Effectiveness of Care: Supportive and Palliative Care

2009 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

 

Supportive and Palliative Care
Long-stay nursing home residents with moderate to severe pain
Long-stay nursing home residents with a urinary tract infection
Long-stay nursing home residents whose depression or anxiety increased
Low-risk, long-stay nursing home residents with loss of control of bowels or bladder
Low-risk, long-stay nursing home residents with a catheter inserted and left in the bladder
Long-stay nursing home residents with too much weight loss
Adult home health care patients whose shortness of breath decreased
Adult home health care patients whose urinary incontinence decreased
Adult home health care patients who received urgent, unplanned medical care
Adult home health care patients who stay at home after an episode of home health care
Long-stay nursing home residents who received influenza vaccination during the flu season
Short-stay nursing home residents who received influenza vaccination during the flu season
Long-stay nursing home residents who were assessed for pneumococcal vaccination
Short-stay nursing home residents who were assessed for pneumococcal vaccination
Short-stay nursing home residents with moderate to severe pain
Adult home health care patients whose pain when moving around decreased
Long-stay nursing home residents with physical restraints
High-risk, long-stay nursing home residents with pressure sores
Low-risk, long-stay nursing home residents with pressure sores
Short-stay nursing home residents with pressure sores
Short-stay nursing home residents with delirium
Adult home health care patients who had to be admitted to the hospital
Hospice patient caregivers who perceived patient was referred to hospice at the right time
Hospice patients who received the right amount of medicine for pain
Hospice patients who received care consistent with their stated end-of-life wishes
Current home health patients with any pain at last assessment and, if any pain present, only PRN orders for pain management
Annual hospice discharges with any pain at last assessment and, if any pain present, only PRN orders for pain management


Supportive and Palliative Care

Measure Title

Long-stay nursing home residents with moderate to severe pain.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_1.1 Long-stay nursing home residents who have moderate to severe pain, United States, 1999 and 2007.

11_1_1.2 Long-stay nursing home residents who have moderate to severe pain, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Residents with moderate pain at least daily, or horrible or excruciating pain at any frequency on the target assessment.

State Tables

11_1_1.3 Long-stay nursing home residents who have moderate to severe pain, by State, 2002 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Rate is risk adjusted using resident-level covariates.

Excludes admission assessments and assessments with inconsistent or missing responses regarding the measure. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Long-stay nursing home residents with a urinary tract infection.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_2.1 Long-stay nursing home residents with a urinary tract infection, United States, 1999 and 2007.

11_1_2.2 Long-stay nursing home residents with a urinary tract infection, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Residents with a urinary tract infection on target assessment.

State Tables

11_1_2.3 Long-stay nursing home residents with a urinary tract infection, by State, 2002 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Excludes admission assessments and missing values on the target assessment. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Long-stay nursing home residents whose depression or anxiety increased.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_3.1 Long-stay nursing home residents who are more depressed or anxious, United States, 1999 and 2007.

11_1_3.2 Long-stay nursing home residents who are more depressed or anxious, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and a valid prior assessment.

National Numerator

Residents whose Mood Scale scores are greater on target assessment relative to prior assessment.

State Tables

11_1_3.3 Long-stay nursing home residents who are more depressed or anxious, by State, 2002 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Excludes residents with missing Mood Scale scores on the target assessment or prior assessment, residents who had a maximum Mood Scale score on the prior assessment, or residents who were comatose or whose comatose status was unknown. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Low-risk, long-stay nursing home residents with loss of control of bowels or bladder.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_4.1 Low-risk long-stay nursing home residents who lose control of their bowels or bladder, United States, 1999 and 2007.

11_1_4.2 Low-risk long-stay nursing home residents who lose control of their bowels or bladder, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and not qualifying as high-risk.

National Numerator

Subset of the denominator population who satisfy either of the following conditions: (1) had no pressure sores on the SNF PPS 5-day assessment and had at least Stage 1 pressure sores on the SNF PPS 14-day assessment, or (2) had pressure sores on the SNF PPS 5-day assessment, and pressure sores worsened or failed to improve on the SNF PPS 14-day assessment. SNF PPS stands for skilled nursing facility prospective payment system.

State Tables

11_1_4.3 Low-risk long-stay nursing home residents who lose control of their bowels or bladder, by State, 2002 and 2008

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Excludes admission assessments, residents with missing values, residents with comatose status, residents who had an indwelling catheter or ostomy, or residents with unknown status for these conditions. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Low-risk, long-stay nursing home residents with a catheter inserted and left in the bladder.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_5.1 Low-risk long-stay nursing home residents with a catheter inserted and left in their bladder, United States, 1999 and 2007.

11_1_5.2 Low-risk long-stay nursing home residents with a catheter inserted and left in their bladder, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Subset of the denominator population with indwelling catheters on target assessment

State Tables

11_1_5.3 Low-risk long-stay nursing home residents with a catheter inserted and left in their bladder, by State, 2002 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Rate is risk adjusted using resident-level covariates.

Excludes admission assessments or residents with missing values. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Long-stay nursing home residents with too much weight loss.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_6.1 Long-stay nursing home residents who lose too much weight, United States, 1999 and 2007.

11_1_6.2 Long-stay nursing home residents who lose too much weight, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and a valid prior assessment.

National Numerator

Residents who have experienced weight loss of 5 percent of more in the last 30 days or 10 percent or more in the last 6 months.

State Tables

11_1_6.3 Long-stay nursing home residents who lose too much weight, by State, 2004 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Excludes admission assessments, residents with missing weight loss data, and residents receiving hospice care. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Adult home health care patients whose shortness of breath decreased.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

11_1_7.1 Home health care patients who have less shortness of breath, United States, 2002 and 2007.

11_1_7.2 Home health care patients who have less shortness of breath, United States, 2007, by:

  • Race
  • Ethnicity

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person's dyspneic status improved compared to a prior assessment.

State Tables

11_1_7.3 Home health care patients who are short of breath less often, by State, 2005 and 2008.

State Data Source

CMS, OASIS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

The OASIS instrument measures dyspneic status on a 4-level scale from 0 (never short of breath) to 3 (dyspnea at rest). Episodes are not included for people who are at the highest level and cannot improve any more.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Adult home health care patients whose urinary incontinence decreased.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

11_1_8.1 Home health care patients who have less urinary incontinence, United States, 2002 and 2007.

11_1_8.2 Home health care patients who have less urinary incontinence, United States, 2007, by:

  • Race
  • Ethnicity

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person's urinary incontinence status improved compared to a prior assessment.

State Tables

11_1_8.3 Home health care patients whose bladder control improves, by State, 2005 and 2008.

State Data Source

CMS, OASIS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Episodes are not included for people who are at the highest level and cannot improve any more.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Adult home health care patients who received urgent, unplanned medical care.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

11_1_9.1 Home health care patients who need urgent, unplanned medical care, United States, 2004 and 2007.

11_1_9.2 Home health care patients who need urgent, unplanned medical care, United States, 2007, by:

  • Race
  • Ethnicity

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes with an assessment indicating that urgent or unplanned medical care was initiated.

State Tables

11_1_9.3 Home health care patients who need urgent, unplanned medical care, by State, 2005 and 2008.

State Data Source

CMS, OASIS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Adult home health care patients who stay at home after an episode of home health care.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

11_1_10.1 Home health care patients who stay at home after an episode of home health care ends, United States, 2004 and 2007.

11_1_10.2 Home health care patients who stay at home after an episode of home health care ends, United States, 2007, by:

  • Race
  • Ethnicity

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes with final assessments indicating patients remained at home at the conclusion of services.

State Tables

11_1_10.3 Home health care patients who stay at home after an episode of home health care ends, by State, 2005 and 2008.

State Data Source

CMS, OASIS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Long-stay nursing home residents who received influenza vaccination during the flu season.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_11.1 Long-stay nursing home residents given influenza vaccination during the flu season, United States, 2006 and 2007.

11_1_11.2 Long-stay nursing home residents given influenza vaccination during the flu season, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents during the most recently completed influenza season with a valid target assessment in effect during any part of the season.

National Numerator

Residents who received an influenza vaccine during the most recently completed influenza season.

State Tables

11_1_11.3 Long-stay nursing home residents given influenza vaccination during the flu season, by State, 2006 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Excludes residents ineligible for the influenza vaccine, residents who were offered the vaccine but declined, and residents in facilities unable to obtain the vaccine.

Top of Page


Supportive and Palliative Care

Measure Title

Short-stay nursing home residents who received influenza vaccination during the flu season.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_12.1 Short-stay nursing home residents given influenza vaccination during the flu season, United States, 2006 and 2007.

11_1_12.2 Short-stay nursing home residents given influenza vaccination during the flu season, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Short-stay residents during the most recently completed influenza season with a valid target assessment in effect during any part of the season.

National Numerator

Subset of denominator who received an influenza vaccine during the most recently completed influenza season.

State Tables

11_1_12.3 Short-stay nursing home residents given influenza vaccination during the flu season, by State, 2006 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Excludes residents ineligible for the influenza vaccine, residents who were offered the vaccine but declined, and residents in facilities unable to obtain the vaccine.

Top of Page


Supportive and Palliative Care

Measure Title

Long-stay nursing home residents who were assessed for pneumococcal vaccination.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_13.1 Long-stay nursing home residents who were assessed and given pneumococcal vaccination, United States, 2006 and 2007.

11_1_13.2 Long-stay nursing home residents who were assessed and given pneumococcal vaccination, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment within the 6-month target period.

National Numerator

Residents who have an up-to-date pneumococcal vaccination.

State Tables

11_1_13.3 Long-stay nursing home residents who were assessed and given pneumococcal vaccination, by State, 2006 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Excludes residents ineligible for the pneumococcal vaccine and residents who were offered the vaccine but declined

Top of Page


Supportive and Palliative Care

Measure Title

Short-stay nursing home residents who were assessed for pneumococcal vaccination.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_14.1 Short-stay nursing home residents who were assessed and given pneumococcal vaccination, United States, 2006 and 2007.

11_1_14.2 Short-stay nursing home residents who were assessed and given pneumococcal vaccination, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Short-stay residents with a valid target assessment within the 6-month target period.

National Numerator

Subset of denominator who have an up-to-date pneumococcal vaccination.

State Tables

11_1_14.3 Short-stay nursing home residents who were assessed and given pneumococcal vaccination, by State, 2006 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Excludes residents ineligible for the pneumococcal vaccine and residents who were offered the vaccine but declined.

Top of Page


Supportive and Palliative Care

Measure Title

Short-stay nursing home residents with moderate to severe pain.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_15.1 Short-stay nursing home residents who had moderate to severe pain, United States, 1999 and 2007.

11_1_15.2 Short-stay nursing home residents who had moderate to severe pain, United States, 2007, by:

  •  Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary post-acute care patients with a valid SNF PPS 14-day assessment. SNF PPS stands for skilled nursing facility prospective payment system.

National Numerator

Subset of the denominator population with moderate pain at least daily or horrible/excruciating pain at any frequency.

State Tables

11_1_15.3 Short-stay nursing home residents who had moderate to severe pain, by State, 2002 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Excludes assessments with inconsistent responses regarding the measure.

PPS refers to Medicare Prospective Payment System for skilled nursing facilities (SNFs).

Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Adult home health care patients whose pain when moving around decreased.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

11_1_16.1 Home health care patients who have less pain when moving around, United States, 2002 and 2007.

11_1_16.2 Home health care patients who have less pain when moving around, United States, 2007, by:

  •  Race
  •  Ethnicity

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person's frequency of pain interfering with activity or movement improved compared to a prior assessment

State Tables

11_1_16.3 Home health care patients who have less pain when moving around, by State, 2005 and 2008.

State Data Source

CMS, OASIS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

The OASIS instrument measures frequency of pain on a 4-level scale from 0 (no pain or pain does not interfere with activity) to 3 (constant). Episodes are not included for people who are at the highest level and cannot improve any more.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Long-stay nursing home residents with physical restraints.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_17.1 Long-stay nursing home residents who were physically restrained, United States, 1999 and 2007.

11_1_17.2 Long-stay nursing home residents who were physically restrained, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Residents who were physically restrained daily on target assessment.

State Tables

11_1_17.3 Long-stay nursing home residents who were physically restrained, by State, 2002 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Excludes admission assessments or residents with missing values. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

High-risk, long-stay nursing home residents with pressure sores.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_18.1 High-risk long-stay nursing home residents who have pressure sores, United States, 1999 and 2007.

11_1_18.2 High-risk long-stay nursing home residents who have pressure sores, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and with any of the following inclusion criteria: impaired in bed mobility or transfer, comatose, or suffering malnutrition on the target assessment.

National Numerator

Subset of the denominator population with pressure sores (stage 1-4) on target assessment.

State Tables

11_1_18.3 High-risk long-stay nursing home residents who have pressure sores, by State, 2002 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Patients with pressure sores at nursing home admission or with missing values are excluded, but their subsequent MDS reassessments are included in the numerator if the sore has not healed.

Excludes facilities with fewer than 30 residents in the denominator. Excludes admission assessments and residents with certain disqualifying responses. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Low-risk, long-stay nursing home residents with pressure sores.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_19.1 Low-risk long-stay nursing home residents who have pressure sores, United States, 1999 and 2007.

11_1_19.2 Low-risk long-stay nursing home residents who have pressure sores, United States, 2007, by:

  •  Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and not qualifying as high-risk.

National Numerator

Subset of the denominator population with pressure sores (stage 1-4) on target assessment.

State Tables

11_1_19.3 Low-risk long-stay nursing home residents who have pressure sores, by State, 2002 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Patients with pressure sores at nursing home admission or with missing values are excluded, but their subsequent MDS reassessments are included in the numerator if the sore has not healed.

Excludes residents with missing values and residents with comatose status. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Short-stay nursing home residents with pressure sores.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_20.1 Short-stay nursing home residents with pressure sores, United States, 1999 and 2007.

11_1_20.2 Short-stay nursing home residents with pressure sores, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary post-acute care patients with a valid SNF PPS 14-day assessment and a valid preceding SNF PPS 5-day assessment.

National Numerator

Subset of the denominator population who satisfy either of the following conditions: (1) Had no pressure sores on the SNF PPS 5-day assessment and had at least Stage 1 pressure sores on the SNF PPS 14-day assessment. (2) Had pressure sores on the SNF PPS 5-day assessment, and pressure sores worsened or failed to improve on the SNF PPS 14-day assessment.

State Tables

11_1_20.3 Short-stay nursing home residents with pressure sores, by State, 2002 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Percentage is risk adjusted using resident-level covariates.

PPS refers to Medicare Prospective Payment System for skilled nursing facilities (SNFs).

Excludes facilities with fewer than 30 residents in the denominator and patients with missing values. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Short-stay nursing home residents with delirium.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

11_1_21.1 Short-stay nursing home residents with delirium, United States, 1999 and 2007.

11_1_21.2 Short-stay nursing home residents with delirium, United States, 2007, by:

  • Race/ethnicity

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary post-acute care patients with a valid SNF PPS 14-day assessment.

National Numerator

Subset of the denominator population with at least 1 symptom of delirium that represents a departure from usual functioning.

State Tables

11_1_21.3 Short-stay nursing home residents with delirium, by State, 2002 and 2008.

State Data Source

CMS, MDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Percentage is risk adjusted using resident-level covariates.

Excludes residents with comatose status, residents with end-stage disease, residents receiving hospice care, and residents with unknown status for these conditions. Residents with neurodegenerative diseases are not automatically excluded.

PPS refers to Medicare Prospective Payment System for skilled nursing facilities (SNFs).

Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInit/s.

Top of Page


Supportive and Palliative Care

Measure Title

Adult home health care patients who had to be admitted to the hospital.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

11_1_22.1 Home health care patients who had to be admitted to the hospital, United States, 2002 and 2007.

11_1_22.2 Home health care patients who had to be admitted to the hospital, United States, 2007, by:

  • Race
  • Ethnicity

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person was hospitalized for an acute condition while receiving home health care services.

State Tables

11_1_22.3 Home health care patients who had to be admitted to the hospital, by State, 2005 and 2008.

State Data Source

CMS, OASIS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Reason for hospitalization may be for emergent, urgent, or elective conditions.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

Top of Page


Supportive and Palliative Care

Measure Title

Hospice patient caregivers who perceived patient was referred to hospice at the right time.

Measure Source

National Hospice and Palliative Care Organization (NHPCO).

National Tables

11_1_23.1 Hospice patient caregivers who perceived patient was referred to hospice at the right time, United States, 2005 and 2008.

National Data Source

Centers for Medicare & Medicaid Services (CMS), NHPCO, Family Evaluation of Hospice Care (FEHC) survey.

National Denominator

Hospice patients age 18 and over.

National Numerator

Subset of denominator for whom the survey respondent indicated the patient was referred to hospice at the right time.

State Tables

11_1_23.2 Hospice patient caregivers who perceived patient was referred to hospice at the right time, by State, 2007 and 2008

State Data Source

CMS, NHPCO, FEHC survey.

State Denominator

Same as National.

State Numerator

Same as National.

Top of Page


Supportive and Palliative Care

Measure Title

Hospice patients who received the right amount of medicine for pain.

Measure Source

National Hospice and Palliative Care Organization (NHPCO).

National Tables

11_1_24.1 Hospice patients who received the right amount of medicine for pain, United States, 2005 and 2008.

National Data Source

Centers for Medicare & Medicaid Services (CMS), NHPCO, Family Evaluation of Hospice Care (FEHC) survey.

National Denominator

Hospice patients age 18 and over.

National Numerator

Subset of denominator who received the right amount of medicine for pain, according to the survey respondent

State Tables

11_1_24.2 Hospice patients who received the right amount of medicine for pain management, by State, 2006 and 2008.

State Data Source

CMS, NHPCO, FEHC survey.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

The Family Evaluation of Hospice Care Survey is administered to family members of deceased recipients of hospice care. See the Data Sources appendix for further information.

Top of Page


Supportive and Palliative Care

Measure Title

Hospice patients who received care consistent with their stated end-of-life wishes.

Measure Source

National Hospice and Palliative Care Organization (NHPCO).

National Tables

11_1_25.1 Hospice patients who received care consistent with their stated end-of-life wishes, United States, 2005 and 2008.

National Data Source

Centers for Medicare & Medicaid Services (CMS), NHPCO, Family Evaluation of Hospice Care (FEHC) survey.

National Denominator

Hospice patients age 18 and over.

National Numerator

Subset of denominator who received care consistent with their stated end of life wishes, according to the survey respondent.

State Tables

11_1_25.2 Hospice patients who received care consistent with their stated end-of-life wishes, by State, 2006 and 2008.

State Data Source

CMS, NHPCO, FEHC survey.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

The Family Evaluation of Hospice Care Survey is administered to family members of deceased recipients of hospice care. See the Data Sources appendix for further information.

Top of Page


Supportive and Palliative Care

Measure Title

Current home health patients with any pain at last assessment and, if any pain present, only PRN orders for pain management.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Table

Data table will not be presented this year.

Data Source

CDC, NCHS, National Home and Hospice Care Survey (NHHCS).

Denominator

Current home health patients.

Numerator

Subset of denominator who had any pain at the last assessment and, if any pain present, only pro re nata (PRN) orders for pain management.

Top of Page


Supportive and Palliative Care

Measure Title

Annual hospice discharges with any pain at last assessment and, if any pain present, only PRN orders for pain management.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Table

Data table will not be presented this year.

Data Source

CDC, NCHS, National Home and Hospice Care Survey (NHHCS).

Denominator

Annual hospice discharges.

Numerator

Subset of denominator who had any pain at the last assessment and, if any pain present, only pro re nata (PRN) orders for pain management.

Top of Page


Current as of March 2010
Internet Citation: Effectiveness of Care: Supportive and Palliative Care: 2009 National Healthcare Quality and Disparities Reports. March 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr09/measurespec/supportive_and_palliative_care.html