Agency for Healthcare Research and Quality Advancing Excellence in Health Care 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.

Advancing Excellence in Health Care Objectives To summarize the quality of health care for Medicare recipients based on findings from the second National Healthcare Quality and Disparities Reports. 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

Advancing Excellence in Health Care Study Design National Healthcare Quality Report National Healthcare Disparities Report Mandated by Congress in the Healthcare Research and Quality Act of 1999 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. Over 30 databases are used to generate the 350+ data tables associated with the two reports.

Advancing Excellence in Health Care NHQR & NHDR links: / National Health Care Quality Report (2004) /qualityreport/browse/brows e.aspx National Health Care Disparity Report (2004) gov/disparitiesreport/bro wse/browse.aspx

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

Advancing Excellence in Health Care CMS Measure Topics & Sources CMS Quality of Health Care – Setting: Nursing Homes - Tables 1.97 – (14 QIs) Nursing Homes - Tables 1.97 – (14 QIs) Home Health Care – Tables – (12 QIs) Home Health Care – Tables – (12 QIs) Hospital & Patient Safety – Tables , 1.85 – 1.89, 2.26 – 2.36 (26 QIs) Hospital & Patient Safety – Tables , 1.85 – 1.89, 2.26 – 2.36 (26 QIs) ESRD – Tables 1.29 – 1.32(26 (4 QIs) ESRD – Tables 1.29 – 1.32(26 (4 QIs) Data Source: MDS (Minimum Data Set) MDS (Minimum Data Set) OASIS (Outcome and Assessment Information Set) OASIS (Outcome and Assessment Information Set) Abstracted Medical Records Abstracted Medical Records

Advancing Excellence in Health Care List of Measures: Heart Disease (example) Treatment of acute myocardial infarction (AMI): Measure Year National estimate National table number State table number Percent of AMI Table 1.36a Table 1.36b Table 1.36a Table 1.36bTable 1.36a Table 1.36b patients admin- istered aspirin within 24 hours of admission

Advancing Excellence in Health Care Table 1.36a: Percent of AMI patients administered aspirin within 24 hours of admission, United States, and Standard Standard Standard Standard Population Group Percent Error Percent Error Population Group Percent Error Percent Error Total Total Gender Male Male Female Female Race a Race a a White White African American African American Hispanic Hispanic Native American Native American Asian Asian Other Other Age Under Under and over and over 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 Overall Trends in Quality Out of 98 measures with trend data available 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%. The quality of health care for Medicare recipients across both Medicare-specific measures and general measures has improved by median of 2.4%.

Advancing Excellence in Health Care Medicare specific measures

Advancing Excellence in Health Care General Measures General measures Level of improvement for general measures is lower than in Medicare-specific 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 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.

Advancing Excellence in Health Care Disparities

Disparities

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