Hospital Readmissions in Medicare Home Healthcare: What Are the Leading Risk Indicators?

A large sample of all 2011 home healthcare users in traditional Medicare was analyzed to identify the risk indicators at start-of-care that were associated with the highest probability of readmission (N = 597,493). Thirty-five patient characteristics found in Outcome and Assessment Information Set, claims history, or other administrative data were associated with a 30-day readmission risk 30% to 100% above the average in the sample. Most of these characteristics were associated with a 30-day readmission probability of approximately 1 in 5, and several were associated with a readmission probability approaching 1 in 10 during the first 7 days.

Giving voice to the vulnerable: the development of a CAHPS nursing home survey measuring family members' experiences.

Background: To complement a nursing home resident survey, the team developed a survey asking family members about their experiences with nursing homes. Although a family member does not receive care directly from a nursing home, their experiences at the nursing home and with staff can contribute to understanding nursing home quality.

Objectives: To describe how the nursing home family member instrument was developed, refined, tested, and finalized.

The development of a CAHPS instrument for Nursing Home Residents (NHCAHPS).

We report on a federal initiative to develop a CAHPS (The Consumer Assessment of Healthcare Providers and Systems) survey to measure residents' experiences with quality-of-care and quality-of-life in nursing homes (known as NHCAHPS). We focus on how we created and tested questions for inclusion in the instrument and tested a possible cognitive screener to determine which residents could participate in a NHCAHPS interview. The major lessons learned were: (1) In contrast to other CAHPS surveys, ratings were more useful than reports because of the difficulty that residents had with summarizing over time and people; (2) consistent with other CAHPS surveys, the 0 to 10 response scale appeared to work well with nursing home residents for many of the quality-of-care questions; however, a different response scale was needed for many of the quality-of-life items; and (3) in contrast with typical survey methodology and other CAHPS surveys where explicit time reference periods are used, a non-specific present reference period in questions seemed to work best.

Incidence and short-term outcomes of primary and revision hip replacement in the United States.

Background: The purpose of this study was to use 2003 nationwide United States data to determine the incidences of primary total hip replacement, partial hip replacement, and revision hip replacement and to assess the short-term patient outcomes and factors associated with the outcomes.

Methods: We screened more than eight million hospital discharge abstracts from the 2003 Healthcare Cost and Utilization Project Nationwide Inpatient Sample and approximately nine million discharge abstracts from five state inpatient databases. Patients who had undergone total, partial, or revision hip replacement were identified with use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes.

Racial and ethnic differences in patient assessments of interactions with providers: disparities or measurement biases?

Patient assessment surveys have established a primary role in health care quality measurement as evidence has shown that information from patients can affect quality improvement for practitioners and lead to positive marketwide changes. This article presents findings from the recently released National Healthcare Disparities Report revealing that although most clinical quality and access indicators show superior health care for non-Hispanic whites compared with blacks and Hispanics, blacks and Hispanics assess their interactions with providers more positively than non-Hispanic whites do. The article explores possible explanations for these racial/ethnic differences, including potential pitfalls in survey design that draw biased responses by race/ethnicity.

Challenges in measuring nursing home and home health quality: lessons from the First National Healthcare Quality Report.

Background: The availability of patient assessment data collected by all Medicare- and Medicaid-certified nursing homes (NHs) (the Minimum Data Set [MDS]) and home health agencies (HHAs) (the Outcome and Assessment Information Set [OASIS]) provides an opportunity to measure quality of care in these settings.

Objective: The objective of this study was to examine methodologic issues encountered as these datasets are used to report the nation's health care in the National Healthcare Quality Report (NHQR) at national and state levels.

Findings: Although the reliability of most data elements from MDS and OASIS are considered acceptable in research studies, mixed evidence exists for the reliability and validity of the quality measures themselves.

Variation in racial and ethnic differences in consumer assessments of health care.

Background: Prior studies have documented significant racial and ethnic disparities in health and healthcare, but data about disparities from consumer assessments of care are inconsistent.

Objective: To examine racial/ethnic differences in consumer assessments and explore variation in such differences across health plans.

Methods: Data included 160694 Consumer Assessment of Health Plans Surveys (CAHPS) responses from 307 commercial health plans and 177 489 Medicare beneficiaries in 308 Medicare+Choice managed care plans collected in 1999.

Consumer assessments of care for children and adults in health plans: how do they compare?

Objectives: The Consumer Assessment of Health Plans Survey (CAHPS) includes an adult version and also a child version for parents or caretakers to rate children's care in health plans. This study examined how adult and child assessments differed in ranking health plans and explored whether the differences justified the additional cost and respondent burden in administering both surveys.

Methods: Data were from 136 commercial health plans participating in the National CAHPS Benchmarking Database, with 80,539 adults and 40,003 children.