2012 National Healthcare Quality and Disparities Reports
Data Sources—Centers for Medicare & Medicaid Services
Fistula First Breakthrough Initiative
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), Office of Clinical Standards and Quality.
Description
The Fistula First Breakthrough Initiative is dedicated to improving care for people with chronic kidney disease by increasing arteriovenous fistula (AVF) placement and use in suitable hemodialysis patients.
Primary Content
The AVF data contain elements that represent core items obtained from an assessment of hemodialysis patients. These data are used to measure the placement and use of AVF in suitable hemodialysis patients.
Population Targeted
End stage renal disease patients receiving hemodialysis.
Demographic Data
Age, gender, race, and ethnicity.
Years Collected
Since 2008.
Schedule
Annual
Geographic Estimates
National and State.
Contact Information
Agency home page: http://www.cms.hhs.gov.
Data system home page: http://www.fistulafirst.org.
Home Health Outcome and Assessment Information Set (OASIS)
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Description
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
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% 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.
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
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.
MCBS was originally designed as a longitudinal survey in which Medicare beneficiaries would be followed indefinitely. Its initial sample (the 1991 panel) was selected through a stratified, multistage area probability design. From 1994 on, the longitudinal design was changed to a rotating design. In 1994, approximately one-third of the sample was rotated out after the round 12 interviews and replaced by a supplemental sample of the same size.
The overlapping panel design allows each sample person to be interviewed three times a year for 4 years, whether he or she resides in the community or a facility or moves between the two settings, using the version of the questionnaire appropriate to the setting.
The target sample size is 12,000 people. Response rates for the community interviews are above 80% in the first round and above 95% in subsequent rounds. Response rates for facility interviews approach 100%.
Primary Survey Content
MCBS has two components: the Cost and Use file and the Access to Care file. Medicare claims are linked to survey-reported events to produce the Cost and Use file. This file provides complete expenditure and source of payment data on all health care services, including those not covered by Medicare. The Access to Care file contains information on beneficiaries' access to health care, satisfaction with care, and usual source of care. The sample for this file represents the always enrolled population, those who participated in the Medicare program for the entire year. In contrast, the Cost and Use file represents the ever enrolled population, including both those who entered Medicare and those who died during the year.
Population Targeted
Elderly, 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].
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. Hospitals collect these data using data collection tools developed by QIOs or related organizations.
Details are in the QIO Statement of Work (http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/9thSOW.html). Quality performance information collected from the more than 4,000 participating hospitals is reported on Hospital Compare, a Web site tool developed by CMS.
Before 2005, QIOs 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 these are CDAC-abstracted data and 2005 data are hospital self-reported for all payers, only hospital self-reported data starting from 2005 are reported in the NHQR and NHDR.
Contact Information
Agency home page: http://www.cms.hhs.gov.
Data system home page: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html.
References
The 10th QIO Statement of Work is available at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/9thSOW.html.
Nursing Home Minimum Data Set (MDS)
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Description
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 are part of this process and provide the foundation on 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; since 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) payment require more frequent assessments (5, 14, 30, 60, and 90 days).
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 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.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/index.html.
References
National Nursing Home Quality Measures, user's manual, version 1.2 (consolidation of original user's manual and technical user's manual). Baltimore, MD: Centers for Medicare & Medicaid Services; November 2004. Available at: http://www.cms.hhs.gov.
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