Data Source: Centers for Medicare & Medicaid Services (CMS)

2010 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.

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.

Description

The CPM collects information on patients with ESRD who are undergoing dialysis. Abstracted clinical information is gathered 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.

Reference

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.Available at: 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. OASIS data are collected, encoded, and transmitted for all Medicare and 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 contains data elements that represent core items obtained from a comprehensive assessment of adult home care patients. These data are used to measure patient outcomes for purposes of outcome-based quality improvement.

Data collected in OASIS include demographic 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, and living arrangement.

Population Targeted

U.S. adult, nonmaternity home care patients receiving skilled services.

Mode of Administration

Completed by home health agency 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 and State.

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 for 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. The calculations for the measures appearing in the NHQR and NHDR tables use the same definitions as are used for the measures displayed in Home Health Compare.


Hospital Compare

Sponsor

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

Description

Hospital Compare data are obtained 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 CAHPS® (Consumer Assessment of Healthcare Providers and Systems) (HCAHPS) survey were added to Hospital Compare. HCAHPS provides a standardized instrument and data collection methodology for measuring patient's perspectives on hospital care.

Whether a hospital uses sampling to derive measures 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.

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 or service. However, complete documentation includes the principal and other ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) diagnosis and procedure codes, which require retrospective data entry.

Primary Survey 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:

  • Hospital characteristics and inspection results from CMS's Online Survey, Certification, and Reporting (OSCAR) database.
  • Clinical Quality Measures Data from the Quality Improvement Organization Clinical Warehouse. Hospitals submit patient record data for the clinical conditions.
  • 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.
  • Patients' hospital experiences data collected and reported through MyQualityNet using the HCAHPS survey.
  • Children's asthma care measure data collected by the Joint Commission.
  • 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/.

Reference

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.

Description

The MCBS collects health care access, utilization, and cost information from Medicare beneficiaries. Sample persons in the community are interviewed with computer-assisted personal interviewing 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 percent in the first round and above 95 percent in subsequent rounds. Response rates for facility interviews approach 100 percent.

Primary Survey Content

The 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

Older, 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 and 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]. [Plugin Software Help]


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 assist providers 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 encourage hospitals to submit clinical performance data to the national QIO clinical warehouse. These data are collected by hospitals using data collection tools developed by QIOs or related organizations. Details are in the QIO Statement of Work at http://www.cms.gov/QualityImprovementOrgs/09_Current.asp#TopOfPage. Quality performance information collected from the more than 4,000 participating hospitals is reported on Hospital Compare, a Web tool developed by CMS.

Before 2005, QIO abstracted data that only included Medicare inpatients. From 2005 on, QIO data are hospital self-reported and include all payers. Hospital self-reported data submitted to the QIO clinical warehouse are subject to random validation audits by an independent CMS contractor.

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 Clinical Data Abstraction Centers (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 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

The 9th QIO Statement of Work is available at http://www.cms.gov/QualityImprovementOrgs/09_Current.asp#TopOfPage.


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. MDS assessments are required for residents on admission to the nursing facility and then within specific guidelines and timeframes. In most cases, the assessment process is conducted by licensed health care professionals employed by the nursing home.

Primary Content

Demographic 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, and race or ethnicity.

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; beginning in June 1998, States have transmitted MDS data to the CMS central repository.

Data Collection Schedule

Assessments are performed upon 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 prospective payment system (PPS) payments require more frequent assessments (5, 14, 30, 60, and 90 day).

Facilities are required to electronically transmit MDS data to the States. The State agencies have 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 and State.

Notes

Chronic care patients are those who typically enter a nursing facility because they can no longer 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 for residents with a full or quarterly MDS assessment in the target quarter.

Post-acute care (PAC) patients are generally admitted to a nursing facility for a period of 30 days or less. 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 patients with a 14-day PPS MDS assessment in the last 6 months.

Contact Information

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

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

Reference

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.

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Current as of February 2011
Internet Citation: Data Source: Centers for Medicare & Medicaid Services (CMS): 2010 National Healthcare Quality and Disparities Reports. February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr10/datasources/cms.html