2012 National Healthcare Quality and Disparities Reports
Multi-Agency Data Sources
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ); and Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB).
HIVRN currently includes 17 medical practices across the United States that collectively treat more than 14,000 patients. Each practice collects information on clinical and demographic characteristics of their patients with HIV infection, prescribed medications, frequency of outpatient clinic visits, and number of inpatient admissions. Each practice sends information to the data coordinating center at the Johns Hopkins School of Medicine, which consolidates this information into a single uniform database.
Data from patients seen at one of the HIVRN medical practices.
Although the data collection sites are located in every region of the country, data are not representative and regional projections cannot be made from HIVRN data.
Organization home page: http://www.ahrq.gov.
Data system home page: http://archive.ahrq.gov/data/hivnet.htm.
HIV Research Network. Hospital and outpatient health services utilization among HIV-infected patients in care in 1999. J Acquir Immune Defic Syndr 2002;30:21-26.
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ); and Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).
Mode of Administration
The MEPS Household Component (HC), the core survey, is an interviewer-administered computer-assisted personal interview household survey. The Self-Administered Questionnaire (SAQ) and Diabetes Care Survey (DCS) are supplementary self-administered paper questionnaires.
Survey Sample Design
The sampling frame for the MEPS-HC is drawn from respondents to the National Health Interview Survey (NHIS), conducted by NCHS. The MEPS-HC augments NHIS by selecting a sample of NHIS respondents, collecting additional data on their health care expenditures, and linking these data with additional information from the respondents' medical providers, employers, and insurance providers.
Each year a new panel of households is selected from among those households that participated in the previous year's NHIS. Data covering 2 calendar years of information are collected for each new annual sample (referred to as a panel), through a series of five rounds of data collection over a 2½-year period. This series of data collection activities is repeated each year on a new sample of households, resulting in overlapping panels of survey data. MEPS annual data are based on information from two separate panels, the panel that began that year and the panel that began in the previous year.
NHIS provides a nationally representative sample of the U.S. civilian noninstitutionalized population, with oversampling of Hispanics and Blacks. Starting in 2006, NHIS oversamples Asians as well. In addition to the oversampling by NHIS, MEPS oversamples policy-relevant groups such as low-income households.
Primary Survey Content
MEPS comprises three component surveys: the HC, the Medical Provider Component, and the Insurance Component. The MEPS-HC collects detailed data on demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment. The data for the NHQR and NHDR are primarily from the following sections of the 2002-2009 MEPS-HC:
- SAQ: This paper questionnaire collects data on a variety of adult health and health care quality measures.
- DCS: This paper questionnaire, given to persons identified as ever having had diabetes, asks about their diabetes care, such as services rendered.
- Child Health and Preventive Care (CHPR) section: Starting in 2001, the CHPR section was added to the MEPS-HC interviews during the second half of the year. It included health care quality measures taken from the health plan version of CAHPS® (Consumer Assessment of Healthcare Providers and Systems); the Children With Special Health Care Needs screener questions; children's general health status as measured by several questions from the General Health Subscale of the Child Health Questionnaire; Columbia Impairment Scale questions about possible child behavioral problems; and child preventive care questions. Before 2001, the CAHPS questions and the Children With Special Health Care Needs screener questions had been in the Parent-Administered Questionnaire. Therefore, estimates from 2001 may not be comparable with estimates for 2000 or earlier years.
- Access to Care: The Access to Care section of the MEPS-HC gathers information on five main topic areas: family members' origins and preferred languages; family members' usual source of health care; characteristics of usual source of health care providers; satisfaction with and access to the usual source of health care provider; and access to medical treatment, dental treatment, and prescription medicines.
- Preventive Care: For each person, a series of questions was asked primarily about the receipt of preventive care or screening examinations.
Like the NHIS population from which its sample is drawn, the MEPS-HC is a nationally representative survey of the U.S. civilian noninstitutionalized population.
The MEPS-HC collects data on demographic characteristics, including age, gender, race, ethnicity, education, industry and occupation, employment status, household composition, and family income. Race and ethnicity variables and categories changed in 2002 in compliance with Office of Management and Budget standards.
MEPS is the third in a series of national probability surveys conducted by AHRQ on the financing and use of medical care in the United States. The National Medical Care Expenditure Survey was conducted in 1977, the National Medical Expenditure Survey was conducted in 1987, and MEPS, an annual survey, began in 1996.
National; four U.S. Census Bureau regions; selected States; metropolitan and nonmetropolitan areas; and urban-rural areas, based on frameworks such as the 2006 Urban-Rural Classification Scheme for Counties (http://www.cdc.gov/nchs/data_access/urban_rural.htm).
Estimates in the NHQR and NHDR Data Tables appendix that are based on MEPS data are weighted to reflect the experiences of the U.S. civilian noninstitutionalized population. Standard errors of the estimates were derived using SUDAAN statistical software, which factors in MEPS complex survey design. MEPS estimates are suppressed when they are based on sample sizes of fewer than 100, or when their relative standard errors are 30% or more.
The combined response rate for MEPS, which includes the NHIS response rate, ranged from 57% to 65 % during the 2002 to 2009 period.
Agency home page: http://www.ahrq.gov.
Data system home page: http://www.meps.ahrq.gov.
Cohen J. Design and methods of the Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 1. Rockville, MD: Agency for Health Care Policy and Research; 1997. AHCPR Publication No. 97-0026. Available at: http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr1/mr1.pdf [Plugin Software Help].
Cohen JW, Monheit AC, Beauregard KM, et al. The Medical Expenditure Panel Survey: a national health information resource. Inquiry 1996/1997;33:373-89. Rockville, MD: Agency for Health Care Policy and Research; 1997. AHCPR Publication No. 97-R043. Available at: http://www.meps.ahrq.gov/mepsweb/data_stats/Pub_ProdResults_Details.jsp?pt=Journal+Articles&opt=3&id=324.
Cohen S. Sample design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 2. Rockville, MD: Agency for Health Care Policy and Research; 1997. AHCPR Publication No. 97-0027. Available at: http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr2/mr2.pdf [Plugin Software Help].
Cohen SB. Sample design of the 1997 Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 11. Rockville, MD: Agency for Healthcare Research and Quality; 2000. AHRQ Publication No. 01-0001. Available at: http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr11/mr11.pdf [Plugin Software Help].
Ezzati-Rice TM, Rohde F, Greenblatt J. Sample design of the Medical Expenditure Panel Survey Household Component, 1998-2007. MEPS Methodology Report No. 22. Rockville, MD: Agency for Healthcare Research and Quality; March 2008. Available at: http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr22/mr22.pdf [Plugin Software Help].
Sponsors for the MPSMS surveillance initiative include the U.S. Department of Health and Human Services (HHS), the HHS Patient Safety Task Force, the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Medicare & Medicaid Services (CMS).
Five agencies constitute the MPSMS Federal Agency Work Group (FAWG) and provide technical assistance for the MPSMS initiative. The agencies are the Centers for Disease Control and Prevention, the Food and Drug Administration, the Office of the National Coordinator for Health Information Technology, the Veterans Health Administration, and the Department of Defense.
In addition to the FAWG, MPSMS depends on guidance from a multidisciplinary Technical Expert Panel of non-Federal experts for their knowledge and experience in the areas of patient safety and quality improvement.
MPSMS is a nationwide surveillance system that aims to identify rates of specific adverse events, or unintended patient harm, injury, or loss among hospitalized patients. The system tracks and monitors interactions with the health care system rather than health conditions.
MPSMS is composed of 21 measures representing six types of adverse drug events (ADEs); four types of hospital-acquired infections; six types of adverse events associated with surgery; three types of infections and complications that can occur as a result of different types of catheterization; patient falls; and hospital-acquired pressure ulcers.
A sample of approximately 34,000 inpatient hospital records is randomly selected from the annual national CMS Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program; and data are collected for hospital inpatients age 18 years and over who are covered by any insurance payer. All RHQDAPU records fall into four categories of interest: heart failure, acute myocardial infarction, pneumonia, and a subset of surgical procedures.i
Records are sent to the Clinical Data Abstraction Center, where trained abstractors abstract each clinical chart by recording predefined questions and responses. The contractor uses algorithms to analyze the abstracted data to identify patient exposure to the processes of care, ascertain the occurrence of specific adverse events, and assess patient risk factors and outcomes. MPSMS data are used to develop a summary Patient Safety Event Rate based on the 21 measures.
The purpose of MPSMS is to provide a tool to facilitate improvements in patient safety by gaining an understanding of the magnitude of specific patient safety issues associated with the processes of hospital care delivery. Adverse event categories monitored by MPSMS include the following:
- Adverse events associated with the use of central venous catheters (CVCs).
- Adverse events associated with surgical procedures.
- Adverse events associated with joint revisions and replacements.
- Hospital-acquired ventilator-associated pneumonia.
- Hospital-acquired infections.
- Adverse drug events associated with the hospital stay and not present on hospital admission.
MPSMS also collects and examines patient risk factors, such as demographics and comorbid conditions. Data on outcomes, such as length of hospital stay and in-hospital mortality, are also collected.
Hospital inpatients age 18 years and over admitted for one of four conditions of interest: heart failure, acute myocardial infarction, pneumonia, and a subset of major surgical procedures, who are covered by any payer.ii
Age, race, gender, and payment source.
2002-2007, 2009, and 2010.
All States except Maryland.
Data are submitted and collected monthly and reported annually.
Table 1. MPSMS Measures and Domains by Phase
|Measure||Primary Domain||Data Period|
|Adverse Events Associated With Hip Replacement|
Hip Replacement Due to Fractures
Hip Replacement Due to Degeneration
|Postoperative||2002-2007 and 2009|
|Adverse Events Associated With Knee Replacement||Postoperative||2002-2007 and 2009|
|Bloodstream Infection Associated With CVC||Infection||2002-2007 and 2009|
|Mechanical Complications Associated With CVC||Postoperative||2002-2007 and 2009|
|Postoperative Pneumonia||Infection||2002-2007 and 2009|
|Postoperative Venous Thromboembolic Event||Postoperative||2002-2007 and 2009|
|ADE – Hospital-Acquired Antibiotic Associated C. difficile||Adverse drug events||2004-2007 and 2009|
|ADE - Digoxin||Adverse drug events||2004-2007 and 2009|
|ADE - Hypoglycemic Agent||Adverse drug events||2004-2007 and 2009|
|ADE - IV Heparin||Adverse drug events||2004-2007 and 2009|
|ADE - Low Molecular Weight Heparin||Adverse drug events||2004-2007 and 2009|
|ADE - Warfarin||Adverse drug events||2004-2007 and 2009|
|Postoperative Cardiac Event|
Postoperative Cardiac Event After Cardiac Surgery
Postoperative Cardiac Event After Noncardiac Surgery
|Postoperative||2004-2007 and 2009|
|Hospital-Acquired Pressure Ulcer||General||2004-2007 and 2009|
|Adverse Events Associated With Femoral Artery Puncture for Angiographic Procedure||Postoperative||2005-2007 and 2009|
|Catheter-Associated Urinary Tract Infection||Infection||2005-2007 and 2009|
|Contrast Nephropathy Associated With Catheter Angiography||Postoperative||2005-2007 and 2009|
|In-Hospital Patient Fall||General||2005-2007 and 2009|
|Hospital-Acquired Methicillin Resistant Staphylococcus aureus||Infection||2005-2007 and 2009|
|Hospital-Acquired Vancomycin Resistant Enterococcus||Infection||2005-2007 and 2009|
|Ventilator-Associated Pneumonia||Infection||2005-2007 and 2009|
Agency home page: http://www.ahrq.gov.
Data system home page: http://www.cms.hhs.gov.
Classen DC, Jaser L, Budnitz DS. Adverse drug events among hospitalized Medicare patients: epidemiology and national estimates from a new approach to surveillance. Jt Comm J Qual Patient Saf 2010 Jan;36(1):12-21.
Huddleston JI, Maloney WJ, Wang Y, et al. Adverse events after total knee arthroplasty: a national Medicare study. J Arthroplasty 2010 Sep;24(6; Supplement):95-100.
Hunt D, Verzier N, Abend S, et al. Fundamentals of Medicare patient safety surveillance: intent, relevance, and transparency. In: Henriksen K, Battles JB, Marks ES, et al., eds. Advances in Patient Safety: From Research to Implementation. Vol. 2: Concepts and methodology. Rockville, MD: Agency for Healthcare Research and Quality; February 2005. Available at: http://www.ncbi.nlm.nih.gov/books/NBK20489/.
Metersky M, Verzier N, Hunt D, et al. Racial disparities in the frequency of patient safety events: results from the National Medicare Patient Safety Monitoring System. Med Care 2011 May;49(5):504-10.
Zhan C, Elixhauser A, Richards CL Jr, et al. Identification of hospital-acquired catheter-associated urinary tract infections from Medicare claims: sensitivity and positive predictive value. Med Care 2009 Mar;47(3): 364-9.