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| National Healthcare Disparities Report, 2006
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Data Sources
Centers for Medicare & Medicaid Services
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ESRD Clinical Performance Measures (CPM) Project
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), Center for Beneficiary Choices.
Mode of Administration
Annually, each end-stage renal disease (ESRD) network conducts a survey of ESRD facilities to validate the census of ESRD patients in the network at the end of the calendar year using two data collection forms, one for hemodialysis patients and one for peritoneal dialysis patients. Clinical information contained in the medical records is abstracted for each patient in the adult hemodialysis sample and for all pediatric in-center hemodialysis patients who received in-center hemodialysis at any time during October, November and December. Clinical information contained in the medical records is also abstracted for each patient in the adult peritoneal dialysis sample who was receiving peritoneal dialysis at any time during the 2-month periods of October-November, December-January, and February-March.
Survey Sample Design
The ESRD clinical performance measures are collected on a national random sample of adult in-center hemodialysis patients, stratified by network area, and a random sample of 5 percent of adult peritoneal dialysis patients in the Nation.
Primary Survey Content
Clinical records about the 16 clinical performance measures in the areas of hemodialysis and peritoneal dialysis adequacy, vascular access, and anemia management.
Population Targeted
ESRD hemodialysis patients and peritoneal dialysis patients.
Demographic Data
Age, gender, race, and ethnicity.
Years Collected
Since 1999.
Geographic Estimates
State.
Home Health Outcome and Assessment Information Set (OASIS)
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Description/Primary Content
The OASIS is a group of data elements that represent core items of a comprehensive assessment for an adult home care patient. Because OASIS can measure changes in a patient's health status between two or more time points, it forms the basis for measuring patient outcomes for purposes of outcome-based quality improvement.
The general categories of data and health status items in OASIS include demographics and patient history, living arrangements, supportive assistance, sensory status, integumentary (skin) status, respiratory status, elimination status, neurological/emotional/behavioral status, activities of daily living, medications, equipment management, and information collected at inpatient facility admission or agency discharge.
Demographic Data
Gender, age, race/ethnicity, State of residence, marital status, informal caregiver assistance, living arrangement, current payment sources for home care and health status.
Population Targeted
U.S. adult, nonmaternity, home care patients receiving skilled services.
Mode of Administration
Completed by home health agency (HHA) personnel.
Years Collected
Medicare and Medicaid certified agencies have been required to collect data since 1999.
Data Collection Schedule
Most OASIS data items are designed to be collected at the start of care and every 2 months thereafter until and including time of discharge.
HHAs are required to electronically transmit OASIS data only for home care patients receiving Medicare and Medicaid skilled services to State survey and certification agencies. The State agencies have the overall responsibility for collecting OASIS data in accordance with CMS specifications. The State is also responsible for preparing OASIS data for retrieval by a national repository established by CMS.
Geographic Estimates
National, State, agency.
Notes
The home health care tables are based on OASIS assessment data from January 1 through December 31 in each year. The data for the measures are based only on home health episodes that began and ended in the same calendar year. Approximately 22 percent of patients have more than one episode in the same year.
Risk Adjustment for Measures: Each State average rate is risk adjusted using logistic regression models (details in RiskModels.pdf available at http://www.cms.hhs.gov). The national rate is the observed rate because the national rate is already reflective of national characteristics.
For OASIS improvement measures, a person is not included if he or she is at the highest level and cannot improve further. Similarly, a person is excluded from stabilization measures if he or she is at the lowest level and cannot decline further. Consequently, the denominator for each of the measures can vary widely because of these definitions. On average, for example, only 30 percent of all episodes are included in the urinary incontinence measure and about 40 percent for the confusion frequency measure, while 95 percent of episodes are included in bathing stabilization and about 83 percent of episodes for ambulation improvement.
Hospital CAHPS® (HCAHPS)
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), in partnership with the Agency for Healthcare Research and Quality (AHRQ).
Mode of Administration
The Hospital CAHPS® (HCAHPS) survey, also known as the CAHPS® Hospital Survey, is a national, standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care.
Participation by hospitals in HCAHPS is voluntary. HCAHPS is designed as a core set of questions that complement the hospital-specific data items that hospitals may currently collect as part of their own patient satisfaction programs.
Primary Survey Content
The HCAHPS survey is composed of 27 items: 18 essential items that encompass fundamental aspects of the hospital experience (communication with medical staff, responsiveness of hospital staff, cleanliness and quietness of the hospital, pain control, communication about medicines, and discharge information); four screening items; three patient mix adjustment items; and two items to support congressionally mandated reports.
Population Targeted
Discharged hospital patients.
Demographic Data
Race, ethnicity, education.
Years Collected
Beginning fall 2006. A three-State pilot study collected data over 3- and 6-month periods in 2003.
Hospital Compare
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Mode of Administration
The data in the Hospital Compare database are obtained from two sources:
- Hospital identification and characteristics are derived from the CMS Online Survey, Certification, and Reporting (OSCAR) database; a summary of the latest survey results is used.
- Clinical quality measure data are extracted from the Medicare Quality Improvement Organization (QIO) Program Clinical Warehouse. Refer to the QIO entry in this document for further information.
Survey Sample Design
Data in the Hospital Compare are provided voluntarily by short-term acute care hospitals and rural small, remote "critical access" hospitals. The facilities agree to report on an initial set of 10 quality performance measures and to have their data available to the public. The short-term acute care facilities receive an incentive payment for participating. Beginning with discharges in the second quarter of 2004, hospitals may elect to submit data on an additional 7 measures.
Primary Survey Content
The hospital compare contains data about 17 quality measures in 3 clinical areas: heart attack (acute myocardial infarction), heart failure, and pneumonia. Data are summarized at the hospital level. State-level estimates are also calculated.
Population Targeted
Discharges from short-term acute care hospitals and rural small, remote "critical access" hospitals.
Demographic Data
None. Only hospital-level data are presented.
Years Collected
Since January, 2004.
Schedule
Annual, updated quarterly.
Geographic Estimates
National, State. Some States may not have enough reporting facilities to calculate reliable measure estimates.
Notes
The State average presented in the tables is calculated by CMS and provided as part of the Hospital Compare dataset.
Medicare Current Beneficiary Survey (MCBS)
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Office of Strategic Planning.
Mode of Administration
MCBS is a computer-assisted personal survey of Medicare beneficiaries residing in the United States and Puerto Rico. The data in this report are from repeat interviews of Medicare beneficiaries who resided in community settings. Community residents receive a baseline questionnaire and community core questionnaires. The baseline questionnaire collects information on health insurance, household composition, health status, access to and satisfaction with medical care, and demographic and socioeconomic characteristics. The core questionnaires collect information on health insurance, medical care use, charges and payments for medical care, and specific topics such as income and assets. These data are supplemented with administrative data on Medicare and Medicaid eligibility, enrollment in Medicare managed care, and claims for Medicare-covered services.
Survey Sample Design
The MCBS sample consists of aged and disabled beneficiaries enrolled in Medicare Part A (hospital insurance) or Part B (medical insurance) or both. Beneficiaries are selected for the survey by using a stratified, multistage area probability design. A key feature of the survey is that sample persons are followed over time as part of a 4-year rotating panel design. Each person is interviewed three times per year over 4 years, regardless of whether he or she resides in the community or a long-term care facility.
The data are used to produce calendar year public use files on access to care and cost and use. All four panels are included in the access to care file. Only three panels are included in the cost and use file because the panel being retired during a calendar year is not asked about medical utilization for that year.
Primary Survey Content
Medical expenditure data as well as detailed data on health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment.
Population Targeted
The MCBS is a nationally representative survey of all Medicare beneficiaries, regardless of age or place of residence.
Demographic Data
Age, race, ethnicity, region, occupation, employment status, and household composition.
Years Collected
1991 to present.
Schedule
Annual releases of access to care and cost and use files. The access to care file for a calendar year is released about 1 year after the end of data collection. The cost and use file for a calendar year is released about 2 years after the end of data collection.
Geographic Estimates
National. The data also can be shown for the four Census Bureau regions (Northeast, Midwest, South, and West).
Notes
The MCBS contains four overlapping panels of Medicare beneficiaries. Each year one panel is dropped from the survey and a new one is added. This design produces 3 calendar years of medical utilization data for each sample person. The data are collected over a 4-year period in which sample persons are interviewed 12 times. The first interview collects baseline information on the beneficiary. The next 11 interviews are used to collect 3 complete years of utilization data.
References
Adler GS., A profile of the Medicare Current Beneficiary Survey. Health Care Financing Review, Summer 1994;15(4): 153-163.
Medicare Patient Safety Monitoring System (MPSMS)
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Patient Safety Task Force of the Department of Health and Human Services.
Mode of Administration
Chart abstraction using electronic data collection tool. Once medical records are selected from the sample, abstractors use explicit clinical criteria to examine the process of care, ascertain the occurrence of specific adverse events, determine that the event is an adverse event, and assess patient risk factors.
Survey Sample Design
Cross-sectional. The MPSMS data sources are a national random sample of medical records for all Medicare hospital discharges stratified by State and Medicare administrative data.
Primary Content
MPSMS inpatient medical records: a randomly selected, nationwide subset of inpatient medical records from the Medicare Hospital Monitoring Program and Medicare administrative data.
The purpose of the system is to identify rates of adverse events in the Medicare population as expressed in medical records and administrative data. Adverse event categories include the following:
- Adverse events associated with the use of central vascular catheters
- A set of adverse events associated with surgical procedures
- A set of adverse events associated with joint revisions and replacements
- Hospital-acquired, ventilator-associated pneumonia
- Hospital-acquired blood stream infections
- Adverse drug events that are hospital associated or the cause of hospital admission
The system also collects and examines patient risk factor information, such as demographics, principal diagnosis and its severity, and comorbid conditions and treatments.
Population Targeted
Medicare beneficiaries as required for the relevant measure.
Demographic Data
Age, race, gender.
Years Collected
Since 2002.
Schedule
Data are collected monthly and aggregated annually.
Geographic Estimates
All States and Puerto Rico.
References
Hunt DR, Verzier N, Abend SL, Lyder C, Jaser LJ, Safer N, Davern P. Fundamentals of Medicare patient safety surveillance: intent, relevance, and transparency. Advances in Patient Safety: From Research to Implementation. (vol. 2), AHRQ Pub. No. 05-0021-2. February 2005. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/qual/advances/.
Medicare Quality Improvement Organization (QIO) Program
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Description
Under the direction of CMS, the Quality Improvement Organization Program consists of a national network of 53 QIOs responsible for each U.S. State, territory, and the District of Columbia. QIOs work with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly among underserved populations. The program also safeguards the integrity of the Medicare trust fund by ensuring payment is made only for medically necessary services, and investigates beneficiary complaints about quality of care.
For the QIOs' 2002-2005 contract cycle, CMS expanded performance expectations to encompass two additional health care settings—nursing homes and home health agencies.
Data Collection
Data are collected by the national network of 53 QIOs responsible for each U.S. State, territory, and the District of Columbia according to data collection tools developed by QIOs or related organizations. The systematic random sample size varies among years and measures. For example, in the 2002 data, all measures have up to 600 records per State; in the 2000-2001 data, acute myocardial infarction and pneumonia measures have up to 750 records per State, and the heart failure measures have up to 800 records per State.
Primary Content
Current national priorities include four health care settings: nursing homes, home health agencies, hospitals, and physician offices. QIO measures included in the NHQR are hospital settings, including those related to acute myocardial infarction, heart failure, and pneumonia.
Population Targeted
Medicare beneficiaries as required for the relevant measure.
Demographic Data
Age, race, gender.
Nursing Home Minimum Data Set (MDS)
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Description/Primary Content
The MDS is the core source of assessment information for the Resident Assessment Instrument. The MDS is a standardized, primary screening and assessment tool of health status; it measures physical, medical, psychological, and social functioning of nursing home residents. The general categories of data and health status items in the MDS include demographics and patient history, cognitive, communication/hearing, vision, and mood/behavior patterns, psychosocial well-being, physical functioning, continence, disease diagnoses, health conditions, medications, nutritional and dental status, skin condition, activity patterns, special treatments and procedures, and discharge potential.
Chronic care: refers to those types of patients who enter a nursing facility typically because they are no longer able to care for themselves at home. These patients (or residents) tend to remain in the nursing facility from several months to several years. The chronic quality measures were calculated on any residents with a full or quarterly MDS assessment in the target quarter.
Postacute care: refers to those types of patients who are admitted to a facility and typically stay less than 30 days. They are also referred to as "short-stay residents". These admissions typically follow an acute care hospitalization and involve high-intensity rehabilitation or clinically complex care. The postacute measures were calculated on any patients with a 14-day prospective payment system (PPS) MDS assessment in the last 6 months.
Demographic Data
Gender, age, marital status, race or ethnicity, current payment sources, and health status.
Population Targeted
All residents in Medicare or Medicaid certified nursing and long-term care facilities.
Mode of Administration
Completed by facility personnel, with attestation of accuracy required.
Years Collected
Nursing homes have been collecting MDS since 1990; since June 1998, States have transmitted MDS to the CMS central repository.
Data Collection Schedule
Administered on admission, quarterly, annually, whenever the resident experiences a significant change in status, and whenever the facility identifies a significant error in a prior assessment. Also, residents receiving Medicare skilled nursing facility PPS payment require more frequent assessments (5, 14, 30, 60, 90 days).
Facilities are required to electronically transmit MDS data to the States. The State agencies have the overall responsibility for collecting MDS data in accordance with CMS specifications. The State is also responsible for preparing MDS data for retrieval by a national repository established by CMS.
Geographic Estimates
National, State, facility.
Notes
The nursing home measures were changed in January 2004.
The data were downloaded from http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteria.asp; the 2005 data were downloaded in March 2006; the 2004 data, in March 2005; and the 2002 data, in November 2002.
State averages are calculated as a simple average (i.e., unweighted by number of residents) of all the facilities located in the State. Reported rates may be affected by the varying number of facilities for each measure in a State due to minimum denominator sizes and may not reflect the true rate of incidence within a State because the simple averages can only be interpreted as an average of facility rates.
Risk adjustment for measures: Three methods are used for risk adjusting the nursing home care measures which use the MDS.
- One method is to exclude residents where the outcomes are not under facility control (e.g., the resident has a condition, such as a pressure ulcer, upon admission) or where the outcome may be unavoidable (e.g., the resident has end-stage disease or is comatose).
- Another method is adjustment based on resident-level covariates that have been found to increase risk for an outcome using logistic regression models.
- The third method is adjustment using logistic regression models based on a Facility Admission Profile, or the proportion of residents who enter the facility over the past year already with that outcome.
Reference
Centers for Medicare & Medicaid Services. National Nursing Home Quality Measures, User's Manual, November, 2004 (V1.2), (consolidation of original User's Manual and Technical User's Manual). Available at http://www.cms.hhs.gov.
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