Data Sources—Centers for Medicare & Medicaid Services (CMS)

ESRD Clinical Performance Measures (CPM) Project

Sponsor

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), Office of Clinical Standards and Quality.

Mode of Administration

Abstract clinical information from patient's medical records. ������

Sample Design

The sampling frame includes all ESRD patients in the 18 ESRD Network facilities at the end of the last calendar year. Adult samples were selected randomly from the stratified ESRD Network. All pediatric patients were included. �The final 2007 sample consisted of 8,937 adult in-center hemodialysis patients (about 5%), 1,474 peritoneal dialysis patients, 720 pediatric in-center hemodialysis patients, and 759 pediatric peritoneal dialysis patients.

Primary Content

Clinical records about the 16 CPM 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.

Schedule

Annual.

Geographic Estimates

State.

Contact Information

Agency home page: http://www.cms.hhs.gov.

Data system home page: http://www.cms.gov/center/esrd.asp.

References

Office of Clinical Standards & Quality. 2007 annual report, End Stage Renal Disease Clinical Performance Measures Project. Baltimore, MD: Centers for Medicare & Medicaid Services; December 2007. http://www.cms.gov/CPMProject/Downloads/ESRDCPMYear2007Report.pdf. [Plugin Software Help]

Home Health Outcome and Assessment Information Set (OASIS)

Sponsor

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).

Description

The OASIS is a key component of Medicare's partnership with the home care industry to foster and monitor improved home health care outcomes. The OASIS data are collected, encoded, and transmitted for all Medicare/Medicaid patients receiving skilled services according to CMS's regulations published in the Federal Register.

Home health agencies encode and transmit data using software available from CMS or software that conforms to CMS standard electronic record layout, editing specifications, and data dictionary and that includes the required OASIS dataset.

Primary Content

The OASIS is a group of data elements that represent core items of a comprehensive assessment for an adult home care patient and form 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, neuro/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

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. �

Geographic Estimates

�National, State, and agency.

Contact Information

Agency home page: http://www.cms.hhs.gov.

Data system home page: http://www.cms.hhs.gov/oasis.

Notes

The OASIS national and disparities tables in the NHQR and NHDR Data Tables appendix are based on OASIS assessment data on home health episodes that began and ended in the same calendar year. Approximately 22% of patients have more than one episode in the same year. The percentages are risk adjusted.

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 any more. Similarly, a person is excluded from stabilization measures if he or she is at the lowest level and cannot decline any more. Therefore, the denominator for each measure can vary widely because of these definitions. On average, for example, only 30% of all episodes are included in the urinary incontinence measure and about 40% are included in the confusion frequency measure. About 95% of episodes are included in bathing stabilization and about 83% of episodes are included in ambulation improvement.

�The State estimates are based on provider-level scores downloaded from http://www.medicare.gov/download/downloaddb.asp in April each year. The data reflect care delivered mainly in the previous year.

The 2007 national total estimates in the NHQR and NHDR tables are the same as those in CMS's Web site tables, which are adjusted.

For each home health agency patient to whom a particular outcome measure applies, a predicted outcome probability is calculated, based on the patient's health status and other attributes at admission to home health care. Predicted outcome probabilities are averaged across all of the agency's current patients to yield a predicted outcome rate, which is displayed as the national (risk-adjusted) reference rate for that agency. This current predicted outcome rate can be interpreted as the outcome rate that patients in the national sample would have experienced if they had the same case mix as the patients served by that particular agency. �Details can be found in Appendix A: Risk Models Update Revised 2008 available at http://www.cms.hhs.gov/HomeHealthQualityInits/16_HHQIOASISOBQI.asp.

Hospital Compare

Sponsor

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).

Description

Hospital Compare data come from hospitals that volunteered to submit their data for public reporting.

Beginning with discharges in 2004, eligible acute care hospitals could elect to report quality data in order to receive the incentive payment established by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). To obtain increased payment, eligible hospitals were required to report on an initial set of 10 quality performance measures (the "starter set") and to agree to have their data publicly displayed.

Initially, almost all hospitals eligible for the payment incentive provided data for the 10 "starter set" measures, reflecting care delivered during 2004. Under Section 5001(a) of the Deficit Reduction Act of 2005, the set of measures included in the incentive was expanded, the magnitude of the incentive was increased, and the time limit for the provision was removed. �

In March 2008, data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was added to Hospital Compare. HCAHPS provides a standardized instrument and data collection methodology for measuring patients' perspectives on hospital care.

Whether or not a hospital uses sampling is determined by rules established by The Joint Commission and CMS. The same sampling methodology is used by hospitals for both their non-Medicare cases and Medicare cases and is based on the number of discharges per topic each quarter. More detailed information is available at http://www.QualityNet.org.

The data collection approach was primarily retrospective. Data sources for required data elements included administrative data and medical record documents. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care. However, complete documentation includes the principal and other ICD-9-CM (International Classification of Diseases, 9^th Revision, Clinical Modification) diagnosis and procedure codes, which require retrospective data entry.

Primary Content

Hospital Compare contains data about quality measures in five clinical areas: heart attack, heart failure, pneumonia, asthma (children only), and surgical care improvement project. Rates are calculated at the hospital level based on the hospital's relevant discharges. The Hospital Compare database contains information from six sources:

1. Hospital characteristics and inspection results from CMS's Online Survey, Certification, and Reporting (OSCAR) database.
2. Clinical Quality Measures Data from the QIO Clinical Warehouse—Hospitals submit patient record data for the clinical conditions.
3. The 30-day risk-adjusted death (mortality) rates and the 30-day risk-adjusted rates of readmission produced using complex statistical models that rely on Medicare claims and enrollment information. 
4. Patients' hospital experiences data collected and reported through MyQualityNet using the HCAHPS survey.
5. Children's asthma care measure data collected by The Joint Commission.
6. The Medicare inpatient hospital payment information and the number of Medicare patients treated (volume) for certain illnesses or diagnoses from Medicare claims. �

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 and State. Some States may not have enough reporting facilities to calculate reliable measure estimates.

Contact Information

Agency home page: http://www.cms.hhs.gov/.

Data system home page: http://www.hospitalcompare.hhs.gov/.

References

Hospital Process of Care Measures, Information for Professionals on Data Collection, available at Hospital Compare Web site: http://www.hospitalcompare.hhs.gov/Hospital/Static/InformationForProfessionals_tabset.asp.

Medicare Current Beneficiary Survey (MCBS)

Sponsor

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), Office of Strategic Planning.

Mode of Administration

Sample persons in the community are interviewed with computer-assisted personal interviewing (CAPI) survey instruments. Information about institutionalized residents is collected from proxy respondents such as nurses and other primary caregivers affiliated with the facility.

Survey Sample Design

� The sample is selected from the Medicare enrollment files, with oversampling among disabled persons under age 65 and persons age 80 and over.

The MCBS was originally designed as a longitudinal survey in which Medicare beneficiaries would be followed indefinitely. Its initial sample (the 1991 panel) was selected through a stratified, multistage area probability design.

From 1994 on, the longitudinal design was changed to a rotating design. In 1994, approximately one-third of the sample was rotated out after the round 12 interviews and replaced by a supplemental sample of the same size. The overlapping panel design allows each sample person to be interviewed three times a year for 4 years, whether he or she resides in the community or a facility or moves between the two settings, using the version of the questionnaire appropriate to the setting.

The target sample size is 12,000 people. Response rates for the community interviews are above 80% in the first round and above 95% in subsequent rounds. Response rates for facility interviews approach 100%.

Primary Survey Content

MCBS has two components: the Cost and Use file and the Access to Care file. Medicare claims are linked to survey-reported events to produce the Cost and Use file. This file provides complete expenditure and source of payment data on all health care services, including those not covered by Medicare. The Access to Care file contains information on beneficiaries' access to health care, satisfaction with care, and usual source of care. The sample for this file represents the always enrolled population-those who participated in the Medicare program for the entire year. In contrast, the Cost and Use file represents the ever enrolled population, including both those who entered Medicare and those who died during the year.

Population Targeted

Aged, disabled, and institutionalized Medicare beneficiaries residing in the United States and Puerto Rico.

Demographic Data

Age, race, ethnicity, education, income, insurance coverage, perceived health status, and residence location.

Years Collected

1991 to present.

Schedule

Annual releases of Access to Care and Cost and Use files. The Access to Care files are released within 1 year of the survey and the Cost and Use files are released within 2 years of the survey.

Geographic Estimates

National. The data also can be shown for the four U.S. Census Bureau regions.

Contact Information

Agency home page: http://www.cms.hhs.gov/.

Data system home page: http://www.cms.hhs.gov/MCBS/.

References

Adler GS. A profile of the Medicare Current Beneficiary Survey. Health Care Financ Rev 1994;15(4):153-63.

Health & health care of the Medicare population: 2003. Appendix A. Technical documentation for the Medicare Current Beneficiary Survey. Baltimore, MD: Centers for Medicare & Medicaid Services; 2003. Available at: http://www.cms.hhs.gov/mcbs/downloads/HHC2003appendixA.pdf. [Plugin Software Help]

Medicare Patient Safety Monitoring System (MPSMS)

Sponsor

U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), HHS Patient Safety Task Force. Technical expert panel includes Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and Veterans Health Administration (VHA).

Description

The MPSMS is a national surveillance project aimed at identifying the rates of specific adverse events within the Medicare population. The hospital records from an annual random national sampling of more than 40,000 Medicare inpatient fee-for-service discharges are sent to two Clinical Data Abstraction Centers (CDACs). At the CDACs, trained abstractors process each clinical chart by recording predefined chart data. The 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.

Primary Content

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 (CVCs).
• Adverse events associated with surgical procedures.
• Adverse events associated with joint revisions and replacements.
• Hospital-acquired, ventilator-associated pneumonia.
• Hospital-acquired bloodstream 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 severity, and comorbid conditions and treatments.

Population Targeted

Medicare beneficiaries as required for the relevant measure.

Demographic Data

Age, race, and gender.

Years Collected

Since 2002.

Schedule

Data are collected monthly and aggregated annually.

Geographic Estimates

All States and Puerto Rico.

Contact Information

Agency home page: http://www.cms.hhs.gov.

Data system home page: http://www.cms.hhs.gov.

References

Hunt DR, Verzier N, Abend SL, et al. Fundamentals of Medicare patient safety surveillance: intent, relevance, and transparency. Advances in patient safety: from research to implementation. Vol. 2. Rockville, MD: Agency for Healthcare Research and Quality; February 2005. AHRQ Pub. No. 05-0021-2. Available at: 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

The QIO Program, created by law in 1982, provides 3-year contracts to organizations throughout the country to improve the quality, safety, efficiency, and economy of health care services delivered to Medicare beneficiaries and the public at large.

The QIO Program is administered through 53 performance-based, cost-reimbursement contracts with 41 independent organizations. The QIOs are staffed with physicians, nurses, technicians, and statisticians. QIOs work statewide encouraging hospitals to submit clinical performance data to the Hospital Quality Alliance (HQA). Data were collected by the QIO network according to data collection tools developed by QIOs or related organizations. Details are in the QIO Statement of Work. Quality performance information collected from the more than 4,000 participating hospitals is reported on Hospital Compare, a Web site tool developed by CMS.

Before 2005, QIO data were abstracted data including Medicare inpatients only. From 2005 on, QIO data are hospital self-reported data including all payers.

Primary Content

Current national priorities include four health care settings: nursing homes, home health agencies, hospitals, and physician offices.

Population Targeted

Medicare beneficiaries and non-Medicare beneficiaries required for the relevant measure in each State, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.

Demographic Data

Age, race, and gender.

Notes

From 2002 to 2004, CMS randomly selected 125 medical charts for each topic per quarter and asked CDACs to perform data abstraction. The results were used for QIO program evaluation and measure surveillance. CMS stopped the measure surveillance program for heart attack, heart failure, and pneumonia topics at the end of 2004. The surveillance program for surgery patient safety was stopped at the end of the third quarter of 2005. Since the 2002-2004 data only reflected Medicare inpatients and these are CDAC-abstracted data and 2005 data are hospital self-reported for all payers, only hospital self-reported data starting from 2005 are reported in the NHQR and NHDR.

Contact Information

Agency home page: http://www.cms.hhs.gov.

Data system home page: http://www.cms.hhs.gov/QualityImprovementOrgs/.

References

8^th QIO Statement of Work available at http://www.cms.hhs.gov/QualityImprovementOrgs/.

CMS and QIOs' public Web site at http://www.medqic.org/ and the quality measures detailed therein.

Nursing Home Minimum Data Set (MDS)

Sponsor

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).

Description

The MDS is part of the federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems. Resident Assessment Protocols (RAPs) are part of this process and provide the foundation upon which a resident's individual care plan is formulated.

MDS assessment forms are completed for all residents in certified nursing homes, regardless of source of payment for the individual resident. MDS assessments are required for residents on admission to the nursing facility and then periodically, within specific guidelines and timeframes. In most cases, participants in the assessment process are licensed health care professionals employed by the nursing home.

Primary Content

�Demographics and patient history, cognitive function, communication/hearing, vision, 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.

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.

Years Collected

Nursing homes have been collecting MDS data since 1990; since June 1998, States have transmitted MDS data 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 (SNF) prospective payment system (PPS) payment require more frequent assessments (5, 14, 30, 60, 90 day).

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, and facility.

Notes

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 anywhere from several months to several years. The chronic care quality measures were calculated on any residents with a full or quarterly MDS assessment in the target quarter.

Post-acute care (PAC): refers to patients admitted to a facility who 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 PAC measures were calculated on any patients with a 14-day PPS MDS assessment in the last 6 months.

Risk Adjustment for Measures: Three methods are used for risk adjusting the nursing home care measures that 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 (FAP), or the proportion of residents who entered the facility over the past year already with that outcome.

State estimates in the NHQR tables are calculated based on facility scores downloaded from CMS's Nursing Home Compare Web site. The rates may be affected by the number of facilities in a State and are different from the rate calculated based on resident-level data.

Contact Information

Agency home page: http://www.cms.hhs.gov.

Oversight and data system home page: http://www.cms.hhs.gov/NursingHomeQualityInits/.

References

National Nursing Home Quality Measures, user's manual, version 1.2 (consolidation of original user's manual and technical user's manual). Baltimore, MD: Centers for Medicare & Medicaid Services; November 2004. Available at: http://www.cms.hhs.gov.