Objectives
Advancing
Excellence
in Health
Care
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
„ 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 MedicareMedicare-specific data are available
– findings on race/ethnicity and socioeconomic
status disparities within the Medicare population
Presenter: Edwin Huff, Ph.D., MA.
Lead Author: Edward Kelley, Ph.D.
CoCo-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.
Study Design
Advancing
Excellence
in Health
Care
National Healthcare Quality Report
National Healthcare Disparities Report
„ Mandated by Congress in the
Healthcare Research and Quality Act of
1999
Advancing
Excellence
in Health
Care
NHQR & NHDR links:
http://www.qualitytools.ahrq.gov/
National Health Care
Quality Report
(2004)
National Health Care
Disparity Report
(2004)
http://www.qualitytools.ahrq.gov
http://www.qualitytools.ahrq.
gov/disparitiesreport/bro
wse/browse.aspx
/qualityreport/browse/brows
e.aspx
„ Over 30 databases are used to generate
the 350+ data tables associated with the
two reports.
Measure Topics
Advancing
Excellence
in Health
Care
Quality of Health Care
„ Effectiveness
–
Cancer, Diabetes,
ESRD, Heart Disease,
HIV/AIDS, Maternal and
Child Health, Mental
Disease, Respiratory
Disease, Nursing Home
and Home Health Care
„ Safety
„ Timeliness
„ Patient
centeredness
Access to Health Care
„ Getting into the
system
–
Insurance, Usual
Source of Care,
Perceptions of Need
„ Getting care within
the system
„ Perceptions of care
–
PatientPatient-provider
communication,
relationship
„ Health care use
Advancing
Excellence
in Health
Care
CMS Measure Topics &
Sources
CMS Quality of Health
Care – Setting:
„ Nursing Homes -
Tables 1.97 – 1.110 (14
QIs)
QIs)
„ Home Health Care –
Tables 1.111 – 1.122 (12
QIs)
QIs)
„ Hospital & Patient
Safety – Tables 1.361.361.45, 1.85 – 1.89, 2.26 –
2.36 (26 QIs)
QIs)
Data Source:
„ MDS (Minimum
Data Set)
„ OASIS (Outcome
and Assessment
Information Set)
„ Abstracted
Medical Records
„ ESRD – Tables 1.29 –
1.32(26 (4 QIs)
QIs)
1
List of Measures: Heart
Disease (example)
Advancing
Excellence
in Health
Care
Advancing
Excellence
in Health
Care
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
0.40
Female
82.90
0.45
82.60 0.45
0.45
Treatment of acute myocardial infarction (AMI):
Measure
Year National estimate National table number State
State table number
Percent of AMI
2002
85.34
Table 1.36a
Table 1.36a: Percent of AMI patients
administered aspirin within 24 hours of
admission, United States, 20002000-2001 and 2002
Race a
White
85.76
African American 80.43
Hispanic
81.54
Native American 83.75
Asian
90.80
Other
Table 1.36b
patients adminadministered aspirin
within 24 hours
of admission
Age
Under 65
6565-74
7575-84
85 and over
86.70
88.28
84.91
80.83
0.32
1.20
1.97
4.18
2.20
0.95
0.47
0.50
0.70
85.21
81.15
0.32
0.32
1.30
83.10
1.48
87.97
87.17
84.72
81.16
1.06
0.51
0.51
0.49
0.49
0.68
a Race categories changed in 2002 data Source:
Centers for Medicare and Medicaid Services,
Medicare Quality Improvement Organization Program.
Advancing
Excellence
in Health
Care
The Medicare Modernization Act
„ 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.
Advancing
Excellence
in Health
Care
Medicare specific measures
Median improvement (2003 NHQR to 2004 NHQR)
25.00%
20.00%
14.66%
15.00%
10.00%
5.00%
2.78%
2.97%
Hospital (14
measures)
Home Health (12
measures)
Advancing
Excellence
in Health
Care
Overall Trends in Quality
„ 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 MedicareMedicare-specific
measures and general measures has
improved by median of 2.4%.
Advancing
Excellence
in Health
Care
General Measures
General measures
„ Level of improvement for general measures is
lower than in MedicareMedicare-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
0.00%
Nursing Home (5
measures)
– 1.4% improvement between data reported in the
2003 NHQR and the 2004 NHQR.
2
Disparities
Advancing
Excellence
in Health
Care
Disparities
Advancing
Excellence
in Health
Care
2
2
3
2
2
1
6
6
6
API
Hispanic
Black
Same as whites
10
9
8
7
6
5
4
3
2
1
0
Total
Race/ethnicity
Better than whites
Black/White ratio for admissions rates for
uncontrolled diabetes
Black/White ratio
Number of
measures
Blacks, APIs and Hispanics compared to whites on
NHDR nursing home measures
Worse than whites
18-44
45-64
65 and over
Age
Black/White Ratio
Advancing
Excellence
in Health
Care
Next Steps
„ Improve hospital selfself-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.
3