Agency for Healthcare Research and Quality
Advancing Excellence in Health Care • www.ahrq.gov
Quality of Care for Medicare Recipients:
Lessons from the Second National
Healthcare Quality and Disparities Report
Presenter: Edwin Huff, Ph.D., MA.
Lead Author: Edward Kelley, Ph.D.
Co-Authors: Nancy Wilson, M.D.,
M.P.H.; Edward Kelley, Ph.D.; Karen
Ho, M.H.S; Edwin Huff, Ph.D.; Ernest
Moy, M.D., M.P.H.; Dan Stryer, M.D.;
Tina Ding, M.S.; Carolyn Clancy, M.D.

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 To summarize the quality of health care for
Medicare recipients based on findings from the second National Healthcare Quality and
Disparities Reports.
– measures used by the Medicare program for quality reporting and monitoring
– measures applicable to the general population where Medicare-specific data are available
– findings on race/ethnicity and socioeconomic status disparities within the Medicare population

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 Mandated by Congress in the
Healthcare Research and Quality Act of
1999
 Over 30 databases are used to generate the 350+ data tables associated with the two reports.

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http://www.qualitytools.ahrq.gov
/
National Health Care
Quality Report
(2004) http:// www.qualitytools.ahrq.gov
/qualityreport/browse/brows e.aspx
National Health Care
Disparity Report
(2004) http://www.qualitytools.ahrq.
gov/disparitiesreport/bro wse/browse.aspx

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Quality of Health Care Access to Health Care
  Effectiveness
– Cancer, Diabetes,
ESRD, Heart Disease,
HIV/AIDS, Maternal and
Child Health, Mental
Disease, Respiratory
Disease, Nursing Home and Home Health Care

Getting into the system
– Insurance, Usual
Source of Care,
Perceptions of Need
Getting care within the system



Safety
Timeliness
Patient centeredness


Perceptions of care
– Patient-provider communication, relationship
Health care use

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CMS Quality of Health
Care – Setting:
Data Source:
 Nursing Homes
-
Tables 1.97 – 1.110 (14
QIs)
 MDS (Minimum
Data Set)
 Home Health Care –
Tables 1.111 – 1.122 (12
QIs)
 OASIS (Outcome and Assessment
Information Set)
 Hospital & Patient
Safety – Tables 1.36-1.45,
1.85 – 1.89, 2.26 – 2.36 (26
QIs)
 Abstracted
Medical Records
 ESRD – Tables 1.29 –
1.32(26 (4 QIs)

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(example)
Treatment of acute myocardial infarction (AMI):
Measure Year National estimate National table number State table number
Table 1.36b
Percent of AMI
2002 85.34 Table 1.36a
patients administered aspirin within 24 hours of admission

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Table 1.36a: Percent of AMI patients administered aspirin within 24 hours of admission, United States, 2000-2001 and 2002
2002 2000 2001
Standard Standard
Population Group Percent Error Percent Error
Total 85.34 0.57 85.14 0.68
Gender
Male 87.50 0.39 87.10 0.40
Female 82.90 0.45 82.60 0.45
Race a
White 85.76 0.32 85.21 0.32
African American 80.43 1.20 81.15 1.30
Hispanic 81.54 1.97
Native American 83.75 4.18
Asian 90.80 2.20
Other 83.10 1.48
Age
Under 65 86.70 0.95 87.97 1.06
65-74 88.28 0.47 87.17 0.51
75-84 84.91 0.50 84.72 0.49
85 and over 80.83 0.70 81.16 0.68
a Race categories changed in 2002 data Source:
Centers for Medicare and Medicaid Services,
Medicare Quality Improvement Organization Program.

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 Among numerous quality initiatives integrated into the MMA, the Medicare Modernization Act of 2003 (MMA) provided a financial incentive for hospitals to report quality of care data by linking it to the payments they will receive for treating Medicare beneficiaries .
Almost 100 percent of covered hospitals reported data by the August 15 (2004) deadline.

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 Out of 98 measures with trend data available
– 30 Medicare specific measures
– 41 general measures.
 The quality of health care for Medicare recipients across both Medicare-specific measures and general measures has improved by median of 2.4%.

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25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Median improvement (2003 NHQR to 2004 NHQR)
2.78% 2.97%
14.66%
Hospital (14 measures)
Home Health (12 measures)
Nursing Home (5 measures)

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General measures
 Level of improvement for general measures is lower than in Medicare-specific measures.
–
–
41 measures with trend data where Medicare populations can be analyzed almost twice as many have improved (25) as have deteriorated (15).
 Modest overall level of improvement across the set of general measures for the 65+ population
– 1.4% improvement between data reported in the
2003 NHQR and the 2004 NHQR.

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Blacks, APIs and Hispanics compared to whites on
NHDR nursing home measures
2
2
2
2
3
1
6 6 6
Black API Hispanic
Race/ethnicity
Better than whites Same as whites Worse than whites

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3
2
1
0
6
5
4
10
9
8
7
Black/White ratio for admissions rates for uncontrolled diabetes
Total 18-44 45-64
Age
Black/White Ratio
65 and over

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


Improve hospital self-reported quality data validity, and make available to consumers.
Self reported data will become the data source for the QIO program.
QIO data sources for hospital quality will become the source for the NHRQ & NHDR.