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2004 National Healthcare Quality Report

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Effectiveness: Nursing Home and Home Health Care

Importance and Measures


  • According to the latest available national data, there were 1.6 million current nursing home residents in 1999 and 2.5 million discharges from nursing homes in 1998-991.
  • There were more than 1.4 million current home health patients and 7.8 million discharges from home health agencies in 20002.
  • Assuring quality for this frail and expanding population has been a significant challenge and longstanding concern3-6.


  • Nursing home and home health services accounted for at least $139.3 billion, or 9%, of national health expenditures in 20027.


  • Nursing home care—Based on the recommendations of the National Quality Forum consensus panel, nine new nursing home measures were selected for the 2004 NHQR; five measures were retained from the 2003 NHQR. There are separate measures for the two major populations that reside in nursing homes: one set for postacute care residents and one set for chronic care residentsi. Some measures are common to both populations. This section highlights the following:
    • Prevalence of pain among postacute and chronic care residents
    • Use of physical restraints among chronic care residents
    • Presence of pressure ulcers among postacute and chronic care residents
  • Home health care—Performance measures for home health show the portion of patients whose conditions improved or declined during the course of their care from a certified home health agency (the measures are the same as in the 2003 NHQR). Based on national dataii for the measures reported here, statistically significant improvement or decline did occur between 2001 and 2003. Quality of home health care is highlighted in this section in two general areas:
    • Improvement in getting around
    • Acute-care hospitalization of home health patients

iData are from the CMS Minimum Data Set (MDS), used by Medicare- and Medicaid-certified nursing homes for all residents, regardless of payer; Medicare Quality Improvement Organization (QIO) data are also presented and show the effect of intensive quality improvement efforts on selected nursing home measures. CMS definitions of postacute and chronic residents are used here. "Postacute" care refers to patients who are admitted to a facility and stay fewer than 30 days. These admissions typically follow an acute-care hospitalization and involve high-intensity rehabilitation or clinically complex care. The postacute quality measures are calculated on any patients with a 14-day MDS assessment (required under the Prospective Payment System) in the last 6 months. "Chronic" care refers to those types of patients who enter a nursing facility typically because they are no longer able to care for themselves at home. These patients (or residents) tend to remain in the nursing facility from several months to several years. The chronic quality measures were calculated on any residents with a full or quarterly MDS in the target quarter. For exact specification see:
iiData are from the Outcome and Assessment Information Set (OASIS), used by Medicare-certified home health agencies for all adult (non-maternity) home health patients receiving skilled services during calendar years 2001-2003.


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