” or “Don’t know”, Fill: "Do not include an overnight

stay in the emergency room.")

1[ ]Yes

2[ ]No

7[ ]Refused

9[ ]Don't know

9. During the past 12 months, have you DELAYED getting medical care because of the cost?

1[ ]Yes

2[ ]No

7[ ]Refused

9[ ]Don't know

10. During the past 12 months, was there any time when you needed medical care, but DID NOT GET IT because of the cost?

1[ ]Yes

2[ ]No

7[ ]Refused

9[ ]Don't know

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a “don’t know” response is provided.

Equipment Needs

The PhenX Working Group acknowledges that these questions can be administered in a computerized or noncomputerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer or handheld computer to administer a computer-assisted questionnaire.

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire

Lifestage

Adult

Participants

Adults

Selection Rationale

The National Health Interview Survey, which has been administered since 1957, is used to monitor trends in human health and track progress toward national health objectives. 

Language

English, Spanish

Standards
StandardNameIDSource
Derived Variables

None

Process and Review

Not applicable

Protocol Name from Source

National Health Interview Survey (NHIS) Utilization Questionnaire, 2020

Source

Centers for Disease Control and Prevention, National Center for Health Statistics. (2020). National Health Interview Survey (NHIS), 2020 (2020 National Health Interview Survey (NHIS) Questionnaire – Interview Module: Adult): Utilization Section, question numbers UTZ.0020.00.1 (PhenX question 1), UTZ.0030.00.1 (PhenX question 2), UTZ.0040.00.1 (PhenX question 3), UTZ.0050.00.1 (PhenX question 4), UTZ.0060.00.1 (PhenX question 5), UTZ.0070.00.1 (PhenX question 6), UTZ.0080.00.1 (PhenX question 7), UTZ.0090.00.1 (PhenX question 8), UTZ.0100.00.1 (PhenX question 9), and UTZ.0110.00.1 (PhenX question 10). Retrieved February 25, 2020, from https://www.cdc.gov/nchs/nhis/data-questionnaires-documentation.htm

General References

Centers for Disease Control and Prevention, National Center for Health Statistics. (2019, March 13). Early release of selected estimates based on data from January-September 2018. Retrieved March 14, 2019, from https://www.cdc.gov/nchs/nhis/releases/released201903.htm

Fang, J., Wang, G., Ayala, C., Lucido, S. J., & Loustalot, F. (2017). Healthcare access among young adults: Impact of the Affordable Care Act on young adults with hypertension. American Journal of Preventive Medicine, 53(6S2), S213–S219.

Tumin, D., Miller, R., Raman, V. T., Uffman, J. C., & Tobias, J. D. (2019). Patterns of health insurance discontinuity and children's access to health care. Maternal and Child Health Journal, 23(5), 667–677.

Protocol ID

270101

Variables
Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX270101_Access_Health_Services_Cost
PX270101100000 During the past 12 months, was there any more
time when you needed medical care, but DID NOT GET IT because of the cost? show less
N/A
PX270101_Access_Health_Services_Delayed_Medical_Care
PX270101090000 During the past 12 months, have you DELAYED more
getting medical care because of the cost? show less
N/A
PX270101_Access_Health_Services_Health_Care_Most_Often
PX270101050000 What kind of place is it/do you go to most more
often - a doctor's office or health center; an urgent care center, a clinic in a drug store or grocery store; a hospital emergency room; a VA Medical Center or VA outpatient clinic; or some other place? Read show less
N/A
PX270101_Access_Health_Services_How_Long_Since_Wellness_Visit
PX270101030000 About how long has it been since you last more
saw a doctor or other health professional for a wellness visit, physical, or general purpose check-up? show less
N/A
PX270101_Access_Health_Services_Last_Seen_Doctor
PX270101010000 About how long has it been since you last more
saw a doctor or other health care professional about your health? show less
N/A
PX270101_Access_Health_Services_Past_12_Months_Emergency_Room
PX270101070100 During the past 12 months, how many times more
have you gone to a hospital emergency room about your health? Read if necessary: This includes emergency room visits that resulted in a hospital admission. Enter 96 if number of times is 96 or more. show less
N/A
PX270101_Access_Health_Services_Past_12_Months_Emergency_Room_Encoded
PX270101070200 During the past 12 months, how many times more
have you gone to a hospital emergency room about your health? Read if necessary: This includes emergency room visits that resulted in a hospital admission. Enter 96 if number of times is 96 or more. show less
N/A
PX270101_Access_Health_Services_Past_12_Months_Hospitalized _Overnight
PX270101080000 During the past 12 months, have you been more
hospitalized overnight? (If Question 7 is 1-96 or "Refused" or "Don't know", Fill: Do not include an overnight stay in the emergency room.) show less
N/A
PX270101_Access_Health_Services_Past_12_Months_Urgent_Care
PX270101060100 During the past 12 months, how many times more
have you gone to an urgent care center or a clinic in a drug store or grocery store about your health? Read if necessary: Urgent care centers and clinics in drug stores or grocery stores are places where you show less
N/A
PX270101_Access_Health_Services_Past_12_Months_Urgent_Care_Encoded
PX270101060200 During the past 12 months, how many times more
have you gone to an urgent care center or a clinic in a drug store or grocery store about your health? Read if necessary: Urgent care centers and clinics in drug stores or grocery stores are places where you show less
N/A
PX270101_Access_Health_Services_Purpose_Visit
PX270101020000 Was this a wellness visit, physical, or more
general purpose check-up? show less
N/A
PX270101_Access_Health_Services_Usual_Place_Health_Care
PX270101040000 Is there a place that you USUALLY go to if more
you are sick and need health care? show less
N/A
Social Determinants of Health: Core
Measure Name

Access to Health Services

Release Date

May 11, 2020

Definition

Access to health services is the appropriate and timely use of health care to attain the best possible outcomes. 

Purpose

Access to health care impacts overall health status and quality of life and can be affected by a variety of factors, including age, gender, race, ethnicity, socioeconomic status, sexual orientation, and residential location. Barriers that prevent access to health services (e.g., costs, availability, lack of insurance) can lead to delay of care and unmet health needs resulting in financial burden, preventable hospitalizations, and adverse outcomes. 

Keywords

Centers for Disease Control and Prevention, CDC, National Center for Health Statistics, NCHS, National Health Interview Survey, NHIS, Social Determinants of Health, healthcare access, usual source of care, Access to Health Care

Measure Protocols
Protocol ID Protocol Name
270101 Access to Health Services
Publications

Pomeroy, A., et al. (2022) Protocol for a Longitudinal Study of the Determinants of Metabolic Syndrome Risk in Young Adults. Translational Journal of the American College of Sports Medicine. 2022 April; 7(2): 8. doi: 10.1249/tjx.0000000000000197