USER DOCUMENTATION FOR THE AREA RESOURCE FILE (ARF) AS OF SEPTEMBER 1993 Office of Health Professions Analysis and Research Bureau of Health Professions Page 001 ARF USER DOCUMENTATION -------------------------------------------CONTENTS-------------------------------------- I. DATA ELEMENT DESCRIPTIONS AND REFERENCES . . . . . . . . . . . . . . . . 4 A. CODES AND CLASSIFICATIONS. . . . . . . . . . . . . . . . . . . . . . . . 4 A-1) Header for ARF . . . . . . . . . . . . . . . . . . . . . . . . . . 4 A-2) State and County Codes . . . . . . . . . . . . . . . . . . . . . . 4 A-3) MSA, PMSA and CMSA Codes, Names and Levels; SMSA Code and Name; Rural/Urban Continuum Code; AMA County Group Code; and Census County Group Code . . . . . . . . . . . . . . . . . . . 9 A-4) Economic Area Codes. . . . . . . . . . . . . . . . . . . . . . . . 16 A-5) Federal Region Code and Census Region and Division Codes and Names. . . . . . . . . . . . . . . . . . . . . . . . . . 17 A-6) Health Service Area (HSA) Codes and Name . . . . . . . . . . . . . 18 A-7) Professional Standards Review Organization (PSRO) Code . . . . . . 22 A-8) Mathematica Policy Research Sampling Unit Codes. . . . . . . . . . 23 A-9) Medicare Prevailing Charges Locality Codes . . . . . . . . . . . . 25 A-10) Veterans Administration Codes. . . . . . . . . . . . . . . . . . . 27 A-11) Contiguous Counties. . . . . . . . . . . . . . . . . . . . . . . . 28 A-12) Health Care Service Area and Health Care Community Area (HCCA) Codes. . . . . . . . . . . . . . . . . . . . . . . . . 30 A-13) Area Health Education Center (AHEC) Code and Name. . . . . . . . . 30 B. HEALTH PROFESSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 B-1) Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 B-2) Dentists and Dental Hygienists . . . . . . . . . . . . . . . . . . 37 B-3) Optometrists . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 B-4) Pharmacists. . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 B-5) Podiatrists. . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 B-6) Veterinarians. . . . . . . . . . . . . . . . . . . . . . . . . . . 42 B-7) Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 B-8) National Health Service Corps (NHSC) Sites . . . . . . . . . . . . 45 B-9) Critical Shortage Codes. . . . . . . . . . . . . . . . . . . . . . 45 B-10) Physician Assistants and Nurse Practitioners . . . . . . . . . . . 46 B-11) Occupational Therapists. . . . . . . . . . . . . . . . . . . . . . 47 B-12) 1980 Decennial Census Occupation Data. . . . . . . . . . . . . . . 47 C. HEALTH FACILITIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 C-1) Hospital Type. . . . . . . . . . . . . . . . . . . . . . . . . . . 50 C-2) Hospital Employment. . . . . . . . . . . . . . . . . . . . . . . . 52 C-3) Nursing and Other Personal Care Homes. . . . . . . . . . . . . . . 53 C-4) Other Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 C-5) Health Maintainance Organizations. . . . . . . . . . . . . . . . . 55 Page 002 D. UTILIZATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 D-1) Utilization Rate . . . . . . . . . . . . . . . . . . . . . . . . . 61 D-2) Inpatient Days . . . . . . . . . . . . . . . . . . . . . . . . . . 61 D-3) Outpatient Visits. . . . . . . . . . . . . . . . . . . . . . . . . 61 D-4) Surgical Operations. . . . . . . . . . . . . . . . . . . . . . . . 61 E. EXPENDITURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 E-1) Hospital Expenditures. . . . . . . . . . . . . . . . . . . . . . . 62 E-2) Medicare Expenditure Data. . . . . . . . . . . . . . . . . . . . . 62 E-3) Medicare Prevailing Charges Data . . . . . . . . . . . . . . . . . 63 F. POPULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 F-1) Population Counts and Number of Families and Households. . . . . . 66 F-2) Population Percents. . . . . . . . . . . . . . . . . . . . . . . . 71 F-3) Population Estimates . . . . . . . . . . . . . . . . . . . . . . . 72 F-4) Labor Force. . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 F-5) Census Total Incomes . . . . . . . . . . . . . . . . . . . . . . . 78 F-6) Per Capita Incomes . . . . . . . . . . . . . . . . . . . . . . . . 78 F-7) Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 F-8) Persons and Families Below Poverty Level . . . . . . . . . . . . . 85 F-9) Median Family Income . . . . . . . . . . . . . . . . . . . . . . . 86 F-10) Household Income . . . . . . . . . . . . . . . . . . . . . . . . . 88 F-11) Aid to Families with Dependent Children, General Assistance, Social Security and Supplemental Security Income Data. . . . . . . 88 F-12) 5-Year Infant Mortality Rates. . . . . . . . . . . . . . . . . . . 93 F-13) Infant Mortality Data. . . . . . . . . . . . . . . . . . . . . . . 94 F-14) Mortality Data . . . . . . . . . . . . . . . . . . . . . . . . . . 95 F-15) Cancer Mortality Rate Data . . . . . . . . . . . . . . . . . . . . 96 F-16) Morbidity Data . . . . . . . . . . . . . . . . . . . . . . . . . . 96 F-17) Natality Data. . . . . . . . . . . . . . . . . . . . . . . . . . . 96 F-18) Births in Hospitals. . . . . . . . . . . . . . . . . . . . . . . . 96 F-19) Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 F-20) Census Housing Data. . . . . . . . . . . . . . . . . . . . . . . . 98 F-21) Population Served with Fluoridated Water . . . . . . . . . . . . . 99 F-22) Veteran Population . . . . . . . . . . . . . . . . . . . . . . . . 100 F-23) Retail Trade . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 F-24) Family Income. . . . . . . . . . . . . . . . . . . . . . . . . . . 100 G. ENVIRONMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 G-1) Land Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 G-2) Population Centroid. . . . . . . . . . . . . . . . . . . . . . . . 101 G-3) Climatic Data. . . . . . . . . . . . . . . . . . . . . . . . . . . 101 G-4) Water Hardness Index . . . . . . . . . . . . . . . . . . . . . . . 102 G-5) Farm Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Page 003 II. TECHNICAL INFORMATION. . . . . . . . . . . . . . . . . . . . . . . . . . 104 A) Tape Specifications. . . . . . . . . . . . . . . . . . . . . . . . 104 B) Missing Values on the ARF. . . . . . . . . . . . . . . . . . . . . 104 C) Flags Contained on the ARF . . . . . . . . . . . . . . . . . . . . 104 D) Criteria for Data Inclusion on the ARF . . . . . . . . . . . . . . 105 III. UPDATES AND ADDITIONS IN THE PAST YEAR . . . . . . . . . . . . . . . . . 106 IV. ASSOCIATED FILES AND DOCUMENTATIONS. . . . . . . . . . . . . . . . . . . 162 A) Technical Documentation of ARF . . . . . . . . . . . . . . . . . . 162 B) COBOL and PL/1 Layouts of ARF. . . . . . . . . . . . . . . . . . . 162 C) Enhanced Source Files. . . . . . . . . . . . . . . . . . . . . . . 162 D) 1976, 1975 and 1974 Hospital Files . . . . . . . . . . . . . . . . 163 Page 004 I. DATA ELEMENT DESCRIPTIONS AND REFERENCES A. CODES AND CLASSIFICATIONS A-1) Header for ARF The 45-character header for ARF was placed at the beginning of each record to enhance the use of the county file. The header includes the State and County Code, Date of the File, Date of Creation, and File Length. The file length equals the length of the file without the 45-byte header. Therefore the actual record length is the file length plus 45 bytes. A-2) State and County Codes FIPS State Code: This code was established by National Bureau of Standards, U.S. Department of Commerce in 1968. It is standard throughout the Federal government and published in "Federal Information Processing Standards Publication June 15, 1970". The basic structure is a sequential ascending two digit number, with spaces for all possible new states. The following table lists the FIPS State Code, the three-character State Name Abbreviation used on ARF and the State Name: FIPS CODE ABBREVIATION STATE + _________ ____________ _____ 01 ALA Alabama 02 ALK Alaska 04 ARI Arizona 05 ARK Arkansas 06 CAL California 08 COL Colorado 09 CON Connecticut 10 DEL Delaware 11 D C District of Columbia 12 FLA Florida 13 GA Georgia 15 HAW Hawaii 16 IDA Idaho 17 ILL Illinois 18 IND Indiana 19 IOW Iowa 20 KAN Kansas Page 005 FIPS CODE ABBREVIATION STATE + _________ ____________ _____ 21 KY Kentucky 22 LA Louisiana 23 ME Maine 24 MD Maryland 25 MAS Massachusetts 26 MIC Michigan 27 MIN Minnesota 28 MIS Mississippi 29 MO Missouri 30 MON Montana 31 NEB Nebraska 32 NEV Nevada 33 N H New Hampshire 34 N J New Jersey 35 N M New Mexico 36 N Y New York 37 N C North Carolina 38 N D North Dakota 39 OH Ohio 40 OKL Oklahoma 41 ORG Oregon 42 PA Pennsylvania 44 R I Rhode Island 45 S C South Carolina 46 S D South Dakota 47 TEN Tennessee 48 TEX Texas 49 UTH Utah 50 VT Vermont 51 VA Virginia 53 WAS Washington 54 W V West Virginia 55 WIS Wisconsin 56 WYO Wyoming GSA 1967 State and County Codes: This code preceded FIPS. Like FIPS, the basic structure of the GSA State Codes is a sequential ascending two-digit number; however, no spaces are included for additions. Alaska and Hawaii are listed as States 50 and 51 rather than in alphabetical order. The GSA - 1967 State Codes are on the file for indexing only. **NOTE: The GSA County Codes are not available for Virginia independent cities. Refer to A-2. Page 006 AHA State Code: This two-digit code was established by the American Hospital Association. The first digit identifies the region of the country (as defined by AHA), and the second digit identifies the state within the region. Modified FIPS County Codes: The FIPS County Codes were established by National Bureau of Standards, U.S. Department of Commerce in 1968, and are published in "Federal Information Processing Standards Publication - Counties and County Equivalents of the United States and the District of Columbia". The current version of this publication, No. 6-3 dated December 15, 1979, has been amended by subsequent "FIPS Publication Change Notices". The basic structure of the codes is sequential, ascending, three-digit odd numbers. The County Codes used in the Area Resource File are those published in FIPS except as noted below: 1) No County Codes have been entered for Alaska, since it is expected that in analysis, the state will always be handled in its entirety. 2) Most independent cities have been included in their original counties because much of the data on the file is only available for counties and can not be separated into county and independent city segments. Therefore, these cities have been recoded into the counties in all cases for consistency of data. The recodings made by are as follows: MODIFIED COUNTY STATE FIPS FIPS Columbus (Muscogee County) Georgia 215 510 Kalawao County (Maui County) Hawaii 009 005 Baltimore City Maryland 007 510 St. Louis City Missouri 191 510 Carson City (Ormsby County) Nevada 025 510 Allocation of Virginia Independent Cities to Counties: ORIGINAL MODIFIED CITY COUNTIES FIPS FIPS Bedford Bedford 019 515 Bristol Washington 191 520 Buena Vista Rockbridge 163 530 Charlottesville Albemarle 003 540 Clifton Forge Alleghany 005 560 Page 007 Colonial Heights Chesterfield 041 570 Covington Alleghany 005 580 Danville Pittsylvania 143 590 Emporia Greensville 081 595 Fairfax Fairfax 059 600 Falls Church Fairfax 059 610 Franklin Southampton 175 620 Fredericksburg Spotsylvania 177 630 Galax Grayson 077 640 Harrisonburg Rockingham 165 660 Hopewell Prince George 149 670 Lexington Rockbridge 163 678 Lynchburg Campbell 031 680 Manassas Prince William 153 683 Manassas Park Prince William 153 685 Martinsville Henry 089 690 Nansemond Nansemond 123 695 Norfolk Norfolk 129* 710 Norton Wise 195 720 Petersburg Dinwiddie 053 730 Poquoson York 199 735 Portsmouth Norfolk 129* 740 Radford Montgomery 121 750 Richmond Henrico 087 760 Roanoke Roanoke 161 770 Salem Roanoke 161 775 South Boston Halifax 083 780 Staunton Augusta 015 790 Suffolk Nansemond 123 800 Waynesboro Augusta 015 820 Williamsburg James City 095 830 Winchester Frederick 069 840 As of November 1984, the following Virginia independent cities are treated as county equivalents, and as such, are maintained as separate entities on ARF: CITY (NEW MOD FIPS CODE) FORMER COUNTY ALLOCATION (OLD MOD FIPS CODE) Alexandria (51510) Arlington (51013) Chesapeake (51550) Norfolk (51129) Hampton (51650) Hampton/Newport News City (51084) Newport News (51700) Hampton/Newport News City (51084) Virginia Beach (51810) Norfolk (51129) To the extent possible, historical data on ARF at the time of the change have been modified to separate data for these independent cities from data for their former counties. Where independent city data could not be broken out from county data, this fact has been noted in the sections of this User Page 008 Documentation which describe the individual data elements and/or sources. Where this has occurred, the data are reported on ARF in the original county (or for Hampton/Newport News Cities, in Newport News) and the city is zero- filled; (i.e., where the data are not broken out, the combined city/county values are reported in Arlington County, Newport News City and Norfolk City; and Alexandria City, Chesapeake City, Hampton City and Virginia Beach City are zero-filled.) **NOTE: FIPS does not have a code for Norfolk since it is no longer a county. The designation of Norfolk County (Mod FIPS Code 51129) includes the independent cities of Norfolk and Portsmouth, Virginia. 3) FIPS Publication Change Notices put out by the U.S. Department of Commerce, National Technical Information Service state: a) In January 1983: 04012 - La Paz County, Arizona has been formed from the northern portion of Yuma County, Arizona (04027, which still exists with reduced boundaries). On ARF, data for La Paz County are recoded to Yuma County. b) In June 1981: 35006 - Cibola County, New Mexico has been formed from portions of Valencia County, New Mexico (35061, which still exists with reduced boundaries). On ARF, data for Cibola County are recoded to Valencia County. c) In September 1979: 29193 - Ste. Genevieve, Missouri has been renumbered so that the county falls in alphabetical order. The FIPS State and County Code is now 29186. 46131 - Washabaugh County, South Dakota has merged with Jackson County, South Dakota (46071). The merged entity retains the name of Jackson and the code of 46071. On ARF, historical data for Washabaugh County have been combined with Jackson County. d) Other: 56047 - Yellowstone National Park (Part), Wyoming was dropped as an entity. The county was dropped from ARF, and all non-zero fields were weighted by population and split between Park County, Wyoming (56029), and Teton County, Wyoming (56039). Page 009 A-3) MSA, PMSA and CMSA Codes, Names and Levels; SMSA Code and Name; Rural/Urban Continuum Code; AMA County Group Code; and Census County Group Code. MSA, PMSA and CMSA Codes, Names and Levels: The Metropolitan Areas (MAs) were announced by the Office of Management and Budget in OMB Bulletin No. 93-05 to be effective December 31, 1992. They reflect the MA standards published on March 30, 1990 and the demographic data drawn from the 1990 Decennial Census. The previous term "Standard Metropolitan Statistical Area" (SMSA) was changed to describe two metropolitan areas, Metropolitan Statistical Area (MSA) and Primary Metropolitan Statistical Area (PMSA). An area is defined as an MSA if there is a city with a population of at least 50,000 or if there is an urbanized area of at least 50,000 population with a total metropolitan population of at least 100,000. In addition to the county containing the central city, an MSA may include additional counties having close economic/social ties to the central county. MSA's comprise entire counties, except for the six New England states, where towns/cities are the units of definition because of the lack of county governments. Except for this base unit, the same criteria are applied to define MSA's in New England as in the rest of the country. If an area has more than one million population and meets other requirements specified in the Metropolitan Area standards published in the Federal Register (55 FR 12154-12160, + ________________ March 30, 1990), it is termed a Consolidated Metropolitan Area (CMSA), consisting of two or more major components recognized as Primary Metropolitan Statistical Areas (PMSA's). On the ARF, the fields for MSA code and PMSA code were combined into one field, MSA/PMSA Codes, as were MSA names and PMSA names combined to form MSA/PMSA Names. The Alaska MSA/PMSA is coded as 0380. However, only Anchorage, Alaska is actually contained in the MSA/PMSA. On the ARF, LaPaz county, Arizona is included in Yuma county, Arizona (04027). The Yuma, AZ MSA/PMSA coded as 9360 which includes Yuma county, does not include Lapaz county. On the ARF, Cibola county New Mexico is included in Valencia county, New Mexico (35061). The Albuquerque, NM MSA/PMSA coded as 200 which includes Valencia county, does not include Cibola county. In New England, MSA/PMSA's are defined with the town instead of the county as primary unit. In order to use county figures for New England in the same manner as other parts of the country with respect to MSA/PMSA's, ARF has used the New England Metropolitan State Economic Areas or population of the towns to resolve problems of MSA/PMSA's with partial counties or counties which cross MSA/PMSA's. With this resolution, several MSA/PMSA's have been redefined and several are not present on ARF as follows: 1120 Boston, MA-NH-ME-CT + ____________________________________________________________________ Bristol County, MA (25005) Essex County, MA (25009) Hampden County, MA (25013) - Included in MSA/PMSA 8000 on the ARF Middlesex County, MA (25017) Page 010 Norfolk County, MA (25021) Plymouth County, MA (25023) Suffolk County, MA (25025) Worcester County, MA (25027) Hillsborough County, NH (33011) Merrimack County, NH (33013) Rockingham County, NH (33015) Stafford County, NH (33017) York County, ME (23031) Windham County, CT (09015) - Included in MSA/PMSA 3280 on the ARF 1200 Brockton, MA (Not Present on the ARF) + ____________________________________________________________________ Bristol County (25005) -Included in MSA/PMSA 1120 on the ARF Norfolk County (25021) -Included in MSA/PMSA 1120 on the ARF Plymouth County (25023) -Included in MSA/PMSA 1120 on the ARF 1160 Bridgeport, CT + ____________________________________________________________________ Fairfield County (09001) New Haven County (09009) - Included in MSA/PMSA 5480 on the ARF 1930 Danbury, CT (Not Present on the ARF) + ____________________________________________________________________ Fairfield County (09001) - Included in MSA/PMSA 1160 on the ARF Litchfield County (09005) - Included in MSA/PMSA 8880 on the ARF 5350 Nashua, NH (Not Present on the ARF) + ____________________________________________________________________ Hillsborough County (33011) - Included in MSA/PMSA 1120 on the ARF Rockingham County (33015) - Included in MSA/PMSA 1120 on the ARF 5480 New Haven-Meriden, CT + ____________________________________________________________________ Middlesex County (09007) - Included in MSA/PMSA 3280 on the ARF New Haven County (09009) 3280 Hartford, CT + ____________________________________________________________________ Hartford County (09003) Litchfield County (09005) - Included in MSA/PMSA 8880 on the ARF Middlesex County (09007) New London County (09011) - Included in MSA/PMSA 5520 on the ARF Tolland County (09013) Windham County (09015) Page 011 5520 New London-Norwich, CT-RI + ____________________________________________________________________ Middlesex County, CT (09007) - Included in MSA/PMSA 3280 on the ARF New London County, CT (09011) Windham County, CT (09015) - Included in MSA/PMSA 3280 on the ARF Washington County, RI (44009) - Included in MSA/PMSA 6480 on the ARF 6480 Providence-Fall River-Warwick, RI-MA + ____________________________________________________________________ Bristol County, RI (44001) Kent County, RI (44003) Newport County, RI (44005) Providence County, RI (44007) Washington County, RI (44009) Bristol County, MA (25005) - Included in MSA/PMSA 1120 on the ARF Norfolk County, MA (25025) - Included in MSA/PMSA 1120 on the ARF Worcester County, MA (25027) - Included in MSA/PMSA 1120 on the ARF 6400 Portland, ME + ____________________________________________________________________ Cumberland County (23005) York County (23031) - Included in MSA/PMSA 1120 on the ARF 8040 Stamford-Norwalk, CT (Not Present on the ARF) + ____________________________________________________________________ Fairfield County (09001) - Included in MSA/PMSA 1160 on the ARF 8880 Waterbury, CT + ____________________________________________________________________ Litchfield County (09005) New Haven County (09009) - Included in MSA/PMSA 5480 on the ARF MSA's and PMSA's are categorized by their 1990 population as follows: 1 = Level A = Areas of 1 million or more 2 = Level B = Areas of 250,000 to 999,999 3 = Level C = Areas of 100,000 to 249,999 4 = Level D = Areas of less than 100,000 Page 012 SMSA Code and Name: This code, established by the National Bureau of Standards, U.S. Department of Commerce, was first issued in 1949 as Standard Metropolitan Areas. The Standard Metro- politan Statistical Area (SMSA) codes were posted from the Federal Information Processing Standards (FIPS) Publication 8-4, June 30, 1974, prepared by the U.S. Department of Commerce, National Bureau of Standards with the exception of the SMSA's as follows: 1) In New England, SMSA's are defined with the town instead of the county as the primary unit. In order to use county figures for New England in the same manner as other parts of the country with respect to SMSA's, ARF has used the New England Metropolitan State Economic Areas instead of SMSA's. Definitions of and codes for these areas follow: 0002 - Lewiston-Auburn, ME + ________________________________________ Androscoggin County (23001) 0004 - New London-Groton-Norwich, CT + ________________________________________ New London County (09011) 1120 - Boston, MA + ________________________________________ Essex County (25009) Middlesex County (25017) Norfolk County (25021) Suffolk County (25025) 1160 - Bridgeport, CT + ________________________________________ Fairfield County (09001) 1200 - Brockton, MA + ________________________________________ Plymouth County (25023) 2480 - Fall River-New Bedford, MA + ________________________________________ Bristol County (25005) 3280 - Hartford, CT + ________________________________________ Hartford County (09003) 4760 - Manchester, NH + ________________________________________ Hillsborough County (33011) 5480 - New Haven-West Haven, CT + ________________________________________ New Haven County (09009) Page 013 6320 - Pittsfield, MA + ________________________________________ Berkshire County (25003) 6400 - Portland, ME + ________________________________________ Cumberland County (23005) 6480 - Providence-Warwick-Pawtucket, RI-MA + ________________________________________ Bristol County (44001) Kent County (44003) Providence County (44007) 8000 - Springfield-Chicopee-Holyoke, MA-CT + ________________________________________ Hampden County (25013) Hampshire County (25015) 9240 - Worcester, MA + ________________________________________ Worcester County (25027) 2) Georgia SMSA with exception is: 1800 - Columbus, GA-AL + ________________________________________ Muscogee County (13215) still included because it contains Columbus, GA. 3) Virginia SMSA with exception is: 6140 - Petersburg-Colonial Heights-Hopewell, VA + ________________________________________ Colonial Heights City (51570) excluded; it is part of Chesterfield County (51041), which is in another SMSA. The updated 1975 SMSA Codes are from the Office of Management and Budget (OMB) Revised Circular A-46. The 1979 SMSA Codes are from the Federal Information Processing Standards (FIPS) Publication 8-4, June 30, 1974 and from Change Notices 6, 7 and 8, dated December 11, 1978, May 4, 1979 and November 23, 1979 respectively. The updates include new designations, redefinitions and changes of titles. The 1980 SMSA Codes and Names are from the Federal Information Processing Standards (FIPS) Publication 8-4, June 30, 1974 Change Notice 9, dated August 1, 1981. The SMSA Names have been abbreviated so as not to exceed 35 characters. Page 014 Rural/Urban Continuum Code: The 1988 Rural/Urban Continuum Codes are from "Rural-Urban Continuum Codes for Metro and Nonmetro Counties", Department of Agriculture. The codes form a classification scheme that distinguishes metropolitan counties by size and nonmetropolitan counties by degree of urbanization or proximity to metropolitan areas. All U.S. counties and county equivalents are grouped according to the official metropolitan status announced by the Office of Management and Budget in June 1983, when the current population and commuting criteria were first applied to results of the 1980 Census of Population. The classification scheme was originally developed in 1975, updated in 1983, and slightly revised in 1988. NAME DESCRIPTION CODE Metropolitan Counties Large Metropolitan: Core Counties Core counties of greater SMSA's 00 of 1,000,000 or more population Fringe Counties Noncore counties of metropolitan areas 01 of 1,000,000 or more population Medium Metropolitan Counties of metropolitan areas of 02 250,000 to 999,999 population Lesser Metropolitan Counties of metropolitan areas of 03 less than 250,000 Nonmetropolitan Counties Urbanized: Adjacent to SMSA Counties contiguous to SMSA and having 04 20,000 or more urban residents Not Adjacent to SMSA Counties not contiguous to SMSA which 05 have 20,000 or more urban residents Less Urbanized: Adjacent to SMSA Counties contiguous to SMSA with 06 less than 20,000 but greater or equal to 2,500 urban residents Not Adjacent to SMSA Counties not contiguous to SMSA and 07 having less than 20,000 but not less than 2,500 urban residents Thinly Populated: Adjacent to SMSA Counties having less than 2,500 urban 08 residents, contiguous to SMSA Page 015 Not Adjacent to SMSA Counties having less than 2,500 urban 09 residents, not contiguous to SMSA Missing Value 99 **NOTE: Adjacent = Counties physically adjacent to one or more MSA's and having at least 2 percent of the employed labor force in the nonmetropolitan county commuting to central metropolitan counties. AMA County Group Code: These codes were obtained from "Physician Distribution and Medical Licensure in the U.S.", Center for Health Services Research and Development, published by the American Medical Association (AMA). The AMA has provided the codes for the following years in the indicated publication(s): YEAR OF CODE AMA PUBLICATION + ____________ _______________ 78 1978 75 1976 and 1977 73 1974 and 1975 72 1973 71 1972 These codes consist of nine classifications based on Sales & Marketing Management's population estimates and SMSA definitions. They were developed by AMA's Department of Survey Research. The former "County Group Classification" of five groups was revised in 1967 to include nine categories, and was renamed the "Demographic County Classification". DEMOGRAPHIC COUNTY CLASSIFICATION DEFINITION 1 Non-Metropolitan Counties with 0 to 9,999 Inhabitants 2 Non-Metropolitan Counties with 10,000 to 24,999 Inhabitants 3 Non-Metropolitan Counties with 25,000 to 49,999 Inhabitants 4 Non-Metropolitan Counties with 50,000 or more Inhabitants 5 Counties Considered Potential SMSA's 6 Counties in SMSA's with 50,000 to 499,999 Inhabitants 7 Counties in SMSA's with 500,000 to 999,999 Inhabitants 8 Counties in SMSA's with 1,000,000 to 4,999,999 Inhabitants 9 Counties in SMSA's with 5,000,000 or more Inhabitants The Standard Metropolitan Statistical Areas which are utilized in Classifications 6 through 9 are Sales & Marketing Management's SMSA definitions of the metropolitan area concept established by the United States Bureau of the Budget. Sales & Marketing Management and the Bureau of the Budget use identical SMSA definitions except for a few instances in New England where the former uses the county unit rather than the township as the geographical boundary. Page 016 Demographic County Classification 5 contains "Potential SMSA's" which, as defined by Sales & Marketing Management, are considered future candidates for SMSA status. Demographic County Classifications 1 through 4 are non-metropolitan areas. **NOTE: 1) Data for 1975 were not reported for the following county: 30113 - Yellowstone Park, Montana 2) Data for 1978, 1973, and 1971 were not reported for the following counties: 02001 - Alaska 30113 - Yellowstone Park, Montana Census County Group Code: The Census County Group Codes are groups of counties smaller than a state, but larger than a county, which are geographically adjacent and have similar characteristics. There are 410 County Group Codes. These codes were extracted from the 1970 County Group Reference File obtained from the Bureau of the Census. **NOTE: 1) Data are not available for: 06039 - Madera, California 2) Norfolk, Virginia (51129) was coded as '02002', which is the Census County Group Code for Norfolk City, because it represents the greater population of the two independent cities comprising this county. A-4) Economic Area Codes BEA Economic Area Code and Name: The BEA Economic Area Code is delineated by the Bureau of Economic Analysis, U.S. Department of Commerce, revised 1977. BEA Economic Areas, originally called OBE Economic Areas, were first delineated in 1969 by the Regional Economics Division, Office of Business Economics, U.S. Department of Commerce. The areas are named for the largest SMSA or, where there is no SMSA, for the largest city. The 1977 delineation resulted in 183 areas and was based primarily on three sets of data: (1) Journey-to-work data from the 1970 Census of Population; (2) Newspaper circulation data for 1972; and (3) 1975 county commuting data developed from Social Security Administration and Internal Revenue Service records. The BEA names have been abbreviated so as not to exceed 35 characters. Page 017 A-5) Federal Region Code and Census Region and Division Codes and Names These are the codes for the ten Federal Regional Offices from the Department of Health and Human Services. The Federal Region Codes, Regional Office names and the states within each region are as follows: 01 = Boston R.O. (Maine, Vermont, Mass., Conn., R.I., N.H.) 02 = New York R.O. (N.Y., N.J., Puerto Rico, Virgin Islands) 03 = Philadelphia R.O. (Penn., Del., D.C., Maryland, Va., W. Va.) 04 = Atlanta R.O. (Ala., Fla., Georgia, Ky., Miss., N.C., S.C., Tenn.) 05 = Chicago R.O. (Ill., Indiana, Minn., Michigan, Ohio, Wisconsin) 06 = Dallas R.O. (Arkansas, N.M., Oklahoma, Texas, Louisiana) 07 = Kansas City R.O. (Iowa, Kansas, Missouri, Nebraska) 08 = Denver R.O. (Colo., Montana, N.D., S.D., Utah, Wyoming) 09 = San Francisco R.O. (Ariz., Calif., Hawaii, Nev., Trust Territories) 10 = Seattle R.O. (Alaska, Idaho, Oregon, Washington) The Census Region Codes and Names and Census Division Codes and Names were taken from the HSA ACCESS System. The codes and names are as follows: ACCESS SYSTEM CODES NAME STATES INCLUDED Region Division 1 Northeast 1 New England Maine, Vermont, Massachusetts, New Hampshire, Connecticut, Rhode Island 2 Middle Atlantic New York, New Jersey, Pennsylvania 2 Midwest 3 East North Central Ohio, Michigan, Indiana, Illinois, Wisconsin 4 West North Central Minnesota, Iowa, Missouri, Kansas, Nebraska, South Dakota, North Dakota 3 South 5 South Atlantic Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida 6 East South Central Kentucky, Tennessee, Mississippi, Alabama Page 018 ACCESS SYSTEM CODES NAME STATES INCLUDED Region Division 7 West South Central Arkansas, Louisiana, Texas, Oklahoma 4 West 8 Mountain Montana, Wyoming, Colorado, New Mexico, Arizona, Utah, Idaho, Nevada 9 Pacific Washington, Oregon, California, Alaska, Hawaii A-6) Health Service Area (HSA) Codes and Name has assigned a six-digit code to the 205 Health Service Areas (HSA's) designated by the Secretary of DHHS. The areas were delineated in response to the National Health Planning and Resources Development Act of 1974 (P.L.93-641). (The states of D.C., Hawaii, and Rhode Island are not included since they have claimed exemption from designating areas under Section 1536 of the Act. Final determinations on those actions are pending.) Of the 205 HSA's, 190 are entirely within state boundaries. The remaining fifteen are interstate areas. Twelve states have been designated as single statewide areas. Only 199 of the 205 designated HSA's have been included on ARF. The six-digit HSA Code is defined as follows: STX0NN Where -- + ______ ST = FIPS State Code **NOTE: A State Code of '99' has been assigned to interstate areas for sorting purposes. X = Type of Area: A = Regular State Area or Single State Area E = Exempted State Area I = Interstate Area NN = Area Number, 1 through 15 Page 019 A four-character HSA Code required by the ACCESS System has been added. This code is defined as STNN, where: ST = the two-character standard FIPS alphabetic abbreviation **NOTE: An abbreviation of 'IS' has been assigned to interstate areas. NN = Area Number, 1 through 15 a) The following states have claimed exemptions from designating HSA's: 6-DIGIT 4-CHARACTER EXEMPTED STATES HSA CODE HSA CODE + _______________ ________ ________ Dist. of Columbia 11E001 DC01 Hawaii 15E002 HA02 Rhode Island 44E003 RI03 b) There are twelve single-state HSA's: Delaware, Idaho, Maine, Mississippi, Montana, New Hampshire, Oklahoma, South Dakota, Vermont, West Virginia, Wyoming, and Puerto Rico (Puerto Rico is not included in this tabulation.) c) There are fifteen interstate HSA's defined as follows: INTERSTATE AREAS SAME AS THESE OVERLAP AREAS + ________________ ___________________________ 99I001 (IS01) Arizona A004 **NOTE: This Tri-State HSA en- Utah A002 compasses the Navajo New Mexico A002 Reservation and is not defined on the file since it does not follow county lines and contains only small parts of counties. 99I002 (IS02) Georgia A001 Tennessee A003 99I003 (IS03) Georgia A004 South Carolina A005 99I004 (IS04) Georgia A005 Alabama A007 Page 020 99I005 (IS05) Iowa A001 Nebraska A004 99I006 (IS06) Iowa A002 Nebraska A003 99I007 (IS07) Iowa A003 Illinois A010 99I008 (IS08) Kentucky A003 Ohio A001 99I009 (IS09) Minnesota A001 North Dakota A002 99I010 (IS10) Minnesota A002 Wisconsin A007 99I011 (IS11) Minnesota A003 North Dakota A003 99I012 (IS12) Missouri A001 Kansas A004 99I013 (IS13) Missouri A003 Illinois A011 99I014 (IS14) New York A004 Pennsylvania A008 99I015 (IS15) Tennessee A001 Virginia A006 d) Because the HSA covers only part of the county, the following areas are defined as follows: STATE AREA COUNTIES INCLUDED + _____________ ______ ___________________ Arizona A001 Gila (FIPS Code 04007) Maricopa (FIPS Code 04013) Pinal (FIPS Code 04021) A002 Cochise (FIPS Code 04003) Graham (FIPS Code 04009) Greenlee (FIPS Code 04011) Pima (FIPS Code 04019) Santa Cruz (FIPS Code 04023) A003 Apache (FIPS Code 04001) Coconino (FIPS Code 04005) Navajo (FIPS Code 04017) Yavapai (FIPS Code 04025) Page 021 A004 **NOTE: This area not defined (Parts of Apache (04001) and Navajo (04017) counties, Arizona are included in Arizona A003) A005 Mohave (FIPS Code 04015) Yuma (FIPS Code 04027) Connecticut A001 Fairfield (FIPS Code 09001) STATE AREA COUNTIES INCLUDED + _____________ ______ ___________________ A002 New Haven (FIPS Code 09009) A003 Middlesex (FIPS Code 09007) New London (FIPS Code 09011) Windham (FIPS Code 09015) A004 Hartford (FIPS Code 09003) Tolland (FIPS Code 09013) A005 Litchfield (FIPS Code 09005) Illinois A006 **NOTE: This area not defined (Chicago included with Cook County (17031) in Illinois A007) A007 Cook (FIPS Code 17031) Dupage (FIPS Code 17043) Massachusetts A001 Berkshire (FIPS Code 25003) Franklin (FIPS Code 25011) Hampden (FIPS Code 25013) Hampshire (FIPS Code 25015) A002 Worchester (FIPS Code 25027) A003 Essex (FIPS Code 25009) Middlesex (FIPS Code 25017) A004 Norfolk (FIPS Code 25021) Suffolk (FIPS Code 25025) A005 Barnstable (FIPS Code 25001) Bristol (FIPS Code 25005) Dukes (FIPS Code 25007) Nantucket (FIPS Code 25019) Plymouth (FIPS Code 25023) Page 022 A006 **NOTE: This area not defined (The part counties of Essex (25009) and Middlesex (25017) are included in Massachusetts A003) New Mexico A001 All Counties in New Mexico A002 **NOTE: This area not defined (Parts of McKinley (35031) and San Juan (35045) are included in New Mexico A001) Utah A001 All Counties in Utah A002 **NOTE: This area not defined (Part of San Juan County (49037) included in Utah A001) e) Independent cities in Virginia were recoded into their appropriate counties, except Alexandria, Chesapeake, Hampton, Newport News and Virginia Beach which are maintained on ARF as county equivalents. f) The state of Alaska was made into a total area (A001) since it is not broken out into counties on the Area Resource File; therefore, areas 02 and 03 in Alaska are not defined. g) There are a total of 202 HSA's on the ARF. This includes the 3 exempted state areas; it excludes Puerto Rico and other areas which are composed of small parts of counties and therefore cannot be defined on the file. h) HSA Names on the ARF are abbreviated to 35 characters or less. "Health Systems Agency" has been abbreviated to "HSA" in all names. A-7) Professional Standards Review Organization (PSRO) Code has assigned a four-digit numerical code to each proposed PSRO area as designated by the Secretary of DHHS. These areas were delineated for the purpose of defining geographical areas over which each PSRO, whose function is to monitor the quality of health care, will have jurisdiction. The PSRO areas presently on ARF are those as listed in the "Federal Register" dated March 18, 1974, with a few exceptions for those PSRO's which are comprised of parts of counties. The current ARF reflects all PSRO updates through July, 1979. **NOTE: 1) Since the county is the base unit on ARF, made exceptions to the PSRO defined for parts of Southern California -- Los Angeles County, CA (06037) is defined as a single PSRO. 2) In Massachusetts, PSRO's are defined by township rather than by county. On ARF, the county has been assigned the PSRO Code corresponding to the townships within the county which have the greatest total population. Page 023 A-8) Mathematica Policy Research Sampling Unit Codes The Mathematica Policy Research (MPR) Sampling Unit IDs and Primary Sampling Unit (PSU) Numbers were added to ARF for each county included in the MPR "Physician Capacity Utilization Telephone Surveys" (1973 and 1974), the "Telephone Resurvey of Physician Capacity Utilization" (1975), and the "1979 Resurvey of Private Practice Physicians" (Sampling Unit ID only). The codes were obtained from the "Report on the Telephone Resurvey of Physician Capacity Utilization", 1975, Volume III, Mathematica Policy Research, and the "Final Report, 1979 Resurvey of Private Practice Physicians," Appendix A, Mathematica Policy Research. The following table summarizes the numbers of PSU's and type of areas surveyed in each of the MPR physician surveys: NUMBERS OF PSU'S INCLUDED IN THE MPR PHYSICIAN SURVEYS, BY YEAR, AND TYPE OF AREA Years Surveyed Type of Sampling Unit 1973 1974 1975 1979 + _________________________________________________________________________________________ Large SMSA's 100 0 100 100 Small SMSA's 0 56 56 56 Nonmetropolitan Areas - Random 0 50 100 100 Nonmetropolitan Areas - Nonrandom 13 2 0 **NOTE: 1) 50 nonmetropolitan PSU's were selected in 1974. These PSU's were resurveyed in 1975 and 1979. An additional 50 nonmetropolitan PSU's were selected and surveyed in 1975, and were resurveyed in 1979. 2) 13 nonrandomly-selected nonmetropolitan areas were surveyed in 1974. Of these areas, two were subsequently surveyed once again, in 1975. Three types of sampling unit ID numbers were added to ARF: FIPS SMSA codes; MPR SMSA codes; and MPR nonmetropolitan area (NMA) codes. MPR's 1973, 1974 and 1975 surveys used both types of SMSA code, as well as the non- metropolitan area codes. The 1979 survey used only FIPS SMSA codes and MPR non- metropolitan area codes. Accordingly, five types of Sample and PSU Numbers were identified and added to ARF. These are: 1) FIPS SMSA code for counties in metropolitan PSU's or MPR NMA code for counties in nonmetropolitan PSU's in the 1973 or 1974 Surveys (1973-74 Mathematica Sample Unit ID-First Year). Page 024 2) MPR SMSA code for counties in metropolitan PSU's or MPR NMA code for counties in nonmetropolitan PSU's in the 1973 or 1974 Surveys (1973-74 Mathematica PSU Number-First Year). For a nonmetropolitan county, the NMA code will be the same in fields 1 and 2. 3) FIPS SMSA code for counties in metropolitan PSU's or MPR NMA code for counties in nonmetropolitan PSU's in the 1975 Resurvey (1975 Mathematica Sample Unit ID-Second Year). 4) MPR SMSA code for counties in metropolitan PSU's or MPR NMA code for counties in nonmetropolitan PSU's in the 1975 Resurvey (1975 Mathematica PSU Number-Second Year). For a nonmetropolitan county, the NMA code will be the same in fields 3 and 4. 5) FIPS SMSA code for counties in metropolitan PSU's or MPR NMA code for counties in nonmetropolitan PSU's in the 1979 Resurvey (1979 Mathematica Sample Unit ID-Third Year). Each of the five fields is 7 characters long and has the following format: Positions 1-4: Sample or PSU Number (as defined above) Position 5: 'L' for Large Metropolitan area; 'S' for Small Metropolitan area; or 'N' for Nonmetropolitan area. Positions 6-7: Year of the survey - '73', '74', '75' or '79'. Counties which were not surveyed in one year have the fields for that year zero- filled. Counties that were never surveyed in the MPR studies have the fields for all years zero-filled. Note that the Sample Unit ID numbers change for some areas from the first to the second survey year because of changes in SMSA definitions. For New England, the following decisions were made: When a New England county was partially coded into several SMSA's, that SMSA which agrees with ARF's SMSA definition for the county was chosen for the Mathematica Sample Unit ID; the corresponding Mathematica PSU Number was coded. **NOTE: 1) PSU's 902 and 909 were excluded from the 1979 survey. 2) Nine counties contained in the 100 nonmetropolitan PSU's surveyed in both 1975 and 1979 have been redefined as metropolitian PSU's since 1975. A definition change also took place in Washington, D.C. SMSA (PSU# 8840) to include the independent cities of Manassas and Manassas Park, Virginia. 3) New London County, CT (FIPS Code 09011) was given the Mathematica Sample Unit ID 3280 and the PSU No. 0333. 4) When linking the Public Use Files and the Area Means File to ARF, data for the Mathematica Sample Unit ID 2600 must be recoded into 9240; 4160 must be recoded into 1120. The corresponding PSU No. 0263 must be recoded into 0891; and 0421 recoded into 0120. Page 025 A-9) Medicare Prevailing Charges Locality Codes The Medicare Prevailing Charges Locality Codes consist of Region, State, Carrier and Locality Codes. For 1984, the codes were obtained from the Health Care Financing Administration (HCFA) Prevailing Charges Tape. The 1978 Codes, consisting of the 1978 Region, 1978 State, 1978 Carrier, and 1978 Locality Codes, were obtained from the Enhanced Medicare File. The Medicare Prevailing Charges Locality Codes have the following format: Region - the two-digit numeric Federal Region Office Code for the locality. (See A-5 for definition.) State - a two-digit numeric code, different from the FIPS State Codes, which identifies the state of the carrier serving the locality. Carrier - the insurance company handling Medicare claims for a locality. Locality - a two-digit code representing an area served by the carrier; this number ranges from 01 to "n", where "n" is the number of localities for that particular carrier. For the purpose of making reasonable charge determinations, a locality is identified as a geographic area for which a carrier derives the prevailing charges for services. Usually, a locality is a political or economic subdivision of a State which should include a cross-section of the population with respect to economic and other characteristics. Most Medicare Prevailing Charges Localities follow county boundaries and encompass one or more counties. There are some states, however, where Medicare has broken out a metropolitan area and assigned it a different Locality Code from the county or counties containing that city or metropolitan area. These states and other exceptions are listed in the notes below. **NOTE: 1) For 1984, the following exceptions were made: a) Arizona (FIPS State Code 04), Mississippi (28), Missouri (29), Nevada (32), New Mexico (35), New York (36), North Carolina (37), Oklahoma (40), Oregon (41), and Washington (53): Counties containing cities which are broken out have been coded into the locality for that city. b) Los Angeles County, California (FIPS Code 06037) contains eight localities. The eight localities are all handled by the same carrier. On ARF the first locality, locality 18, is indicated as the Los Angeles locality. See Section E-4 for a discussion of the procedure used in determining the prevailing charges for Los Angeles. c) The Connecticut (FIPS State Code 09) localities cross county boundaries. On ARF the counties have been coded into the following localities: 001 - Fairfield - locality 02 - Southwest 003 - Hartford - locality 01 - Northwest and North Central 005 - Litchfield - locality 01 - Northwest and North Central 007 - Middlesex - locality 04 - Northeast and Southeast Page 026 009 - New Haven - locality 03 - South Central 011 - New London - locality 04 - Northeast and Southeast 013 - Tolland - locality 01 - Northwest and North Central 015 - Windham - locality 04 - Northeast and Southeast d) Iowa: Cedar (FIPS Code 19031), Johnson (FIPS Code 19102), and Muscatine (FIPS Code 19139) counties are coded into the Iowa City locality. e) Kentucky: Fayette (FIPS Code 21067) and Jefferson (FIPS Code 21111) counties are coded into the "Metropolitan" locality; the 42 counties containing "urban" cities are coded into the "Urban" locality. All other counties are coded into the "Rural" locality. e) Massachusetts (FIPS State Code 25) counties have been coded into the localities which correspond to the ARF SMSA definitions, as follows: 001 - Barnstable - locality 02 - Rural 003 - Berkshire - locality 01 - Pittsfield SMSA 005 - Bristol - locality 02 - Fall River, MA-RI SMSA 007 - Dukes - locality 02 - Rural 009 - Essex - locality 01 - Boston SMSA 011 - Franklin - locality 02 - Rural 013 - Hampden - locality 01 - Springfield-Chicopee-Holyoke, MA-CT SMSA 015 - Hampshire - locality 01 - Springfield-Chicopee-Holyoke, MA-CT SMSA 017 - Middlesex - locality 01 - Boston SMSA 019 - Nantucket - locality 02 - Rural 021 - Norfolk - locality 01 - Boston SMSA 023 - Plymouth - locality 01 - Brockton SMSA 025 - Suffolk - locality 01 - Boston SMSA 027 - Worcester - locality 01 - Worcester SMSA g) The Pennsylvania (FIPS State Code 42) localities cross county boundaries. In all such cases on ARF, the county is assigned to the most urban of the localities in which it is contained. h) The Prevailing Charges State Code for Illinois (FIPS State Code 17) was incorrectly coded as 11 in the source data. This code was changed to 12 on the ARF. i) The Prevailing Charges State Code for Alaska (FIPS State Code 02) was incorrectly coded as 51 in the source data. This code was changed to 50 on the ARF. 2) For 1978 the following exceptions were made: a) Arizona (FIPS State Code 04), Mississippi (28), Missouri (29), Nevada (32), New Mexico (35), New York (36), North Carolina (37), Oklahoma (40), and Oregon (41): Counties containing cities which are broken out have been coded into the locality for that city. b) Los Angeles County, California (FIPS Code 06037) contains eight localities. The eight localities are all handled by the same carrier. On ARF the first locality, locality 18, is indicated as the Los Angeles locality. See Section E-4 for a discussion of the procedure used in determining the prevailing charges for Los Angeles. Page 027 c) Iowa: Cedar (FIPS Code 19031), Johnson (FIPS Code 19102), and Muscatine (FIPS Code 19139) counties are coded into the Iowa City locality. d) Kentucky: Fayette (FIPS Code 21067) and Jefferson (FIPS Code 21111) counties are coded into the "Metropolitan" locality; the 42 counties containing "urban" cities are coded into the "Urban" locality. All other counties are coded into the "Rural" locality. e) Massachusetts (FIPS State Code 25) counties have been coded into the localities which correspond to the ARF SMSA definitions, as follows: 001 - Barnstable - locality 02 - Rural 003 - Berkshire - locality 01 - Pittsfield SMSA 005 - Bristol - locality 02 - Fall River, MA-RI SMSA 007 - Dukes - locality 02 - Rural 009 - Essex - locality 01 - Boston SMSA 011 - Franklin - locality 02 - Rural 013 - Hampden - locality 01 - Springfield-Chicopee-Holyoke, MA-CT SMSA 015 - Hampshire - locality 01 - Springfield-Chicopee-Holyoke, MA-CT SMSA 017 - Middlesex - locality 01 - Boston SMSA 019 - Nantucket - locality 02 - Rural 021 - Norfolk - locality 01 - Boston SMSA 023 - Plymouth - locality 01 - Brockton SMSA 025 - Suffolk - locality 01 - Boston SMSA 027 - Worcester - locality 01 - Worcester SMSA f) Pennsylvania: Part of Pittsburgh (in Allegheny County - 42003), and part of Philadelphia (in Philadelphia County - 42101) are assigned the locality "Areas of Medical Schools/Speciality Hospitals"; Allegheny and Philadelphia counties have been coded to this locality. g) In Texas, the "Statewide" locality (260) is not used. A-10) Veterans Administration Codes 1988 and 1978 Veterans Administration (VA) Codes were obtained from the Veterans Administration. The codes include VA Primary Service Area Code, VA Medical District Code, and VA Medical Region Code. The VA Medical Region Code is defined as follows: 1 = North-Eastern 2 = Mid-Atlantic 3 = South-Eastern 4 = Great Lakes 5 = Mid-Western 6 = Western 7 = South-Western Page 028 **NOTE: The independent cities have been recoded in their county of origin. As a result, the following Virginia independent cities have been affected for Primary Service Area Code and Medical District Code: FIPS VA SOURCE CODE ARF CODE + ____ ______________ _______ _ Primary Service Area Code 51590 558 658 51640 658 621 51678 652 658 51780 558 652 Medical District Code 51590 08 07 51640 07 08 51780 08 07 The Veteran Population as of 3/31/90 and 3/31/78 is also carried on the file; refer to Section F-27 below. A-11) Contiguous Counties Contiguous Counties were taken from the United States Department of Commerce, Bureau of the Census, Map of Boundaries of Counties and County Equivalents as of January 1, 1970, U.S. Government Printing Office, 1971, Stock Number 0-424-798. These fourteen fields contain, for a given county, the Modified FIPS State and County Codes for all counties contiguous to that county. There can be a maximum of fourteen counties contiguous to a given county. Unused fields are zero-filled. Thus, if a county has three counties contiguous to it, the fields for Contiguous Counties # 4-14 will be zero-filled. Alaska is treated as one county and is not considered contiguous to any other state or county. Counties are considered contiguous by water rights to other counties when they both border the same body of water. Islands and peninsulas are considered contiguous to neighboring counties by either water rights or accessibility. The following Hawaiian counties are considered contiguous by water rights: COUNTY CONTIGUOUS TO: + ______ ______________ 15001 Hawaii 15009 Maui 15003 Honolulu 15007 Kauai 15009 Maui 15007 Kauai 15003 Honolulu 15009 Maui 15001 Hawaii 15003 Honolulu Page 029 The following New York City counties are considered contiguous even though some are separated by water: COUNTY CONTIGUOUS TO: + ______ ______________ 36005 Bronx, N.Y. 34003 Bergen, N.J. 36061 New York, N.Y. 36081 Queens, N.Y. 36119 Westchester, N.Y. COUNTY CONTIGUOUS TO: + ______ ______________ 36047 Kings, N.Y. 36061 New York, N.Y. 36081 Queens, N.Y. 36085 Richmond, N.Y. 36061 New York, N.Y. 36005 Bronx, N.Y. 36047 Kings, N.Y. 36081 Queens, N.Y. 36085 Richmond, N.Y. 36081 Queens, N.Y. 36005 Bronx, N.Y. 36047 Kings, N.Y. 36059 Nassau, N.Y. 36061 New York, N.Y. 36085 Richmond, N.Y. 34013 Essex, N.J. 34017 Hudson, N.J. 34023 Middlesex, N.J. 34039 Union, N.J. 36047 Kings, N.Y. 36061 New York, N.Y. Virginia Independent Cities: Virginia independent cities are included as part of their former counties when considering the counties to which the former counties are contiguous (e.g., the independent city of Richmond is considered within the boundaries of Henrico County, VA - 51087 - when determining the counties that are contiguous to Henrico County). However, the Virginia independent cities of Alexandria, Chesapeake, Hampton, Newport News and Virginia Beach are treated as county equivalents on ARF, and their surrounding (i.e., former) counties are considered contiguous to them. Page 030 A-12) Health Care Service Area and Health Care Community Area (HCCA) Codes Health Care Service Area Code: Health Care Service Area Codes were obtained from the National Center for Health Statistics. The specific source reference is "Vital and Health Statistics - Health Service Areas for the United States", Makuc DM, Haglund B, Ingram DD, Kleinman JC, Feldman JJ, November 1991. A health service area is defined as one or more counties that are relatively self-contained with respect to the provision of routine hospital care. Service areas that include more than one county are characterized by travel between the counties for routine hospital care. Health Care Community Area (HCCA) Code: Health Care Community Areas are county groups based on 1968 national natality data, 1969 national mortality data, and 1970 Census data on the journey to work. An algorithm which minimized travel between areas for employment and for health care services at birth and death, was used to determine the county groups. Eight different sets of weights were assigned to the natality, mortality and employment data; the codes added to ARF assign relatively more weight to the natality data and less to mortality and employment. The codes were developed under contract to in an "Evaluation of Alternative Health Area Definition Methods" study. A-13) Area Health Education Center (AHEC) Code and Name Area Health Education Centers (AHEC's) are independent, non-profit organizations which link the academic resources of university health care centers with community-based health service delivery systems in medically underserved areas. Primarily funded by cooperative agreements awarded by the Bureau of Health Professions/HRSA under section 781 of the Public Health Service Act, AHEC's determine the manpower and resource needs of scarity areas, and coordinate the activities of health profession students who are provided by cooperating medical and osteopathic schools and universities. (These students serve 10% of their clinical training at AHEC sites in underserved areas, thereby redistributing health personnel to areas of need and increasing the services provided to the community.) The individual activities and programs administered by the regional AHEC projects are determined by the needs and problems of the localities they serve. The 1985 Area Health Education Center fields were defined from a list of AHEC's developed by the Division of Medicine, Bureau of Health Professions. The codes are four digits; the first two digits are the FIPS State Code, the second two digits indicate the number of the center within the state. If there is only one center in the state, the number is zero. The AHEC Year of Initiation Code is the calendar year date indicating the year of creation of the AHEC. Each AHEC services a group of counties or county equivalents. The following exceptions were made to the list developed by the Division of Medicine: 2504 - Greater Lowell______________ Essex County, Massachusetts (25009)* Middlesex County, Massachusetts (25017)* 2505 - Boston______ Suffolk County, Massachusetts (25025) Page 031 2902 - Urban Kansas City Area______________________ Clay County, Missouri (29047) Jackson County, Missouri (29095) Platte County, Missouri (29165) 2903 - West Central Region___________________ Bates County, Missouri (29013) Benton County, Missouri (29015) Cass County, Missouri (29037) Cedar County, Missouri (29039) Henry County, Missouri (29083) Hickory County, Missouri (29085) Johnson County, Missouri (29101) LaFayette County, Missouri (29107) Pettis County, Missouri (29159) Ray County, Missouri (29177) St. Clair County, Missouri (29185) Vernon County, Missouri (29217) **NOTE: Portions of Clay County, Missouri (29047), Jackson County, Missouri (29095) and Platte County, Missouri (29165) are served by the West Central Region; however, these counties have been included in the Urban Kansas City Area which also serves parts of the counties. 3501 - New Mexico__________ This AHEC serves the Navajo Nation which includes portions of the following counties: Apache County, Arizona (04001)* Navajo County, Arizona (04017)* McKinley County, New Mexico (35031)* San Juan County, New Mexico (35045)* San Juan County, Utah (49037)* These counties on ARF indicate that they are served by the AHEC. **NOTE: San Juan County Utah is served by an AHEC that crosses state boundaries although it's code is 3501 it is the sole AHEC in Utah. 5101 - Western Tidewater_________________ Accomack, Virginia (51001) Chesapeake City, Virginia (51550) Isle of Wight, Virginia (51093) Nansemond, Virginia (51123) Northampton, Virginia (51131) Southampton, Virginia (51175) 5103 - Norfolk_______ Norfolk, Virginia (51129)* **NOTE: Norfolk City, Virginia (51710) is combined with Portsmouth City on ARF to form Norfolk County (51129). Only Norfolk City is served by the Norfolk AHEC. * Only portions of these counties are served by the AHEC. On ARF, the county record indicates that it is served by the AHEC. Page 032 B. HEALTH PROFESSIONS B-1) Physicians M.D. Physicians: The 1979, 1983, 1985, 1986, 1988-1990 and 1992 AMA Non-Federal M.D. Specialty data were obtained from the respective year's American Medical Association Physician Masterfile. The totals contained on the file are for Total Non-Federal M.D.'s and are broken out by Specialty and Major Professional Activity for 1985, 1990 and 1992. Total and Inactive M.D.'s by Sex and M.D.'s by Specialty and Age are for 1985, 1989 and 1992. M.D.'s by County/State of Graduation are for 1985 and 1992. The reporting period for data through 1986 is as of December 31 of the respective year; 1988 and later is as of January 1 of the respective year. **NOTE: 1) In 1985 Nuclear Medicine became a subspecialty of Radiology, and Emergency Medicine became a subspecialty of Other Specialties. To compare historical data with 1985 and later data, the subspecialty data should be added back into their respective major specialties. 2) In 1986, Internal Medicine was broken into General Internal Medicine and Internal Medicine subspecialties. The following subspecialties are included in Internal Medicine subspecialties: Diabetes Endocrinology Geriatrics Hematology Infectious Diseases Nephrology Nutrition Medical Oncology Rheumatology Note that in 1990, Allergy and Immunology was reported separately; therefore, this subspecialty data will not be comparable with prior years. In 1992, the following were added to Internal Medicine subspecialties: Internal Medicine, Cardiac Electrophysiology Internal Medicine, Diagnostic Laboratory Immunology 3) The specialty Therapeutic Radiology was changed to Radiation Oncology in the 1986 and later data. The data are the same. 4) In the 1986 and later data, the category of Clinical Fellows was added to the Hospital Based Practice group, which now comprises Residents, Clinical Fellows, and Full-Time Physician Staff in hospitals. Previously, Clinical Fellows were included in the Research category. As a result of this change, there are fewer physicians in Research and a larger number in Total Patient Care for 1986 and later compared to earlier years. 5) Primary Care is defined as Office-Based MDs for General Practice, Family Practice, General Internal Medicine and General Pediatrics. This definition is different than past years, therefore it will not be comparable with prior years. In the 1989 data, Primary Care included General Practice, Family Practice, General Internal Medicine and Pediatrics (includes Pediatric Subspecialties) for Office-Based MD's. The 1975, 1979, 1983 and 1985 Primary Care data included Office-Based MD's for General Practice, Family Practice, Internal Medicine, Pediatrics and Obstetrics and Gynecology. Page 033 6) In 1990, Pediatrics was broken into General Pediatrics and Pediatrics Subspecialties. The following are included in Pediatrics Subspecialties: Adolescent Medicine Neonatal-Perinatal Medicine Pediatric Allergy Pediatrics, Endocrinology Pediatrics Pulmonology Pediatric Hematology-Oncology Pediatrics, Nephrology In 1992, the following were added to Pediatric Subspecialties: Pediatric Critical Care Pediatric Emergency Medicine Pediatric Gastroenterology Pediatric/Diagnostic Laboratory Immunology 7) In 1990, Obstetrics and Gynecology was broken into Obstetrics and Gynecology; and Obstetrics and Gynecology subspecialties. The following are included in Obstetrics and Gynecology subspecialties: Gynecology Gynecological Oncology Maternal and Fetal Medicine Obstetrics Reproductive Endocrinology In 1992, the following was added to Obstetrics and Gynecology Subspecialties: Obstetrics and Gynecology, Critical Care Medicine The 1990 and 1992 AMA Federal M.D. Specialty data were obtained from the 1990 and 1992 American Medical Association Physician Masterfiles. The totals contained on the file are for Total Federal M.D.'s and are broken out by Specialty and Major Professional Activity. **Note: 1) In 1990, Obstetrics and Gynecology was broken into Obstetrics and Gynecology; and Obstetrics and Gynecology subspecialties. The following are included in Obstetrics and Gynecology subspecialties: Gynecology Gynecological Oncology Maternal and Fetal Medicine Obstetrics Reproductive Endocrinology In 1992, the following was added to Obstetrics and Gynecology Subspecialties: Obstetrics and Gynecology, Critical Care Medicine 2) The following subspecialties are included in Other Medical Subspecialties: Allergy and Immunology Cardiovascular Disease Dermatology Gastroenterology Pediatric Subspecialties Pediatric Cardiology Pulmonary Disease Internal Medicine Subspecialties Page 034 3) The following subspecialties are included in Other Surgical Subspecialties: Colon & Rectal Surgery Neurological Surgery Opthalmology Orthopedic Surgery Otolaryngology Plastic Surgery Thoracic Surgery Urological Surgery 4) The following subspecialties are included in Other Other Subspecialties: Aerospace Medicine Anesthesiology Child Psychiatry Diagnoltic Radiology Emergency Medicine Forensic Pathology General Preventive Medicine Neurology Nuclear Medicine Occupational Medicine Public Health Physical health Physical Medicine & Rehabilitation Pathology, Anatomic/Clinical Radiology Radiation Oncology Other Specialty Unspecified 1968-1983, 1985 and 1986 Non-Federal M.D.'s were obtained from "Physician Characteristics and Distribution in the U.S.", published by the Center for Health Services Research and Development of the American Medical Association in each respective year. The 1975 AMA M.D. data were obtained from the Physician Specialty File which is the result of processing the 1975 AMA Biographic Data Tapes. Estimates for 1940, 1950, and 1960 Total Active Non-Federal M.D.'s come from AMA punch cards. AMA estimates have been used rather than Census estimates because Census estimates occasionally included interns and residents as well as chiropractors, dentists, and veterinarians in the physician counts when enumerators failed to properly differentiate the response of "doctor". 1960 data for Alaska (02001), and New York City Counties (FIPS 36005 Bronx, 36047 Kings, 36061 New York, 36081 Queens, 36085 Richmond) are taken from the Health Manpower Source Book, Section 10, DHHS, Public Health Service Pub. No. 263. **NOTE: 1) 1940 and 1950 M.D.'s are not available for Alaska (02001), Weston County, Wyoming (56045), or any of the Hawaii counties (Hawaii (15001), Honolulu (15003), Kauai (15007), Maui (15009)). Page 035 2) 1960 data for Alaska, Hawaii, and the New York City counties of Bronx, Kings, New York, Queens, and Richmond are as of the middle of the calendar year 1959. 3) 1960 data for the state of Hawaii are not broken out by county; they are all contained in Honolulu (FIPS 15003); the other Hawaii counties (FIPS 15001 Hawaii, 15007 Kauai, 15009 Maui) are zero-filled. 4) The 1960 data for Bronx, N.Y. (FIPS 36005) are included in New York County (FIPS 36061); Bronx, N.Y. is zero-filled. 5) 1960 M.D.'s in Alaska and Hawaii include all Non-Federal M.D.'s. Active Non-Federal M.D.'s are not available for these states for 1960. 6) 1960 M.D.'s are not available for Weston County, Wyoming (FIPS 56045). 7) Total Active Non-Federal M.D.'s for St Louis City (FIPS 29191) for 1960 are from "Health Manpower Source Book, Section 10, Physicians' Age, Type of Practice, and Location", DHEW, Public Health Service, Table A, 1959. 8) 1940, 1950 and 1960 data for the independent cities of Hampton and Newport News, Virginia are included in York County (51199). Hampton (51650) and Newport News (51700) are zero-filled for these fields. 9) 1940, 1950 and 1960 data for the independent city of Galax, Virginia are included in Carroll County (51035), rather than Grayson County (51077). 10) 1940, 1950 and 1960 data for Charles City County, Virginia (51036) are not reported. 11) Data could not be obtained to break out 1940, 1950 and 1960 Total Active Non-Federal M.D.'s for the Virginia independent cities of Alexandria, Chesapeake and Virginia Beach from their former counties. M.D. and D.O. Physicians: The field 1980 M.D. and D.O. Physicians was obtained from the 1980 Census of Population and Housing: Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupa- tion. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia Page 036 D.O. Physicians: The 1989 D.O. data are from the American Osteopathic Association. These data include Total Active D.O.'s, and D.O.'s by Specialty and Sex for Federal and Non-Federal. In 1989, there were no D.O.'s reported for 1387 counties. The 1987 D.O. data are from the 1987 American Osteopathic Microdata Tape. These data include Total Active Federal and Non-Federal D.O.'s, Total Active Federal D.O.'s, and Total Active Non-Federal D.O.'s. In 1987, there were no D.O.'s reported for 1417 counties. Data for 1981 Non-Federal D.O.'s are from the 1981 American Osteopathic Association Microdata Tape. These data include Total Non-Federal D.O.'s, Total Active Non-Federal D.O.'s, Non-Federal D.O.'s by Major Professional Activity (including Inactive and Not Classified), and Non-Federal Office-Based D.O.'s by Specialty. In 1981, there were no D.O.'s reported for 1522 counties. Data for 1978 and 1976 Active Non-Federal D.O.'s in Primary Care Specialties are from the Bureau of Community Health Services D.O. County-Level Tapes. Primary care specialties include General Practice, Internal Medicine, Pediatrics and Ob/Gyn. **NOTE: 1) These data are not available for Yellowstone Park, Montana (30113). 2) The 1976 data were updated to include Total Active Non-Federal D.O.'s and Active Non-Federal D.O.'s in Patient Care. 3) Two invalid FIPS County Codes which were previously miscoded into non-existent counties in the 1976 data were adjusted. The affected counties are Linden, NJ (FIPS 34039) erroneously coded as 34049; and Woodland, CA (FIPS 06113) erroneously coded as 06119. 4) 1976 data are not available for Virginia independent cities. Refer to A-2. 1974 Total D.O.'s are taken from the American Osteopathic Association Tape, modified by the Bureau of Health Manpower. **NOTE: 1) County data for Weston County, Wyoming (56045) and all of the Hawaii counties (Hawaii (15001), Honolulu (15003), Kauai (15007), and Maui (15009)) are from the original D.O. tape. The rest of the data are taken from the modified BHM tape. Data on the 1974 and 1971 Total Active Non-Federal D.O.'s are from the 1974 and 1971, respectively, American Osteopathic Association Tapes. **NOTE: 1) All D.O. totals include respondents to the survey only. 2) Data are not available for Virginia independent cities. Refer to A-2. Page 037 B-2) Dentists and Dental Hygienists Dentists: The 1987 Total Active Non-Federal Dentists, Total Dentists by Age, Total Practicing (Full-Time and Part-Time) Dentists; Dental Graduates, Interns and Residents, and Total Dentists by (Govt, Hosp, Other Organization) category are taken from the American Dental Association Dental Tape provided by the Division of Associated and Dental Health Professions, Bureau of Health Professions. The 1981 Total Active Non-Federal Dentists; Total Dentists by Age; Total Practicing (Full-Time and Part-Time) Dentists; Dental Interns and Residents; and Total Dentists by (Govt, Hosp, Other Organization) category are taken from the American Dental Association Dental Tape provided by the Division of Dentistry, Bureau of Health Professions. The field 1980 Dentists was obtained from the 1980 Census of Population and Housing: Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia The 1976 Total Active Non-Federal Dentists, Total Patient Care Dentists, and Total Practicing (Full-Time and Part-Time) Dentists are taken from the American Dental Association Dental Tape provided by the Division of Dentistry, Bureau of Health Professions. **NOTE: 1) 226 counties were not updated with the Active Non-Federal Dentists as none were reported for them. 2) An enhanced file has been created which includes data for the individual dentists in more detail. See description of Enhanced Source Files (IV-C). 3) Data are not available for Virginia independent cities. Refer to A-2. The 1974 and 1972 Licensed Dentists are taken from the Dental Register, the Division of Dentistry, Bureau of Health Professions. **NOTE: 1) In 1974, there are no data available for: Pennsylvania (FIPS State Code 42) 2) In 1974, Total Instate Dentists for California are reported as 14,254. The county totals equal 14,253. 3) In 1974, Chicago dentists were included in DuPage, Illinois (17043) in the Dental Register. Licensed Dentists for 1971 are from the Dental Register of the State Licensing Boards for all States except Pennsylvania and Indiana -- dentist data for Pennsylvania are for the year 1968; and for Indiana are for the year 1969. **NOTE: Data are not available for Virginia independent cities. Refer to A-2. Page 038 Dental Hygienists: The field 1980 Dental Hygienists was obtained from the 1980 Census of Population and Housing: Equal Employ- ment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia The 1974 Licensed Dental Hygienists are from the National Center of Health Statistics supported by the Division of Dentistry, Bureau of Health Manpower. **NOTE: There are no data available for: Pennsylvania (FIPS State Code 42) The 1972 Licensed Dental Hygienists are listed in the "Number Licensed Hygienists, Located Instate, By County Location: Dec. 31, 1972" from the Census Bureau supported by the Division of Dentistry, Bureau of Health Manpower. **NOTE: There are no data available for the following counties: 30113 - Yellowstone Park, Montana 55078 - Menominee, Wisconsin B-3) Optometrists The field 1980 Optometrists was obtained from the 1980 Census of Population and Housing: Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia The 1979 through 1981 Total Active (Federal and Non-Federal) and Active Non-Federal Optometrists data have been calculated as follows: 1979 Total Active Optometrists is equal to the number of 1978 Total Active Optometrists plus the number of 1979 Total Active Optometrist Graduates. 1980 Total Active Optometrists is equal to the number of 1978 Total Active Optometrists plus the number of 1979 and 1980 Total Active Optometrist Graduates. 1981 Total Active Optometrists is equal to the number of 1978 Total Active Optometrists plus the number of 1979, 1980 and 1981 Total Active Optometrist Graduates. Page 039 Active Non-Federal Optometrists have been calculated in the same way. The 1978 values were taken from the National Center for Health Statistics 1978 National Inventory of Optometrists Tape described below. The 1979-1981 graduate figures were extracted from the 1983 Association of Schools and Colleges of Optometry Survey of Recent Graduates of Optometry Schools Tape. Optometrists reporting foreign or military (APO/FPO) addresses have been excluded from the file. **NOTE: An enhanced file has been created which includes data for the individual optometrists in more detail. See description of Enhanced Source Files (IV-C). The 1978 Total Active (Federal and Non-Federal) and Active Non-Federal Optometrists are extracted from the National Center for Health Statistics 1978 National Inventory of Optometrists Tape. Out of the Total Optometrist count of 24,336, 413 had invalid FIPS Codes and could not be processed. The tape included information for 2,904 Optometrists obtained from the 1978 Blue Book of Optometrists. The activity status could not be determined for these Optometrists; therefore, they are not included in the ARF counts. In addition, 1,262 responded with an activity code of "No" and 144 had an activity code of "Not Available". **NOTE: 1) An enhanced file has been created which includes data for the individual optometrists in more detail. See description of Enhanced Source Files (IV-C). 2) An Optometrist is defined as "Active" if the Activity Status Code on the source file indicates Active (1). The 1972 Active Non-Federal Optometrists (Weighted) are from the 1972-73 Inventory of Optometrists conducted by the American Optometric Association and supported by the Bureau of Health Manpower. **NOTE: 1) An enhanced file has been created which includes data for the individual optometrists in more detail. See description of Enhanced Source Files (IV-C). 2) There are actually eight fewer records on the original input file than the documentation states (19,638 as opposed to 19,646). 3) On the enhanced file, 54 optometrists have been left out of the counts since they did not report their county of practice. Data on the characteristics of 1968 Active Optometrists, which are stored on the file but not tabulated, are from the 1968 Vision and Eye Care Manpower Survey of Optometrists. **NOTE: Data are not available for Virginia independent cities. Refer to A-2. Page 040 B-4) Pharmacists The field 1980 Pharmacists was obtained from the 1980 Census of Population and Housing: Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia The 1980 Total Pharmacists and Active Pharmacists were extracted from the NCHS 1980 Pharmacy Manpower Information Project Tape. **NOTE: 1) Out of the Total Pharmacists count of 160,664, 55,688 could not be processed due to invalid FIPS Codes; of these, only 5,488 were Active Pharmacists. 104,406 Total Pharmacists and 104,125 Active Pharmacists were included on the file. The 1973-74 Active Pharmacists are from the 1973-74 Inventory of Pharmacists, American Association of Colleges of Pharmacy and supported by the Bureau of Health Manpower. **NOTE: 1) Many counties have zeroes for Active Pharmacists for 1973-74, and it is not sure whether the data are missing or that zero is the actual number of Active Pharmacists. 2) An enhanced file has been created which includes data for the individual pharmacists in more detail. See description of Enhanced Source Files (IV-C). Data on the number of 1966 Active Pharmacists are from a survey conducted by the National Association of Boards of Pharmacy, in cooperation with the National Center for Health Statistics. This was a questionnaire sent with a licensing renewal form to each pharmacist at the appropriate renewal time. State data on pharmacists are available in "Pharmacy Manpower U.S., 1966". **NOTE: 1) There are no data available for the following counties: 15001 - Hawaii, Hawaii 15003 - Honolulu, Hawaii 15007 - Kauai, Hawaii 15009 - Maui, Hawaii 30113 - Yellowstone Park, Montana 55078 - Menominee, Wisconsin 56045 - Weston, Wyoming 2) Data are not available for Virginia independent cities. Refer to A-2. Page 041 B-5) Podiatrists The field 1980 Podiatrists was obtained from the 1980 Census of Population and Housing: Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia The 1980 Podiatrists by Age data are from the American Podiatry Association (APA Data Tape). The podiatrists are those who applied for membership in the APA. The counts of Podiatrists (Total and by Age) include federal and non-federal; active and inactive; part-time and retired podiatrists. 337 podiatrists are not included in the counts on ARF because of unknown county codes. **NOTE: Data are not available for Virginia independent cities. Refer to A-2. The 1974 Total Active Podiatrists (Weighted) are from the Podiatrists Tape created by the National Center for Health Statistics. Podiatrist counts include federal and non-federal podiatrists. **NOTE: 1) Enhanced files have been created which include data for the individual podiatrists in more detail. See description of Enhanced Source Files (IV-C). 2) Since the 1974 podiatrist source file contains no county names for a majority of the inactive podiatrists, the enhanced file consists of only active podiatrists. 3) Twelve active podiatrists were also dropped from the 1974 enhanced file since they did not have county names. 4) In 1974, the following counties have weighting factors less than 1.03 (lowest range per documentation): 38015 1.00 38017 1.00 38035 1.00 38101 1.00 41003 1.02 41005 1.02 41011 1.02 41019 1.02 41029 1.02 41033 1.02 41035 1.02 41039 1.02 41043 1.02 41045 1.02 41047 1.02 41051 1.02 41065 1.02 Page 042 41067 1.02 46013 1.00 46029 1.00 46035 1.00 46099 1.00 46103 1.00 46135 1.00 Data on the number of 1968 Total Active Podiatrists is from unpublished State Licensing lists provided by the American Podiatry Association. **NOTE: Data are not available for Virginia independent cities. Refer to A-2. B-6) Veterinarians The field 1980 Veterinarians was obtained from the 1980 Census of Population and Housing: Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia Data on the number of 1979, 1977 and 1975 Veterinarians by Type of Practice were extracted from the American Veterinary Medical Association Directory Tapes for each year. Because the AVMA Directory Tape is by individual address and zip code, this tape had to be processed through a ZIP/FIPS conversion match program. Approximately ten percent of the zip codes did not have a unique match to a FIPS Code. These were manually coded and merged back into the recoded FIPS Veterinarian Tape. **NOTE: 1) For 1979, 1,143 Veterinarian records on the AVMA Tape could not be matched with a FIPS Code; of these, 115 had military addresses, 93 had territory addresses, and 11 had no zip code. 2) Totals do not include Retired, Military, or International Government Veterinarians. 3) Total Active Veterinarians are defined as those not having a professional specialty code of 70 (Retired) or a type of employer code of 80 (Retired) or 20 (Not in Active Practice). 4) For 1979, 349; for 1977, 455; and for 1975, 292 Veterinarians were excluded from ARF because they did not fall into one of the following specified specialty codes (positions 93-94): (1) '13' or '10' or '12' or '18' = Large Animal Practice (2) '14' = Mixed Practice (over 50% Large Animal) (3) '15' = Mixed Practice (50-50 Large & Small) (4) '16' = Mixed Practice (over 50% Small Animal) (5) '17' or '11' = Small Animal Practice (exclusive & Equine exclusive) Page 043 (6) '20' or '21' or '22' or '23' or '24' or '25' or '26' or '27' '28' or '29' or '30' or '36' or '40' or '41' or '42' or '43' '44' or '60' or '80' or '81' or '82' or '83' or '84' = Other Practice For 1979 data, the specialty codes counted in "Other Practice" were expanded to include: '31' or '32' or '38' or '45' or '55' or '85' or '86' or '87'. 5) For 1977, 27 Veterinarians were excluded from ARF because the correct county code could not be positively established. 6) In 1977, 2,980 Veterinarians were excluded from ARF because they did not fall into the specified type of employer codes (position 95): '1' or '2' or '4' or '6' or '7' or '9' or '0'. 7) In 1975, 2,954 Veterinarians were excluded from ARF because they did not fall into the specified type of employer codes (position 95): '1' or '2' or '4' or '6' or '7' or '9' or '0'. 8) A 1979 and 1977 enhanced veterinarian file has been created which includes data for the individual veterinarians in more detail. See description of Enhanced Source Files (IV-C). 9) Data are not available for Virginia independent cities. Refer to A-2. Data on the number of 1967 Total Veterinarians were provided from membership records of the American Veterinary Medical Association. **NOTE: 1) 1968 data were used for Weston County, Wyoming (56045) and all Hawaii counties (Hawaii (15001), Honolulu (15003), Kauai (15007), and Maui (15009)). 2) Data are not available for Virginia independent cities. Refer to A-2. B-7) Nurses R.N.'s: The field 1980 Registered Nurses was obtained from the 1980 Census of Population and Housing: Equal Employ- ment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia Data on the 1977 Total Estimated Employed R.N.'s, Full-Time Estimated Employed R.N.'s, and Part-Time Estimated Employed R.N.'s are from the 1977 American Nurses Association Inventory of Registered Nurses Data Tape of revised estimates. These data have been adjusted by the ANA for non-response. The data were calculated as follows: 1) Total Estimated Employed R.N.'s are taken from the column titled "Estimated Employed R.N.'s". Page 044 2) Full-Time Estimated R.N.'s = The Sum of (Full-Time R.N.'s * Weight), where Weight = The Sum of the Estimated Employed R.N.'s /The Sum of the Total Employed R.N.'s. The sums apply to all components included in the county. 3) Part-Time Estimated R.N.'s = The Sum of (Part-Time R.N.'s * Weight), where the Weight and Sums are defined as in 2) above. The data for Virginia are defined as the summing of Virginia independent cities data and their respective county data, except the independent cities of Alexandria, Chesapeake, Hampton, Newport News and Virginia Beach, Virginia which are maintained separately on ARF as county equivalents. **NOTE: No data are available for the following county: 30113 - Yellowstone Park, Montana. Data on the number of 1972 Active Registered Nurses (Total Employed in Nursing) are from the 1972 American Nurses Association Tape. **NOTE: Data are not available for Virginia independent cities. Refer to A-2. Data on the number of 1972 Employed Registered Nurses are from the 1972 American Nurses Association Inventory of Registered Nurses publication. The number of Employed R.N.'s is that number which the Division of Nursing reported as "Estimated Employed R.N.'s" after adjustment for non-response. **NOTE: 1) These data are not available for Yellowstone Park, Montana (30113) 2) Data could not be obtained to separate the independent city of Alexandria, Virginia (51510) from it's former county, Arlington, Virginia (51013). Therefore, on ARF, 1972 Estimated R.N.'s for both Alexandria City and Arlington County are reported in 51013, and 51510 is zero-filled. Data on the number of 1966 Registered Nurses are on the file, but are not used in tabulations. They are from the 1966 Inventory of Registered Nurses conducted by the American Nurses Association. **NOTE: Data are not available for Virginia independent cities. Refer to A-2. L.P.N.'s: The field 1980 Licensed Practical Nurses was obtained from the 1980 Census of Population and Housing: Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupa- tion. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia Page 045 Data on the number of 1974 Total Licensed Practical Nurses and Employed Licensed Practical Nurses are from the 1974 American Nurses Association Inventory of Licensed Practical Nurses publication. The number of Employed L.P.N.'s is that number which the Division of Nursing reported as "Estimated Employed L.P.N.'s" after adjustment for non-response. **NOTE: This publication reports that the number of Employed L.P.N.'s is greater than the number of Total L.P.N.'s for Los Angeles, CA (FIPS Code 06037). Data on the number of 1967 Licensed Practical Nurses are from the 1967 Inventory of Licensed Practical Nurses conducted by the American Nurses Association. **NOTE: Data are not available for Virginia independent cities. Refer to A-2. B-8) National Health Service Corps (NHSC) Sites The National Health Service Corps (NHSC) Sites data for 1986 and 1981 including: Number of Staffed Rural Sites; Number of Staffed Urban Sites; Number of Approved but Unstaffed Sites; Number of Terminated Sites; and the Current Staff Level for M.D.'s, Physician Extenders (Nurse Practitioners, Physician Assistants, and Midwives), R.N.'s, D.D.S.'s, and Other Personnel, were obtained from the 1986 and 1981 NHSC Site Tapes, respectively. There were 1567 counties updated for the 1986 NHSC data. 1976 and 1974 data, including the sites, status and rural/urban designation, were obtained from NHSC Site Listings. The site designates a specific allocation of manpower to shortage areas. **NOTE: 1) Two records on the source tape had blank county codes. The zip codes for the sites were used to find the FIPS Codes. The sites are located in: 05141 - Van Buren, Arkansas 38033 - Golden Valley, North Dakota 2) 1974 data are not available for Virginia independent cities. Refer to A-2. B-9) Critical Shortage Codes The Shortage Area codes were obtained from the National Health Service Critical Health Manpower Shortage Areas (CHMSA) and Health Manpower Shortage Areas (HMSA) Data Bases, respectively, which are maintained by the Bureau of Health Professions. The area must be identified as a Health Service Scarcity Area by the appropriate Area-Wide Comprehensive Health Planning (CHP) Agency or by the State CHP Agency according to specific guidelines. These data are as of July 1976 for Dental and November 1977 for M.D. CHMSA codes. HMSA data for Primary Care Physicians, Dentists, Pharmacists, Optometrists, Podiatrists, Psychiatrists, and Veterinarians are defined as follows: Page 046 1) For Critical Physician Shortage, the identifying CHP Agency must have indicated a shortage of physicians in primary care (i.e., M.D.'s and D.O.'s practicing general or family medicine, internal medicine, pediatrics, obstetrics/gynecology, and those general surgeons who spend 50% or more of their patient care time in primary care practice). The proposed shortage area must have a primary care physician-to-population ratio of less than 1:4000. 2) For Critical Dental Shortage, the identifying CHP Agency must have indicated a shortage of dentists in general practice. If the area is an entire county, the overall dentist-to-population ratio (including both general and specialty dentists) in the county within which the area is located must be less than 1:5000. 3) Since April 1980, HMSA data classifies counties as follows: 0 = None of the county designated as a shortage area; 1 = The whole county was designated as a shortage area; 2 = One or more parts of the county was designated as a shortage area. 4) Before April 1980, except for Veterinarians, these areas are classified as either "whole" counties or "part" counties (only specified sections of the county are included). They are coded as follows: 1 = Whole county designated as a shortage area; 2 = One or more parts of the county was designated as a shortage area. **NOTE: 1978 data are not available for Virginia independent cities. Refer to A-2. B-10) Physician Assistants and Nurse Practitioners The number of 1981 Total Physician Assistants was taken from the June 1983 American Academy of Physician Assistants File. **NOTE: 1) Four records on the source file did not have valid county codes; these counts are not included on ARF. Additionally, Physician Assistants reporting foreign or military (APO/FPO) addresses were excluded from ARF. 2) Where business zip code was not availiable, home zip code was used when available. Of the 11,399 records on the source file, 7133 had blank business zip codes; 4252 of these had a home zip code available. 1691 of the 10,406 records counted are believed to have out-of-date addresses, but have been included as the best available information. 3) Physician Assistants were reported in 1508 counties. The field 1980 Physicians Assistants was obtained from the 1980 Census of Population and Housing: Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupa- tion. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia The number of 1980 Non-Federal Certified Physician Assistants was taken from the Physician Assistant File obtained from the National Center For Health Services Research. Page 047 **NOTE: 1) 488 records on the source file did not have county codes; these counts are not included on ARF. 2) Physician Assistants were reported in 1354 counties. The 1980 and 1977 Nurse Practitioners data were obtained from the National Center for Health Services Research. The data represent only graduates of formal training programs. The data do not distinguish between county of residence and county of practice. The field "Other NP Programs" includes graduates of the following NP programs: rural, school, college and Ob/Gyn. **NOTE: 1) The 1980 data represent a response rate of 70% from Nurse Practitioner training programs (138 programs out of 197). The 1977 data represent a response rate of 94% (169 programs out of 180). 2) For 1980, 222 Nurse Practitioners were excluded from ARF because the county and/or state code was unknown; 136 Nurse Practitioners were excluded in 1977 for unknown state and/or county codes. 3) Seven Nurse Practitioners records had invalid program codes in 1977. These Nurse Practitioners were added to the field "Graduates of Other Programs" on ARF. 4) Four source records in 1977 with a state code of California did not contain the number of graduates. These were not added to ARF. 5) 1977 data are not available for Virginia independent cities. Refer to A-2. B-11) Occupational Therapists The number of 1982 Total Occupational Therapists is taken from the 1982 American Occupational Therapy Association Membership Tape. Occupational Therapists reporting foreign or military (APO/FPO) addresses have been excluded from the file. **NOTE: An enhanced file has been created which includes data for the individual occupational therapists in more detail. See description of Enhanced Source Files (IV-C). The field 1980 Occupational Therapists was obtained from the 1980 Census of Population and Housing: Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupa- tion. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia B-12) 1980 Decennial Census Occupation Data The 1980 Decennial Census health-related occupation data come from the 1980 Census of Population and Housing: Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation. The data are based on the 1980 census sample (approximately 19-percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count. **NOTE: Data for the following counties were not available from the source file: 51123 - Nansemond, Virginia Page 048 C. HEALTH FACILITIES 1970, 1975-1991 Hospital Data: All hospital data are from the AHA Annual Survey of Hospitals reporting for a twelve-month period: preferably October 1 through September 30 of the following year. The year of the data on ARF refers to latter year; e.g., 1991 data are from the October 1, 1990 through September 30, 1991 survey. For 1977 and subsequent years, these data have been taken from the American Hospital Association Hospital Facilities Tapes. For 1976 and before, these data were extracted from NCHS Hospital Facilities Tapes. Some of these data have been published in the "AHA Guide to the Health Care Field". Copies of the questionnaires used are published in the "AHA Guide to the Health Care Field". The survey reports hospitals in Baltimore and St. Louis cities as being in Baltimore and St. Louis counties, respectively. The county codes for these hospitals have been changed on the hospital files and all fields re-aggregated for ARF for these four counties: Baltimore, Maryland (24005); Baltimore City, Maryland (24007); St. Louis, Missouri (29189); and St. Louis City, Missouri (29191). The reliability of the data is only as good as the hospitals' responses to the AHA Hospital Surveys for the respective years. For hospitals not responding to the survey, AHA reports previously-reported data for approximately 50 general data fields (e.g., hospital ID type of control, service type, name and address, length of stay, and all of the approval codes). In 1991, AHA reported data for 6,763 U.S. Hospitals. Of these 6,763, 629 failed to respond, and AHA provided previously-reported data for the fields described above. For hospitals that did respond to the survey, but did not respond to particular fields, the AHA has estimated the data for some of these fields. Refer to the AHA file documentation for identification of the specific fields. To be reported as a "hospital", an institution must have at least six inpatient beds, cribs or pediatric bassinets which shall be continually available for the care of patients. **NOTE: 1) Beds by hospital type fields were calculated using the AHA hospital tape variable 'Statistical Beds'. This variable was derived by adding the total number of beds available each day during the hospital's reporting period and dividing this figure by the total number of days in the reporting period. Previous years' data for the same field was taken from the AHA hospital tape variable 'Beds Set Up and Staffed at End of Reporting Period'. This change was made to agree with the procedure AHA now uses for its published figures. Page 049 2) All 1980 and later hospital data are available for Virginia independent cities. The majority of pre-1980 hospital data are also available; however the following fields are not available for the independent cities (refer to A-2): 1975 and 1970 Short Term Community Hospital Admissions 1975 and 1970 Distribution of Hospitals by Counts of Services 1975 and 1970 Emergency Outpatient Visits in Short Term General Hospitals 1975 Number of Hospitals Reporting Expenses 1975 Total Reported Hospital Expenditures There are 151 hospitals that did not report in 1991 which were on the 1990 hospital file. These hospitals are assumed to be closed. Sixteen hospitals were reported as being closed and reopened. Either these sixteen hospitals have been reopened, or they failed to respond to the survey for one or more years prior to 1991. There are 425 counties without hospitals according to the 1991 AHA tape. There are 147 hospitals that did not report in 1990 which were on the 1989 hospital file. These hospitals are assumed to be closed. Seven hospitals were reported as being closed and reopened. Either these seven hospitals have been reopened, or they failed to respond to the survey for one or more years prior to 1990. There are 425 counties without hospitals according to the 1990 AHA tape. There are 110 hospitals that did not report in 1989 which were on the 1988 hospital file. These hospitals are assumed to be closed. Six hospitals were reported as being closed and reopened. Either these six hospitals have been reopened, or they failed to respond to the survey for one or more years prior to 1989. There are 426 counties without hospitals according to the 1989 AHA tape. There are 169 hospitals that did not report in 1988 which were on the 1987 hospital file. These hospitals are assumed to be closed. Nineteen hospitals were reported as being closed and reopened. Either these nineteen hospitals have been reopened, or they failed to respond to the survey for one or more years prior to 1988. There are 426 counties without hospitals according to the 1988 AHA tape. There are 145 hospitals that did not report in 1987 which were on the 1986 hospital file. These hospitals are assumed to be closed. Seventeen hospitals were reported as being closed and reopened. Either these seventeen hospitals have been reopened, or they failed to respond to the survey for one or more years prior to 1987. There are 426 counties without hospitals according to the 1987 AHA tape. There are 117 hospitals that did not report in 1986 which were on the 1985 hospital file. These hospitals are assumed to be closed. Ten hospitals were reported as being closed and reopened. Either these ten hospitals have been reopened, or they failed to respond to the survey for one or more years prior to 1986. There are 434 counties without hospitals according to the 1986 AHA tape. There are 111 hospitals that did not report in 1985 which were on the 1984 hospital file. These hospitals are assumed to be closed. Eleven hospitals were reported as being closed and reopened. Either these eleven hospitals have been reopened, or they failed to respond to the survey for one or more years prior to 1985. There are 436 counties without hospitals according to the 1985 AHA tape. Page 050 There are 79 hospitals that did not report in 1984 which were on the 1983 hospital file. These hospitals are assumed to be closed. Five hospitals were reported as being closed and reopened. Either these five hospitals have been reopened, or they failed to respond to the survey for one or more years prior to 1984. There are 435 counties without hospitals according to the 1984 AHA tape. There are 4 hospitals that did not report in 1983 which were on the 1982 hospital file. These hospitals are assumed to be closed. There are 436 counties without hospitals according to the 1983 AHA tape. There are 79 hospitals that did not report in 1982 which were on the 1981 hospital file. These hospitals are assumed to be closed. Fifteen hospitals were reported as being closed and reopened. Either these fifteen hospitals have been reopened, or they failed to respond to the survey for one or more years prior to 1982. There are 439 counties without hospitals according to the 1982 AHA tape. There are 18 hospitals that did not report in 1981 which were on the 1980 hospital file. These hospitals are assumed to be closed. Either these hospitals have been reopened, or they failed to respond to the survey for one or more years. 1968 Hospital Data: 1968 hospital data were developed by the American Medical Association from the American Hospital Association's "Master Mailing File" tape as of December 1, 1968, and were published in the 1968 "Distribution of Physicians, Hospitals, and Hospital Beds in the U.S.". The number of Short Term Community hospitals extracted from this source include data for non-federal short-term general and other special hospitals, as defined by AHA. These data exclude federal, long-term, psychiatric, tuberculosis, chronic disease and/or convalescent, and children's hospitals. Also excluded are hospital units of an institution. **NOTE: Data are not reported for Yellowstone Park, Montana (30113). C-1) Hospital Type Short Term General Hospitals: Short Term General Hospitals are those coded as follows by the American Hospital Association: Length of Stay = '1', Short-term; Type of Service = '10', General medical and surgical. These hospitals provide non-specialized care, and the majority of their patients stay for fewer than 30 days. Short Term Non-General Hospitals: Short Term Non-General Hospitals are those coded as follows by the American Hospital Association: Length of Stay = '1', Short-term; Type of Service not equal '10', General medical and surgical. These hospitals provide specialized care, and the majority of their patients stay for fewer than 30 days. Page 051 Long Term Hospitals: Long Term Hospitals are those coded as follows by the American Hospital Association: Length of Stay = '2', Long-term. These hospitals may provide either non-specialized or specialized care, and the majority of their patients stay for 30 or more days. Short Term Non-General and Long Term Hospitals : Short Term Non-General and Long Term Hospitals are those coded by the American Hospital Association as either: 1) Short Term Non-General Hospitals (see definition above), or 2) Long Term Hospitals (see definition above). Short Term Community Hospitals: The following definition of "Community Hospitals" was obtained from the American Hospital Association: "Community hospitals are defined as all non-federal short-term general and other special hospitals, excluding hospital units of institutions." (Children's hospitals are also included in this type of hospital). 1975, 1980 and 1985-1991 Short Term Community Hospitals are those coded as follows: Yr. of Current Data = '5' for 1975; '6' for 1976; and last two digits of current year for subsequent years, eg., '91' for 1991; Yr. Deleted from File = '0'; Hospital Control = '12', '13', '14', '15', '16', '21', '23', '31', '32', or '33'; Hospital Type = '10', '44', '45', '46', '47', '49', '50', '55', '56', '57', or '59'; Length of Stay Code = '1'. 1970 Short Term Community Hospitals were taken from the NCHS Hospital Tape. The definition is the same, except "Year of Current Data" and "Year Deleted from File" do not apply. 1968 Short Term Community Hospital data were extracted from the AMA's 1968 "Distribution of Physicians, Hospitals, and Hospital Beds in the U.S.". The definition of "Hospital Control", "Hospital Type" and "Length of Stay Code" are the same, except that children's hospitals are excluded (Hospital Type not = '50', '55', '56', '57', or '59'). See C "1968 Hospital Data". Short Term General Osteopathic Hospitals: 1988-1991 Short Term AOHA Hospitals were obtained from the 1988-1991 AHA Hospital Tape and are defined as follows: Length of Stay = '1', General Service Code = '10', and Registered Osteopathic Hospital = '1'. 1975, 1980 and 1985-1987 AOHA Hospital data have been added to ARF based on the following criteria: All osteopathic hospitals published in the AOHA Directories for 1975, 1980 and 1985-1987 with more than six beds were matched to the Hospital Tapes from the American Hospital Association. Those osteopathic hospitals which were defined by AHA and NCHS as being short term (code 1) and general (code 10) were added to ARF for these years. Page 052 **NOTE: 1) Hospitals which are reported in the AOHA Directory but are reported as closed on the AHA Hospital tape for the same year are not included in the ARF AOHA Hospital figures. 2) Three hospitals were reported in the AOHA Directory for 1987 that had no match on the AHA Hospital tape. Therefore, these facilities are not reported in the AOHA Hospital figures. 3) Two hospitals were reported in the AOHA Directories for 1985 that had no match on the AHA Hospital tape. Therefore, these facilities are not reported in the AOHA Hospital figures. 4) The AOHA Directory for 1975 reported no beds for University Heights Hospital in Albuquerque, New Mexico. Telephone contact revealed that the hospital had 112 beds; therefore, the hospital was treated as having 112 beds. 5) The number of osteopathic hospitals reported in the AOHA Directory for 1975 does not agree with the number of osteopathic members and non-members specified on the NCHS Hospital Tapes. Veterans Administration Hospitals: Veterans Administration Hospitals are those coded as follows by the American Hospital Association: Hospital Control = '45'. Veterans Administration Hospital fields are available on ARF for 1979, 1984, 1990 and 1991. C-2) Hospital Employment 1981, 1986 and 1991 Full-Time Equivalent Personnel and number of Personnel by Occupational Category and Type of Hospital were extracted from the 1981, 1986 and 1991 AHA Hospital Tapes, respectively. Full-Time Equivalency is calculated by AHA as number of full-time personnel plus one-half number of part-time personnel. **NOTE: 1) # FTE Personnel for Short Term General Hospitals and for Short Term Non-General and Long Term Hospitals includes M.D.'s, D.D.S.'s, Interns and Residents and the AHA category All Other Personnel. R.N.s, L.P.N.s and L.V.N.s are not included. 2) Other Hospital Personnel (Full-Time and Part-Time) for Short Term Non-General and Long Term Hospitals include the following: Administrators/Asst Admin; Dental Resident/Interns; Dentists; Lab Personnel, Oth; Med Record Technician; Nursing Personnel, Ancillary; Nursing Home Personnel; Occupational Therapy Asst; Other Health Prof/Tech Personnel; Other Trainees (Including Nursing Homes); Pharmacy Technician; Physical Therapy Asst; Physical Therapists; Radiologic Personnel, Oth; Respiratory Therapy Tech; Medical Resident/Interns; and the AHA category Other Personnel. 3) Other Surgical Specialties Medical Staff for Short Term Non-General and Long Term Hospitals include the following: Plastic Surgery Medical Staff; Thoracic Surgery Medical Staff; and the AHA category Other Surgical Specialties Medical Staff. 4) Other Specialties Medical Staff for Short Term Non-General and Long Term Hospitals include the following: Nuclear Medicine Medical Staff; Pathology Medical Staff; and the AHA category Other Specialties Medical Staff. 5) Personnel shared between a Hospital unit and a Nursing Home unit are reported as Part-Time Personnel in each unit. Page 053 C-3) Nursing and Other Personal Care Homes The 1986 Nursing and Personal Care Home data are from the 1986 Inventory of Long-term Care Places obtained from the National Center for Health Statistics (NCHS). Data contained on the ARF are number of facilities, number of beds, and number of residents. These data are broken out by ownership class, hospital based and total. The following fields are also carried: number of Medicare-certified skilled beds, number of Medicaid-certified skilled beds, number of Medicaid-certified intermediate beds, the number of nursing homes containing each of these types of beds and total number of residents in nursing homes that have these types of beds. Ownership Classes: 1. Profit (code 1) 2. Non-Profit (code 2) 3. Government (codes 3-4) **NOTE: 1) Residential and Family Care Homes cannot be excluded from the data. As a result, the 1986 data may not be comparable to earlier years of data. 2) Many nursing homes had incorrect FIPS Codes. They were resolved using the address and zip code. 3) Inconsistencies between the technical docummentation and the raw data were clarified after consulting with NCHS. Fields requiring adjustments include: the identification number, type of facility, type of ownership and hospital-based nursing home. 4) Occupancy rate can be determined by dividing the number of residents by the total number of beds. Variations in reporting among nursing homes can produce an occupancy rate that is greater than 100% for a county. The 1982 Nursing and Personal Care Home data are from the 1982 National Master Facility Inventory (NMFI) Nursing Homes and Residential Care Homes Tape obtained from the National Center for Health Statistics (NCHS). Data contained on the ARF are number of facilities, number of beds, and number of residents. These data are broken out by ownership class and total. The following fields are also carried: number of Medicare-certified and Medicaid-certified skilled beds, number of Medicaid-certified intermediate beds, the number of nursing homes containing each of these types of beds and the total number of residents in nursing homes that have these types of beds. Ownership Classes: 1. Government (codes 11-19) 2. Non-Profit (codes 20-22) 3. Profit (codes 23-25) 4. Hospital Based ('H' in facility identification) **NOTE: 1) Many nursing homes had incorrect FIPS Codes. They were resolved using the address and zip code. 2) The following imputations were made to the data by NCHS: a) 1980 data were used for approximately 500 nursing homes in New York. b) Some states issue a nursing home license and a residential license for the same facility. Whenever this occured, it created duplicate homes but not duplicate beds. Every effort was made to unduplicate the homes in such situations. c) Hospital based nursing homes were obtained from the Health Care Financing Administration. The data from these facilities were imputed. Page 054 3) Occupancy rate can be determined by dividing the number of residents by the total number of beds. Variations in reporting among nursing homes can produce an occupancy rate that is greater than 100% for a county. The 1978 and 1976 data are from the edited Nursing Home File which is based on the 1978 and 1976 MFI data respectively. The 1980, 1973 and 1971 Nursing and Personal Care Home data are from 1980, 1973 and 1971 Master Facility Inventory (MFI) Nursing Home and Other Health Facilities tapes obtained from the National Center for Health Statistics. Data contained on ARF are number of facilities, number of beds, and number of residents. These data are broken out by ownership class (3 classes) and total. For 1980, 1978 and 1976, the following fields are also carried: number of Medicare-certified skilled beds, number of Medicaid-certified skilled beds, number of Medicaid- certified intermediate beds, the number of nursing homes containing each of these types of beds (3 fields), and the number of residents in these nursing homes that have these types of beds. Ownership Classes: 1. Government (codes 11-19) 2. Non-Profit (codes 20-22) 3. Profit (codes 23-25) For 1978, the National Master Facility Inventory tape only carried nursing homes. The facilities selected for inclusion on ARF are "Nursing or personal care homes" (Codes '31'-'35' in 1976; Codes '01'-'06' in 1973 ; '01'-'09' in 1971). **NOTE: 1) For 1978, due to low response rates to the MFI survey, the MFI tape used the 1976 names, addresses and data for the following states: California District of Columbia New York North Carolina. 2) In the 1978 source data, one nursing home in Arizona was assigned an invalid FIPS Code of 04014. It was not added to the ARF, because its