Presenter: Edwin Huff, Ph.D., MA. Lead Author: Edward Kelley, Ph.D.

1. 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.

2. Objectives • 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

3. Study Design National Healthcare Quality Report National Healthcare Disparities Report • 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.

4. National Health Care Quality Report (2004) http://www.qualitytools.ahrq.gov/qualityreport/browse/browse.aspx National Health Care Disparity Report (2004) http://www.qualitytools.ahrq.gov/disparitiesreport/browse/browse.aspx NHQR & NHDR links: http://www.qualitytools.ahrq.gov/

5. 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 Patient-provider communication, relationship Health care use Measure Topics

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

7. Treatment of acute myocardial infarction (AMI): Measure Year National estimate National table number State table number Percent of AMI 2002 85.34 Table 1.36aTable 1.36b patients admin- istered aspirin within 24 hours of admission List of Measures: Heart Disease (example)

8.  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. Table 1.36a: Percent of AMI patients administered aspirin within 24 hours of admission, United States, 2000-2001 and 2002

9. 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.

10. 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 Medicare-specific measures and general measures has improved by median of 2.4%.

11. Medicare specific measures

12. General Measures 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.

13. Disparities

14. Disparities

15. Next Steps • 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.