2004 National Nursing
Home Survey
National Nursing
Home Survey (NNHS)
z Component of the National Health Care
Survey (NHCS)
z Nationally representative sample survey
of nursing homes
z Collects information
Annual AcademyHealth Research Meeting
Robin E. Remsburg, APRN, BC
Long-term Care Statistics Branch
Division of Health Care Statistics
‹
National Center for Health Statistics
‹
Providers
Recipients of care
z Conducted 7 times since 1973 (1973-74,
1977, 1985, 1995, 1997, 1999 and 2004)
2004 Redesign Process
1. Reviewed documents from expert meetings
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Future Directions for Residential LTC
Health Services Research (October 1999)
Future Directions for Community-based LTC Health Services
Research (June 2000)
Institute of Medicine Report from the Committee on Improving
Quality in LTC (2001).
Process
3. Identify data gaps
-1999 National Nursing Home Survey (NNHS)
-1997 Medicare Current Beneficiary Survey (MCBS)
-CMS’ Minimum Data Set (MDS)
-CMS’ Online Survey Certification and Reporting
Survey (OSCAR)
-1996 Medical Expenditures Survey Nursing Home
Component (MEPS NHC)
-1999 National Long-term Care Survey
-National Longitudinal Study of Aging
2. Policy and Practice questions
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Characteristics of nursing homes residents
Care and services provided by nursing homes
Cost/reimbursement
Quality/outcomes
Conceptual Model
Structure
-Key Personnel
-Advance practice RNs
-Turnover
-Benefits
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Process
-Immunization practices
-Mechanical Lifts
-Permanent assignments
-Palliative care
Outcomes
-ED/hospitalizations
-Pressure sores
-Falls
-Medications
(cont.)
Features of the NNHS Redesign
z Computer Assisted Personal
Interview (CAPI)
z New sample design
z New content
z Linkage to CMS’ Minimum Data Set
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‹
Expanded clinical content
Care episodes
z Expanded sample
z National Nursing Assistant Survey (NNAS)
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Content: Facility
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Content: Facility
Administrators, Medical Directors, & Directors of Nursing

Preparation
Years of experience
Tenure at the facility
Specialty certification
•Accreditation
•Medical services
•Electronic/computerized information systems
•Recreation activities
•Dining practices
•Mechanical lifts
•Immunization policies & practices
•End-of-life practices (POLST, Last Acts)
•Special care programs (e.g., wound, dementia)
Nursing Staff
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FTEs
RN mix
Specialty certification
New roles----MDS nurses, case managers, QI, infection control
personnel
APNs
Entry-level wages
Recruitment/retention strategies
Benefits
Collective bargaining arrangements
Staff turnover and stability
Content: Resident-New
Content: Resident-MDS
‹ Advance
directives
skills
‹ Cognitive
‹ Mood
‹ Behavioral
‹ ADLs
z
z
z
z
z
z
z
z
z
symptoms
‹ Continence
‹ Accidents
‹ Weight
change
therapy
‹ Pressure ulcers
‹ Restraints
‹ Nutritional
2004 NNHS
z National probability sample survey
z
z 2-stage stratified sample design
‹
‹
Nursing homes (facilities)
Residents, NAs
z Licensed or certified; 3 or more
beds
Data were collected through
onsite interviews with
knowledgeable facility staff
who refer to medical and facility
records
z
Results are weighted to create
national estimates
z
1,500 facilities sampled; 1,174
participated
z
82% facility response rate
z Participation is voluntary
z Confidentiality protected by
Section 308(d) of the Public Health
Service Act
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Admission to a specialty unit (e.g., Alzheimer’s, hospice)
Receiving specialty services (e.g., Alzheimer’s, hospice)
Hospitalizations
ED visits
Pain assessment, management, relief
Medications
Recent drug adverse experiences
End-of-life care
Out of pocket charges
National Nurse Assistant
Survey (NNAS)
Reduces NNAS costs by utilizing a subsample of an existing sample frame and data
collection methodology
‹ Enhances response rates and reduces burden
‹ Increases the analytical usefulness of NNAS
and NNHS
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Plans for Dissemination
z Data products
‹ Public use data files
‹ Reports, journal articles
z Access data products
‹ Downloadable from the Internet
‹ Data files on CD-ROMS
‹ Research Data Center
‹ NCHS Office of Information Services
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Telephone: 866-441-6247 (NCHS)
Fax: 301-458-4027
Email: nchsquery@cdc.gov
z To learn more--‹ One way Listserv
‹ www.cdc.gov/nchs/nnhs.htm
‹ LTCSB 301-458-4747
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