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National Healthcare Disparities Report, 2007

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Effectiveness of Care: Nursing Home and Home Health Care


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 who had 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 stay 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

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Chronic Care in Nursing Facilities

Measure Title

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

Measure Source

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

Table

121 Percent of long-stay nursing home residents who have moderate to severe pain, United States, 2005, by

  • Race/ethnicity.

Data Source

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

Table

122 Percent of long-stay nursing home residents who were physically restrained, United States, 2005, by

  • Race/ethnicity.

Data Source

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

Table

123 Percent of long-stay nursing home residents who spend most of their time in bed or in a chair, United States, 2005, by

  • Race/ethnicity.

Data Source

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

Table

124 Percent of long-stay nursing home residents with a urinary tract infection, United States, 2005, by

  • Race/ethnicity.

Data Source

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

Table

125 Percent of long-stay nursing home residents who are more depressed or anxious, United States, 2005, by

  • Race/ethnicity.

Data Source

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

Table

126 Percent of low-risk long-stay nursing home residents who lose control of their bowels or bladder, United States, 2005, by

  • Race/ethnicity.

Data Source

CMS, Nursing Home 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 who 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 & Medicaid Services (CMS), Nursing Home Quality Initiative.

Table

127 Percent of low-risk long-stay nursing home residents who have or had a catheter inserted and left in the bladder, United States, 2005, by

  • Race/ethnicity.

Data Source

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

Table

128 Percent of high-risk long-stay nursing home residents who have pressure sores, United States, 2005, by

  • Race/ethnicity.

Data Source

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

Table

129 Percent of low-risk long-stay nursing home residents who have pressure sores, United States, 2005, by

  • Race/ethnicity.

Data Source

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

Table

130 Percent of long-stay nursing home residents whose ability to move about in and around their room got worse, United States, 2005, by

  • Race/ethnicity.

Data Source

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

Table

131 Percent of long-stay nursing home residents whose need for help with daily activities has increased, United States, 2005, by

  • Race/ethnicity.

Data Source

CMS, Nursing Home 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 one or two of the four Late-Loss ADL self-performance items (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 & Medicaid Services (CMS), Nursing Home Quality Initiative.

Table

132 Percent of long-stay nursing home residents who lose too much weight, United States, 2005, by

  • Race/ethnicity.

Data Source

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

Table

133 Percent of short-stay nursing home residents with delirium, United States, 2005, by

  • Race/ethnicity.

Data Source

CMS, Nursing Home Minimum Data Set (MDS).

Denominator

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

Numerator

Medicare beneficiary post-acute care patients at SNF PPS 14-day assessment with at least one 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 & Medicaid Services (CMS), Nursing Home Quality Initiative.

Table

134 Percent of short-stay nursing home residents who had moderate to severe pain, United States, 2005, by

  • Race/ethnicity.

Data Source

CMS, Nursing Home Minimum Data Set (MDS).

Denominator

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

Numerator

Medicare beneficiary post-acute 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 & Medicaid Services (CMS), Nursing Home Quality Initiative.

Table

135 Percent of short-stay nursing home residents with pressure sores, United States, 2005, by

  • Race/ethnicity.

Data Source

CMS, Nursing Home Minimum Data Set (MDS).

Denominator

Medicare beneficiary post-acute 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 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 & Medicaid Services (CMS), Home Health Quality Initiative.

Tables

136 Home health care patients who get better at taking their medication correctly, 2005, by

  • Race.
  • Ethnicity.

Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in year after study year.

Numerator

Episodes in which patients get better at taking their medication correctly compared with 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 IV medications.

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Home Health Care

Measure Title

Home health care patients who get better at bathing.

Measure Source

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

Tables

137 Home health care patients who get better at bathing, 2005, by

  • Race.
  • Ethnicity.

Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in year after study year.

Numerator

Episodes in which a person's ability to bathe improved compared with 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 & Medicaid Services (CMS), Home Health Quality Initiative.

Tables

138 Home health care patients who get better at getting in and out of bed, 2005, by

  • Race.
  • Ethnicity.

Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in year after study year.

Numerator

Episodes in which a person gets better at getting in and out of bed compared with 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 & Medicaid Services (CMS), Home Health Quality Initiative.

Tables

139 Home health care patients who get better at walking or moving around, 2005, by

  • Race.
  • Ethnicity.

Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in year after study year.

Numerator

Episodes in which a person gets better at walking or moving around compared with 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 & Medicaid Services (CMS), Home Health Quality Initiative.

Tables

140 Home health care patients who have less pain when moving around, 2005, by

  • Race.
  • Ethnicity.

Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in year after study year.

Numerator

Episodes in which a person has less pain when moving around compared with 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 & Medicaid Services (CMS), Home Health Quality Initiative.

Tables

141 Home health care patients who have less shortness of breath, 2005, by

  • Race.
  • Ethnicity.

Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

Denominator

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

Numerator

Episodes in which a person has less shortness of breath compared with 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 & Medicaid Services (CMS), Home Health Quality Initiative.

Tables

142 Home health care patients who have less urinary incontinence, 2005, by

  • Race.
  • Ethnicity.

Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in year after study year.

Numerator

Episodes in which a person has less urinary incontinence compared with 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 & Medicaid Services (CMS), Home Health Quality Initiative.

Tables

143 Home health care patients who had to be admitted to the hospital, 2005, by

  • Race.
  • Ethnicity.

Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

Denominator

All home health episodes that begin and end in year after study year.

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 medical care.

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Home Health Care

Measure Title

Need for urgent, unplanned medical care.

Measure Source

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

Tables

144 Home health care patients who need urgent, unplanned medical care, 2005, by

  • Race.
  • Ethnicity.

Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

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 stay at home after an episode of home health care ends.

Measure Source

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

Tables

145 Home health care patients who stay at home after an episode of home health care ends, 2005, by

  • Race.
  • Ethnicity.

Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

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).

Table

146 Percent of hospice patients who received the right amount of medicine for pain management, United States, 2006

Data Source

Centers for Medicare & Medicaid Services (CMS), NHPCO.

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 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).

Table

147 Percent of hospice patients who received care consistent with patient's wishes, United States, 2006

Data Source

Centers for Medicare & Medicaid Services (CMS), NHPCO.

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 the Data Sources section of this appendix for further information.

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