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National Healthcare Disparities Report, 2006

Effectiveness of Care: Nursing Home, Home Health, and Hospice Care

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Chronic Care in Nursing Facilities
Long-stay nursing home residents who have moderate to severe pain
Long-stay nursing home residents who were physically restrained
Long-stay nursing home residents who spend most of their time in bed or in a chair
Long-stay nursing home residents with a urinary tract infection
Long-stay nursing home residents who are more depressed or anxious
Low-risk long-stay nursing home residents who lose control of their bowels or bladder
Low-risk long-stay nursing home residents who had a catheter inserted and left in the bladder
High-risk long-stay nursing home residents who have pressure sores
Low-risk long-stay nursing home residents who have pressure sores
Long-stay nursing home residents whose ability to move about in and around their room got worse
Long-stay nursing home residents whose need for help with daily activities has increased
Long-stay nursing home residents who lose too much weight
Post-Acute Care in Nursing Facilities
Short-stay nursing home residents with delirium
Short-stay nursing home residents who have moderate to severe pain
Short-stay nursing home residents who have pressure sores
Home Health Care
Home health care patients who get better at taking their medication correctly
Home health care patients who get better at bathing
Home health care patients who get better at getting in and out of bed
Home health care patients who get better at walking or moving around
Home health care patients who have less pain when moving around
Home health care patients who have less shortness of breath
Home health care patients who have less urinary incontinence
Home health care patients who had to be admitted to the hospital
Need for urgent, unplanned medical care.
Home health care patients who stayed at home after an episode of home health care ends
Hospice Care
Hospice patients who received the right amount of medicine for pain
Hospice patients who received care consistent with their stated end of life wishes


Chronic Care in Nursing Facilities

Measure Title

Long-stay nursing home residents who have moderate to severe pain.

Measure Source

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

Table

113. Long-stay nursing home residents who have moderate to severe pain, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

Long-term care residents with a valid target assessment.

Numerator

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

Comments

Excludes admission assessments and assessments with inconsistent responses regarding the measure.

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Chronic Care in Nursing Facilities

Measure Title

Long-stay nursing home residents who were physically restrained.

Measure Source

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

Table

114. Long-stay nursing home residents who were physically restrained, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

Long-term care residents with a valid target assessment.

Numerator

Residents who were physically restrained on target assessment.

Comments

Excludes admission assessments.

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Chronic Care in Nursing Facilities

Measure Title

Long-stay nursing home residents who spend most of their time in bed or in a chair.

Measure Source

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

Table

115. Long-stay nursing home residents who spend most of their time in bed or in a chair, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

Long-term care residents with a valid target assessment.

Numerator

Residents who were bedfast on target assessment.

Comments

Excludes admission assessments.

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Chronic Care in Nursing Facilities

Measure Title

Long-stay nursing home residents who had a urinary tract infection.

Measure Source

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

Table

116. Long-stay nursing home residents who had a urinary tract infection, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

Long-term care residents with a valid target assessment.

Numerator

Residents with urinary tract infection on target assessment.

Comments

Excludes admission assessments.

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Chronic Care in Nursing Facilities

Measure Title

Long-stay nursing home residents who are more depressed or anxious.

Measure Source

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

Table

117. Long-stay nursing home residents who are more depressed or anxious, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

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

Numerator

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

Comments

Excludes admission assessments.

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Chronic Care in Nursing Facilities

Measure Title

Low-risk long-stay nursing home residents who lose control of their bowels or bladder.

Measure Source

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

Table

118. Low-risk long-stay nursing home residents who lose control of their bowels or bladder, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

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

Numerator

Residents who were frequently incontinent or fully incontinent on target assessment.

Comments

Excludes admission assessments, residents with missing values, residents with comatose status, residents had an indwelling catheter or ostomy, or residents with unknown status for these conditions.

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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Chronic Care in Nursing Facilities

Measure Title

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

Measure Source

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

Table

119. Low-risk long-stay nursing home residents who had a catheter inserted and left in the bladder, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

Medicare beneficiary chronic care low-risk residents with a valid target assessment.

Numerator

Residents with indwelling catheters on target assessment.

Comments

Excludes admission assessments.

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Chronic Care in Nursing Facilities

Measure Title

High-risk long-stay nursing home residents who have pressure sores.

Measure Source

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

Table

120. High-risk long-stay nursing home residents who have pressure sores, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

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

Numerator

Residents with indication of pressure sores.

Comments

Excludes admission assessments.

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Chronic Care in Nursing Facilities

Measure Title

Low-risk long-stay nursing home residents who have pressure sores.

Measure Source

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

Table

121. Low-risk long-stay nursing home residents who have pressure sores, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

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

Numerator

Residents with indication of pressure sores.

Comments

Excludes admission assessments.

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Chronic Care in Nursing Facilities

Measure Title

Long-stay nursing home residents whose ability to move about in and around their room got worse.

Measure Source

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

Table

122. Long-stay nursing home residents whose ability to move about in and around their room got worse, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

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

Numerator

Residents from the denominator whose value for locomotion self-performance is greater at target relative to a qualified prior assessment.

Comments

Excludes admission assessments.

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Chronic Care in Nursing Facilities

Measure Title

Long-stay nursing home residents whose need for help with daily activities has increased.

Measure Source

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

Table

123. Long-stay nursing home residents whose need for help with daily activities has increased, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

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

Numerator

Residents with worsening (increasing MDS item score) in at least 1 or 2 of the 4 Late-Loss ADL self-performance (bed mobility, transfers, toilet use and eating) or at target relative to prior assessment.

Comments

Excludes admission assessments.

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Chronic Care in Nursing Facilities

Measure Title

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

Measure Source

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

Table

124. Long-stay nursing home residents who lose too much weight, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

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

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.

Comments

Excludes admission assessments.

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Post-Acute Care in Nursing Facilities

Measure Title

Short-stay nursing home residents with delirium.

Measure Source

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

Table

125. Short-stay nursing home residents with delirium, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

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

Numerator

Medicare beneficiary postacute care patients at SNF PPS 14-day assessment with at least 1 symptom of delirium that represents a departure from usual functioning.

Comments

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). 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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Post-Acute Care in Nursing Facilities

Measure Title

Short-stay nursing home residents who have moderate to severe pain.

Measure Source

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

Table

126. Short-stay nursing home residents who have moderate to severe pain, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

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

Numerator

Medicare beneficiary postacute care patients at SNF PPS 14-day assessment with moderate pain at least daily or horrible/excruciating pain at any frequency.

Comments

Excludes assessments with inconsistent responses regarding the measure.

PPS refers to Medicare Prospective Payment System for skilled nursing facilities (SNFs). 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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Post-Acute Care in Nursing Facilities

Measure Title

Short-stay nursing home residents who have pressure sores.

Measure Source

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

Table

127. Short-stay nursing home residents who have pressure sores, United States, 2004, by

  • Race/ethnicity

Data Source

CMS, Minimum Data Set (MDS).

Denominator

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

Numerator

SNF PPS patients who satisfy either of the following conditions:

  1. Had no pressure sores on the SNF PPS 5-day assessment and has at least Stage 1 pressure sores on the SNF PPS 14-day assessment
  2. Had a pressure sores on the SNF PPS 5-day assessment and pressure sores worsened or failed to improve on the SNF PPS 14-day assessment

Comments

Excludes patients with missing values. PPS refers to Medicare Prospective Payment System for skilled nursing facilities (SNFs). 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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Home Health Care

Measure Title

Home health care patients who get better at taking their medication correctly.

Measure Source

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

Tables

128. Home health care patients who get better at taking their medication correctly, United States, 2004, by

  • Race
  • Ethnicity

Data Source

CMS, Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in 2004.

Numerator

Episodes in which patients get better at taking their medication correctly compared to a prior assessment.

Comments

The OASIS instrument measures management of oral medications on a 3-level scale from 0 (fully independent) to 2 (entirely dependent) and refers to ability, not medication compliance. Episodes are not included for persons who are at the highest level and cannot improve any more.

Excludes injectable and intravenous medications.

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Home Health Care

Measure Title

Home health care patients who get better at bathing.

Measure Source

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

Tables

129. Home health care patients who get better at bathing, United States, 2004, by

  • Race
  • Ethnicity

Data Source

CMS, Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in 2004.

Numerator

Episodes in which a person's ability to bathe improved compared to a prior assessment.

Comments

The OASIS instrument measures bathing ability on a 6-level scale from 0 (fully independent) to 5 (completely dependent). Episodes are not included for persons who are at the highest level and cannot improve any more.

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Home Health Care

Measure Title

Home health care patients who get better at getting in and out of bed.

Measure Source

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

Tables

130. Home health care patients who get better at getting in and out of bed, United States, 2004, by

  • Race
  • Ethnicity

Data Source

CMS, Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in 2004.

Numerator

Episodes in which a person gets better at getting in and out of bed compared to a prior assessment.

Comments

The OASIS instrument measures transferring on a 6-level scale from 0 (independent) to 5 (bedfast and unable to turn or position). Episodes are not included for persons who are at the highest level and cannot improve any more.

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Home Health Care

Measure Title

Home health care patients who get better at walking or moving around.

Measure Source

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

Tables

131. Home health care patients who get better at walking or moving around, United States, 2004, by

  • Race
  • Ethnicity

Data Source

CMS, Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in 2004.

Numerator

Episodes in which a person gets better at walking or moving around compared to a prior assessment.

Comments

The OASIS instrument measures ambulation or locomotion ability on a 6-level scale from 0 (full, independent ambulation) to 5 (bedfast). Episodes are not included for persons who are at the highest level and cannot improve any more.

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Home Health Care

Measure Title

Home health care patients who have less pain when moving around.

Measure Source

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

Tables

132. Home health care patients who have less pain when moving around, United States, 2004, by

  • Race
  • Ethnicity

Data Source

CMS, Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in 2004.

Numerator

Episodes in which a person has less pain when moving around compared to a prior assessment.

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 persons who are at the highest level and cannot improve any more.

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Home Health Care

Measure Title

Home health care patients who have less shortness of breath.

Measure Source

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

Tables

133. Home health care patients who have less shortness of breath, United States, 2003, by

  • Race
  • Ethnicity

Data Source

CMS, Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in 2003.

Numerator

Episodes in which a person has less shortness of breath compared to a prior assessment.

Comments

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

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Home Health Care

Measure Title

Home health care patients who have less urinary incontinence.

Measure Source

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

Tables

134. Home health care patients who have less urinary incontinence, United States, 2004, by

  • Race
  • Ethnicity

Data Source

CMS, Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in 2004.

Numerator

Episodes in which a person has less urinary incontinence compared to a prior assessment.

Comments

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

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Home Health Care

Measure Title

Home health care patients who had to be admitted to the hospital.

Measure Source

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

Tables

135. Home health care patients who had to be admitted to the hospital, United States, 2004, by

  • Race
  • Ethnicity

Data Source

CMS, Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in 2004.

Numerator

Episodes 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.

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Home Health Care

Measure Title

Need for urgent, unplanned medical care.

Measure Source

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

Tables

136. Home health care patients who need urgent, unplanned medical care, United States, 2004, by

  • Race
  • Ethnicity

Data Source

Calculated by the Center for Health Services and Policy, Research, University of Colorado, from Outcome and Assessment Information Set (OASIS) data.

Denominator

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

Numerator

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

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/.

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Home Health Care

Measure Title

Home health care patients who stayed at home after an episode of home health care ends.

Measure Source

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

Tables

137. Home health care patients who stayed at home after an episode of home health care ends, United States, 2004, by

  • Race
  • Ethnicity

Data Source

Calculated by the Center for Health Services and Policy, Research, University of Colorado, from Outcome and Assessment Information Set (OASIS) data.

Denominator

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

Numerator

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

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/.

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Hospice Care

Measure Title

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

Measure Source

National Hospice and Palliative Care Organization (NHPCO).

Tables

Data source does not support detailed tables.

Data Source

NHPCO, Family Evaluation of Hospice Care Survey data.

Denominator

Hospice patients age 18 and over.

Numerator

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

Comments

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

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Hospice 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).

Tables

Data source does not support detailed tables.

Data Source

NHPCO, Family Evaluation of Hospice Care Survey data.

Denominator

Hospice patients age 18 and over.

Numerator

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

Comments

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

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