Protocol - Access to Health Services
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
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 Category | Required |
|---|---|
| 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
| Standard | Name | ID | Source |
|---|---|---|---|
| Logical Observation Identifiers Names and Codes (LOINC) | PhenX - access health services last seen doctor protocol 270101 | 105470-9 | LOINC |
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 ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX270101_Access_Health_Services_Cost | ||||
| PX270101100000 | During the past 12 months, was there any more | N/A | ||
| PX270101_Access_Health_Services_Delayed_Medical_Care | ||||
| PX270101090000 | During the past 12 months, have you DELAYED more | N/A | ||
| PX270101_Access_Health_Services_Health_Care_Most_Often | ||||
| PX270101050000 | What kind of place is it/do you go to most more | N/A | ||
| PX270101_Access_Health_Services_How_Long_Since_Wellness_Visit | ||||
| PX270101030000 | About how long has it been since you last more | N/A | ||
| PX270101_Access_Health_Services_Last_Seen_Doctor | ||||
| PX270101010000 | About how long has it been since you last more | N/A | ||
| PX270101_Access_Health_Services_Past_12_Months_Emergency_Room | ||||
| PX270101070100 | During the past 12 months, how many times more | N/A | ||
| PX270101_Access_Health_Services_Past_12_Months_Emergency_Room_Encoded | ||||
| PX270101070200 | During the past 12 months, how many times more | N/A | ||
| PX270101_Access_Health_Services_Past_12_Months_Hospitalized _Overnight | ||||
| PX270101080000 | During the past 12 months, have you been more | N/A | ||
| PX270101_Access_Health_Services_Past_12_Months_Urgent_Care | ||||
| PX270101060100 | During the past 12 months, how many times more | N/A | ||
| PX270101_Access_Health_Services_Past_12_Months_Urgent_Care_Encoded | ||||
| PX270101060200 | During the past 12 months, how many times more | N/A | ||
| PX270101_Access_Health_Services_Purpose_Visit | ||||
| PX270101020000 | Was this a wellness visit, physical, or more | N/A | ||
| PX270101_Access_Health_Services_Usual_Place_Health_Care | ||||
| PX270101040000 | Is there a place that you USUALLY go to if more | N/A | ||
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
Levites Strekalova, Y. A., et al. (2024) Application of the Delphi method to the development of common data elements for social drivers of health: A systematic scoping review. Translational Behavioral Medicine. 2024 June; 14(7): 426-433. doi: 10.1093/tbm/ibae020
Burnett-Bowie, S. A. M., et al. (2024) The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report. Journal of Bone and Mineral Research. 2024 May; 39(5): 517-530. doi: 10.1093/jbmr/zjae048
Bartholomew, T. S., et al. (2024) Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services Addiction Science & Clinical Practice. 2024 March; 19(1). doi: 10.1186/s13722-024-00447-9
Chan, N. W., et al. (2022) Social determinants of health data in solid organ transplantation: National data sources and future directions. Am J Transplant. 2022 October; 22(10): 2293-2301. doi: 10.1111/ajt.17096
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