|National Healthcare Disparities Report, 2006
Agency for Healthcare Research and Quality
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Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ). Participating sponsors include State Medicaid agencies, State Children's Health Insurance Programs (SCHIP), public and private employers, individual health plans, Medicare, and the Department of Defense.
Mode of Administration
By responding to a standardized set of questions administered through a mail or telephone questionnaire, health plan members report on their experiences and rate their health plans and providers in several areas.
Survey Sample Design
CAHPS® surveys are administered to a random sample of health plan members by independent survey vendors, following standardized procedures.
Primary Survey Content
Consumer experiences in obtaining health care, including the following five major areas: getting needed care; getting care without long waits; how well doctors communicate; courtesy and helpfulness of office staff, and customer service.
CAHPS® has specific populations for specific surveys and databases, such as adults, children, children with chronic conditions, commercial, Medicaid, Medicare and/or Medicare managed care, etc. See specific table and measure specification information.
Estimates for tables based on CAHPS® data were calculated using plan-level weights; i.e., all respondents in a plan received the same weight. Further, all plans within a State were weighted to contribute equally to the State-level statistic. CAHPS® data were provided by the National CAHPS® Benchmarking Database (NCBD).
The primary purpose of the NCBD is to facilitate comparisons of CAHPS® survey results by survey sponsors. By compiling survey results from a variety of sponsors into a single national database, the NCBD enables participants to compare their own results to relevant benchmarks. The NCBD also offers an important source of primary data for specialized research related to consumer assessments of quality as measured by CAHPS®.
The NCBD currently contains 8 years (1998-2005) of data from the CAHPS® Health Plan Survey. The 2005 database holds survey results for approximately 327,000 adults and children enrolled in commercial, Medicaid, SCHIP, and Medicare plans.
Age, gender, education, race, ethnicity, region, insurance coverage, health status.
Since 1998. CAHPS® was formerly known and is sometimes referred to as the Consumer Assessment of Health Plans Study.
State; Census Bureau regions.
Healthcare Cost and Utilization Project (HCUP)
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ).
Mode of Collection
HCUP databases bring together the data collection efforts of State government data organizations, hospital associations, private data organizations, and the Federal Government to create a national information resource of discharge-level health care data. The number of participating States increased to 37 in 2003. See "Sources of HCUP Data" below.
HCUP includes a collection of longitudinal hospital care data, with all-payer, discharge-level information beginning in 1988. Two HCUP discharge datasets were used in this report:
- The HCUP Nationwide Inpatient Sample (NIS) is a nationally stratified sample of hospitals (with all of their discharges) from States that contribute data to the NIS dataset. Weights are used to develop national estimates. NIS 2003 contains data for approximately 7.9 million discharges from 994 hospitals located in 37 States, approximating a 20-percent stratified sample of U.S. community hospitals.
- The 2003 HCUP Statewide Inpatient Databases (SID) include all hospitals (with all of their discharges) from 38 participating States. In aggregate, the SID represent approximately 90 percent of all U.S. hospital discharges, totaling over 34 million inpatient discharge abstracts.
The HCUP NIS and SID contain over 100 clinical and nonclinical data variables, including age, gender; race; ethnicity; length of stay; discharge status; source of payment; total charges, hospital size, ownership, region, teaching status; diagnoses and procedures.
Some NHDR measures that use HCUP data are based on the following AHRQ Quality Indicators:
- Inpatient Quality Indicators (IQIs), which reflect quality of care in hospitals, include 13 mortality indicators for conditions or procedures for which mortality can vary from hospital to hospital; 9 utilization indicators for procedures for which utilization varies across hospitals or geographic areas; and 7 volume indicators for procedures for which outcomes may be related to the volume of those procedures performed.
- Prevention Quality Indicators (PQIs) identify hospital admissions for 16 ambulatory care sensitive conditions, which evidence suggests could have been avoided, in part, through high-quality outpatient care.
- Patient Safety Indicators (PSIs) reflect potential inpatient complications and other patient safety concerns following surgeries, other procedures, and childbirth.
Any person, U.S. citizen or foreign, using non-Federal, non-rehabilitation, community hospitals in the United States as defined by the American Hospital Association (AHA).
The AHA defines community hospital as "all non-Federal, short-term, general, and other specialty hospitals, excluding hospital units of institutions." Included among community hospitals are specialty hospitals, such as obstetrics-gynecology, ear-nose-throat, short-term rehabilitation, orthopedic, and pediatric institutions. Also included are public hospitals and academic medical centers. The NIS and analyses of the SID for this report excluded short-term rehabilitation hospitals (beginning with 1998 data), long-term hospitals, psychiatric hospitals, and alcoholism/chemical dependency treatment facilities.
Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.
Age, gender, race, insurance coverage, median household income of the patient's ZIP Code, urbanized location, and region of the United States.
National, four U.S. Census Bureau regions, and State levels (for States participating in SID).
Use of AHRQ Quality Indicator Software in Generating NHQR Tables
The following AHRQ QI software versions were used for generating the HCUP tables in this report: IQIs: Version 2.1, revision 3 (July 2004); PQIs: Version 2.1, revision 3 (January 2004); PSsI: Version 2.1, revision 2 (October 2004). For more information, see the methods section for each quality report, available at http://qualitytools.ahrq.gov.
For detailed information about each measure, see the individual guides to the quality indicators listed below, available from the archives at http://www.qualityindicators.ahrq.gov.
Inpatient Quality Indicators (IQIs)
AHRQ Quality Indicators—Guide to Inpatient Quality Indicators: Quality of Care in Hospitals—Volume, Mortality, and Utilization. Rockville, MD: Agency for Healthcare Research and Quality, 2002. Revision 3 (July 21, 2004). AHRQ Pub. No. 02-RO204.
Prevention Quality Indicators (PQIs)
AHRQ Quality Indicators—Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions. Rockville, MD: Agency for Healthcare Research and Quality. Revision 3. (January 9, 2004). AHRQ Pub. No. 02-R0203.
Patient Safety Indicators (PSIs)
AHRQ Quality Indicators—Guide to Patient Safety Indicators. Rockville, MD: Agency for Healthcare Research and Quality, 2003. Version 2.1, Revision 2, (October 22, 2004). AHRQ Pub.03-R203.
Sources of HCUP Data
Arizona Department of Health Services
California Office of Statewide Health Planning & Development
Colorado Health & Hospital Association
Florida Agency for Health Care Administration
Georgia—GHA: An Association of Hospitals & Health Systems
Hawaii Health Information Corporation
Illinois Department of Public Health
Indiana Hospital & Health Association
Iowa Hospital Association
Kansas Hospital Association
Kentucky Department for Public Health
Maine Health Data Organization
Maryland Health Services Cost Review Commission
Massachusetts Division of Health Care Finance and Policy
Michigan Health & Hospital Association
Minnesota Hospital Association
Missouri Hospital Industry Data Institute
Nebraska Hospital Association
Nevada Department of Human Resources, Center for Health Information Analysis
New Hampshire Department of Health & Human Services
New Jersey Department of Health & Senior Services
New York State Department of Health
North Carolina Department of Health and Human Services
Ohio Hospital Association
Oregon Association of Hospitals & Health Systems
Pennsylvania Health Care Cost Containment Council
Rhode Island Department of Health
South Carolina State Budget & Control Board
South Dakota Association of Healthcare Organizations
Tennessee Hospital Association
Texas Department of State Health Services
Utah Department of Health
Vermont Association of Hospitals and Health Systems
Virginia Health Information
Washington State Department of Health
West Virginia Health Care Authority
Wisconsin Department of Health & Family Services
Medical Expenditure Panel Survey (MEPS)
U.S. Department of Health and Human Services: Agency for Healthcare Research and Quality (AHRQ); and Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).
Mode of Administration
MEPS comprises three component surveys: the Household Component (HC), the Medical Provider Component (MPC) and the Insurance Component (IC). The MEPS Household Component, the core survey, is an interviewer administered CAPI (computer assisted personal interview) household survey. The data for this report are primarily from the following sections of the 2000 and 2003 MEPS-HC.
Self-Administered Questionnaire (SAQ)
This self-administered paper questionnaire collects a variety of health and health care quality measures of adults. The health care quality measures in the SAQ were taken from the health plan version of CAHPS®, an AHRQ-sponsored family of survey instruments designed to measure quality of care from the consumer's perspective.
Diabetes Care Survey (DCS)
This self-administered paper questionnaire, given to persons identified as ever having had diabetes, asks about their diabetes care.
Child Health and Preventive Care (CHPR) section
Starting in 2001, a Child Health and Preventive Care section was added to the MEPS-HC interviews during the second half of the year. It included: health care quality measures taken from the health plan version of CAHPS®; the Children with Special Health Care Needs Screener questions; children's general health status as measured by several questions from the General Health Subscale of the Child Health Questionnaire; Columbia Impairment Scale questions about possible child behavioral problems; and child preventive-care questions. The CAHPS® questions and the Children with Special Health Care Needs Screener questions had been in a parent administered paper questionnaire (PAQ) in 2000. The PAQ estimates for 2000 may not be completely comparable to the CHPR estimates in later years due to differences in the administration of the PAQ and the CHPR section (parent self-administered paper questionnaire for the PAQ vs. interviewer-administered in-person household interview of household respondent for the CHPR).
Access to Care (AC)
The AC section of the MEPS-HC gathers information on five main topic areas: family members' origins and preferred languages; family members' usual source of health care; characteristics of usual source of health care providers; satisfaction with and access to the usual source of health care provider; and access to medical treatment, dental treatment, and prescription medicines.
Preventive Care (PC)
For each person, a series of questions was asked primarily about the receipt of preventive care or screening examinations.
Survey Sample Design
The sampling frame for the MEPS-HC is drawn from respondents to the National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics (NCHS). The MEPS-HC augments NHIS by selecting a sample of NHIS respondents; collecting additional data on their health care utilization, expenditures, sources of payment, quality, and insurance coverage; and linking these data with additional information from the respondents' medical providers, employers, and insurance providers.
Primary Survey Content
The MEPS-HC collects detailed data on demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment.
Like the NHIS population from which its subpopulation is drawn, the MEPS-HC is a nationally representative survey of the U.S. civilian noninstitutionalized population.
The MEPS HC collects data on demographic characteristics including: age, gender, race, ethnicity, education, industry and occupation, employment status, household composition, and family income. Race and ethnicity variables and categories changed in 2002 to be compliant with Office of Management and Budget (OMB) standards that required changes by 2003. The race and ethnicity estimates starting in 2002 may not be completely comparable to estimates in prior years.
The residence location categories in the MEPS tables are based on the 2003 urban influence codes developed by the Department of Agriculture's Economic Research Service. The UIC form a 12-part county codification scheme for classifying standard OMB metropolitan counties by size and nonmetropolitan counties by size of the largest city or town as well as proximity to metropolitan and micropolitan areas. In the tables with four residence location categories, metropolitan counties are divided into large metropolitan and small metropolitan; nonmetropolitan counties are divided into micropolitan and noncore. In some tables, the noncore counties are further divided into noncore-adjacent and noncore-not adjacent; thus, these tables have five residence location categories. Note that noncore-not adjacent includes noncore counties adjacent to micropolitan areas that do not have their own town.
For more information on urban influence codes, go to: http://www.ers.usda.gov/Data/UrbanInfluenceCodes.
1996 to present.
National. The HC data also can be shown for the four Census Bureau regions (Northeast, Midwest, South, and West), as well as residence location status.
AHRQ fields a new MEPS panel each year. In this design, 2 calendar years of information are collected from each household in a series of five rounds of data collection over a 2½-year period. These data are then linked with additional information collected from the respondents' medical providers, employers, and insurance providers. This series of data collection activities is repeated each year on a new sample of households, resulting in overlapping panels of survey data.
Estimates in the NHQR and NHDR detailed tables based on MEPS data are suppressed if the unweighted cell value is less than 100. Estimates are flagged if the relative standard error is greater than 30 percent.
Cohen J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, MD: AHCPR, 1997.
Cohen S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, MD: AHCPR, 1997.
Cohen JW, Monheit AC, Beauregard KM, et al. The Medical Expenditure Panel Survey: a national health information resource. Inquiry 33:373-389, 1996/1997. Also available as AHCPR Pub. No. 97-R043.