| Design, Measure, Characteristics |
1997 Medicare Current Beneficiary Survey (MCBS)* |
1999 National Nursing Home Survey (NNHS) |
Administrative Data from HCFA |
1996 Medical Expenditure Survey—Nursing Home Component (MEPS NHC) |
| Sample Design |
| Design |
Person-based national probability design with a rotating longitudinal panel |
Periodic cross-sectional multi-stage design with facilities sampled in first stage and persons in the last stage |
-Person-specific health status (Minimum Data Set; MDS) data
-Medicare enrollment and claims data
-Medicaid claims data
-Facility-specific state survey inspection (OSCAR) data and SNF cost reports |
Multi-stage probability facilities sampled in the first stage and persons in the last stage |
Target population
and sample size |
Current Medicare Beneficiaries, from the HCFA enrollment files:
11,884 persons (for 1997):
-Persons with
community-only data:
10,398, no SNF NH days; 239, with SNF NH days
-1,015 persons in LTC only
-232 persons in community & LTC |
Nursing homes, NH residents and NH discharges:
8,056 persons (for 1999):
-Residents
-Discharges
1,496 nursing homes |
-MDS: All NH residents in certified NHs
-All Medicare Beneficiaries and their claims
-Medicaid enrollees and their claims for persons in the 35 states with SMRF data
-OSCAR: All certified NHs
-SNF cost reports: SNF certified NHs |
Nursing homes and persons who used NH during year:
5,899 persons (for 1996):
-3,209 Jan. 1 residents
-2,690 persons admitted to NH
815 nursing homes |
| Residential facility type(s) in population |
All LTC residential facilities |
Licensed or certified NHs2 |
Certified NHs |
Certified NHs or licensed NH w/ 24 hr/7 day/week nursing staff 3 |
| Reference period |
Three calendar years' worth of use and expenditures data for a person |
A single cross-section for a person; some items refer to "last month" or at admission. |
-MDS: at NH admission, quarterly, annually and when there is a significant change; 1999 first year with Complete repository data.
-Claims: Ongoing
-OSCAR: Annually and quarterly cross-sections
-SNF Cost Report: Yearly |
A calendar year's worth of use and expenditures data |
| Frequency of (survey) administration |
Ongoing since 1991. Since 1997 LTC facility questionnaire has mirrored much of the MEPS NHC instrument |
Six times since 1973/74; scheduled again for 2001 |
Ongoing |
Conducted for 1987 and 1996 |
| Rounds and mode of data collection |
12 Rounds of computer-assisted personal interviewing, over 4 years |
A round of in-person interviewing with a paper instrument |
Self-administered paper or electronic filing; transmitted to HCFA in a standardized data format |
3 rounds of computer-assisted personal interviewing, over 1 1/2 years |
| Respondents and data sources |
-In LTC facility: Administrators and staff, medical records, and NH billing department sources
-Community: Sampled person or their proxy
-For Medicare HMO's enrollees: medical provider sources
- Medicare claims data |
In the NH: Administrators and staff, medical records and NH billing department data4 |
-MDS: Care providers in the NH
-Claims: Medical providers and providers' staff, medical records and NH billing departments
-OSCAR: State inspection surveyors
-SNF Cost Report: NH administrators and billing department staff
|
-In the NH: Administrators and staff, medical records and NH billing sources
-Community residing next-of-kin
-Can be linked to Medicare claims data |
| Person Measures |
| Changes in health status |
Mirrors MDS items, but collected annually for 4 years; for persons admitted to LTC during year, health status is also measured upon admission and 90 days later. |
Cross-sectional measures not directly comparable to MDS items, no measure of change/outcomes |
MDS: Measured at multiple points in time (at least quarterly) |
Mirrors MDS items; collected for two points in time. The occurrence of infections, pressure ulcers, fractures are measured over a calendar year |
| Expenditures and sources of payments (SOPs) |
-Amounts billed, amounts paid and sources of payment, by 10 SOP types, for services in the LTC facility and in the community
-Data linked to Medicare claims to improve estimates |
Total charges billed for care last month, and primary and secondary SOPs; not collected are amounts paid, source, and data for community-based care. |
Only Medicare/ Medicaid reimbursements |
-For care provided in the NH, amounts billed, amounts paid and sources of payment, by 10 SOP types
-Community-based expenditures not collected
-Linkage of NH residents to Medicare claims data possible |
| Income and assets |
A question on gross total income |
None |
None |
Detailed income and asset questions |
| Follows persons across care settings |
Follows persons across all settings, but sample of LTC persons who transition is very limited:
-232 who moved between community and LTC, and with data from both sources
-239 with short SNF stay, but no facility reported data |
For residents, admission source
For discharges, discharge source |
Limited |
Information on NH transitions between:
-NH units (general to Alzheimer's)
-Different NHs
-NHs and the hospital
-NHs and the community
-NH admission and discharge sources |
| Use of services provided while a resident in the facility |
3 years of medical provider use while resident in LTC settings; includes use provided by trained staff and frequency of use (for 13 service types), hospital-based use (inpatient, outpatient, and ER) and prescribed medicine use |
Services provided to person last month, by type of service (for 17 service types); no measure of frequency or use of hospital-based services (inpatient, outpatient or ER) |
Services reimbursed by Medicare or Medicaid; eventually prescribed medicine use |
1 year of medical provider use while resident in NH; includes use of services provided by trained staff and frequency (for 15 service types), hospital-based use (inpatient, outpatient and ER) and prescribed medicine use |
| Process measures |
Limited, could measure:
- Appropriateness of prescribed medicine (PMED) use
- Linkage of LTC services use, PMED use,
-Occurrence of preventive services (i.e., mammogram, chest x-ray, and pap smear) |
Limited: Administration of flu shots, pneumococcal vaccine, and Tetanus-Diphtheria (Td) Toxoid booster |
In future, could measure, for NH residents, appropriateness of prescribed medicine use in conjunction with a person's health status characteristics |
Limited, could measure:
-Appropriateness of prescribed medicine (PMED) use
-Linkage of NH services use, PMED and person characteristics (e.g., conditions) |
| Facility Characteristics |
Basic characteristics, e.g., number
of beds, ownership, certification |
Facility characteristics can be linked to persons; facility-level estimates not possible |
Facility-level estimates possible; cannot link facility data to persons on recent public use files |
Yes (for certified facilities) |
Facility-level estimates possible; can link facility data to persons in the MEPS Data Center environment |
| Characteristics of facility units (e.g., special care units) |
-Unit type (e.g., personal care) and number of beds; for special care units (e.g., sub-acute) also captures whether unit has dedicated staff & proportion of residents with Medicare/Medicaid as an SOP
-Persons can be linked to their specific unit(s)
- Facility-level analysis not possible |
-Facility-level analysis possible
- Type of unit (for 12 unit types) and number of unit beds; no specific mention of personal care beds
- A person cannot be linked to a specific unit. |
-For certified NHs type of special care unit (for 12 types) and number of beds in the unit
-Facility-level analysis possible
-Facility data can be linked to person-level MDS data. |
-Unit type (e.g., personal care) and number of beds; for special care units (e.g., sub-acute) also captures whether unit has dedicated staff & portion of residents with Medicare/Medicaid as an SOP
- Persons can be linked to their specific unit(s)
-Facility-level analysis possible |
| Facility staffing levels |
Not currently collected |
Number of FTEs, by type, that work in the NH (for 13 types) |
Number of FTEs that work in the facility, by type (for 13+ types) and employer (facility or contractor) |
For two points in time: nursing staff FTEs, by type (RN, LPN, aide) and employer (NH or contract), their wage rates, staff turnover rates |
| Facility cost reports |
Not collected, but linkage to HCFA SNF cost report data theoretically possible |
Attempted in 1995; due to low response rates not repeated in 1997 or 1999 |
SNF cost reports available; linkage to persons theoretically possible |
Attempted, high levels of non-response; linkage to persons |
| Linkage of facility to market characteristics (e.g., county-specific data) |
Not with public use files |
Not with public use files |
Not with public use files |
Could be done in the MEPS Data Center environment |
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