Community Tracking and Related Studies

Overview

The Community Tracking Study (CTS) is a large-scale longitudinal investigation of health system change and its effects on people. Originally designed to track a cohort of American communities at two-year intervals beginning in 1996, this major research effort, sponsored by the Robert Wood Johnson Foundation (RWJF), has collected information to monitor and understand the evolution of health care in the United States. CTS is investigating the ways in which hospitals, health plans, physicians, safety net providers, and other provider groups are restructuring their systems, and the forces driving the organizational change. Additionally, the project is tracking health insurance coverage, access to care, use of health services, health care costs, and perceived quality of health care.

Sixty sites (51 metropolitan areas and 9 nonmetropolitan areas) were randomly selected to form the core of CTS and to be representative of the nation as a whole. Twelve of the sites, consisting of metropolitan areas with more than 200,000 people, are being studied in depth, with site visits and survey samples large enough to draw conclusions about change in each community. The other 48 sites are being studied less intensively, with smaller survey samples and no site visits.

CTS is a project of the Center for Studying Health System Change (HSC). Numerous publications on the CTS, including the site visit reports, are available on the HSC web site. HSC also provides CTSonline, an interactive system that offers customized tabulations of CTS survey estimates.

CTS Surveys

Much of the information collected by CTS comes from nationally representative surveys of households, health plans, and physicians that were conducted by HSC.

Household and Followback Surveys. The Household Survey interviewed Americans about their health status, chronic conditions, health insurance coverage, use of health services, perceived quality and satisfaction with care, unmet medical needs, medical expenses, and other health related topics. Administered to organizations that offered or administered the private health insurance policies reported in the first two rounds of the Household Survey, the Followback Survey collected detailed information about private health plans, such as policy type, gatekeeping, consumer cost sharing, provider payment methods, and coverage of mental health and substance abuse services. In a major change, the community focus of the Household Survey was discontinued in its fifth round: Unlike the first four rounds, the fifth Household Survey sample was not concentrated in the CTS sites or designed to measure change in some of them. Accordingly, "Community" was dropped from the title of the fifth Household Survey. Both rounds of the Followback Survey and the five rounds of the Household Survey are available from HMCA:

Physician Survey. The Physician Survey, which interviewed practicing physicians, collected information about physician supply and specialty distribution, practice arrangements, sources of practice revenue, level and determinants of physician compensation, care management strategies, and physicians' allocation of time, provision of charity care, and career satisfaction. Like the fifth Household Survey, the fifth Physician Survey (conducted in 2008) discontinued the clustered 60-site sample design. HMCA currently distributes the first four rounds of the Physician Survey and expects to release the fifth round in 2010:

Related Surveys

RWJF built a network of research organizations studying various facets of the changing health care system. Some of them simultaneously examined the CTS communities.

Employer Survey. With a specific emphasis on the 60 CTS sites and 12 states of interest to the RWJF State Initiatives in Health Care Reform Program, this survey was administered to a national probability sample of 22,000 private and public employers. Conducted by Stephen H. Long and M. Susan Marquis at RAND, the Employer Survey collected information on employers' offers of health insurance coverage, employees' eligibility and enrollment in health plans, and for each plan offered, the plan type (HMO, POS, PPO, conventional), the premiums (employer and employee contributions), benefits, cost-sharing, and employer self-insurance status. This study is available from HMCA:

Healthcare for Communities. Kenneth B. Wells, Roland Sturm, and Audrey Burnam (UCLA and RAND) are the principal investigators of the Healthcare for Communities Project (HCC), which tracked changes in health policy, health care delivery, access to care, and costs and outcomes of care related to alcohol, drug abuse, and mental health conditions. As part of this project, respondents to the first and second CTS Household Surveys were reinterviewed about their health, mental health, and daily activities; alcohol and illicit drug use; use of medications; general health insurance coverage and coverage for mental health, substance abuse, and prescription medications; access, utilization, and quality of behavioral health care; labor market status, income, and wealth; and life difficulties. Both rounds of the HCC survey are available from HMCA: