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National Healthcare Quality Report, 2007

Effectiveness of Care: Nursing Home and Home Health Care

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Nursing Facility Care
Residents whose need for help with daily activities has increased
Residents who have moderate to severe pain
Pain management practices for long- and short-stay residents with moderate, severe, or excruciating pain
Residents who were physically restrained
Residents who spent most of their time in bed or in a chair
Residents whose ability to move about in and around their room got worse
Residents with a urinary tract infection
Residents who have become more depressed or anxious
High-risk residents who have pressure sores
Low-risk residents who have pressure sores
Low-risk residents who lose control of their bowels or bladder
Residents who have/had a catheter inserted and left in their bladder
Short-stay residents who had moderate to severe pain
Short-stay residents with delirium
Short-stay residents with pressure sores
Residents who lose too much weight
Long-stay nursing home residents given influenza vaccination during the flu season
Short-stay nursing home residents given influenza vaccination during the flu season
Long-stay nursing home residents who were assessed and given pneumococcal vaccination
Short-stay nursing home residents who were assessed and given pneumococcal vaccination
Home Health Care
Home health care patients with improvement in management of oral medications
Home health care patients with improvement in bathing
Home health patients with improvement getting in and out of bed
Home health care patients with improvement in ambulation/locomotion
Home health care patients with improvement in pain interfering with activity
Home health care patients with improvement in dyspnea
Home health care patients with improvement in urinary incontinence
Home health care patients who had to be admitted to the hospital
Home health care patients who needed urgent, unplanned medical care
Home health care patients who stay at home after an episode of home health care ends
Hospice patients who received the right amount of medicine for pain
Hospice patients who received care consistent with their stated end-of-life wishes


Nursing Facility Care

Measure Title

Residents whose need for help with daily activities has increased.

Measure Source

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

National Tables

1.114a Percent of long-stay nursing home residents whose need for help with daily activities has increased, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

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

National Numerator

Residents with worsening (increasing MDS item score) in at least one or two of the four Late-Loss activities of daily living (ADL) self-performance (bed mobility, transfers, toilet use, and eating) or at target relative to prior assessment.

State Tables

1.114b Percent of long-stay nursing home residents whose need for help with daily activities has increased, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes residents who cannot show decline due to maximum values on target and prior assessments, residents with comatose status, residents with end stage disease, residents receiving hospice care, and residents with unknown status for these conditions. Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Residents who have moderate to severe pain.

Measure Source

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

National Tables

1.115a Percent of long-stay nursing home residents who have moderate to severe pain, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

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

State Tables

1.115b Percent of long-stay nursing home residents who have moderate to severe pain, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Rate is risk adjusted using resident-level covariates.

Excludes admission assessments and assessments with inconsistent or missing responses regarding the measure. Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Pain management practices for long- and short-stay residents with moderate, severe, or excruciating pain.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Nursing Home Survey (NNHS).

Tables

1.115c Percent of nursing home residents with any pain and pain management strategies used, United States, 2004.

1.115d Percent of nursing home residents with moderate, severe, or excruciating pain and pain management strategies used, United States, 2004.

Data Source

CDC, NCHS, NNHS.

Denominator

Number of nursing home residents with evidence of pain.

Numerator

Number of residents with a documented pain management strategy.

Comments

The survey measures pain on a four-level scale from mild to excruciating. Pain management strategies include standing orders for pain medication, pro re nata orders for pain medication, non-pharmacological methods, and other approaches.

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Nursing Facility Care

Measure Title

Residents who were physically restrained.

Measure Source

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

National Tables

1.116a Percent of long-stay nursing home residents who were physically restrained, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Residents who were physically restrained daily on target assessment.

State Tables

1.116b Percent of long-stay nursing home residents who were physically restrained, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes admission assessments or residents with missing values. Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Residents who spent most of their time in bed or in a chair.

Measure Source

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

National Tables

1.117a Percent of long-stay nursing home residents who spend most of their time in bed or in a chair, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Residents who were bedfast on target assessment.

State Tables

1.117b Percent of long-stay nursing home residents who spend most of their time in bed or in a chair, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes admission assessments, residents with comatose status, or residents with missing values. Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

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.

National Tables

1.118a Percent of long-stay nursing home residents whose ability to move about in and around their room got worse, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

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

National Numerator

Residents whose value for locomotion self-performance is greater at target relative to prior assessment.

State Tables

1.118b Percent of long-stay nursing home residents whose ability to move about in and around their room got worse, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Percent is risk adjusted using resident-level covariates.

Excludes admission assessments; residents with missing values on the target assessment or with "total dependence," "activity did not occur," or missing values on the prior assessment; residents with comatose status; residents with end stage disease; residents receiving hospice care; and residents with unknown status for these conditions on the target assessment. Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Residents with a urinary tract infection.

Measure Source

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

National Tables

1.119a Percent of long-stay nursing home residents with a urinary tract infection, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Residents with a urinary tract infection on target assessment.

State Tables

1.119b Percent of long-stay nursing home residents with a urinary tract infection, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes admission assessments and missing values on the target assessment. Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Residents who have become more depressed or anxious.

Measure Source

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

National Tables

1.120a Percent of long-stay nursing home residents who are more depressed or anxious, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

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

National Numerator

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

State Tables

1.120b Percent of long-stay nursing home residents who are more depressed or anxious, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes 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. Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

High-risk residents who have pressure sores.

Measure Source

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

National Tables

1.121a Percent of high-risk long-stay nursing home residents who have pressure sores, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and with any one of the following inclusion criteria: impaired in bed mobility or transfer, comatose, or suffering malnutrition on the target assessment.

National Numerator

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

State Tables

1.121b Percent of high-risk long-stay nursing home residents who have pressure sores, by State, 2002 and 2006.

State Data Source

CMS, MDS.

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 reassessments are included in the numerator if the sore has not healed. Excludes facilities with fewer than 30 residents in the denominator. Excludes admission assessments and residents with certain disqualifying responses. 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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Nursing Facility Care

Measure Title

Low-risk residents who have pressure sores.

Measure Source

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

National Tables

1.122a Percent of low-risk long-stay nursing home residents who have pressure sores, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

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

National Numerator

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

State Tables

1.122b Percent of low-risk long-stay nursing home residents who have pressure sores, by State, 2002 and 2006.

State Data Source

CMS, MDS.

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 reassessments are included in the numerator if the sore has not healed. The measure also excludes residents with missing values and residents with comatose status. Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Low-risk residents who lose control of their bowels or bladder.

Measure Source

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

National Tables

1.123a Percent of low-risk long-stay nursing home residents who lose control of their bowels or bladder, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

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

National Numerator

Subset of the denominator population 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, or (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 Tables

1.123b Percent of low-risk long-stay nursing home residents who lose control of their bowels or bladder, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

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. Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Residents who have/had a catheter inserted and left in their bladder.

Measure Source

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

National Tables

1.124a Percent of low-risk long-stay nursing home residents who have or had a catheter inserted and left in their bladder, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

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

State Tables

1.124b Percent of long-stay nursing home residents who have or had a catheter inserted and left in their bladder, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Rate is risk adjusted using resident-level covariates.

PPS refers to Medicare Prospective Payment system for skilled nursing facilities (SNFs).

Excludes admission assessments or residents with missing values. Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Short-stay residents who had moderate to severe pain.

Measure Source

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

National Tables

1.125a Percent of short-stay nursing home residents who had moderate to severe pain, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

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

National Numerator

Subset of the denominator population with moderate pain at least daily or horrible/excruciating pain at any frequency.

State Tables

1.125b Percent of short-stay nursing home residents who had moderate to severe pain, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes assessments with inconsistent responses regarding the measure.

PPS refers to Medicare Prospective Payment System for skilled nursing facilities (SNFs).

Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Short-stay residents with delirium.

Measure Source

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

National Tables

1.126a Percent of short-stay nursing home residents with delirium, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

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

National Numerator

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

State Tables

1.126b Percent of short-stay nursing home residents with delirium, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Percent is risk adjusted using resident-level covariates.

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).

Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Short-stay residents with pressure sores.

Measure Source

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

National Tables

1.127a Percent of short-stay nursing home residents with pressure sores, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

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

National Numerator

Subset of the denominator population 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, or (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 Tables

1.127b Percent of short-stay nursing home residents with pressure sores, by State, 2002 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Percent is risk adjusted using resident-level covariates.

PPS refers to Medicare Prospective Payment System for skilled nursing facilities (SNFs).

Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Residents who lose too much weight.

Measure Source

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

National Tables

1.128a Percent of long-stay nursing home residents who lose too much weight, United States, 2004 and 2005.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

All residents with a valid target assessment.

National Numerator

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

State Tables

1.128b Percent of long-stay nursing home residents who lose too much weight, by State, 2004 and 2006.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes admission assessments, residents with missing weight loss data, and residents receiving hospice care. Excludes facilities with fewer than 30 residents in the denominator. 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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Nursing Facility Care

Measure Title

Long-stay nursing home residents given influenza vaccination during the flu season.

Measure Source

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

State Tables

1.129 Percent of long-stay nursing home residents given influenza vaccination during the flu season, by State, 2006.

State Data Source

CMS, Nursing Home Minimum Data Set (MDS).

State Denominator

Medicare beneficiary chronic care residents during the most recently completed influenza season with a valid target assessment in effect during any part of the season.

State Numerator

Residents who received an influenza vaccine during the most recently completed influenza season.

Comments

Excludes residents ineligible for the influenza vaccine, residents who were offered the vaccine but declined, and residents in facilities unable to obtain the vaccine.

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Nursing Facility Care

Measure Title

Short-stay nursing home residents given influenza vaccination during the flu season.

Measure Source

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

State Tables

1.130 Percent of short-stay nursing home residents given influenza vaccination during the flu season, by State, 2006.

State Data Source

CMS, Nursing Home Minimum Data Set (MDS).

State Denominator

Short-stay residents during the most recently completed influenza season with a valid target assessment in effect during any part of the season.

State Numerator

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

Comments

Excludes residents ineligible for the influenza vaccine, residents who were offered the vaccine but declined, and residents in facilities unable to obtain the vaccine.

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Nursing Facility Care

Measure Title

Long-stay nursing home residents who were assessed and given pneumococcal vaccination.

Measure Source

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

State Tables

1.131 Percent of long-stay nursing home residents who were assessed and given pneumococcal vaccination, by State, 2006.

State Data Source

CMS, Nursing Home Minimum Data Set (MDS).

State Denominator

Medicare beneficiary chronic care residents with a valid target assessment within the 6-month target period.

State Numerator

Residents who have an up-to-date pneumococcal vaccination.

Comments

Excludes residents ineligible for the pneumococcal vaccine and residents who were offered the vaccine but declined.

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Nursing Facility Care

Measure Title

Short-stay nursing home residents who were assessed and given pneumococcal vaccination.

Measure Source

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

State Tables

1.132 Percent of short-stay nursing home residents who were assessed and given pneumococcal vaccination, by State, 2006.

State Data Source

CMS, Nursing Home Minimum Data Set (MDS).

State Denominator

Short-stay residents with a valid target assessment within the 6-month target period.

State Numerator

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

Comments

Excludes residents ineligible for the pneumococcal vaccine and residents who were offered the vaccine but declined.

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Home Health Care

Measure Title

Home health care patients with improvement in management of oral medications.

Measure Source

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

National Tables

1.133a Home health care patients who get better at taking their medication correctly, United States, 2004 and 2005.

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

Episodes in which a person showed improvement in ability to manage oral medications compared to a prior assessment.

State Tables

1.133b Percent of home health care patients who get better at taking their medicines correctly (by mouth), by State, 2005 and 2006.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures management of oral medications on a three-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.

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 with improvement in bathing.

Measure Source

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

National Tables

1.134a Home health care patients who get better at bathing, United States, 2004 and 2005.

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

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

State Tables

1.134b Percent of home health care patients who get better at bathing, by State, 2005 and 2006.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures bathing ability on a six-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.

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 patients with improvement getting in and out of bed.

Measure Source

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

National Tables

1.135a Home health care patients who get better at getting in and out of bed, United States, 2004 and 2005.

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

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

State Tables

1.135b Percent of home health care patients who get better at getting in and out of bed, by State, 2005 and 2006.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures transferring on a six-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.

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 with improvement in ambulation/locomotion.

Measure Source

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

National Tables

1.136a Home health care patients who get better at walking or moving around, United States, 2004 and 2005.

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

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

State Tables

1.136b Percent of home health care patients who get better at walking or moving around, by State, 2005 and 2006.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures ambulation or locomotion ability on a six-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.

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 with improvement in pain interfering with activity.

Measure Source

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

National Tables

1.137a Home health care patients who have less pain when moving around, United States, 2004 and 2005.

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

Episodes in which a person's frequency of pain interfering with activity or movement improved compared to a prior assessment.

State Tables

1.137b Percent of home health care patients who have less pain when moving around, by State, 2005 and 2006.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures frequency of pain on a four-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.

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 with improvement in dyspnea.

Measure Source

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

National Tables

1.138a Home health care patients who have less shortness of breath, United States, 2004 and 2005.

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

Episodes in which a person's dyspneic status improved compared to a prior assessment.

State Tables

1.138b Percent of home health care patients who are short of breath less often, by State, 2005 and 2006.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures dyspneic status on a four-level scale from 0 (never short of breath) to 3 (dyspnea at rest). Episodes are not included for persons who are at the highest level and cannot improve any more.

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 with improvement in urinary incontinence.

Measure Source

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

National Tables

1.139a Home health care patients who have less urinary incontinence, United States, 2004 and 2005.

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

Episodes in which a person's urinary incontinence status improved compared to a prior assessment.

State Tables

1.139b Home health care patients who have less urinary incontinence, by State, 2005 and 2006.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

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

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 had to be admitted to the hospital.

Measure Source

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

National Tables

1.140a Home health care patients who had to be admitted to the hospital, United States, 2004 and 2005.

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

Episodes in which a person was hospitalized for an acute condition while receiving home health care services.

State Tables

1.140b Percent of home health care patients who had to be admitted to the hospital, by State, 2005 and 2006.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

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

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 needed urgent, unplanned medical care.

Measure Source

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

National Tables

1.141a Home health care patients who needed urgent, unplanned medical care, United States, 2004 and 2005.

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

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

State Tables

1.141b Percent of home health care patients who needed urgent, unplanned medical care, by State, 2005 and 2006.

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. 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.

National Tables

1.142a Home health care patients who stayed at home after an episode of home health care ended, United States, 2004 and 2005.

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

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

State Tables

1.142b Percent of home health care patients who stayed at home after an episode of home health care ended, by State, 2005 and 2006.

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. 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

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

Measure Source

National Hospice and Palliative Care Organization (NHPCO).

National Tables

1.143a Percent of hospice patients who received the right amount of medicine for pain management, United States, 2005 and 2006.

National Data Source

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

National Denominator

Hospice patients age 18 and over.

National Numerator

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

State Tables

1.143b Percent of hospice patients who received the right amount of medicine for pain management, by State, 2006.

State Data Source

CMS, NHPCO.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

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

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Home Health 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 Tables

1.144a Percent of hospice patients who received care consistent with patient's wishes, United States, 2005 and 2006.

National Data Source

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

National Denominator

Hospice patients age 18 and over.

National Numerator

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

State Tables

1.144b Percent of hospice patients who received care consistent with patient's wishes, by State, 2006.

State Data Source

CMS, NHPCO.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

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

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