Effectiveness: Supportive and Palliative Care

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.

Effectiveness of Care: Supportive and Palliative Care

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, 1999-2008

11_1_1.2 Long-stay nursing home residents who have moderate to severe pain, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Medicare chronic care nursing home residents with a valid target assessment, excluding admission assessments and assessments with inconsistent or missing responses.

National Numerator

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

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Rate is risk adjusted using resident-level covariates.

Long-stay residents enter a nursing facility typically because they can no longer care for themselves at home; they tend to remain in the facility for several months or years.

Facilities with fewer than 30 residents in the denominator are excluded.

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/.

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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, 1999-2008

11_1_2.2 Long-stay nursing home residents with a urinary tract infection, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Medicare chronic care residents with a valid target assessment, excluding admission assessments and target assessments with missing values.

National Numerator

Subset of the denominator with urinary tract infection on target assessment.

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Facilities with fewer than 30 residents in the denominator are excluded.

Long-stay residents enter a nursing facility typically because they can no longer care for themselves at home; they tend to remain in the facility for several months or years.

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/ .

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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 became more depressed or anxious, United States, 1999-2008

11_1_3.2 Long-stay nursing home residents who became more depressed or anxious, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

All nursing home residents with a valid target assessment and a valid prior assessment, excluding 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.

National Numerator

Subset of the denominator with a Mood Scale score that indicated greater anxiety.

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Facilities with fewer than 30 residents in the denominator were excluded.

Long-stay residents enter a nursing facility typically because they can no longer care for themselves at home; they tend to remain in the facility for several months or years.

Mood Scale score is defined as the count of the number of the following eight conditions that are satisfied (range 0 through 8) on the target assessment:

.
Any verbal expression of distress..
Shows signs of crying, tearfulness..
Motor agitation..
Leaves food uneaten on target or last full assessment..
Repetitive health complaints..
Repetitive/recurrent verbalizations..
Negative statements..
Mood symptoms not easily altered..

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/.

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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 -2008

11_1_4.2 Low-risk, long -stay nursing home residents who lose control of their bowels or bladder, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Medicare chronic care nursing home residents with a valid target assessment and who do not qualify as high-risk, excluding admission assessments, residents with missing assessment values, residents with comatose status, residents who had an indwelling catheter or ostomy, or residents with unknown status for these conditions.

National Numerator

Subset of the denominator who indicated loss of control of bowels or bladder.

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Facilities with fewer than 30 residents in the denominator are excluded.

Long-stay residents enter a nursing facility typically because they can no longer care for themselves at home; they tend to remain in the facility for several months or years.

Low-risk residents are active, can change positions, and are getting the nutrients they need to maintain good skin health.

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/ .

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Supportive and Palliative Care

Measure Title

Low-risk, long -stay nursing home residents with a catheter inserted and left in their 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, 1999-2008

11_1_5.2 Low-risk, long -stay nursing home residents with a catheter inserted and left in their bladder, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Medicare chronic care nursing home residents with a valid target assessment, excluding admission assessments or assessments with missing values.

National Numerator

Subset of the denominator population with indwelling catheters on target assessment.

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Rate is risk adjusted using resident-level covariates.

Facilities with fewer than 30 residents in the denominator are excluded.

Long-stay residents enter a nursing facility typically because they can no longer care for themselves at home; they tend to remain in the facility for several months or years.

Low-risk residents are active, can change positions, and are getting the nutrients they need to maintain good skin health.

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/ .

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Supportive and Palliative Care

Measure Title

Long-stay nursing home residents who lost too much weight.

Measure Source

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

National Tables

11_1_6.1 Long-stay nursing home residents who lost too much weight, United States, 1999-2008

11_1_6.2 Long-stay nursing home residents who lost too much weight, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Medicare chronic care nursing home residents with a valid target assessment and a valid prior assessment, excluding admission assessments, residents with missing weight loss data, and residents receiving hospice care.

National Numerator

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

State Table

11_1_6.3 Long-stay nursing home residents who lost too much weight, State, 2008, by:

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Long-stay residents enter a nursing facility typically because they can no longer care for themselves at home; they tend to remain in the facility for several months or years.

Facilities with fewer than 30 residents in the denominator are excluded.

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/ .

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Supportive and Palliative Care

Measure Title

Adult home health care patients whose episodes of 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, 2002-2008

11_1_7.2a-b Home health care patients who have less shortness of breath, United States, 2008, 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, excluding episodes for persons who are at the highest level and cannot improve any more.

National Numerator

Subset of the denominator in which a person's dyspneic status improved compared with a prior assessment.

State Tables

11_1_7.3a-b Home health care patients who are short of breath less often, State, 2008, by:

Race.
Ethnicity.

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).

Risk-adjusted rates are available for State estimates only.

Further information about risk adjustment and the Home Health Quality Initiative measures are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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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, 2002-2008

11_1_8.2a-b Home health care patients who have less urinary incontinence, United States, 2008, 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, excluding episodes for persons who are at the highest level and cannot improve any more.

National Numerator

Subset of the denominator in which a person's urinary incontinence status improved compared with a prior assessment.

State Tables

11_1_8.3a-b Home health care patients whose bladder control improves, by State, 2008, by:

Race.
Ethnicity.

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.

Further information about risk adjustment and the Home Health Quality Initiative measures are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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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, 2004-2008

11_1_9.2a-b Home health care patients who need urgent, unplanned medical care, United States, 2008, 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

Subset of the denominator with an assessment indicating that urgent or unplanned medical care was initiated.

State Tables

11_1_9.3a-b Home health care patients who need urgent, unplanned medical care, by State, 2008, by:

Race.
Ethnicity.

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.

Further information about this and the Home Health Quality Initiative measures are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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Supportive and Palliative Care

Measure Title

Adult home health care patients who stayed 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 stayed at home after an episode of home health care ended, United States, 2004-2008

11_1_10.2a-b Home health care patients who stayed at home after an episode of home health care ended, United States, 2008, 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

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

State Tables

11_1_10.3a-b Home health care patients who stayed at home after an episode of home health care ended, by State, 2008, by:

Race.
Ethnicity.

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. Further information about risk adjustment and the Home Health Quality Initiative measures are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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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 who received an influenza vaccination during the flu season, United States, 2006-2008

11_1_11.2 Long-stay nursing home residents who received an influenza vaccination during the flu season, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Medicare chronic care residents who, during the most recently completed influenza season, had a valid target assessment in effect, excluding residents ineligible for the influenza vaccine, residents who were offered the vaccine but declined, and residents in facilities unable to obtain the vaccine.

National Numerator

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

State Table

11_1_11.3 Long-stay nursing home residents who received an influenza vaccination during the flu season, by State, 2008, by:

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Long-stay residents enter a nursing facility typically because they can no longer care for themselves at home; they tend to remain in the facility for several months or years.

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Supportive and Palliative Care

Measure Title

Short-stay nursing home residents who received an 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 an influenza vaccination during the flu season, United States, 2006-2008

11_1_12.2 Short-stay nursing home residents given an influenza vaccination during the flu season, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Short-stay nursing home residents who, during the most recently completed influenza season, had a valid target assessment in effect, excluding residents ineligible for the influenza vaccine, residents who were offered the vaccine but declined, and residents in facilities unable to obtain the vaccine.

National Numerator

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

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Short stay refers to residents who are admitted to a facility and stay fewer than 30 days; these admissions, also referred to as "postacute," typically follow an acute care hospitalization.

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Supportive and Palliative Care

Measure Title

Long-stay nursing home residents who were assessed for receipt of a 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 received a pneumococcal vaccination, United States, 2006-2008

11_1_13.2 Long-stay nursing home residents who were assessed and received a pneumococcal vaccination, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Medicare chronic care nursing home residents with a valid target assessment within the 6-month target period, excluding residents ineligible for the pneumococcal vaccine and residents who were offered the vaccine but declined.

National Numerator

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

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Long-stay residents enter a nursing facility typically because they can no longer care for themselves at home; they tend to remain in the facility for several months or years.

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Supportive and Palliative Care

Measure Title

Short-stay nursing home residents who were assessed for receipt of a 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 received a pneumococcal vaccination, United States, 2006-2008

11_1_14.2 Short-stay nursing home residents who were assessed and received a pneumococcal vaccination, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Short-stay nursing home residents with a valid target assessment within the 6-month target period, excluding residents ineligible for the pneumococcal vaccine and residents who were offered the vaccine but declined.

National Numerator

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

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Short stay refers to residents who are admitted to a facility and stay fewer than 30 days; these admissions, also referred to as "postacute," typically follow an acute care hospitalization.

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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, 1999-2008

11_1_15.2 Short-stay nursing home residents who had moderate to severe pain, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

All post-acute care patients with valid Skilled Nursing Facility Prospective Payment System (SNF PPS) 14-day assessment.

National Numerator

Subset of the denominator with moderate pain daily or severe/excruciating pain at any frequency.

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Facilities with fewer than 30 residents in the denominator are excluded.

Short stay refers to residents who are admitted to a facility and stay fewer than 30 days; these admissions, also referred to as "postacute," typically follow an acute care hospitalization.

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/ .

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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, 2002-2008

11_1_16.2a-b Home health care patients who have less pain when moving around, United States, 2008, 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, excluding episodes for persons who are at the highest level and cannot improve any more.

National Numerator

Subset of the denominator in which the frequency of pain interfering with activity or movement became fewer compared with a prior assessment.

State Tables

11_1_16.3a-b Home health care patients who have less pain when moving around, by State, 2008, by:

Race.
Ethnicity.

State Data Source

CMS, OASIS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

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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, 1999-2008

11_1_17.2 Long-stay nursing home residents who were physically restrained, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Medicare chronic care residents with a valid target assessment, excluding admission assessments or assessments with missing values.

National Numerator

Subset of the denominator who were physically restrained daily on target assessment.

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Facilities with fewer than 30 residents in the denominator are excluded.

Long-stay residents enter a nursing facility typically because they can no longer care for themselves at home; they tend to remain in the facility for several months or years.

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/ .

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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, 1999-2008

11_1_18.2 High-risk, long -stay nursing home residents who have pressure sores, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Medicare chronic care nursing home 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; excluding admission assessments and residents with certain disqualifying responses.

National Numerator

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

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

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 2.0 reassessments are included in the numerator if the sore has not healed.

Facilities with fewer than 30 residents in the denominator are excluded.

High-risk residents are those who are in a coma, do not get the nutrients they need to maintain good skin health, or cannot change position on their own.

Long-stay residents enter a nursing facility typically because they can no longer care for themselves at home; they tend to remain in the facility for several months or years.

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/ .

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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, 1999-2008

11_1_19.2 Low-risk, long -stay nursing home residents who have pressure sores, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Medicare chronic care residents with a valid target assessment and who are not high-risk, excluding residents with missing values and residents with comatose status.

National Numerator

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

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

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 2.0 reassessments are included in the numerator if the sore has not healed.

Facilities with fewer than 30 residents in the denominator are excluded.

Long-stay residents enter a nursing facility typically because they can no longer care for themselves at home; they tend to remain in the facility for several months or years.

Low-risk residents are active, can change positions, and are getting the nutrients they need to maintain good skin health.

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/ .

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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, 1999-2008

11_1_20.2 Short-stay nursing home residents with pressure sores, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Medicare post-acute care patients with valid Skilled Nursing Facility Prospective Payment System (SNF PPS) 14-day assessment and a valid preceding SNF PPS 5-day assessment.

National Numerator

Subset of the denominator 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 Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Percentages are risk adjusted using resident-level covariates.

Facilities with fewer than 30 residents in the denominator and patients with missing values are excluded from the analyses.

Short stay refers to residents who are admitted to a facility and stay fewer than 30 days; these admissions, also referred to as "postacute," typically follow an acute care hospitalization.

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/ .

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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, 1999-2008

11_1_21.2 Short-stay nursing home residents with delirium, United States, 2008, by:

Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS 2.0).

National Denominator

Postacute Medicare beneficiaries with a valid Skilled Nursing Facility Prospective Payment System (SNF PPS) 14-day assessment, excluding comatose residents, residents with end stage renal disease, residents receiving hospice care, and residents with unknown status for these conditions.

National Numerator

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

State Table

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

Race/ethnicity.

State Data Source

CMS, MDS 2.0.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Percentages are risk adjusted using resident-level covariates.

Residents with neurodegenerative diseases are not automatically excluded.

Facilities with fewer than 30 residents in the denominator are excluded.

Short stay refers to residents who are admitted to a facility and stay fewer than 30 days; these admissions, also referred to as "postacute," typically follow an acute care hospitalization.

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/ .

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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 were admitted to the hospital, United States, 2002-2008

11_1_22.2a-b Home health care patients who were admitted to the hospital, United States, 2008, 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

Subset of the denominator in which a person was hospitalized for an acute condition while receiving home health care services.

Comments

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

Further information about risk adjustment and the Home Health Quality Initiative measures are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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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 Table

11_1_23.1 Hospice patient caregivers who perceived patient was referred to hospice at the right time, United States, 2008-2009

National Data Source

NHPCO, Family Evaluation of Hospice Care Survey (FEHCS).

National Denominator

Caregivers of hospice patients age 18 and over.

National Numerator

Subset of denominator who indicated that the patient was referred to hospice at the right time.

State Table

11_1_23.2 Hospice patient caregivers who perceived patient was referred to hospice at the right time, by State, 2007-2009

State Data Source

NHPCO, FEHCS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

The FEHCS is administered to family members of deceased recipients of hospice care. Data represent responses from caregivers who had a family member in a hospice that contributes data to the FEHCS. See the Data Sources appendix for further information.

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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 Table

11_1_24.1 Hospice patients who received the right amount of medicine for pain, United States, 2008-2009

National Data Source

NHPCO, Family Evaluation of Hospice Care Survey (FEHCS).

National Denominator

Caregiver of hospice patients age 18 and over.

National Numerator

Subset of denominator who indicated the patient received the right amount of medicine for pain.

State Table

11_1_24.2 Hospice patients who received the right amount of medicine for pain management, by State, 2008-2009

State Data Source

NHPCO, FEHCS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

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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 Table

11_1_25.1 Hospice patients who received care consistent with their stated end-of-life wishes, United States, 2008-2009

National Data Source

NHPCO, Family Evaluation of Hospice Care (FEHCS).

National Denominator

Caregivers of hospice patients age 18 and over.

National Numerator

Subset of denominator who indicated the patient or family member received care consistent with their stated end-of-life wishes.

State Table

11_1_25.2 Hospice patients who received care consistent with patient's wishes, by State, 2006-2009

State Data Source

NHPCO, FEHCS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

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Supportive and Palliative Care

Measure Title

Family caregivers who did not want more information about what to expect while the patient was dying.

Measure Source

National Hospice and Palliative Care Organization (NHPCO).

National Table

11_1_28.1 Family caregivers who did not want more information about what to expect while the patient was dying, United States, 2008-2009

National Data Source

Family Evaluation of Hospice Care Survey (FEHCS).

National Denominator

Adults age 18 years and over who were caregivers for hospice patients.

National Numerator

Subset of the denominator who indicated that they would not have wanted additional information about what to expect when the family member/patient in hospice was dying.

State Table

11_1_28.2 Family caregivers who did not want more information about what to expect while the patient was dying, by State, 2007-2009

State Data Source

NHPCO, FEHCS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

This measure is based on responses to question D7 in the Family Evaluation of Hospice Care Survey: "Would you have wanted more information about what to expect while the patient was dying?" Surveys are administered following the death of the patient.

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Supportive and Palliative Care

Measure Title

Hospice patients who received the right amount of help for feelings of anxiety or sadness.

Measure Source

National Hospice and Palliative Care Organization (NHPCO).

National Table

11_1_29.1 Hospice patients who received the right amount of help for feelings of anxiety or sadness, United States, 2008-2009

National Data Source

NHPCO, Family Evaluation of Hospice Care Survey (FEHCS).

National Denominator

Caregivers of hospice patients age 18 and over.

National Numerator

Subset of the denominator who indicated that the patient or family member received the right amount of help for feelings of anxiety or sadness.

State Table

11_1_29.2 Hospice patients who received the right amount of help for feelings of anxiety or sadness, by State, 2009

State Data Source

NHPCO, FEHCS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

This measure is based on responses to question B10 in the Family Evaluation of Hospice Care Survey: "How much help in dealing with these feelings did the patient receive?" Survey administered to the caregiver.

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Return to Measure Specifications

Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850 Telephone: (301) 427-1364

Current as of February 2011

Internet Citation: Effectiveness: Supportive and Palliative Care: 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/measurespec/supportive_and_palliative_care.html