National Healthcare Quality & National Healthcare Disparities Reports: Data Sources Appendix, 2013
Home Health Outcome and Assessment Information Set (OASIS)
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Description
OASIS is a key component of Medicare's partnership with the home care industry to foster and monitor improved home health care outcomes. OASIS data are collected, encoded, and transmitted for all Medicare and Medicaid patients receiving skilled services according to CMS's regulations published in the Federal Register.
Home health agencies encode and transmit data using software available from CMS or software that conforms to CMS standard electronic record layout, editing specifications, and data dictionary and that includes the required OASIS dataset.
Primary Content
OASIS contains data elements that represent core items obtained from a comprehensive assessment of adult home care patients. These data are used to measure patient outcomes for purposes of outcome-based quality improvement.
Data collected in OASIS include demographic and patient history, living arrangements, supportive assistance, sensory status, integumentary (skin) status, respiratory status, elimination status, neuro/emotional/behavioral status, activities of daily living, medications, equipment management, and information collected at inpatient facility admission or agency discharge.
Demographic Data
Gender, age, race/ethnicity, State of residence, marital status, and living arrangement.
Population Targeted
U.S. adult, home care patients who are responsive.
Mode of Administration
Completed by home health agency personnel.
Years Collected
Since 1999.
Data Collection Schedule
Most OASIS data items are designed to be collected at the start of care and every 2 months thereafter until and including time of discharge.
Geographic Estimates
National and State.
Contact Information
Agency home page: http://www.cms.hhs.gov.
Data system home page: http://www.cms.hhs.gov/oasis.
Notes
The OASIS national and disparities tables in the NHQR and NHDR are based on OASIS assessment data for home health episodes that began in the calendar year. The calculations for the measures appearing in the NHQR and NHDR tables use the same definitions as are used for the measures displayed in Home Health Compare.
Medicare Quality Improvement Organization (QIO) Program
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Description
The QIO Program, created by law in 1982, provides 3-year contracts to organizations throughout the country to assist providers to improve the quality, safety, efficiency, and economy of health care services delivered to Medicare beneficiaries and the public at large.
The QIO Program is administered through 53 performance-based, cost-reimbursement contracts with 41 independent organizations. The QIOs are staffed with physicians, nurses, technicians, and statisticians. QIOs encourage hospitals to submit clinical performance data to the national QIO clinical warehouse. Hospitals collect these data using data collection tools developed by QIOs or related organizations.
Details are in the QIO Statement of Work (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html). Quality performance information collected from the more than 4,000 participating hospitals is reported on Hospital Compare, a Web site tool developed by CMS.
Before 2005, QIOs abstracted data that only included Medicare inpatients. From 2005 on, QIO data are hospital self-reported and include all payers. Hospital self-reported data submitted to the QIO clinical warehouse are subject to random validation audits by an independent CMS contractor.
Primary Content
Current national priorities include four health care settings: nursing homes, home health agencies, hospitals, and physician offices.
Population Targeted
Medicare beneficiaries and non-Medicare beneficiaries required for the relevant measure in each State, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.
Demographic Data
Age, race, and gender.
Notes
From 2002 to 2004, CMS randomly selected 125 medical charts for each topic per quarter and asked clinical data abstraction centers (CDACs) to perform data abstraction. The results were used for QIO program evaluation and measure surveillance. CMS stopped the measure surveillance program for heart attack, heart failure, and pneumonia topics at the end of 2004. The surveillance program for surgery patient safety was stopped at the end of the third quarter of 2005. Since the 2002-2004 data only reflected Medicare inpatients and these are CDAC-abstracted data and 2005 data are hospital self-reported for all payers, only hospital self-reported data starting from 2005 are reported in the NHQR and NHDR.
Contact Information
Agency home page: http://www.cms.hhs.gov.
Data system home page: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html.
References
The 10th QIO Statement of Work is available at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html.
Medicare Enrollment and Claims (or Medicare Data and Chronic Conditions)
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Description
Medicare is the United States' Federal health insurance program for people age 65 years and over, people under age 65 years with certain disabilities, and people of any age with end-stage renal disease (ESRD). Medicare enrollment and claims data for beneficiaries enrolled in the fee-for-service program are available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org).
Primary Content
The CMS Chronic Condition Data Warehouse includes Medicare beneficiary demographics and claims for both institutional and noninstitutional settings. The CMS Chronic Condition Data Warehouse includes indicators for 27 chronic conditions, 9 mental health and tobacco use conditions, and 15 disability-related conditions, which are identified by International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes on claims. A Medicare beneficiary is considered to have a condition if there are Medicare claims indicating that the beneficiary was receiving a service or treatment for the specific condition.
Of the conditions available in the CMS Chronic Condition Data Warehouse, we included 17 conditions. We collapsed four cancer sites into one cancer category. Conditions are identified through diagnosis codes on the Medicare claims and each condition has a specific algorithm listing the diagnosis codes, the claim types to be searched, and the number of years that claims are searched. Detailed information on the identification of the following conditions is available at www.ccwdata.org:
- Alzheimer's disease and related dementia.
- Arthritis.
- Asthma.
- Atrial fibrillation.
- Autism spectrum disorders.
- Cancer (breast, colorectal, lung, and prostate).
- Chronic kidney disease.
- Chronic obstructive pulmonary disease.
- Depression.
- Diabetes.
- Heart failure.
- Hyperlipidemia.
- Hypertension.
- Ischemic heart disease.
- Osteoporosis.
- Schizophrenia and other psychotic disorders.
- Stroke.
Chronic conditions were counted and grouped into four categories (0-1, 2-3, 4-5, and 6 or more).
Demographic Data
Age, gender, race/ethnicity, Medicaid eligibility ("dual eligible"), and State/Territory of residence, which includes the District of Columbia, Puerto Rico, and U.S. Virgin Islands.
Population Targeted
Medicare beneficiaries continuously enrolled in the fee-for-service program for both Parts A and B. Beneficiaries with any Medicare Advantage enrollment during the year and who first became eligible for Medicare after January 1 of the calendar year are excluded. Beneficiaries who died during the year were included up to their date of death if they met the other inclusion criteria.
Mode of Administration
Medicare claims for reimbursement for health care services.
Years Collected
Since 1999.
Data Collection Schedule
Medicare claims are submitted continuously throughout the year by health care providers and CMS data files are loaded to the CMS Chronic Condition Data Warehouse on a monthly basis. A full 12 months is allowed for claims to "mature" and for the data files to be considered final.
Geographic Estimates
National and State/Territory.
Contact Information
Agency home page: http://www.cms.hhs.gov.
Data system home page: http://www.ccwdata.org.
Notes
There are known limitations in the classification of a beneficiary's race and ethnicity from the Medicare enrollment data. Therefore, we used a race/ethnicity variable that is based on a validated algorithm that improves the accuracy of race/ethnicity classification for Medicare beneficiaries. More information on this methodology can be found in Eicheldinger C, Bonito A. More accurate racial and ethnic codes for Medicare administrative data. Health Care Financ Rev 2008;29(3):27-42.
Minimum Data Set (MDS)
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Description
MDS is a key component of Medicare's partnership with the nursing home industry to foster and monitor improved nursing home care outcomes. MDS data are collected, encoded, and transmitted for all nursing home residents receiving skilled nursing or long-term services at a Medicare- or Medicaid-certified nursing home. Nursing homes encode and transmit data using software available from CMS or software that conforms to CMS standard electronic record layout, editing specifications, and data dictionary and that includes the required MDS dataset.
Primary Content
MDS contains data elements that represent core items obtained from a comprehensive assessment of adult nursing home residents. These data are used to measure patient outcomes for purposes of outcome-based quality improvement.
The information collected includes the resident's health, physical functioning, mental status, and general well-being.
Demographic Data
Gender, age, race/ethnicity, State of residence, marital status, and living arrangement.
Population Targeted
U.S. nursing home residents.
Mode of Administration
Completed by nursing home personnel.
Years Collected
Since 1998.
Data Collection Schedule
MDS data items are designed to be collected at admission to the nursing home and at regular intervals until transfer, discharge, or death.
Geographic Estimates
National and State.
Contact Information
Agency home page: http://www.cms.hhs.gov.
Data system home page: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30.html.
Notes
The MDS national and disparities tables in the NHQR and NHDR are based on MDS assessment data for nursing home stays that began in the calendar year. The calculations for the measures appearing in the NHQR and NHDR tables use the same definitions as are used for the measures displayed in Nursing Home Compare.
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